Evaluation of Air Polishing With Ultrasonic Debridement in the Treatment of Initial Periodontal Pockets

Clinical evaluation of using erythritol powder as air polishing with ultrasonic scaling and root planing in the treatment of initial periodontal pockets. This trial will be split-mouth design, in which each patient will receive traditional treatment (ultrasonic mechanical therapy and polishing) in one side, while the contralateral two quadrants of the jaws will be treated with erythritol powder by means of air polishing and ultrasonic scaling and root planing.

The aim of the study is to evaluate the usage of erythritol powder by means of air polishing in hand of undergraduate dental students as a single way to remove biofilm and the adjunctive application of ultrasonic piezo afterward for calculus removal and root planing only in the treatment of initial periodontal pockets.

The sample size will be 15 patients. Initially, oral hygiene instructions with scaling and root planing will consist of the treatment phase. Each subject will be informed comprehensively about oral hygiene instructions using disclosing solution (such as erythrosine) and hand mirror. The participant will be shown modified bass technique and the proper usage of dental floss and appropriate interdental brushes.

The control side will be treated with supra- and subgingival ultrasonic piezo scalers then supragingival polishing with rubber cup and a special fluoride containing paste as a traditional way of removal of plaque and calculus, while the test side, will be confined to erythritol powder by means of air polishing as the only way to remove ultrasonic piezo scalers.

At the end of treatment, hand instruments may be used to ensure the smoothness 0f the teeth surfaces.

Clinical measurements will be performed at baseline and at 2 weeks, 4 and 6 weeks for the plaque index and gingival indices, whereas probing will be performed only after 6 weeks.

Eligibility Criteria:
Inclusion Criteria:

1. Patients are in generally good health
2. Patients are from both gender and their age is between 18 to 60 years.
3. Patients have a minimum of 20 teeth
4. The patient is a non-smoker (less than 5 cigarettes per day) and non-alcoholic.
5. Female participants must not be pregnant or breastfeeding (lactation).
6. the absence of severe oral habits
7. the presence of at least one residual pocket with pocket depth \>4 mm with interdental sites with a probing depth of 3 to 5 mm without furcation involvement or subgingival restorations.
8. A sign informed consent from participation and permission to use obtained data for research purposes.

Exclusion Criteria:

1. Bruxism
2. Allergy to glycine or chlorhexidine;
3. systemic medical conditions requiring antibiotic prophylaxis (for endocarditis prophylaxis) and anti-inflammatory drugs before dental procedures;
4. active systemic infectious disease;
5. major systemic illnesses (diabetes mellitus, cancer, immunodeficiency virus, bone metabolic diseases or disorders that compromise wound healing, radiation or immunosuppressive therapy, neutropenia, agranulocytosis, or bleeding disorders.
6. chronic high dose steroid therapy
7. Patients are undergone to radiotherapy or chemotherapy before or during the study period.
8. actively smoking more than five cigarettes per day;
9. signs of generalized severe periodontitis;
10. having received periodontal maintenance within 3 months before baseline
11. patients treated with antibiotics 6 months prior to the study
12. chronic bronchitis and asthma
13. compromised immune system
14. hypersensitivity to sugar alcohols.
15. any physical limitations or restrictions that might preclude normal oral hygiene procedures.