Guided biofilm therapy: The low-abrasive method sets a positive tone for periodontal treatment

Nov. 15, 2016
Karen Davis, RDH, shares some information about guided biofilm therapy for periodontal treatment.

By Karen Davis, RDH, BSDH

There are many reasons to go to Geneva, Switzerland, but attending the First World Congress on Guided Biofilm Therapy in June 2016 ranked right at the top of the reasons that piqued my interest! It was a meeting of the minds, so to speak, of dental professionals around the globe who are part of a movement to manage biofilm differently. EMS, makers of Air-Flow technology that was featured there, sponsored the meeting, but don't lose the impact of the message just because the meeting was hosted by a manufacturing company. There was an abundance of science presented, compelling cases, and consistent messages from clinicians worldwide that there are valid reasons to take a different approach with regard to biofilm removal.

Guided biofilm therapy (GBT) denotes a method of biofilm management inclusive of the use of EMS Air-Flow technology. The method refers to the intentional removal of biofilm as a definitive procedure with low-abrasive powders in an air polishing device, and it is performed prior to the instrumentation of hard deposits.

Air polishing with low-abrasive powder early in the appointment minimizes the use of power and hand instruments for biofilm removal, which are shown to be more abrasive on exposed roots and restorative materials than air polishing with low-abrasive powder.1 Certainly power and/or hand instruments are still required for the removal of calcified deposits, but for supra- and subgingival biofilm removal, GBT becomes a much more efficient approach to biofilm management within the appointment. Once the slimy biofilm is removed, it increases visibility and tactile sensitivity to remove any remaining hard deposits.

Separating the procedure of definitive and thorough biofilm removal from that of hard deposit removal is a shift for clinicians, since most have been removing biofilm and calcified deposits simultaneously with power instruments, hand instrumentation, and prophy paste. The shift is as simple as informing patients early in the procedure that you will be air polishing the plaque biofilm away as opposed to polishing at the end. This method has the added benefits of being more efficient, more comfortable, and less abrasive than traditional methods.

A key focus of the congress was the issue of biofilm removal with the least abrasive method possible. Within the world of minimally invasive procedures, GBT is being adopted by clinicians as the ideal method to obliterate biofilm from enamel, exposed root surfaces, porcelains, ceramics, gold materials, implants, and deep periodontal pockets with periodontal nozzles. The issue of repeated instrumentation on the variety of surfaces patients present with is a real concern in regard to surface alterations, and GBT is a comfortable, efficient, and effective approach to "do no harm" in the process of definitive biofilm removal.

An interesting study published in the Journal of Clinical Dentistry revealed that prophy pastes used with a rubber cup flattened enamel rods and abraded them, leaving debris behind in the microstructures. Air polishing with a low-abrasive erythritol powder, however, left the enamel rods intact and clean down to the microstructures.2

The consideration of accessibility to remove biofilm from a crowded dentition, deep periodontal pockets, and around implants also makes GBT an ideal option as the air polishing devices use a combination of water, powder, and air to remove the biofilm without physically having to touch the tooth or implant-unlike repeated and overlapping strokes necessary for biofilm removal with power and hand instrumentation. Consider the difference between air polishing with low-abrasive powders to the use of a rubber cup and hand or power instruments to get the job done. I like the analogy of washing a car with a power nozzle to access nooks and crannies compared to washing it by hand with a scrub brush, which would require many overlapping strokes to accomplish the task.

Interestingly, GBT currently appears to be more widely accepted outside the United States than within. But hopefully very soon more U.S. clinicians will appreciate the value of this different approach for biofilm management, and academia will equip clinicians with air polishing skills to enter the workplace. Having incorporated GBT with my own patients since 2012, these are some of the comments they've expressed. "Wow, I can't believe how good this feels." "This is so much easier." "Please don't ever go back to the old method." "Do all dental hygienists have this technology?" Given the low-abrasiveness, accessibility, efficiency, and comfort of this approach, I cannot imagine providing preventive and periodontal maintenance treatment without GBT. RDH


1. Hägi TT, Klemensberger S, Bereiter R, Nietzsche S, et al. A biofilm pocket model to evaluate different non-surgical periodontal treatment modalities in terms of biofilm removal and reformation, surface alterations and attachment of periodontal ligament fibroblasts. Plos One. 2015. Open Access.
2. Camboni S, Donnet M. Tooth structure comparison after air polishing and rubber cup: A scanning electron microscopy study. J Clin Dent. 2016;27:13-18.

Karen Davis, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp., Periosciences, and Hu-Friedy/EMS. She can be reached at [email protected].