334
Effects of Airpolishing on Dental Plaque Removal and Hard Tissues Evaluated by Scanning Electron
as
Microscopy Vuokko Kontturi-Närhi,
*
Seppo Markkanen, f and Helena
Markkanen*
The effect of an air-powder abrasive system on dental hard tissues was tested on 20 volunteers. Impressions of 150 randomly selected areas were taken before and after airpolishing and positive replicas were prepared for scanning electron microscopic examination (SEM). The amount of dental plaque on tooth surfaces was reduced by the treatment (P < 0.001). The abrasive changes caused by airpolishing on enamel were greater on the surfaces covered by dental plaque before the airpolishing compared to the surfaces without plaque (P < 0.01). The enamel and cementai surfaces were more abraded after the treatment compared with the initial condition. Despite the effectiveness of the dental airpolishing technique, the negative aspects should be considered in the decision to use airpolishing in routine prophylaxis, especially in patients with root surfaces exposed to the oral cavity. J Periodontol 1990;61:334-338.
Key Words: Dental enamel; dental plaque/adverse effects; airpolishing. The airpolishing technique has been shown to be an effective and time saving tooth cleaning method,1-5 although there are also some reports on its negative effects. In vitro studies indicate that airpolishing may cause wearing of the hard tissues of the tooth.4-8 Recently, Galloway and Pashley9 showed in their in vitro study that airpolishing had no visible effects on enamel when the spray was directed on the surface for as long as 60 seconds. However, as little as 5 seconds of spraying caused a substantial loss of surface structure when the spray was directed on dentin and cementum. This structural loss was linearly related to the spraying time. In another in vitro study, the air-flow technique had an abrasive effect on the root surface up to about 25 µ in depth after 30 seconds treatment. Atkinson et al.6 reported the average removal of root surface of extracted teeth to be 636.6 µ per 30 seconds of continuous exposure corresponding to the hypothesized effect of maintenance therapeutic use during 15 years. Berkstein et al.4 estimated that one maintenance treatment with airpolishing removed an average of 10.68 µ of root surface, while a curette removed 2.5 times more. Atkinson's6 and Berkstein's4 estimates corresponded well. Cementum as well as dentin surfaces became rougher after treatment as assessed by SEM micrographs.10 Boyde7 found that various hard tissues wore differently in vitro. He stated that the airpolishing method is safe only on sound enamel. White spots as well as ce-
mentum and dentin were found to be vulnerable.
Horning
and co-workers" studied the effects of airpolishing in flap surgery. They found that root surface removal was 18 µ per 10 seconds in a preliminary in vitro experiment and about the same in in vivo during the flap operation. We have studied the effects of airpolishing on plaque removal and dental hard tissues in clinical situations using the equipment as it is normally used in routine prophylaxis. Positive replica technique for SEM examination was used to evaluate the results. MATERIALS AND METHODS The subjects of this study consisted of 20 volunteers (20 to 50 years old) who had no systemic diseases and were not on any medication. Each of them had at least 20 teeth. They were advised not to brush their teeth for at least 24 hours before the airpolishing. At the time of the examination the subjects had no detectable dental calculus. The teeth were cleaned using an air-powder abrasive device* according to the instructions of the manufacturer, until all the visible plaque and stains were removed. The time required for treating the teeth varied from 5 to 10 minutes. Impressions of the randomly selected tooth surfaces (n 150) were taken using a low viscosity silicone based material8 before and after the airpolishing. Epoxy resin!l was =
*Air Flow, EMS SA, Le Sender, Switzerland.
"Department of Periodontology, University 'Department of Electron Microscopy.
of
Kuopio, Kuopio,
Finland.
sXantopren, Light Body Bayer AG, Leverkusen, West Germany. 'Spurr epon, Ladd Research Industries, Inc., Burlington, VT.
Volume 61 Number 6
KONTTURI-NÄRHI, MARKKANEN, MARKKANEN
Table 1. Enamel Condition Before and After Initially Plaque-Free Surfaces
Enamel Condition No abrasion Mild abrasion Severe abrasion Total
Table 2. Enamel Condition After Airpolishing in Free and Plaque Covered Surfaces (n = 68).
in
Before
After
Airpolishing
Airpolishing
82.1% 14.3% 3.6%
(n)
Severity
Airpolishing
100.0
(28)
of enamel abrasion before and after
airpolishing:
46.4% 32.1% 21.4%
No abrasion Mild abrasion Severe abrasion
100.0
Total
Effects of Airpolishing on Dental Plaque Removal and Hard Tissues Evaluated by Scanning Electron
as
Microscopy Vuokko Kontturi-Närhi,
*
Seppo Markkanen, f and Helena
Markkanen*
The effect of an air-powder abrasive system on dental hard tissues was tested on 20 volunteers. Impressions of 150 randomly selected areas were taken before and after airpolishing and positive replicas were prepared for scanning electron microscopic examination (SEM). The amount of dental plaque on tooth surfaces was reduced by the treatment (P < 0.001). The abrasive changes caused by airpolishing on enamel were greater on the surfaces covered by dental plaque before the airpolishing compared to the surfaces without plaque (P < 0.01). The enamel and cementai surfaces were more abraded after the treatment compared with the initial condition. Despite the effectiveness of the dental airpolishing technique, the negative aspects should be considered in the decision to use airpolishing in routine prophylaxis, especially in patients with root surfaces exposed to the oral cavity. J Periodontol 1990;61:334-338.
Key Words: Dental enamel; dental plaque/adverse effects; airpolishing. The airpolishing technique has been shown to be an effective and time saving tooth cleaning method,1-5 although there are also some reports on its negative effects. In vitro studies indicate that airpolishing may cause wearing of the hard tissues of the tooth.4-8 Recently, Galloway and Pashley9 showed in their in vitro study that airpolishing had no visible effects on enamel when the spray was directed on the surface for as long as 60 seconds. However, as little as 5 seconds of spraying caused a substantial loss of surface structure when the spray was directed on dentin and cementum. This structural loss was linearly related to the spraying time. In another in vitro study, the air-flow technique had an abrasive effect on the root surface up to about 25 µ in depth after 30 seconds treatment. Atkinson et al.6 reported the average removal of root surface of extracted teeth to be 636.6 µ per 30 seconds of continuous exposure corresponding to the hypothesized effect of maintenance therapeutic use during 15 years. Berkstein et al.4 estimated that one maintenance treatment with airpolishing removed an average of 10.68 µ of root surface, while a curette removed 2.5 times more. Atkinson's6 and Berkstein's4 estimates corresponded well. Cementum as well as dentin surfaces became rougher after treatment as assessed by SEM micrographs.10 Boyde7 found that various hard tissues wore differently in vitro. He stated that the airpolishing method is safe only on sound enamel. White spots as well as ce-
mentum and dentin were found to be vulnerable.
Horning
and co-workers" studied the effects of airpolishing in flap surgery. They found that root surface removal was 18 µ per 10 seconds in a preliminary in vitro experiment and about the same in in vivo during the flap operation. We have studied the effects of airpolishing on plaque removal and dental hard tissues in clinical situations using the equipment as it is normally used in routine prophylaxis. Positive replica technique for SEM examination was used to evaluate the results. MATERIALS AND METHODS The subjects of this study consisted of 20 volunteers (20 to 50 years old) who had no systemic diseases and were not on any medication. Each of them had at least 20 teeth. They were advised not to brush their teeth for at least 24 hours before the airpolishing. At the time of the examination the subjects had no detectable dental calculus. The teeth were cleaned using an air-powder abrasive device* according to the instructions of the manufacturer, until all the visible plaque and stains were removed. The time required for treating the teeth varied from 5 to 10 minutes. Impressions of the randomly selected tooth surfaces (n 150) were taken using a low viscosity silicone based material8 before and after the airpolishing. Epoxy resin!l was =
*Air Flow, EMS SA, Le Sender, Switzerland.
"Department of Periodontology, University 'Department of Electron Microscopy.
of
Kuopio, Kuopio,
Finland.
sXantopren, Light Body Bayer AG, Leverkusen, West Germany. 'Spurr epon, Ladd Research Industries, Inc., Burlington, VT.
Volume 61 Number 6
KONTTURI-NÄRHI, MARKKANEN, MARKKANEN
Table 1. Enamel Condition Before and After Initially Plaque-Free Surfaces
Enamel Condition No abrasion Mild abrasion Severe abrasion Total
Table 2. Enamel Condition After Airpolishing in Free and Plaque Covered Surfaces (n = 68).
in
Before
After
Airpolishing
Airpolishing
82.1% 14.3% 3.6%
(n)
Severity
Airpolishing
100.0
(28)
of enamel abrasion before and after
airpolishing:
46.4% 32.1% 21.4%
No abrasion Mild abrasion Severe abrasion
100.0
Total
