Efficacy of Air-Polishing in Managing Biofilm Formation in Patients Wearing Fixed Orthodontic Appliances: A Single-Blind, Split-Mouth, Randomised Controlled Trial.

Abstract

Objectives: To investigate the efficacy of air-polishing in managing biofilm formation in patients wearing fixed orthodontic appliances.

Methods: This pilot study was designed as a single-blind split-mouth randomised controlled study. Twenty patients undergoing fixed orthodontic treatment were enrolled. Each patient received monthly air-polishing with an erythritol-based powder via the Airflow Handy 3.0 plus handpiece (EMS, Switzerland) in two quadrants for five months, and the other two quadrants received the traditional oral hygiene instruction (OHI) toothbrushing as the control. The allocation was based on computer-generated random sequencing using balanced block randomisation. The gingival index (GI), plaque index (PI), enamel loss assessed by quantitative light-induced fluorescence (QLF), and white-spot lesion area were measured and analysed.

Results: The air-polishing resulted in a two-fold greater immediate reduction in PI scores (p < 0.001) than traditional OHI toothbrushing for all time points in the trial. However, when compared with traditional OHI, the air-polishing did not show a significant difference in GI and PI scores (time × intervention interaction F = 0.2; p = 0.943). After five months, changes in QLF (p = 0.089) and white-spot lesion size (p = 0.311) did not differ significantly between the two groups either.

Conclusion: Air-polishing produced a significantly greater immediate reduction in plaque in patients with fixed orthodontic appliances, approximately twice that of conventional OHI toothbrushing, suggesting its usefulness for rapid professional biofilm removal. These findings indicate a short-term adjunctive benefit when used alongside routine oral hygiene rather than as a replacement for established home care practices.