The parameters that improve the cleaning efficiency of sub-gingival air polishing on titanium implant surfaces: An in-vitro study

Background: The aim was to unravel how the air-polishing behaves on a titanium surface by evaluating the size and the shape of the cleaned area, influence of the different device settings, and pocket depths and cleaning movements. Methods: 48 titanium SLA surface film-coated discs were treated with an air abrasive system using a subgingival plastic nozzle. Two subgingival models were employed: open-ended (step 1) and defined-size (step 2). In step 1, the most effective parameters were investigated by 5 sec static applications under different settings. In step 2, the best settings were used for dynamic application to test the influence of different movements (up-down, slowly up, rotation). For both steps, the powder and water consumption and total cleaned area were calculated. Results: Air pressure was the main factor which had the strongest effect on the cleaning. Increasing the air pressure extended the cleaning area. Other factors, like the nozzle depth and excessive powder flow amount had a weak influence. The cleaning effect reached deeper than the nozzle physically reached. The step 2 showed that there was no significant difference between different nozzle movements however the cleaning efficiency decreased significantly without movement. Conclusions: To get the most effective clinical use of air polishing, it should be applied with high pressure, with deep insertion of the nozzle and enough water flow. On top of these, the nozzle has to be moved to get the best cleaning effect.