Title Air Polishing with Glycine Powder for Plaque and Stain Removal is Safer on Hard and Soft Tissues than Air Polishing with Sodium Bicarbonate Powder
Clinical Question Is air polishing with glycine powder for plaque and stain removal safer on hard and soft periodontal tissues compared to air polishing with sodium bicarbonate powder?
Clinical Bottom Line Air polishing with glycine powder for plaque and stain removal is safer on hard and soft tissues than air polishing with sodium bicarbonate. Systematic review analysis showed four studies reporting data on the outcome with respect to the state of gingival erosion and gingival trauma. Surface modifications on cementum and dentine were addressed in 13 studies. Spraying with glycine powder seemed to result in less gingival trauma compared to sodium bicarbonate, conventional therapy with curettes, or ultrasonic scaling; however, one publication showed that spraying with sodium bicarbonate was more time efficient compared to scaling and root planing with curettes.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25690301Buhler/2016115 patients in 5 included studies, plus 12 in vitro studiesSystematic review of non-randomized trials
Key resultsOutcomes for gingival trauma and gingival erosion effects on dental hard and periodontal soft tissues were histologically scored ranging from 1 to 4 where 1 = no lesion and 4 = severe lesion. Glycine powder showed scores of 1 and 2 for erosive changes of gingival epithelium compared to using hand instruments and curettes, which had scores of 3 and 4. Sodium bicarbonate powder had scores of 2 and 3. “Treatment with sodium bicarbonate is associated with gingival trauma (score: 0.6, Table 2) and distinct defects on the root surface (score: 0.8). On the contrary, spraying with glycine powder seems to result in less gingival trauma (score: 0) and less surface modifications on dentine (score: 0) compared to sodium bicarbonate."
Evidence Search systematic[sb] AND (("powders"[MeSH Terms] OR "powders"[All Fields] OR "powder"[All Fields]) AND ("air"[MeSH Terms] OR "air"[All Fields]) AND polishing [All Fields])
Comments on
The Evidence
Validity: Buhler et al. stated that different studies used different air polishing devices; also, different technical parameters were used such as different air pressure, powder delivery mechanisms, and powder emission rates, all of which may have contributed to different defect dimensions and treatment outcomes. It was also noted that working distance and angulation of the spraying nozzle varied within a great range and may have had an impact on defect depths and volume. Buhler et al. stated that treatment time varied between studies, ranging from 5 seconds to 1 minute, which had a strong effect on defect depth and volume when treatment time was increasing. Perspective: Although the treatment parameters in the studies were different, there was consistent evidence that sodium bicarbonate powder air polishing is not recommended; however, glycine powder air polishing is recommended due to lower potential for harm to cementum, dentine, and gingiva.
Applicability The evidence shown in the systematic reviewed demonstrated that glycine powder is preferred over sodium bicarbonate due to the harmful effect of sodium bicarbonate on hard and soft tissues, cementum, dentin, and gingiva. Moreover, in patients with extensive root exposure, glycine would be a safer choice. Glycine powder is readily available and accepted by patients.
Specialty (General Dentistry) (Periodontics)
Keywords Powder air polishing, glycine powder air polishing
ID# 3270
Date of submission 11/28/2017
E-mail guevaraeg@livemail.uthscsa.edu
Author Emma Guevara
Co-author(s) e-mail
Faculty mentor Carol Nguyen
Faculty mentor e-mail NGUYENC@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available