All participants will receive full mouth EPAP as an adjunct to RSD using ultrasonic scalers and Gracey currettes. The EPAP procedure will be performed using the Air-Flow Master R (EMS) equipment. For supragingival biofilm removal, the Air-Flow handpiece will be used, while the Perio-Flow handpiece with a disposable nozzle will be used for subgingival debridement at sites with PPD ≥ 5mm. No time limit is applicable for supragingival air polishing. However, for subgingival debridement, the nozzle will be inserted for 5 seconds into each pocket, and moved vertically up and down. Gracey currettes will be used at sites with PPD ≥ 5mm.

All participants will receive full mouth RSD using ultrasonic scalers and Gracey currettes. Gracey currettes will be used at sites with PPD ≥ 5mm.

Periodontitis

Full mouth subgingival debridement using ultrasonic scaler and Gracey currettes

Ultrasonic scaler and Gracey currettes

Air polishing with erythritol powder

Nor Adinar Baharuddin

Air Polishing as an Adjunct in Non-surgical Periodontal Therapy

Erythritol Powder Air Polishing as an Adjunct in Non-surgical Periodontal Therapy in the Management of Periodontitis: a Randomised Clinical Trial

Probing Pocket Depth (PPD) at 6 sites: Distance of margin of free gingiva to base of the pocket measured in millimetre using UNC-15 periodontal probe.

To determine change in clinical attachment level, measured in millimetre, from cementoenamel junction to base of pocket (sum of periodontal pocket and recession).

Gingival recession (REC): Distance from CEJ to margin of free gingiva measured in millimetre using UNC-15 periodontal probe.

To determine change in periodontal inflamed surface area i.e. the sum of the periodontal pocket depth of bleeding on probing - positive sites for the total dentition and can be easily calculated using routine periodontal charting

Full mouth bleeding score (FMBS): Using Gingival Bleeding Index (Ainamo and Bay, 1975), bleeding will be assessed at 6 sites each tooth using a dichotomous scoring method. It will be considered as present (1) if there is bleeding within 10 seconds after probing of the gingiva, and absent (0) if there is no bleeding.

Full mouth plaque score (FMPS): Using the Visible Plaque Index (Ainamo and Bay, 1975) visible plaque on the mesiobuccal, midbuccal, distobuccal, and lingual/palatal, surfaces will be recorded using a dichotomous scoring method. It will be considered as present (1) if there is visible plaque on the respective surfaces, and absent (0) if there is no visible plaque. Plaque disclosing solution will be used to aid in the scoring.

Using Incremental Cost Effectiveness ratio to identify if the adjunctive use of air polishing during conventional periodontal treatment in periodontal pockets up to 6mm deep is cost effective compared to conventional periodontal therapy alone. The analytic horizon will be for six months.

Associate Professor

University of Malaya

All participants will receive full mouth conventional ultrasonic subgingival debridement, followed by air-polishing with erythritol powder which include activating device for 5 seconds of each surface (Petersilka 2003). Subsequently, Perio-Flow handpiece with a special disposable nozzle will be used for pocket depth >4mm. Perio-Flow handpiece with a special disposable nozzle will be used for pocket depth >4mm

All participants will receive full mouth conventional ultrasonic subgingival debridement only. No time limit (Flemmig 2012), until dental surfaces feel smooth.

Ultrasonic instrumentation

Faculty of Dentistry

Compare Air Polishing With Ultrasonic During Maintenance

Subgingival Debridement by Erythritol Powder Air-Polishing (EPAP) in Comparison With Ultrasonic Instrumentation During Periodontal Maintenance. A Randomised Clinical Trial

To determine presence of pocket depth > 4 mm after 6 months

To determine presence of CAL after 6 months

Patient reported outcome measures using visual analogue scales score where 0 is no pain and 10 is the worst pain

Patient reported outcome measures using oral health impact profile (OHIP-14) score, based on the likert scale responses; which were coded as (1) very often, (2) quite often, (3) sometimes, (4) seldom, (5) never and (6) don't know.

erythritol/karies

Air Polishing as an Adjunct in Non-surgical Periodontal Therapy

Compare Air Polishing With Ultrasonic During Maintenance

Effect of Erythritol and Xylitol on Dental Caries Prevention in Children

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