BYE,BYE BIOFILM! MAINE DENTAL HYGIENISTS’ ASSOCIATION Senator Hotel and Spa April 8, 2016 Augusta, Maine

Understand the role biofilm plays in dental disease Connect the role of air polishing to successful biofilm management Differentiate between supragingival and subgingival biofilm removal technology Review of power scaler instrumentation for hard deposit removal Water and plume control via high speed evacuation techniques Discover the “return on investment” potential for your practice Objectives

CURRENT: ANTI-INFECTIVE AND BOOST HOST IMMUNITY Periodontal debridement/biofilm removal Goal: tissue response, removal of all irritants Hand instruments, micro-ultrasonics, chemicals/ medicaments, AirFlowTherapy

6mm pocket for bacteria put in human terms

A FULL MOUTH PERIODONTAL INFECTION….. Compares in size to an open wound covering the entire palm of your hand……… Jill Rethman RDH BA ACCESS

AIR POLISHING – AN EVOLVING THERAPY Traditional Approach - Esthetic Stain removal Supragingival use New Approach – Therapeutic Biofilm removal Supra and Subgingival use Perio and Implant Maintenance

Effective – Efficient – Safe ProductEffectiveEfficientSafe Prophy Paste Coarse Medium Prophy Paste Fine Prophy Paste Sodium Bicarbonate Air polish Glycine Air polish Unless followed by med, then fine Unless followed by fine Enamel only followed by glycine Enamel only followed by glycine

BIOFILM Clinical studies show Air Flow Therapy is as effective as ultrasonic instrumentation in pocket resolution Air Flow Therapy takes less time to be effective More effective than hand instrumentation

After 1 minute 15 seconds After 35 seconds

Grain size relates to comfort NaHCO3 ~65 µm –Jagged particles CaCO3 ~45 µm –Rounded particles Glycine ~25 µm Powder Selection Kosher Salt Cornstarch

# Autoclavable Widemouth Adaptors $12/25 Vented HVE tips #21-75 ~~~~~~~~~~~~~~ 3” vented HVE tips Young Vento-Vac

Mohs Hardness PowderMohs Hardness Particle Size Glycine< 2~ µm Sodium Bicarbonate2.5~ µm Calcium Bicarbonate (Pearls)3~ 55 µm Aluminum Trihydroxide (Jet Fresh)3.5 – 4~ µm Calcium Sodium Phosphosilicate (Sylc)4.8 – 6~ 50 µm Pumice6 – 7~ µm StructureMohs Hardness Enamel4 – 5 Dentin3 – 4 Cementum2 – 4

Subgingival glycine-based air polishing is safe for the oral environment Equal subgingival biofilm removal to ultrasonics Considerably faster subgingival biofilm removal than curettes & ultrasonics Can be more comfortable than hand & ultrasonic instrumentation Summary of Clinical Evidence

Application based on Power Dispersion #3 Front and Back Surfaces

Tip Geometry PL3 A PS

SCALING IMPLANTS Damage from scratching studies done in vitro not in vivo-inconclusive “No existing evidence that scratched abutments lead to increased inflammation or aggravate peri-implantitis. Removing as much biofilm and calculus as possible to decrease perio bone loss is more important than scratching a surface.” Dr. Timothy Hempton Former Director of Post-Grad Periodontology at Tufts University 2016

3 CATEGORIES OF MAINTENANCE Class I-no access to titanium abutment Class II-exposure of titanium abutment Class III-exposure of the implant itself

Would you love to have extra minutes per patient?

Traditional Hygiene Appointment for Biofilm Management (Prophylaxis/PM) Screening/Data Collection Communication/Treatment Enrollment Biofilm/Calculus Removal with Hand and Ultrasonic Instruments 33 min. Rubber Cup Polishing 5 min. Examination Hand Off & Disinfect Room 60 min. 38 min

Biofilm Management With Glycine Powder Air Polishing (Prophylaxis / PM) Screening/Data Collection Communication/Treatment Enrollment Coronal and Subgingival Biofilm Removal w/ Air Polishing Using a Low Abrasive Powder 10 min. Calculus/Stain Removal with Hand and Ultrasonic Instruments 16 min. Examination Hand Off & Disinfect Room 60 min. -12 min

$198,6807% $13,907 Annually Typical Hygiene Supply Budget

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