1.  DH 202 Clinic VI 2-13

2.  US Market since 1976  Invented to remove extrinsic stains and soft deposits from tooth surfaces  Intended to remove biofilm layer  Sodium bicarbonate 1st  Technology invented by Dr. Robert Black in 1945 o Air Dent: device that used compressed air, water, and a highly abrasive powder to eliminate pain from cavity preparation, making anesthesia unnecessary o Air Dent had numerous problems that could not be overcome 2-13

3.  Air polishing is accomplished by the propulsion of abrasive particles through a mixture of compressed air and water through a handpiece nozzle  Kinetic energy propels the air polishing paste particles against the tooth surface—removing stains and dental plaque

4.  Efficient and effective means of removing extrinsic stain and plaque from tooth surfaces: enamel, dentin, cementum  Removes stain 3x as fast as scaling  Less fatigue to operator  Faster than polishing with rubber cup  Intact enamel surface are not damaged by its use 2-13

5.  Moderate to heavy stains on tooth surfaces  Periodontal surgery to clean and roughen root structures  To clean effectively around orthodontic appliances  Controversy on cementum/dentin use o Air polishing removes less tooth structure than scalers o Food-for-Thought: Any method capable of removing moderate stain from root surfaces will also be capable of removing cementum: Bottom line: Follow manufacturer’s recommendations – doing so will not damage anything! 2-13

6.  Polish implants o Bacteria completely removed o Inhibit plaque formation and smooth implants o Minimal alterations to implant: fibroblasts readily re-attach to surfaces  Prior to sealant placement o Superior to pumice with prophy cup o Allows for deeper penetration of sealant material o Enhances sealant bond 2-13

7. 1. Hypertension or on sodium restricted diets  However, research shows that the amount of sodium bicarbonate ingested during air polishing is not sufficient to cause an increase in blood pressure or blood levels of sodium or alkalosis 2. Respiratory problems: COPD, any condition that interferes with breathing or swallowing.  These patients may be bothered by the aerosols created by air polishing and they are also vulnerable to the development of pneumonia 3. End-stage renal disease or immunocompromised 4. Communicable infection 5. Addison's disease or Cushing's disease. 6. Taking potassium, anti-diuretics, or steroid therapy 2-13

8.  Suction! – control the aerosols  Cover pt’s lips with lubricant  Towels draped over the face and protective eye wear  Polish 5 seconds or less per tooth  Strokes o Rapid/Sweeping Motion over the teeth o 60 degree angle for anterior o 80 degrees for posterior o 90 degrees for occlusal 2-13

9.  If sprayed on gums = will make them bleed o Effects are temporary o Uncomfortable for patient, not painful o Avoid tissue trauma = follow manufacturer recommendations for use o Lubricate the lips o Point tip toward F/L/O and avoid gingival margins o Most tips come angled for this purpose 2-13

11.  Incorrect handpiece angulation with air polishers must be avoided in order to prevent the occurrence of a very serious medical condition— iatrogenic facial emphysema o Symptoms: facial swelling, a "crackling" sensation on the face and neck area, tenderness, and pain. o Detected early: require observation, analgesia, and antibiotic therapy o Detected Late: Thrombosis, Fatal embolism, Pneumothorax throm·bo·sis THräm ˈ bōs ə s *local coagulation or clotting of the blood in a part of the circulatory system em·bo·lism, ˈ emb ə ˌ liz ə m *obstruction of an artery, typically by a clot of blood or an air bubble. pneu·mo·tho·rax, n(y)oomō ˈ THôraks *the presence of air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung. 2-13

12.  Nozzles should never be directed subgingivally into periodontal pockets where there is little or no bony support remaining, into or near traumatic lacerations or surgical wounds where there is disruption of the intraoral barrier (dentoalveolar membrane), or into extraction sites 2-13

13. 1. Self-contained  Attach to the compressed air and water lines of the dental unit  Require an electric outlet 2. Attach to handpieces  Obtaining the compressed air and water from the handpiece lines  No electrical connection is required for the handpiece connection unit 2-13

14.  Almost same rules for cavitron/prophy cup polish apply to air polishing o Avoid porcelain restorations (scratch) o Avoid margins of composite, metal or amalgam fillings o Air polishing will dull, matte finishes, roughen or cause structural alterations o Most manufacturer recommendations state: “Avoid prolonged or excessive use on restorative dental materials.” 2-13

15. 1. Sodium Bicarbonate 2. Aluminum Trihydroxide 3. Calcium Carbonate (Pearls) 4. Glycine 5. Calcium Phosphosilicate: NovaMin® 2-13

16.  First one used, most studies and widely used  Heavy stain removal  Particle size: 65-250um  Uses o Enamel, some restorative materials o Stain removal “Sand blaster”  Physical o Hard particles o Salt crystal substance o Biocompatible o Salty-Taste 2-13

17.  Do not use o Subgingival o Implants o Veneers, porcelain restorations, ceramics o Roots o Patients with restricted sodium diets o Gingiva 2-13

20.  Highly abrasive  Used for air abrasive treatments: heavy stains  Particle size: 80-325um  Round, hard particles  Sodium free: 1 st alternative invented for patients who are sodium intolerant  Similar to antacid tablets  “Sandy Feeling” 2-13

21.  Used on ENAMEL only  Do not use o Restorations o Subgingival o Implants o Veneers, ceramics  Effects o Abrasive to roots/cementum o Gingival irritation 2-13

22.  Best alternative to sodium bicarbonate  Particle size: 40-90um  Spherical soft particles  Sodium-free  No salty taste  Heavy-Light stains  Effective biofilm removal 2-13

23.  Do not use: subgingival  Use on o Enamel o Limited root surfaces o Restorations except Gold o Implants except Zircon ceramics  Effects o Decreased gingival irritation o Easy to apply 2-13

24.  Subgingival biofilm removal  Supragingival stain removal  Particle size: 25-60um Small angular particles  Water soluble amino acid glycerin  Sodium-free  No salty taste, comfortable  Water rinse feeling  2 grades: pharmaceutical & technical  Used on all surfaces (enamel, dentin, cememtum) 2-13

25.  Used for subgingival biofilm removal  Not used for stain removal  Effects o Reduced biofilm up to 5mm pocket depths, 10mm with Perio nozzle o Ideal for implant maintenance o Good for restorative materials 2-13

26.  Desensitizing Root structure  Promote remineralization of dentinal tissues  Particle size: 20-100um  Hard, spherical particles  Ca, sodium, phosphosilicate minerals  No salty taste  Used on enamel, root surfaces  No long-term in vivo studies yet (“living organisms”)  Hardest on market 2-13

27.  Used for stain removal, desensitizing, remineralization  Do not use o Subgingival o Implants o Restorative materials  Effects o Remove surface debris prior to treatment for better remineralization and desensitization effects o Some healing properties when close to gingival margins 2-13

28.  In vitro studies “in the glass” o Show that calcium sodium phosphosilicate interacts with oral fluids and releases sodium, calcium, and phosphate ions o Primary focus of research conducted on calcium sodium phosphosilicate is on its ability to form hydroxycarbonate apatite when combined with oral fluids for the purpose of remineralization and the treatment of dentinal hypersensitivity by occluding dentinal tubules 2-13

29. 1. Barnes C. “An In-Depth Look at Air Polishing:.” Dimension of Dental Hygiene. Marh 2010. 8(3):33-40. 2. Gutmann M. “Air polishing: a comprehensive review of the literature. “ J.Dental Hygiene. 2000.72(3):47-57 3. Lennemann T. “Air Polishing: Overview.” Can J Dent Hygiene. 2011.45(3):145-148 4. Wilkins 2-13