Novel Approach to Dental Biofilm Management through Guided Biofilm Therapy (GBT): A Review

Abstract

Dental biofilm plays a very crucial role in the etiopathogenesis of periodontal andperi-implant diseases. Over the past decade, tremendous research has been carried outto know the structure of biofilm and the mechanism by which it causes the destruction of supporting tissues of tooth or implant. Periodontal or peri-implant therapy usually begins with primarily removing thebiofilm and is considered as non-surgical mechanical debridement. Although scaling and root planing (SRP) is regarded as a gold standard for mechanical plaque debridement, various other means of biofilm removal have constantly been evolving. These may vary from different scaling systems such as vector systems to decontamination of pockets with LASER therapy. Nowadays, a new concept has emerged known as "guided biofilm therapy" (GBT). It is beneficial in removing the biofilm around the tooth and implant structures, resulting in better or comparable clinical outcomes than SRP. These results were substantiated with the reduction in the microbial load as well as the reduction in the inflammatory cytokines. This review will highlight the various aspects of GBT used in periodontal and peri-implant disease.

Keywords: air abrasives; biofilm; dental plaque; disclosing agents; peri-implantitis; periodontitis.

Figure 1

Steps in guided biofilm therapy (GBT).

Figure 2

(A–F): Guided biofilm treatment (GBT) procedure in a patient with generalized bleeding on probing with plaque accumulation and localized calculus. (A) Pre-operative view; (B) application of disclosing agent on left half of the patient’s mouth; (C) application of disclosing agent over the patient’s entire mouth; (D) removal of supragingival biofilm and stains with air-polishing device (AIRFLOW^® Handy); (E) removal of the calculus removal from natural teeth with PIEZON^® PS allows thorough cleaning; (F) immediate post-operative view of the patient’s mouth after implementing the GBT protocol.