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Air Polishing / Prophy Jet

DH 202 Clinic VI

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History 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

How Air Polishing Works

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

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Uses 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

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Uses 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 scalerso 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!

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Uses Polish implants

o Bacteria completely removedo Inhibit plaque formation and smooth implantso Minimal alterations to implant: fibroblasts readily re-

attach to surfaces Prior to sealant placement

o Superior to pumice with prophy cupo Allows for deeper penetration of sealant materialo Enhances sealant bond

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Medical History Contraindications

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 immunocompromised4. Communicable infection5. Addison's disease or Cushing's disease. 6. Taking potassium, anti-diuretics, or steroid therapy

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Technique 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 teetho 60 degree angle for anterioro 80 degrees for posterioro 90 degrees for occlusal

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Technique If sprayed on gums = will make them bleed

o Effects are temporary o Uncomfortable for patient, not painfulo Avoid tissue trauma = follow manufacturer

recommendations for useo Lubricate the lipso Point tip toward F/L/O and avoid gingival marginso Most tips come angled for this purpose

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Technique

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Incorrect Technique

Incorrect handpiece angulation with air polishers must be avoided in order to prevent the occurrence of a very serious medical condition— iatrogenic facial emphysemao Symptoms: facial swelling, a "crackling" sensation on the face

and neck area, tenderness, and pain.o Detected early: require observation, analgesia, and antibiotic

therapyo Detected Late: Thrombosis, Fatal embolism, Pneumothoraxthrom·bo·sis THrämˈbōsəs*local coagulation or clotting of the blood in a part of the circulatory system

em·bo·lism,ˈembəˌlizəm*obstruction of an artery, typically by a clot of blood or an air bubble.

pneu·mo·tho·rax, n(y)oSomōˈTHôraks*the presence of air or gas in the cavity between the lungs and the chest wall, causing collapse of the lung.

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Incorrect Technique 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

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Delivery Systems1. 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

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Restorations Almost same rules for cavitron/prophy cup polish

apply to air polishingo Avoid porcelain restorations (scratch)o Avoid margins of composite, metal or amalgam fillingso Air polishing will dull, matte finishes, roughen or cause

structural alterationso Most manufacturer recommendations state:

• “Avoid prolonged or excessive use on restorative dental materials.”

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5 Types of powders1. Sodium Bicarbonate2. Aluminum Trihydroxide3. Calcium Carbonate (Pearls)4. Glycine5. Calcium Phosphosilicate: NovaMin®

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1. Sodium Bicarbonate

First one used, most studies and widely used Heavy stain removal Particle size: 65-250um Uses

o Enamel, some restorative materialso Stain removal “Sand blaster”

Physicalo Hard particleso Salt crystal substanceo Biocompatibleo Salty-Taste

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1. Sodium Bicarbonate Do not use

o Subgingivalo Implantso Veneers, porcelain restorations, ceramicso Rootso Patients with restricted sodium dietso Gingiva

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Sodium Bicarbonate Units

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Heavy Stain Supragingival

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2. Aluminum Trihydroxide

Highly abrasive Used for air abrasive treatments: heavy stains Particle size: 80-325um Round, hard particles Sodium free: 1st alternative invented for patients

who are sodium intolerant Similar to antacid tablets “Sandy Feeling”

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2. Aluminum Trihydroxide

Used on ENAMEL only Do not use

o Restorationso Subgingivalo Implantso Veneers, ceramics

Effectso Abrasive to roots/cementumo Gingival irritation

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3. Calcium Carbonate (Pearls)

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

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3. Calcium Carbonate (Pearls)

Do not use: subgingival Use on

o Enamelo Limited root surfaceso Restorations except Goldo Implants except Zircon ceramics

Effectso Decreased gingival irritationo Easy to apply

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4. Glycine

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)

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4. Glycine 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 maintenanceo Good for restorative materials

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5. Calcium Phosphosilicate

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

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5. Calcium Phosphosilicate

Used for stain removal, desensitizing, remineralization

Do not useo Subgingivalo Implantso Restorative materials

Effectso Remove surface debris prior to treatment for better

remineralization and desensitization effectso Some healing properties when close to gingival margins

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5. Calcium Phosphosilicate

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

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Sources1. 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):47-573. Lennemann T. “Air Polishing: Overview.” Can J Dent Hygiene.

2011.45(3):145-1484. Wilkins