Assessment of Air Polishing with Erythritol Powder on the Removal of Biofilm and Dental Calculus: An Ex Vivo Pilot Study

Background: Air polishing with erythritol powder has recently been promoted as a method for removing calculus and biofilm in periodontal pockets of up to 9 mm depth. This ex vivo study was conducted to determine the impact of erythritol air polishing, for various time periods, on subgingival calculus and associated biofilm. Methods: Specimens consisted of 33 extracted teeth. Test sites with visible calculus were circumscribed using a 4 mm trephine bur on the root surface of each specimen. Positive controls were treated with air–water spray only. Test site treatment consisted of air polishing with erythritol powder with a 14 µm particle size. Fifteen positive control and 15 test specimens were subdivided into 3 groups of 5 specimens each and treated for 5, 10 and 15 s, respectively. The remaining three specimens were untreated negative controls. All specimens were examined using SEM. Selected specimens were subjected to EDS analysis. Results: Calculus was observed in all specimens across all treatment groups. Bacteria embedded in calculus and the extracellular polymeric matrix were consistently present across treatment groups. Treatment duration was associated with a reduction in surface biofilm, but no duration of treatment eliminated calculus or deeply embedded bacteria. Conclusions: The results of this ex vivo pilot study suggest that erythritol air polishing of calculus-laden root surfaces does not completely remove subgingival calculus or calculus-embedded microbes. Following treatment, smear layers with embedded microbes were noted on 55% of specimens. The study results suggest that erythritol air polishing protocols, in a clinical setting, may still be dependent on subgingival scaling and root planning to achieve the traditional endpoints of periodontal therapy.