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Dental Tribune Middle East & Africa Edition | 5/2016 hygiene tribune 4 fistula adjacent to an implant placed ten years ago (Figures 5a-b). Peri- odontal probing showed loss of at- tachment distal to 21. A periapical x-ray confirmed bone loss at the level of the first three threads (Fig- ure5c).Theimplantwastreatedwith subgingival air-polising with the Air-Flow Plus powder sprayed under anaesthesia at the level of the loss of attachment(Figure5d-f). CaseNo5 The patient presented with periim- plantitis on an implant put in place in a context of aggressive periodon- titis without the aid of periodontal therapy. An 8mm pocket was found in the vestibular, mesial and lingual areas of the implant in 46 with pu- rulent discharge (Figure 6a). Given the extent of bone loss seen in the x-ray, a non-surgical approach was preferred for raising a flap (Figure 6b). The absence of bone walls distal to the implant indicates that bone regeneration via grafting is unpre- dictable. The goal was to achieve decontamination of the implant surface. Treatment by subgingival air polishing was performed under anaesthesic (Figure 6c). A clear im- provement was quickly noticeable: absence of purulent discharge and inflammation, reduction of pockets by4mm(Figure6d). A method that is both heal- ingandpreventive The use of this new powder has sev- eral advantages. First, its effective- ness in the removal of supra- and subgingival biofilm without damag- ing the tooth and implant surfaces is a real breakthrough. The ease of implementing this protocol is also significant. Subgingival air polishing is well received by patients and can be performed without anaesthesia in most cases. Access to the deep- est pockets is made easy thanks to the tips (“Perio-Flow”). Finally, the speed with which the pockets are treated (five seconds per site) is very attractive for both practitioner and patient. Today, air polishing has an im- portant place in our line of work, whether in periodontal treatments or in periodontal and implant main- tenance. Thus, when signs of inflam- mation are raised at the level of the peri-implant mucosa, the sites are treated immediately (Figure 7a-b). Very quickly, we can see inflamma- tiondisappear(Figure7c). During periodontal maintenance sessions, the use of subgingival air polishing is very common, with ap- parentlythesameefficiencyasultra- sonics,whilebeingmoreacceptedby ourpatients(Müller,2014).5 Hence, this is a method that is effec- tive in removing bacterial biofilm andisbothcurativeandpreventive. References 1. Kawashima H., Sato S., Kishida M., Yagi H., Matsumoto K., Ito K. Treat- ment of Titanium Dental Implants with Three Piezoelectric Ultrasonic Scalers:AninVivoStudy;J.Periodon- tol.2007Sep;78(9):1689-94. 2. Schmage P., Thielemann J., Nergiz I., Scorziello T.-M., Pfeiffer P. Effects of 10 Cleaning Instruments on Four Different Implant Surfaces; Int J Oral Maxillofac Implants. 2012 Mar- Apr;27(2):308-17. 3. Drago L., Del Fabbro M., Bortolin M., Vassena C., De Vecchi E., Taschieri S. Biofilm Removal and Antimicro- bialActivityofTwoDifferentAir-Pol- ishing Powders; An in Vitro Study; J Periodontol2014Jul25:1-11. 4. Hashino E., Kuboniwa M., Algham- diS.-A.,YamaguchiM.,YamamotoR., Cho H., Amano A. Erythritol Alters Microstructure and Metabolomic Profiles of Biofilm Composed of Streptococcus Gordonii and Porphy- romonas Gingivalis; Mol Oral Micro- biol.2013Dec;28(6):435-51. Figure 5a-b. Probing through the fistula, as well as distal to the implant. No infec- tious episode has so far been reported by thepatient. Figure5c.Bonelossdistal to theimplant. Figure5d.Sprayingparticlesdeepinto the pocket with the tip(“Perio-Flow”). Figure 5f. Stability on bone level at + 1 year. Figure 6c. Treatment by “Perio-Flow”and powder(“Plus”). Figure 5e. Healing of the fistula after treatment. Figure 6a. Periimplantitis with purulent discharge. Figure6d.Threemonthspost treatment. Figure 6b. Significant bone loss as well as theabsenceofbonewallsdistal to46. Figure 7c. Appearance of the gingiva 15 daysafter treatment. Figure7a.Bleedingonprobingoftheperi- implant mucosa found during a mainte- nanceappointment.Figure7b.Treatment by“Perio-Flow”during thesamesession. DrFranckSimonandDrJérômeLiberman aredentalsurgeonsandformerassistants at the Nancy Faculty of Dental Surgery. They are both trained in surgical and prosthetic implants (Paris VII) and pre- implantandperiimplantsurgery(ParisXI) andworkinprivatepracticelimitedtoim- plantology,gnathologyandperidontics. 5. Müller N., Moëne R., Cancela J.-A., Mombelli A. Subgingival Air-Pol- ishing with Erythritol During Peri- odontal Maintenance: Randomized ClinicalTrialofTwelveMonths;JClin Periodontol.2014Sep;41(9):883-9. Cleanliness is Key: How hygiene improves our quality of life ByDentsplySirona The merger of DENTSPLY and Sirona at the beginning of the year created the largest manufacturer of technol- ogies, equipment and consumables in the dental sector. The company is now working together as one com- bined force to develop solutions for the current challenges in dentistry, including products for enhanced hygienic safety in practices. The re- cently published edition of the cus- tomermagazineVISIONalsofocuses onthistopic,whereinternationalex- perts take a closer look at the various facets of hygiene. The in-depth dis- cussions clearly show that the scope of this issue extends far beyond germ-freedentalpractices. “Hygiene is important and desir- able because it protects us and oth- ers against infection and promotes health,” explained Jeffrey T. Slovin, CEO of Dentsply Sirona. “It affects all aspects of our lives and requires our constant attention – everywhere in the world.” Because this issue is so prominent in the dental industry, the latest edition of VISION, the cus- tomer magazine from Dentsply Si- rona, focuses on and emphasizes the significanceofdentalhygiene. Hygiene is of central importance when it comes to health. A prime example here is water, which is used for cleaning, personal hygiene and drinking water. Water was long considered to be harmful; it was not until the 19th century that scientific studies highlighted the cleansing effect of water, which, in turn, had a fundamental impact on society’s ap- proachtohygiene.VISIONtracesthis history and takes a look at the activi- ties in clinics, which were initially a pretty “dirty business,” as infection protection based on hygiene and disinfectiondidnotemergeuntilthe middle of the 19th century. Hygiene, what was treated back then as an in- novation, is now standard practice and its working conditions are now the norm, especially in dental prac- tices. Practice hygiene: High-qual- ity standards do not mean higherexpenses Thisstartswiththetreatmentcenter: The transmission instruments must be kept germ-free, and the hygiene features in the treatment centers ◊Page2 ÿPage 6