Management of biofilm formation with Airflow in patients with fixed orthodontic appliances

Abstract

Introduction: Orthodontic braces imped patient oral care and promote dental plaque accumulation. If left to mature, dental plaque will result in gum inflammation and eventually enamel damage. Current preventative treatments remain inadequate with an unacceptable proportion of orthodontic patients having enamel damage post treatment. The air-polishing based technique of Air-Flow offers considerable potential as an effective intervention, that could prevent these adverse outcomes in the future. Materials and Methods: A prospective, single-blind randomised controlled trial was conducted. Participants were randomly allocated to two-groups and treatment conducted as per a split-mouth design. The intervention of interest was air-polishing via the Air-Flow Handy 3.0 Plus handpiece (EMS, Switzerland) with an erythritol based powder. The comparison intervention was guided toothbrushing following plaque disclosure and oral hygiene instruction. Outcome measures included the Gingival index (GI), Plaque Index, average fluorescence loss, and white-spot lesion area as recorded via quantitative light-induced fluorescence. Results: Both interventions resulted in a reduction of GI scores from baseline to the end of the trial. No statistical significance was found between either intervention and GI scores were not significantly influenced by sex or by time. Pre- and post-intervention plaque score change was consistently two-fold greater reduction in the Air-Flow treatment compared to OHI, for all time intervals. Changes in fluorescence and white-spot lesion size do not differ significantly between either Air-flow or OHI treatments. Conclusion: Both techniques reduce plaque levels in patients wearing fixed orthodontic appliances. Air-flow is twice as effective at removing plaque compared to OHI at the time of intervention. However, the effect of increased plaque removal, over a five month period, appears to be clinically insignificant with respect to gingival health and enamel demineralisation. In the constraints of this trial, air-polishing does not appear superior as a biofilm management tool compared to the current standard.