A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy

Ingvild M Ulvik, Terje Sæthre, Dagmar F Bunæs, Stein Atle Lie, Morten Enersen, Knut N Leknes, Ingvild M Ulvik, Terje Sæthre, Dagmar F Bunæs, Stein Atle Lie, Morten Enersen, Knut N Leknes

Abstract

Background: Due to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.

Methods: Twenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA-DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).

Results: A significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).

Conclusions: The 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.

Trial registration: The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

Keywords: Air-polishing; Erythritol; Furcation involvement; Periodontal maintenance; Visual analogue scale.

Conflict of interest statement

The authors report no conflicts of interest related to the article.

Figures

Fig. 1
Fig. 1
Flowchart of the study
Fig. 2
Fig. 2
Percent test and control furcation sites showing plaque at baseline, 6 and 12 months
Fig. 3
Fig. 3
Percent test and control furcation sites showing bleeding on probing at baseline, 6 and 12 months
Fig. 4
Fig. 4
Numbers of bacterial species in test and control furcation sites
Fig. 5
Fig. 5
Percent test and control furcation sites harboring targeted bacterial species > 105 at baseline, and at 6 and 12 months

References

    1. Wilson TG., Jr Supportive periodontal treatment introduction–definition, extent of need, therapeutic objectives, frequency and efficacy. Periodontology. 2000;1996(12):11–15.
    1. Badersten A, Nilveus R, Egelberg J. Effect of nonsurgical periodontal therapy. II. Severely advanced periodontitis. J Clin Periodontol. 1984;11(1):63–76. doi: 10.1111/j.1600-051X.1984.tb01309.x.
    1. Zappa U, Smith B, Simona C, Graf H, Case D, Kim W. Root substance removal by scaling and root planing. J Periodontol. 1991;62(12):750–754. doi: 10.1902/jop.1991.62.12.750.
    1. Flemmig TF, Petersilka GJ, Mehl A, Hickel R, Klaiber B. Working parameters of a magnetostrictive ultrasonic scaler influencing root substance removal in vitro. J Periodontol. 1998;69(5):547–553. doi: 10.1902/jop.1998.69.5.547.
    1. Lie T, Leknes KN. Evaluation of the effect on root surfaces of air turbine scalers and ultrasonic instrumentation. J Periodontol. 1985;56(9):522–531. doi: 10.1902/jop.1985.56.9.522.
    1. Schmidlin PR, Beuchat M, Busslinger A, Lehmann B, Lutz F. Tooth substance loss resulting from mechanical, sonic and ultrasonic root instrumentation assessed by liquid scintillation. J Clin Periodontol. 2001;28(11):1058–1066. doi: 10.1034/j.1600-051X.2001.281111.x.
    1. Petersilka GJ. Subgingival air-polishing in the treatment of periodontal biofilm infections. Periodontology. 2011;55(1):124–142. doi: 10.1111/j.1600-0757.2010.00342.x.
    1. Fischer C, Wennberg A, Fischer RG, Attstrom R. Clinical evaluation of pulp and dentine sensitivity after supragingival and subgingival scaling. Endod Dent Traumatol. 1991;7(6):259–265. doi: 10.1111/j.1600-9657.1991.tb00214.x.
    1. Latheef P, Sirajuddin S, Gundapaneni V, Mn K, Apine A. Iatrogenic damage to the periodontium caused by periodontal treatment procedures. Open Dent J. 2015;9:203–207. doi: 10.2174/1874210601509010203.
    1. Lin YH, Gillam DG. The prevalence of root sensitivity following periodontal therapy: a systematic review. Int J Dent. 2012;2012:407023. doi: 10.1155/2012/407023.
    1. Petersilka GJ, Steinmann D, Haberlein I, Heinecke A, Flemmig TF. Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-polishing powder. J Clin Periodontol. 2003;30(4):328–333. doi: 10.1034/j.1600-051X.2003.00290.x.
    1. Moene R, Decaillet F, Andersen E, Mombelli A. Subgingival plaque removal using a new air-polishing device. J Periodontol. 2010;81(1):79–88. doi: 10.1902/jop.2009.090394.
    1. Flemmig TF, Arushanov D, Daubert D, Rothen M, Mueller G, Leroux BG. Randomized controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-to-deep periodontal pockets. J Periodontol. 2012;83(4):444–452. doi: 10.1902/jop.2011.110367.
    1. Wennstrom JL, Dahlen G, Ramberg P. Subgingival debridement of periodontal pockets by air polishing in comparison with ultrasonic instrumentation during maintenance therapy. J Clin Periodontol. 2011;38(9):820–827. doi: 10.1111/j.1600-051X.2011.01751.x.
    1. Caygur A, Albaba MR, Berberoglu A, Yilmaz HG. Efficacy of glycine powder air-polishing combined with scaling and root planing in the treatment of periodontitis and halitosis: a randomised clinical study. J Int Med Res. 2017;45(3):1168–1174. doi: 10.1177/0300060517705540.
    1. Kruse AB, Akakpo DL, Maamar R, Woelber JP, Al-Ahmad A, Vach K, et al. Trehalose powder for subgingival air-polishing during periodontal maintenance therapy: a randomized controlled trial. J Periodontol. 2019;90(3):263–270. doi: 10.1002/JPER.17-0403.
    1. Hagi TT, Hofmanner P, Salvi GE, Ramseier CA, Sculean A. Clinical outcomes following subgingival application of a novel erythritol powder by means of air polishing in supportive periodontal therapy: a randomized, controlled clinical study. Quintessence Int. 2013;44(10):753–761.
    1. Hagi TT, Hofmanner P, Eick S, Donnet M, Salvi GE, Sculean A, et al. The effects of erythritol air-polishing powder on microbiologic and clinical outcomes during supportive periodontal therapy: six-month results of a randomized controlled clinical trial. Quintessence Int. 2015;46(1):31–41.
    1. Muller N, Moene R, Cancela JA, Mombelli A. Subgingival air-polishing with erythritol during periodontal maintenance: randomized clinical trial of twelve months. J Clin Periodontol. 2014;41(9):883–889. doi: 10.1111/jcpe.12289.
    1. Ng E, Byun R, Spahr A, Divnic-Resnik T. The efficacy of air polishing devices in supportive periodontal therapy: a systematic review and meta-analysis. Quintessence Int. 2018;49(6):453–467.
    1. Hashino E, Kuboniwa M, Alghamdi SA, Yamaguchi M, Yamamoto R, Cho H, et al. Erythritol alters microstructure and metabolomic profiles of biofilm composed of Streptococcus gordonii and Porphyromonas gingivalis. Mol Oral Microbiol. 2013;28(6):435–451. doi: 10.1111/omi.12037.
    1. Bunaes DF, Lie SA, Enersen M, Aastrom AN, Mustafa K, Leknes KN. Site-specific treatment outcome in smokers following non-surgical and surgical periodontal therapy. J Clin Periodontol. 2015;42(10):933–942. doi: 10.1111/jcpe.12462.
    1. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1–6. doi: 10.1902/annals.1999.4.1.1.
    1. Muhlemann HR, Son S. Gingival sulcus bleeding–a leading symptom in initial gingivitis. Helv Odontol Acta. 1971;15(2):107–113.
    1. O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol. 1972;43(1):38. doi: 10.1902/jop.1972.43.1.38.
    1. Hamp SE, Nyman S, Lindhe J. Periodontal treatment of multirooted teeth. Results after 5 years. J Clin Periodontol. 1975;2(3):126–135. doi: 10.1111/j.1600-051X.1975.tb01734.x.
    1. Cortellini P, Cortellini S, Tonetti MS. Papilla preservation flaps for periodontal regeneration of molars severely compromised by combined furcation and intrabony defects: retrospective analysis of a registry-based cohort. J Periodontol. 2020;91(2):165–173. doi: 10.1002/JPER.19-0010.
    1. Barros SP, Williams R, Offenbacher S, Morelli T. Gingival crevicular fluid as a source of biomarkers for periodontitis. Periodontology. 2000;70(1):53–64. doi: 10.1111/prd.12107.
    1. Belibasakis GN, Schmidlin PR, Sahrmann P. Molecular microbiological evaluation of subgingival biofilm sampling by paper point and curette. APMIS. 2014;122(4):347–352. doi: 10.1111/apm.12151.
    1. Socransky SS, Haffajee AD, Smith C, Martin L, Haffajee JA, Uzel NG, et al. Use of checkerboard DNA-DNA hybridization to study complex microbial ecosystems. Oral Microbiol Immunol. 2004;19(6):352–362. doi: 10.1111/j.1399-302x.2004.00168.x.
    1. Socransky SS, Smith C, Martin L, Paster BJ, Dewhirst FE, Levin AE. “Checkerboard” DNA-DNA hybridization. Biotechniques. 1994;17(4):788–792.
    1. Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent RL., Jr Microbial complexes in subgingival plaque. J Clin Periodontol. 1998;25(2):134–144. doi: 10.1111/j.1600-051X.1998.tb02419.x.
    1. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13(4):227–236. doi: 10.1002/nur.4770130405.
    1. Hujoel P. Dietary carbohydrates and dental-systemic diseases. J Dent Res. 2009;88(6):490–502. doi: 10.1177/0022034509337700.
    1. Baumgartner S, Imfeld T, Schicht O, Rath C, Persson RE, Persson GR. The impact of the stone age diet on gingival conditions in the absence of oral hygiene. J Periodontol. 2009;80(5):759–768. doi: 10.1902/jop.2009.080376.
    1. Woelber JP, Gartner M, Breuninger L, Anderson A, Konig D, Hellwig E, et al. The influence of an anti-inflammatory diet on gingivitis. A randomized controlled trial. J Clin Periodontol. 2019;46(4):481–490. doi: 10.1111/jcpe.13094.
    1. Krohn-Dale I, Boe OE, Enersen M, Leknes KN. Er:YAG laser in the treatment of periodontal sites with recurring chronic inflammation: a 12-month randomized, controlled clinical trial. J Clin Periodontol. 2012;39(8):745–752. doi: 10.1111/j.1600-051X.2012.01912.x.
    1. Jentsch HFR, Heusinger T, Weickert A, Eick S. Professional tooth cleaning prior to non-surgical periodontal therapy: a randomized clinical trial. J Periodontol. 2020;91(2):174–182. doi: 10.1002/JPER.19-0023.
    1. Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol. 1994;65(3):260–267. doi: 10.1902/jop.1994.65.3.260.
    1. Lang NP, Bartold PM. Periodontal health. J Clin Periodontol. 2018;45(Suppl 20):S9–S16.
    1. Hujoel PP, Loesche WJ. Efficiency of split-mouth designs. J Clin Periodontol. 1990;17(10):722–728. doi: 10.1111/j.1600-051X.1990.tb01060.x.
    1. Hujoel PP, DeRouen TA. Validity issues in split-mouth trials. J Clin Periodontol. 1992;19(9 Pt 1):625–627. doi: 10.1111/j.1600-051X.1992.tb01709.x.
    1. Hujoel PP. Design and analysis issues in split mouth clinical trials. Community Dent Oral Epidemiol. 1998;26(2):85–86. doi: 10.1111/j.1600-0528.1998.tb01932.x.
    1. Cobb CM. Non-surgical pocket therapy: mechanical. Ann Periodontol. 1996;1(1):443–490. doi: 10.1902/annals.1996.1.1.443.
    1. Bower RC. Furcation morphology relative to periodontal treatment. Furcation entrance architecture. J Periodontol. 1979;50(1):23–27. doi: 10.1902/jop.1979.50.1.23.
    1. Bower RC. Furcation morphology relative to periodontal treatment. Furcation root surface anatomy. J Periodontol. 1979;50(7):366–374. doi: 10.1902/jop.1979.50.7.366.
    1. Petersilka GJ, Tunkel J, Barakos K, Heinecke A, Haberlein I, Flemmig TF. Subgingival plaque removal at interdental sites using a low-abrasive air polishing powder. J Periodontol. 2003;74(3):307–311. doi: 10.1902/jop.2003.74.3.307.
    1. Armitage GC. Analysis of gingival crevice fluid and risk of progression of periodontitis. Periodontology. 2000;2004(34):109–119.
    1. Tsang YC, Corbet EF, Jin LJ. Subgingival glycine powder air-polishing as an additional approach to nonsurgical periodontal therapy in subjects with untreated chronic periodontitis. J Periodontal Res. 2018;53(3):440–445. doi: 10.1111/jre.12532.
    1. Bunaes DF, Mustafa M, Mohamed HG, Lie SA, Leknes KN. The effect of smoking on inflammatory and bone remodeling markers in gingival crevicular fluid and subgingival microbiota following periodontal therapy. J Periodontal Res. 2017;52(4):713–724. doi: 10.1111/jre.12438.
    1. Sharawy AM, Sabharwal K, Socransky SS, Lobene RR. A quantitative study of plaque and calculus formation in normal and periodontally involved mouths. J Periodontol. 1966;37(6):495–501. doi: 10.1902/jop.1966.37.6.495.
    1. Haffajee AD, Cugini MA, Dibart S, Smith C, Kent RL, Jr, Socransky SS. The effect of SRP on the clinical and microbiological parameters of periodontal diseases. J Clin Periodontol. 1997;24(5):324–334. doi: 10.1111/j.1600-051X.1997.tb00765.x.
    1. Hagi TT, Klemensberger S, Bereiter R, Nietzsche S, Cosgarea R, Flury S, et al. A biofilm pocket model to evaluate different non-surgical periodontal treatment modalities in terms of biofilm removal and reformation, surface alterations and attachment of periodontal ligament fibroblasts. PLoS ONE. 2015;10(6):e0131056. doi: 10.1371/journal.pone.0131056.
    1. Antczak-Bouckoms AA, Tulloch JF, Berkey CS. Split-mouth and cross-over designs in dental research. J Clin Periodontol. 1990;17(7 Pt 1):446–453. doi: 10.1111/j.1600-051X.1990.tb02343.x.
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 2012;10(1):28–55. doi: 10.1016/j.ijsu.2011.10.001.

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