Ultima modifica 17 January 2026
Evolution of Professional Dental Hygiene: From the Classical Method to GBT
What is Dental Hygiene?
Dental hygiene is the set of practices designed to keep the mouth clean and free of disease. It includes both home hygiene, such as brushing and flossing, and professional procedures performed by a dentist or dental hygienist, such as removing tartar and biofilm. Thorough dental hygiene is essential to prevent problems such as gingivitis, periodontitis, and tooth decay.
Importance of Professional Dental Hygiene
Even with good daily oral hygiene, regular professional dental hygiene sessions are essential. These sessions allow removal of tartar and bacterial biofilm, which are the main causes of gum inflammation and tooth decay. In addition, regular checkups allow the dentist to detect any problems at an early stage, avoiding more complex interventions in the future.
Comparison of Classical Dental Hygiene and GBT Technique
Before delving into the technical analysis of the Guided Biofilm Therapy (GBT) protocol, it is essential to understand how this innovative methodology differs from the classical approach to professional dental hygiene.
Classical Dental Hygiene
The traditional dental hygiene session typically follows this procedure:
- Visual examination: The hygienist assesses the state of oral health.
- Tartar ablation: Use of hand instruments (curettes) and/or ultrasound to remove supragingival and subgingival tartar.
- Root smoothing: Smoothing of root surfaces to prevent plaque accumulation.
- Polishing: Use of rubber cups and abrasive pastes to remove stains and residual biofilm.
- Fluoride application: Final treatment to remineralize the enamel.
Dental Hygiene with the GBT Technique (Guided Biofilm Therapy)
GBT, on the other hand, follows a systematic protocol based on scientific evidence:
- Diagnosis and risk assessment: Thorough examination with advanced diagnostic technologies.
- Biofilm detection: Use of dyes to make bacterial plaque visible.
- Patient motivation: Individualized education based on biofilm visualization.
- Airflow: Biofilm and stain removal with minimally invasive powder technology.
- Perioflow: Targeted subgingival treatment for deep periodontal pockets.
- Removal of residual tartar: Only if necessary, with precision ultrasonic instruments.
- Quality control: Accurate verification of results.
- Maintenance: Customized follow-up planning.
Technical Comparison
| Appearance | Classic Method | GBT Technique |
|---|---|---|
| Biofilm removal | Mechanical (hand tools/ultrasound) | Aerodynamics (Airflow with powders) |
| Abrasiveness | Moderate to High | Low (erythritol) to Moderate (bicarbonate) |
| Treatment time | 45-60 minutes | 30-45 minutes |
| Patient comfort | Variable, can be uncomfortable | Generally high, minimally invasive |
| Biofilm removal efficacy | 50-80% | Up to 99.9% |
| Customization | Limited | High, based on individual diagnosis |
| Impact on enamel/cement | Potentially significant | Minimal, preserves hard tissue |
| Dental Hygiene Cost | 70 to 120 € (both arches) | 90 to 160 € (both arches) |
GBT represents a paradigm shift in professional dental hygiene, shifting the focus from mechanical tartar removal to biofilm management. This approach not only improves treatment efficacy, but also patient comfort and long-term oral tissue preservation.
Airflow MAX Technology: Technical Analysis and Operating Parameters
The Airflow MAX is a crucial component of the GBT technique, using PLUS (Guided Laminar Airflow) technology to combine compressed air, water, and powder in a calibrated mixture. This technology generates a hydrodynamic effect that amplifies the effectiveness of biofilm removal. Let us examine the operating parameters and their clinical importance in detail:
Key Operating Parameters
- Air pressure: 2-5 bar
- Water flow: 30-80 ml/min
- Water temperature: 30-40°C
1. Air pressure (2-5 bar)
Air pressure is a critical parameter that directly affects the effectiveness of biofilm removal and patient comfort.
- Clinical significance:
- Low pressure (2-3 bar): Ideal for sensitive areas such as soft tissue or exposed dentin.
- High pressure (4-5 bar): Most effective for removing stubborn stains or tenacious biofilm.
- Impact on procedure:
- Too little pressure can reduce the effectiveness of biofilm removal.
- Too high a pressure can cause patient discomfort or potential soft tissue damage.
- Adjustment: The pressure can be adjusted according to the patient’s sensitivity and the area treated.
2. Water flow (30-80 ml/min)
Water flow is essential to create the optimal spray mixture and facilitate biofilm removal.
- Clinical significance:
- Low flow (30-50 ml/min): Useful for areas with limited access or to reduce splashing.
- High flow (60-80 ml/min): Improves cooling and flushing effect.
- Impact on procedure:
- Insufficient flow can lead to local overheating and reduce the effectiveness of debris removal.
- Excessive flow can impair visibility and increase the risk of aerosol.
- Adjustment: The flow rate can be adjusted according to the treated region and the amount of biofilm present.
3. Water temperature (30-40°C)
Water temperature affects patient comfort and treatment effectiveness.
- Clinical significance:
- Lower temperatures (30-35°C): May reduce sensitivity in patients with sensitive teeth.
- Higher temperatures (35-40°C): Can improve overall comfort and acceptance of treatment.
- Impact on procedure:
- Too low temperatures can cause discomfort, especially in patients with sensitive teeth.
- Too high temperatures can potentially irritate soft tissue.
- Adjustment: The temperature can be adjusted according to patient preference and tooth sensitivity.
Interaction between Parameters
It is important to note that these parameters interact with each other:
- An increase in air pressure generally requires an increase in water flow to maintain optimal balance.
- Water temperature can affect the patient’s perception of pressure.
Parameter Optimization
Optimization of these parameters is crucial for:
- Maximizing the effectiveness of biofilm removal
- Minimizing patient discomfort
- Reduce the risk of hard and soft tissue damage
- Tailor treatment to the specific needs of each patient
Clinical Studies on Operational Parameters.
Bühler et al. (2016)[1] conducted a study on the impact of various operational parameters in air-polishing. The study showed that:
- An air pressure of 2-3 bar is sufficient for effective removal of supragingival biofilm.
- A water flow rate of 50-60 ml/min provides a good balance between efficacy and aerosol control.
- Water temperature around 35°C has been associated with increased patient comfort.
In conclosion , understanding and correctly adjusting the operating parameters of the Airflow MAX are critical to the effectiveness and safety of the GBT technique. These parameters allow customization of treatment, tailoring it to the specific needs of each patient and different areas of the oral cavity.
[1] Bühler, J., Amato, M., Weiger, R., & Walter, C. (2016). A systematic review on the effects of air polishing devices on oral tissues. International journal of dental hygiene, 14(1), 15-28.
Enamel Relative Abrasivity Index (REA) and Comparative Analysis of Powders.
The Relative Enamel Abrasivity (REA) Index is a crucial parameter for assessing the potential impact of different substances on dental enamel. In the GBT technique, this index is particularly relevant for understanding the characteristics and effectiveness of the powders used.
Definition and Measurement of REA
The REA quantifies the abrasiveness of a substance with respect to dental enamel, with a reference value of 100 assigned to the abrasiveness of hydroxyapatite powder.
- REA < 100: Less abrasive than hydroxyapatite
- REA > 100: More abrasive than hydroxyapatite
Interpretation of REA Values
- REA < 40: Minimally abrasive, ideal for frequent use
- REA 40-100: Moderate abrasiveness, acceptable for regular use with precautions
- REA > 100: Highly abrasive, use with caution
Comparative Analysis of Powders: Erythritol vs. Bicarbonate
Erythritol Powder
- Chemical composition: C4H10O4
- Average particle size: 14 μm
- Enamel relative abrasiveness index (REA): < 4
Bicarbonate powder
- Chemical composition: NaHCO3
- Average particle size: 40-65 μm
- Relative enamel abrasiveness index (REA): 28
Clinical Implications
- Erythritol:
- With an REA < 4, it is extremely gentle on enamel.
- The fine grain size (14 μm) allows effective cleaning even in subgingival areas.
- Ideal for frequent treatments and patients with sensitive enamel.
- Bicarbonate:
- REA of 28, significantly lower than traditional prophylactic pastes.
- Larger grain size (40-65 μm) makes it effective for removing surface stains.
- Suitable for less frequent treatments or more stubborn stains.
Clinical Significance in GBT
The choice between erythritol and bicarbonate in GBT depends on:
- Condition of the patient’s enamel
- Presence of surface stains
- Frequency of treatments needed
- Dental sensitivity of the patient
The use of low REA powders, particularly erythritol, allows:
- Minimization of enamel wear during repeated treatments
- Effective cleaning without compromising the integrity of hard tissue
- Safe treatments for patients with sensitive or eroded enamel
Extended Comparative Study
By integrating the data provided with the study by Pelka et al. (2010)[1], we can create a more complete comparative table:
| Material | REA | Average particle size (μm) |
|---|---|---|
| Erythritol | < 4 | 14 |
| Bicarbonate | 28 | 40-65 |
| Glycine | 32 | ~25 |
| Prophylactic pastes | > 40 | Variable |
This table highlights how modern powders used in GBT offer optimal cleaning efficiency with significantly less abrasiveness than traditional methods.
[1] Pelka, M., Trautmann, S., Petschelt, A., & Lohbauer, U. (2010). Influence of air-polishing devices and abrasives on root dentin-An in vitro confocal laser scanning microscope study. Quintessence International, 41(7), e141-e148.
Impact on Dental Enamel: Microscopic Analysis and Clinical Studies.
Scanning electron microscope (SEM) studies and clinical research have shown significant differences in the impact on dental enamel among various professional hygiene techniques. Here are some key references:
- Erythritol and minimal impact on enamel: Hägi et al. (2013) conducted a randomized clinical trial showing that erythritol powder caused minimal changes to the enamel surface, preserving the prismatic microstructure[1].
- Comparison of air-polishing powders: Bühler et al. (2016) compared several air-polishing powders, including erythritol and bicarbonate. Their results showed that erythritol caused the least loss of dental hard substance compared to other powders[2].
- Abrasiveness of bicarbonate vs. conventional prophylactic pastes: A study by Pelka et al. (2010) found that although bicarbonate is more abrasive than erythritol, it produces significantly less wear than conventional prophylactic pastes[3].
- Long-term impact of GBT on enamel: Mensi et al. (2018) conducted a longitudinal study of patients undergoing regular GBT for 5 years, demonstrating minimal impact on enamel and root cement over time[4].
These studies support the use of the GBT technique, particularly with erythritol powder, as a safe and minimally invasive method for professional dental hygiene, offering an optimal balance between effectiveness in biofilm removal and preservation of dental hard tissue.
Bibliographical References
[1] Hägi, T. T., Hofmänner, P., Salvi, G. E., Ramseier, C. A., & Sculean, A. (2013). Clinical outcomes following subgingival application of a novel erythritol powder by means of air polishing in supportive periodontal therapy: a randomized, controlled clinical study. Quintessence International, 44(10), 753-761.
[2] Bühler, J., Amato, M., Weiger, R., & Walter, C. (2016). A systematic review on the effects of air polishing devices on oral tissues. International journal of dental hygiene, 14(1), 15-28.
[3] Pelka, M., Trautmann, S., Petschelt, A., & Lohbauer, U. (2010). Influence of air-polishing devices and abrasives on root dentin-An in vitro confocal laser scanning microscope study. Quintessence International, 41(7), e141-e148.
[4] Mensi, M., Scotti, E., Sordillo, A., Agosti, R., & Calza, S. (2018). Plaque disclosing agent as a guide for professional biofilm removal: A randomized controlled clinical trial. International journal of dental hygiene, 16(3), 407-415.
Effectiveness in Biofilm Removal: Quantitative Data
Several clinical studies have provided quantitative data on the effectiveness of biofilm removal using the GBT technique with Airflow and different powders. Here are some of the most significant results:
- Efficacy of erythritol: Hägi et al. (2015) conducted a randomized clinical trial showing that the use of erythritol powder with Airflow removed up to 98% of supragingival bio film and up to 96.9% of subgingival biofilm in periodontal pockets up to 4 mm deep[1].
- Comparison between erythritol and manual instrumentation: Müller et al. (2014) compared the effectiveness of biofilm removal between air-polishing with erythritol and manual instrumentation. The study revealed that air-polishing with erythritol removed 98 percent of biofilm, compared to 78 percent with manual instrumentation[2].
- Effectiveness of bicarbonate on exogenous stains: Wilmes et al. (2019) evaluated the effectiveness of bicarbonate in removing exogenous stains and biofilms. Their study showed 98.2% biofilm removal on free surfaces and superior effectiveness in stain removal compared to other powders[3].
- Penetration into periodontal pockets: Petersilka et al. (2011) studied the penetration ability of air-polishing powders into periodontal pockets. They found that powders with low abrasiveness, such as erythritol, could effectively penetrate up to 5 mm into periodontal pockets, removing subgingival biofilm[4].
These studies support the high efficacy of the GBT technique in removing biofilm, both supragingival and subgingival, with removal rates consistently exceeding 95% in accessible areas.
Additional Bibliographical References
[1] Hägi, T. T., Hofmänner, P., Eick, S., Donnet, M., Salvi, G. E., Sculean, A., & Ramseier, C. A. (2015). The effects of erythritol air-polishing powder on microbiologic and clinical outcomes during supportive periodontal therapy: Six-month results of a randomized controlled clinical trial. Quintessence International, 46(1), 31-41.
[2] Müller, N., Moëne, R., Cancela, J. A., & Mombelli, A. (2014). Subgingival air-polishing with erythritol during periodontal maintenance: randomized clinical trial of twelve months. Journal of Clinical Periodontology, 41(9), 883-889.
[3] Wilmes, C., Oinonnone, V., Krust, K. C., Ulbricht, S., & Ganss, C. (2019). Cleaning efficacy and efficiency of new and used air-polishing powders. Journal of Dental Hygiene, 93(6), 13-20.
[4] Petersilka, G., Steinmann, D., Häberlein, I., Heinecke, A., & Flemmig, T. F. (2011). Subgingival plaque removal in buccal and lingual sites using a novel low abrasive air-polishing powder. Journal of Clinical Periodontology, 38(4), 358-365.
Specific Clinical Applications
- Routine prophylaxis: Erythritol for its gentleness and low abrasiveness.
- Periodontal patients: Erythritol for subgingival biofilm management.
- Removal of extrinsic stains: Bicarbonate for its greater abrasive action.
- Orthodontic patients: Erythritol for cleaning around brackets and bands.
Operational Protocol Used by the Grimaldi Dental Center
- Initial assessment and diagnosis
- Application of erythrosine-based plaque detector
- Initial debridement with Airflow MAX and erythritol powder (“PERIO” setting for subgingival areas)
- Selective use of baking soda powder for stubborn stains (“SUPRA” setting)
- Ultrasonic scaling for residual tartar (if needed)
- Hygienic Rationale (explanation of home hygiene techniques)
Conclusions and Future Perspectives
The adoption of the GBT protocol with Airflow MAX represents a significant advancement in the practice of professional oral hygiene. Clinical data support increased efficacy in biofilm removal, reduced treatment time, and improved patient comfort compared with traditional methodologies.
Longitudinal studies are underway to evaluate the long-term impact on periodontal health and caries prevention.
Direttore Sanitario del Centro Odontoiatrico Grimaldi. Si occupa di implantologia e chirurgia avanzata. Ha frequentato diversi corsi di perfezionamento in Italia e all’estero riguardanti l’implantologia dentale, la protesi fissa e mobile e anche odontoiatria estetica.
