Hygiene Tribune U.S. Edition

cliNical Hygiene Tribune U.S. Edition | April 2012D2 Publisher & Chairman Torsten Oemus t.oemus@dental-tribune.com ViCe President glObal sales Peter Witteczek p.witterczek@dental-tribune.com Chief OPerating OffiCer Eric Seid e.seid@dental-tribune.com grOuP editOr & designer Robin Goodman r.goodman@dental-tribune.com editOr in Chief dental tribune Dr. David L. Hoexter feedback@dental-tribune.com editOr in Chief hygiene tribune Patricia Walsh, RDH feedback@dental-tribune.com managing editOr Robert Selleck r.selleck@dental-tribune.com managing editOr shOw dailies Kristine Colker k.colker@dental-tribune.com managing editOr Fred Michmershuizen f.michmershuizen@dental-tribune.com managing editOr Sierra Rendon s.rendon@dental-tribune.com PrOduCt & aCCOunt manager Mark Eisen m.eisen@dental-tribune.com marketing manager Anna Kataoka-Wlodarczyk a.wlodarczyk@dental-tribune.com sales & marketing assistant Lorrie Young l.young@dental-tribune.com C.e. direCtOr Christiane Ferret c.ferret@dtstudyclub.com Dental Tribune America, LLC 116 West 23rd Street, Suite 500 New York, NY 10011 Phone (212) 244-7181 Published by Dental Tribune America © 2012 Dental Tribune America, LLC All rights reserved. Dental Tribune strives to maintain the utmost ac- curacy in its news and clinical reports. If you find a factual error or content that requires clarification, please contact Managing Editor Robert Selleck at r.selleck@dental-tribune.com. Dental Tribune cannot assume responsibility for the validity of product claims or for typographical er- rors. The publisher also does not assume responsibil- ity for product names or statements made by adver- tisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune. editOrial bOard Dr. Joel Berg Dr. L. Stephen Buchanan Dr. Arnaldo Castellucci Dr. Gorden Christensen Dr. Rella Christensen Dr. William Dickerson Hugh Doherty Dr. James Doundoulakis Dr. David Garber Dr. Fay Goldstep Dr. Howard Glazer Dr. Harold Heymann Dr. Karl Leinfelder Dr. Roger Levin Dr. Carl E. Misch Dr. Dan Nathanson Dr. Chester Redhead Dr. Irwin Smigel Dr. Jon Suzuki Dr. Dennis Tartakow Dr. Dan Ward Tell us what you think! Do you have general comments or criticism you would like to share? Is there a particular topic you would like to see articles about in Hygiene Tribune? Let us know by e-mailing feedback@dental-tribune.com. We look forward to hearing from you! If you would like to make any change to your subscription (name, address or to opt out) please send us an e-mail at database@dental- tribune.com and be sure to include which publication you are referring to. Also, please note that subscription changes can take up to six weeks to process. naturally sweet taste and is completely bio- compatible. The choice of glycine is because ofitsphysicalproperties,inthatitproduces veryfine,roundsoftparticles.Incontrastto NaCOH3, glycine has a particle size of less than 63 μm, making this powder ideal for use along the gingival margins and in deep subgingival pockets. An in vitro evaluation of glycine powder on subgingival cementum and dentine showed that subgingival application re- sultedinsignificantlysmallerdefectdepths compared with NaCOH3 powder (19.6 μm and 71.1 μm, respectively).11 Laboratory test data also confirm that in comparison with NaCOH3, in vitro evalu- ation of enamel surface roughness and enamel wear after treatment with glycine powder was considerably less and resem- bledtheuntreatedenamelcontrolsurface.12 An in vitro evaluation and comparison of the surface roughness of human enamel after air polishing with glycine powder and conventional polishing procedures found that while conventional polishing leaves grooves and scratches on the enamel sur- face, glycine powder resulted in a smooth enamel surface similar to untreated enam- el.13 Plaque removal A number of studies have evaluated the plaque removal efficacy of glycine powder and the subsequent effect on the soft tis- sues. Two studies14,15 looked at interdental plaque removal and buccal and lingual sites respectively. Both studies compared subgingival plaque removal with glycine powder and traditional hand instrumenta- tion (curettes) in periodontal pockets of 3 to 5 mm in depth. Using a split-mouth design in 23 and 27 patients respectively, plaque samples were taken before and after treat- ment with either glycine powder or hand curettes. Plaque samples were also taken from untreated sites as a negative control. Anaerobe cultivation was used to assess themeanreductionoftotalcolony-forming units (CFU’s) immediately after treatment. In both studies, test treatment with glycine powder resulted in significantly greater re- duction in CFUs at interproximal sites (two times more) and buccal and lingual sites (three times more) compared with hand in- strumentation. Additional study16 has shown that pen- etration of the pocket with glycine powder is comparable to hand instrumentation, with 80 percent debridement of the root surface in pockets 2–3 mm in depth and 65 percent in pockets of more than 4 mm. Pre- vious studies17,18 on debridement efficacy of curettes and ultrasonic scalers showed on average, 66 percent of the root surfaces plaque free in pockets of more than 4 mm. Attachment and tissue trauma The use of conventional NaCOH3 air polish- ingpowderhasbeenshowntocausesignifi- cant epithelial erosion with exposure of the underlying connective tissue.19,20 The use of glycine powder is, however, associated with minimal gingival irritation and increased patient comfort.15,16 This finding has also been confirmed by in vivo histological ex- amination of the gingival epithelium fol- lowing subgingival debridement using an air-polishing device with glycine powder.11 Histological analysis revealed that when glycine powder is compared with hand in- strumentation, NaCOH3 powder and a neg- ative control, the glycine powder exhibited a tissue appearance comparable with the control specimens. Epithelial attachment, keratinisedlayerandbasemembrane allre- mained intact following the use of glycine powder for subgingival biofilm removal. This was in comparison with hand instru- mentation, which displayed loss of the ke- ratinised layer and gingival epithelial layer, loss of prominent papillae in the lamina propria and strands of epithelial ridges ex- tending into the connective tissue because of the stimulus of inflammation. Patient acceptance. For periodontal therapy to be successful, regular maintenance and pocket disinfec- tionisparamount.Thisisgreatlyinfluenced by patient acceptance, pain perception and post-operative comfort. Patient acceptance surveys conducted across five dental practices involving a total of 80 patients, indicate that treatment with glycine air polishing is widely accepted.6 Seventy percent of patients reported either minimal discomfort or no pain at all, with 76 percent of patients willing to undertake the treatment again. Further study21 has also reported greater patient acceptance and comfort with gly- cine air polishing compared with hand instrumentation. This was a single blind, randomised split-mouth trial using a new subgingival delivery system with glycine powder compared with hand instrumenta- tion (curettes). No adverse effects were re- ported in the test group, with patients per- ceiving less pain than the hand-instrument group (0.9 versus 2.2 on a score of 1–10). Treatment in the test group was also com- pleted three times more quickly than the control group, with comparable microbial reduction. Conclusion Subgingival debridement is considered es- sential in treating periodontitis and has been shown to be pivotal in arresting dis- ease progression.22 Biofilm formation oc- curs rapidly in periodontal pockets follow- ing instrumentation, and re-establishment of pathogenic microbial flora occurs after a few months following treatment,23 indicat- ing frequent maintenance is required. Regular and repeated debridement of root surfaces with hand instruments and or sonic/ultrasonic instruments has been shown to lead to root surface loss over time. Plaque removal on enamel surfaces can be accomplished effectively with air-polishing devices with little or no abrasive effects. However, this method is not indicated for root surfaces, because conventional air-pol- ishing powders (NaCOH3) are highly abra- sive to root dentine and cementum. When repeatedly performed during maintenance therapy, this cleaning method’s cumulative effects may become clinically significant. The advent of a new glycine-based pow- der for use with air-polishing devices has been shown to be suitable for root surface debridement, causing little or no surface loss, tissue trauma or patient discomfort. Reduction in pathogenic microbial-colony- forming units is greater than with hand in- strumentation and is achieved in less time, with less operator fatigue and with greater patient comfort and compliance. Precautionary measures for patients with upper respiratory tract conditions remain the same as with conventional air- polishing powders; however, since glycine was first trialled in 2003, no adverse effects have been reported, making it an effective method of removing subgingival biofilm from the root surfaces and disinfection of the periodontal pocket. Considering the high level of patient ac- ceptance, biocompatibility and efficacy, the use of glycine powder for biofilm removal may greatly enhance the success of peri- odontal maintenance therapy and has the potential to offer significant benefits in the supportive care of the periodontal patient. ˙ References 1. Sbordone L,Ramaglia L,Gulleta E et al: Recolo- nization of the subgingival microflora after scaling and root planning in human periodon- titis. J Periodontol 1990; 61:579–584 2. Flemming TF, Petersilka GJ, Mehl A et al: Working parameters of magnetostrictive ul- trasonic scaler influencing root substance re- moval in vitro. J Periodontol 1998;(b):69;547–553. 3. Flemming TF, Peterslika GJ, Mehl A et al: Working parameters of a sonic scaler influ- encing substance removal in vitro. Clin Oral Invest 1997;1:55–60 4. Zappa U, Smith B, Simona C et al: Root sub- stance removal by scaling and root planning. J Periodontol 1991; 62(12):750–754. 5. Willmann D, Norling B, Johnson W: A new pro- phylaxis instrument. Effect on enamel altera- tions. JADA 1980; 101:923–925. 6. 3M ESPE: Technical Product Profile Clinpro Prophy Powder. Powder for sub and supragin- gival plaque removal using powder stream devices. June 2007. 7. Knotturi-Narhi V, Markkanen S, Markkanen H: Effects of air-polishing on dental plaque re- moval and hard tissues ae evaluated by scan- ning electron microscopy. J Periodontol 1990; 61(6): 334–338. 8. Boyde A: Air polishing effects on enamel, den- tine, cements and bone. BDJ 1984;156:287–291. 9. Rams TE, Slots J: Air-polishing effects on sub- gingival microflora in human periodontal pockets. Program of the 80th Annual Meeting of the American Academy of Periodontology. 1994. 168 10. Atkinson DR, Cobb CM, Killoy WJ: The effect of air-powder abrasive system on in vitro root surfaces. J Periodontol 1984;55(1):13–18. 11. Petersilka Gj, Bell M, Haberlein I et al: In vitro evaluation of novel low abrasive air polishing powders. J Clin Perio 2003;30(1):9–13. 12. Haberlein I, Schmidt B: In Vitro evaluation of the abrasive property of 3M ESPE Clinpro Pro- phy Powder. Internal laboratory test data. 3M ESPE, Seefeld, Germany. 2002. 13. Derange M: Comparison of Enamel Rough- ness after Air-polishing with 3M ESPE Clinpro Prophy Powder and Conventional Polishing Procedure. Department of Paediatric Dentist- ry, Faculte de Chirurgie Dentaire, Univesite Rene Descartes, Paris V, Montrouge, France. 2002. 14. Petersilka GJ, Steinmann D, Haberlein I et al: Subgingival plaque removal in buccal and lin- gual sites using a novel low abrasive air-pol- ishing powder. J Clin Perio 2003;30(4): 328–333 15. Petersilka GJ, Tunkel J, Barakos K et al: Subgin- gival plaque removal in interdental sites using a low-abrasive air polishing powder. J Peri- odontol 2003;74:307–311. 16. Flemming T, Hetzel M, Topoli H et al: Subgin- gival debridement efficacy of glycine powder air polishing. J Periodontol 2007;76(6):1002–1010. 17. Breininger DR, O’Leary TJ, Blumenshine RV: Comparative effectiveness of ultrasonic and hand scaling for the removal of subgingival plaque and calculus. J Periodontol 1987;58:9–18. 18. Thornton S, Gamick J: comparison of ultra- sonic to hand instruments in the removal of subgingival plaque. J Periodontol 1982;53:35–37. 19. Weaks LM, Lescher NB, Barnes CM et al: Clini- cal evaluation of the Prophy-Jet as an instru- ment for routine removal of tooth stain and plaque. J Periodontol 1984;55:486–488. 20. Koslovsky A, Artzi Z, Nemeovsky CE et al: Ef- fect of air polishing devices on the gingival; histologic study in the canine. J Clin Perio 2005;32:329–334. 21. Moene R, Decaillet F, Anderson E et al: Subgin- gival plaque removal using a new air polishing device. IADR 87th General Session Miami 2009. (J Periodontol. 2010 Jan;81(1):79–88.) 22. Kaldahl WB, Kalkwarf KL, patil KD et al: Long- term evaluation of periodontal therapy: I Re- sponse to 4 theraputic modalities. J Periodon- tal 1996;67:93–102. 23. Haffajee AD, Cugini MA, Dibart S et al: The ef- fect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Pe- rio 1997;24:324–334. ◊ GLYCINE, page D1 HYGIENE TRIBUNE