Dental Tribune Middle East

Roughness and loss of substance of tooth surfaces after biofilm removal

By Michael Haas, Martin Koller, Behrouz Arefnia
February 03, 2019

Aim: To assess the roughness and loss of substance of tooth surfaces after instrumentation with AirFlow, ultrasonics, hand instruments and polishing methods or their different combinations. This was a pilot study.

Materials and methods
Post extraction, impacted 3rd molars were marked and stored teeth were then divided and subjected to the following treatments:

  • 1A – Airflow EMS PLUS powder at 2mm distance for 5 sec with a pressure of 1.8 bar at an angle of 45° with a wiping movement
  • 1B – Airflow EMS PLUS powder +conventional polishing with rubber cup and polishing paste of varying  RDA 170>120>40>7
  • 2A – Ultrasonic EMS with PS instrument for 60 sec/ surface, brushstroke movements, pressure ~ 30p
  • 2B – Ultrasonic + Airflow EMS PLUS powder used as above 
  • 2C – Ultrasonic + conventional polishing used as above 
  • 3A – Hand scaler/ curette. On enamel scaler curved. On root Gracey curette from  Deppeler blue, scaling movement per position one stroke 
  • 3B – scaler/ curette + Airflow EMS PLUS powder as above
  • 3C – scaler + Airflow EMS PLUS powder +Conventional polishing as above 
  • 3D – scaler + conventional polishing as above
  • Substance loss and roughness were assessed 2 control groups: enamel untreated, cementum untreated 

On enamel: Group 1: Airflow
• There are no additional benefits in conventional polishing and Airflow in comparison to using AIRFLOW alone 

Group 2: Ultrasonic
• In comparison to Air-Flow, all other instrumentations produced small roughness values. Additional conventional polishing does not alter the overall results. 

Group 3: Hand instrument
• Hand instrument scaler also causes a loss of substance in the enamel. No additional improvement by additional instrumentation with Air-Flow, conventional polishing or a combination of both.

On cementum: Group 1: AirFlow
Slight roughness due to additional conventional polishing. 

Group 2: Ultrasonic
Ultrasonic produces  a smooth cementum surfaces with low roughness values, which are not significantly altered by combinations with Air-Flow or conventional polishing.

Group 3: Hand instrument
Gracey curette: A smooth surface is produced of the processed cementum, addition of Air-Flow worsens the result, polishing measures as already described above lead to an apparently smoother surface.


  • Air-Flow with PLUS  powder produces the highest level of cleaning on enamel and cementum in comparison to ultrasonics or hand instrumentation.
  • Repeated instrumentation, too high pressure  and too long exposure times lead to high substance loss with all systems.
  • Use of conventional instrumentation leads of unnecessary over instrumentation especially in use on ceramics or restorations 
  • Airflow is the most efficient solution providing maximum tooth preservation
  • Ultrasound and hand instruments enable a stripe-shaped cleaning pattern through punctiform contact with the tooth surface. A planar pattern is achieved with Air-Flow. This makes it easier to achieve a homogeneous result on large surfaces. This is much more difficult with ultrasound and hand instruments and quickly leads to grooves and furrows.

Recommended treatment approach is:

  • Assessment followed by disclosure for motivation
  • Deep cleaning with Air-Flow followed by ultrasonic if necessary
  • Quality check for remaining stains, biofilm or calculus

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