Anne L. Miller, RDH, MS

Clinical Education Manger

Hu-Friedy Manufacturing, LLC

Put the Power in

Your Hands

Advanced Biofilm

Management

Objectives

• Discuss the complexity of pathogenic oral biofilm.

• Explain the concept of guided biofilm therapy.

• Identify technologies that lead to improved clinical

patient outcomes.

• Detail air polishing powder characteristics.

• Discuss scientific evidence supporting air polishing

technologies.

Hygiene Treatment Challenges

Availability of quality

instruments

Outdated equipment

Fatigue and pain

Sharpening frustrations

Time management

Periodontal Debridement Goals

• Routinely remove hard, calcified tooth deposits.

• Routinely remove pathogenic biofilm.

• Arrest the process of inflammation.

• Maintain a healthy periodontium.

Knowing the Enemy

Planktonic bacteria vs. biofilm.

Sophisticated environment.

Source of periodontal disease process.

Requires mechanical disruption and removal.

Hard Deposit Removal

Hand and Power Instrumentation

Soft Deposit Removal

Hand and Power Instrumentation

Prophy Cup and Pumice Paste

Contemporary Biofilm Removal

Low abrasive polishing powders

Glycine

Erythritol

65 µm

40 µm

Photos compliments of EMS

Powders

Sodium Bicarbonate

• Hydrophobic

• Supragingival biofilm and

stain

• Enamel surfaces only

Photo compliments of EMS

Powders

Glycine

• Amino Acid

• Supragingival biofilm and

stain

• Shallow Subgingival

biofilm

• Deeper Subgingival

biofilm with Perio nozzle 25 µm

25 µm

Photo compliments of EMS

Powders

Erythritol

• Sugar Alchohol

• Supragingival biofilm and

stain

• Shallow Subgingival

biofilm

• Deeper Subgingival

biofilm with Perio nozzle

14 µm

14 µm

Powder Mohs Hardness Particle Size

Glycine < 2 ~ 20-65 µm

Sodium Bicarbonate 2.5 ~ 40-120 µm

Calcium Bicarbonate (Pearls) 3 ~ 40 µm

Aluminum Trihydroxide (Jet Fresh) 3.5 – 4 ~ 80 µm

Bioactive Glass (Sylc) 4.8 – 6 ~ 50 µm

Pumice 6 – 7 ~ 81-120 µm

Structure Mohs Hardness

Enamel 4 – 5

Dentin 3 – 4

Cementum 2 – 4

Mohs Hardness

• Supragingival biofilm and stain

• Shallow Subgingival biofilm

• Deeper Subgingival biofilm with Perio nozzle

Application

Must have at least 3mm of alveolar bone

support for perio nozzle use.

Use disclosing solution to “Guide” use.

Areas of crowding and inflammation.

Application

A B

Use disclosing solution to “Guide” use.

Areas of crowding and inflammation.

Application

Caries Detection

Application

Pediatric Patients

Application

Implant Maintenance

Peri-implantitis

Application

Implant Deposit Removal

Orthodontic patients

Frequent application

Positive outcomes post treatment

Application

Periodontal Maintenance Patients

Exposed Cementum and Dentin

Application

Light to Moderate Stains

Support Removal with Power Scaling

Application

Light to Moderate Stains

Support Removal with Power Scaling

Application

Ideal Set Up

• Follow Mfg. directions for use

• Use air-polishing technology

before scaling &

root planing procedures

• Check and adjust air pressure

before use

• Use an inline air pressure gauge

to measure air pressure at the

hand-held handpiece.

Supragingival Application

Technique

• Angle towards the incisal or

occlusal surface at 30o – 60o

• 3 – 5 mm from tooth

• Continuous fluid movement

Confirm your unit supports the use of

glycine powder!

Shallow Subgingival Application

Technique

• Angle towards the gingival

margin at 30o – 60o angle.

• 3 – 5 mm from tooth.

• 5 second sweeping motion.

• Only low abrasive powders.

Deeper Subgingival Application

Technique

• Utilize a disposable, single patient use Perio-Flow® Nozzle

• Insert to the base of the pocket

• Move the nozzle coronally 1mm.

• Activate the air polisher.

• Allow for 5 seconds in the pocket working your way coronally.

• Tooth must have at least 3mm of alveolar bone support for this application.

• Up to 5mm in US, 10mm in Canada

Clinical Protocol Paradigm Shift

Contraindications

• Immunocompromised Patients

• Communicable Diseases

• Respiratory Diseases

Cautions

• Sodium Bicarbonate Powder

– Sodium-Restricted Diet

– Hypertension

– Addison’s Disease

– Cushing’s Syndrome

• Nanocomposites/resins

Air Polishing Therapy

Clinical Protocols Proper PPE

• Face Mask/Face Shield

• Eye Protection, Clinician and Patient

• Remove contact lenses

• HVE a must.