Adjunctive air-polishing with erythritol in nonsurgical periodontal therapy: a randomized clinical trial

Abstract

Background: This study was aimed to investigate if the adjunctive use of erythritol air-polishing powder applied with the nozzle-system during subgingival instrumentation (SI) has an effect on the outcome of non-surgical periodontal treatment in patients with moderate to severe periodontitis.

Methods: Fourty-two individuals with periodontitis received nonsurgical periodontal therapy by SI without (controls, n = 21) and with adjunctive air-polishing using nozzle + erythritol powder (test, n = 21). They were analyzed for the clinical variables BOP (primary outcome at six months), probing depth (PD), attachment level, four selected microorganisms and two biomarkers at baseline, before SI as well as three and six months after SI. Statistical analysis included nonparametric tests for intra- and intergroup comparisons.

Results: In both groups, the clinical variables PD, attachment level and BOP significantly improved three and six months after SI. The number of sites with PD ≥ 5 mm was significantly lower in the test group than in the control group after six months. At six months versus baseline, there were significant reductions of Tannerella forsythia and Treponema denticola counts as well as lower levels of MMP-8 in the test group.

Conclusions: Subgingival instrumentation with adjunctive erythritol air-polishing powder does not reduce BOP. But it may add beneficial effects like reducing the probing depth measured as number of residual periodontal pocket with PD ≥ 5 mm when compared with subgingival instrumentation only.

Clinical relevance: The adjunctive use of erythritol air-polishing powder applied with the nozzle-system during SI may improve the clinical outcome of SI and may reduce the need for periodontal surgery. Trial registration The study was retrospectively registered in the German register of clinical trials, DRKS00015239 on 6th August 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL .

Keywords: Biomarker; Clinical variables; Erythritol; Periodontitis; Subgingival instrumentation; Subgingival microorganisms.

Fig. 1

Timeline of the study using adjunctive air-polishing with erythritol in nonsurgical periodontal therapy

Fig. 2

Flowchart (adapted to Moher et al. 2001) of the study using adjunctive air-polishing with erythritol in nonsurgical periodontal therapy

Fig. 3

Levels of MMP-8 (a) and IL-1β (b) in gingival crevicular fluid of the test group (subgingival instrumentation + subgingival erythritol air-polishing) and control group (subgingival instrumentation alone) at baseline (T1) as well as three (T2) and six months (T3) after subgingival instrumentation incl. statistically significant results (Wilcoxon signed rank test for paired samples)

Fig. 4

Counts of Aggregatibacter actinomycetemcomitans (a), Porphyromonas gingivalis (b), Tannerella forsythia (c) and Treponema denticola (d) in the subgingival biofilm of the test group (subgingival instrumentation + subgingival erythritol air-polishing) and control group (subgingival instrumentation alone) at baseline (T1) as well as three (T2) and six months (T3) after subgingival instrumentation incl. statistically significant results (Wilcoxon signed rank test for paired samples)