BYE BYE BIOFILM MAINE DENTAL HYGIENISTS ASSOCIATION Senator

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

Objectives • 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

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

6 mm pocket for bacteria put in human terms

Compares in size to an open wound covering the entire palm of your hand……… A FULL MOUTH PERIODONTAL INFECTION…. . Jill Rethman RDH BA ACCESS 3 -2016

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 Product Prophy Paste Coarse Medium Prophy Paste Effective Efficient Safe Unless followed by med, then fine Unless followed by fine Fine Prophy Paste Sodium Bicarbonate Air polish Glycine Air polish 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

Powder Selection • Grain size relates to comfort • Na. HCO 3 ~65 µm – Jagged particles • Ca. CO 3 Kosher Salt ~45 µm – Rounded particles • Glycine ~25 µm Cornstarch

#21 -795 Autoclavable Widemouth Adaptors $12/25 Vented HVE tips #21 -75 ~~~~~~~ 3” vented HVE tips Young Vento-Vac

Mohs Hardness Structure Mohs Hardness Enamel 4– 5 Dentin 3– 4 Cementum 2– 4 Powder Mohs Hardness Particle Size Glycine <2 ~ 20 -25 µm Sodium Bicarbonate 2. 5 ~ 40 -120 µm Calcium Bicarbonate (Pearls) 3 ~ 55 µm Aluminum Trihydroxide (Jet Fresh) 3. 5 – 4 ~ 80 -325 µm Calcium Sodium Phosphosilicate (Sylc) 4. 8 – 6 ~ 50 µm Pumice 6– 7 ~ 81 -120 µm

Summary of Clinical Evidence • 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

Application based on Power Dispersion #3 Front and Back Surfaces

Tip Geometry PL 3 100 A PS 1000

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

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 10 -12 extra minutes per patient?

Traditional Hygiene Appointment for Biofilm Management (Prophylaxis/PM) Screening/Data Collection Communication/Treatment Enrollment Biofilm/Calculus Removal with Hand Ultrasonic Instruments 33 min. Rubber Cup Polishing 5 min. 38 min Examination Hand Off & Disinfect Room 60 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 Ultrasonic Instruments 16 min. Examination Hand Off & Disinfect Room 60 min. -12 min

Typical Hygiene Supply Budget $198, 680 7% $13, 907 Annually