Clinical evaluation of air polishing with erythritol powder followed by ultrasonic calculus removal versus conventional ultrasonic debridement and rubber cup polishing for the treatment of gingivitis: A split-mouth randomized controlled clinical trial
International Journal of Dental Hygiene 20 (2) :371-380 (2022)
Abstract
Objectives: To evaluate the clinical efficacy in the short-term resolution of gingivitis of a novel protocol involving full-mouth erythritol powder air polishing followed by ultrasonic calculus removal.
Methods: Forty-one healthy patients completed the study. Following a split-mouth design, quadrants 1–4 and 2–3 were randomly allocated to receive air polishing followed by ultrasonic calculus removal (A+US) or traditional full-mouth ultrasonic debridement followed by polishing with a rubber cup and prophylactic paste (US+P). Bleeding on probing (BoP) and plaque index (PI) were collected at baseline and 2 and 4 weeks. Moreover, the residual plaque area (RPA), treatment time and patient comfort/satisfaction were evaluated at the end of the treatment.
Results: Both treatments showed a significant reduction in BoP and PI. At 4 weeks, A+US seems to reach a statistically significant lower BoP (8.7% [6.9; 10.9] vs. 11.6%[9.3; 14.4], p < 0.0001) and PI (10.7% [8.9; 13.0] vs. 12.3% [10.2; 14.9], p = 0.033). Moreover, A+US treatment time lasted on average 9.2% less than US+P (p < 0.0001) and was the preferred treatment for a significantly higher number of patients (73.2% vs. 17.1%, p = 0.0001).
Conclusion: The A+US protocol is suitable for the short-term resolution of plaque-induced gingivitis.
Keywords
Citazione
Mensi M, Scotti E, Sordillo A, Dalè M, Calza S. Clinical evaluation of air polishing with erythritol powder followed by ultrasonic calculus removal versus conventional ultrasonic debridement and rubber cup polishing for the treatment of gingivitis: A split-mouth randomized controlled clinical trial. International Journal of Dental Hygiene. 2022;20(2):371-380. doi: 10.1111/idh.12537
Study Highlights
Context: This is the ERICO trial Part 1, establishing short-term efficacy of air-polishing + ultrasonic (GBT protocol) for gingivitis treatment. Part 2 (Mensi 2024, doi:10.1111/idh.12812) extends follow-up to 12 months.
Design: Double-blinded, split-mouth RCT | n=41 (100% completion) | 4-week follow-up | Ethics: ASST Spedali Civili di Brescia #2637
Population: Systemically healthy adults aged 20-40 with gingivitis (BoP >25%), ≥5 teeth/quadrant, non-smokers (<10 cig/day)
Interventions compared:
| Protocol | Steps |
|---|---|
| A+US (GBT) | Plaque disclosing → Erythritol+CHX air-polishing (PLUS powder) → Site-specific ultrasonic (PS tip) |
| US+P | Plaque disclosing → Full-mouth ultrasonic debridement → Rubber cup + prophy paste (RDA 27) |
Primary outcome: BoP change at 2 and 4 weeks
Key Results:
| Parameter | Baseline | 2 weeks | 4 weeks | p-value (4wk) |
|---|---|---|---|---|
| BoP US+P | 56.7% | 7.3% | 14.8% | — |
| BoP A+US | 56.9% | 6.1% | 11.2% | <0.01 |
| PI US+P | 65.3% | 14.6% | 14.7% | — |
| PI A+US | 65.0% | 14.9% | 12.7% | 0.023 |
Both treatments achieved BoP <10% at 2 weeks (below localized gingivitis threshold)
Residual Plaque Area (software analysis):
- A+US: 1.51% [1.2; 1.9]
- US+P: 2.96% [2.3; 3.8]
- No significant difference (both treatments effective with plaque disclosing guidance)
Treatment Time:
- A+US: 18:39 min
- US+P: 20:32 min
- 9.2% time saved (p<0.0001)
Patient Preference:
| Parameter | A+US preferred | US+P preferred |
|---|---|---|
| Quality | 70.7% | 7.3% |
| Comfort | 85.4% | 7.3% |
| Cleanliness | 39.0% | 14.6% |
| Overall | 73.2% | 17.1% |
Discomfort scores: 0% A+US reported maximum discomfort vs 7.3% US+P
Proposed mechanism for A+US superiority at 4 weeks:
- Erythritol+CHX powder may inhibit bacterial re-colonization (Mensi 2018 in vitro study)
- Erythritol impairs streptococcal adherence and sucrose metabolism
- CHX substantivity provides sustained antimicrobial effect
- Authors hypothesize delayed biofilm maturation on treated surfaces
Clinical significance:
- GBT protocol non-inferior to traditional prophylaxis for gingivitis resolution
- Additional benefits: time savings, superior patient comfort, equivalent plaque removal
- Air-polishing more conservative on enamel than ultrasonic + rubber cup (in vitro evidence)
- Pre-procedural CHX rinse recommended for aerosol control
Limitations: Young healthy population (20-40y), excludes orthodontic/prosthetic patients, RPA only measured in anterior sextants, light smokers only
Related publications:
- Part 2: Mensi 2024 (doi:10.1111/idh.12812) — 12-month maintenance follow-up
- In vitro: Mensi 2018 (doi:10.3390/ma11091510) — biofilm re-colonization inhibition
- Plaque disclosing RCT: Mensi 2020 (doi:10.1111/idh.12442)