Fig. 1 (above) Testing powders observational study 2023
Discover what’s new in powders for the popular powder streaming air polishers. Originally, air polishers were called Prophy-Jets™ designed to be used supragingival for stain removal. Air polishers and newly developed powders have come a long way and are primarily used now for subgingival for biofilm disruption to control microbes, decontaminate the oral cavity.
Various powder streaming units are now available. For ease of use and maintenance I recommend a table-top unit. Most come with air polisher on one side and piezoelectric scaler on the other side. These units have key components; one or multiple powder containers, flush cycle for maintenance, handpieces for supragingival stain removal and subgingival tips for biofilm disruption.
There is a proper protocol for clinicians to follow when using a subgingival air polisher. Set up the air polishing unit with the supragingival or subgingival handpiece. Select the powder for the specific treatment to achieve optimal results; stain removal, biofilm disruption, or both, and most importantly safe for the patient.
The new powders are designed for and categorized by particle size to use supragingival or subgingival. Supragingival powers are a larger, more abrasive particle size, between 35–75 microns. Primarily used for stain removal.
Subgingival powders, 25 microns particle size or less, are the ONLY powders proven to be safe to use subgingival. Powders higher than 25-micron value, could damage the soft tissue, root structure on natural teeth, and implants if used below the gumline.
Sodium Bicarbonate, the original supragingival powder formulated for stain removal. It is a water-soluble salt powder of 40-micron particle size, indicated only for supragingival air polishing. Clinicians need to be aware that studies indicate there are contraindications to using this powder. It is contraindicated for patients with veneers, crowns and bridge, implants, and lab created prostheses with light cured glazes (i.e. full fixed arch implant prostheses). Contraindicated for patients with multiple medical conditions, hypertension, respiratory illness, infectious disease, renal insufficiency, Addison and Cushing disease. Including patients on sodium- restricted diets, metabolic alkalosis, or medications such as mineralocorticoid steroids, antidiuretics, or potassium supplements.
Calcium Carbonate, made from minerals found in rocks, eggshells, and seashells. A good alternative powder to Sodium Bicarbonate, 35-micron particle size, for supragingival air polishing. Excellent stain remover, appropriate for patients on salt- restricted diets, and can be used to remove biofilm supragingival. Proven gentle on enamel and a good choice for patients with sensitive teeth. Safe to use on restorations, orthodontic brackets, and does not have any contraindications for patients with medical conditions.
Glycine, a non-essential amino acid low abrasive powder, 25-micron particle size, most universally used and researched air polishing powder. Used subgingival for biofilm disruption with NO risk of harming tissues, dentin or cementum. Glycine, 25-micron powder does not remove stains, but can be used safely around restorative materials, restorations, and dental implants. It is used for improved nonsurgical results in disease treatments for periodontal and peri-implant therapy.
Erythritol, low-calorie sweetener, sugar alcohol polyol, 14-microns and used subgingival for biofilm disruption. It is deemed safe for tissues, dentin and cementum. It can also be used safely around dental implants and for disease treatment.
Tagatose, a monosaccharide (simple sugar), non-cariogenic, chemically classified as a ketose with an extremely low glycemic index, making it ideal for diabetic patients. A new powder patented by Prisman GmbH, can be used for supragingival and subgingival air polishing as a low abrasive powder for biofilm disruption and stain removal. Also, tested safe on tissues, dentin, and cementum root surfaces of natural teeth,
Fig. 2 (above) Testing stain removal using tagatose powder on a quail egg.
Air polishing protocol
Once the unit is set up and the powder selected, seat the patient. Be sure both the patient and the operator are protected. As the clinician, use high-volume evacuation (HVE) to remove aerosols for patient and operator. For the patient, place an OptraGate, an ideal retraction product to protect the patient’s lips and nose. The new OptraGate® 2 adds an additional ring for better stabilization. Great for hygienists to use prophylaxis appointments and doctors for longer restoration or cosmetic procedures like prepping or placing veneers.
Figure #3 (above) OptraGate® 2 by Ivoclar
To place an OptraGate, size the patient using the guide on the package. Pull OptraGate apart, fold and place in the corners of the patient’s mouth. Position in the vestibular regions for optimal visibility. Now you are ready to proceed to air polishing using a supragingival or subgingival protocol.
Supragingival, using the supragingival handpiece remove all the biofilm and stain; buccal, interproximal, and direct lingual on teeth, restorations, and complete dentition.
Subgingival, insert the subgingival specific tip next to the tooth or parallel to the implant. Go to the base of the pocket until resistance is felt and pull back slightly. Activate the air polisher for five seconds per site (four sites). Start on the buccal surfaces; distal, buccal, mesial, and then complete with all the direct linguals.
Air polishing is now widely accepted for biofilm management at professional in-office maintenance appointments on natural teeth, dental implants, restorations, and disease (periodontal and peri-implant) treatments. Use air polishing with the selected appropriate powder for stain removal and/or biofilm disruption. Proven to decrease inflammation and bleeding caused by host response to bacterial and oral pathogens for patient’s oral and overall health.
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