Air Polishing for Pain and Compliance in Supportive Periodontal Therapy

Overview

Supportive periodontal therapy (SPT) is essential for maintaining periodontal stability and preventing disease recurrence in patients who have been successfully treated for periodontitis. However, long-term effectiveness depends on regular attendance at maintenance visits, and negative experiences associated with periodontal instrumentation, such as pain or discomfort, may affect patient acceptance and adherence to the maintenance program. The aim of this randomized clinical trial is to evaluate whether supportive periodontal therapy performed using an air-polishing device with low-abrasive trehalose powder reduces patient-perceived pain and improves the clinical experience compared with conventional biofilm removal using ultrasonic instrumentation. The study will also assess whether the use of air polishing is associated with better adherence to the periodontal maintenance program while maintaining comparable periodontal clinical outcomes. Forty periodontally stabilized adult patients enrolled in the supportive periodontal therapy program of the Master's Degree in Periodontology and Peri-implantology at the University of Barcelona will be randomly allocated in a 1:1 ratio to one of two parallel treatment groups. The control group will receive conventional supportive periodontal therapy using ultrasonic instrumentation, while the experimental group will receive supportive periodontal therapy using an air-polishing device with low-abrasive trehalose powder. Participants will be followed for 24 months. The primary outcome will be patient-perceived pain associated with supportive periodontal therapy, assessed using a visual analogue scale (VAS). Secondary outcomes will include treatment duration, adherence to scheduled maintenance visits, patient experience and acceptance of treatment, and periodontal clinical parameters. Periodontal status will be monitored throughout follow-up by assessing probing pocket depth, clinical attachment level, bleeding on probing, and plaque index. This study aims to determine whether air polishing with trehalose powder can provide a more comfortable and patient-centered approach to supportive periodontal therapy without compromising periodontal clinical outcomes, and whether an improved treatment experience may contribute to better long-term adherence to periodontal maintenance.

Periodontitis is a chronic inflammatory disease that requires long-term supportive periodontal therapy (SPT) after completion of active periodontal treatment in order to maintain periodontal stability and reduce the risk of disease recurrence. The effectiveness of SPT is strongly influenced by long-term patient adherence. Therefore, improving patient comfort and treatment experience during maintenance visits may contribute to better adherence to periodontal maintenance programs. Conventional SPT commonly involves mechanical removal of supra- and subgingival biofilm and deposits using ultrasonic instrumentation. Air-polishing devices using low-abrasive powders have been proposed as an alternative approach for biofilm removal during periodontal maintenance. Previous studies suggest that air polishing may provide effective biofilm removal while reducing patient discomfort and treatment time. However, evidence regarding the use of newer-generation air-polishing systems with trehalose-based powder during SPT remains limited. This study will therefore evaluate both patient-reported outcomes and periodontal clinical outcomes associated with this approach. This study is designed as a randomized, superiority, parallel-group clinical trial with a 24-month follow-up period. A total of 40 periodontally stabilized adult patients enrolled in the SPT program of the Master's Degree in Periodontology and Peri-implantology at the University of Barcelona will be included. Participants who meet the eligibility criteria and provide written informed consent will be randomly allocated in a 1:1 ratio to either the experimental group or the control group, with an expected sample of 20 participants per group. Participants allocated to the control group will receive conventional biofilm removal using ultrasonic instrumentation during supportive periodontal therapy. Participants allocated to the experimental group will receive supportive periodontal therapy using an air-polishing device with low-abrasive trehalose powder. The purpose of this comparison is to determine whether the air-polishing approach reduces patient-perceived pain and improves the overall treatment experience and adherence to the maintenance program compared with conventional ultrasonic instrumentation, while maintaining comparable periodontal clinical outcomes. Participants will be prospectively evaluated at baseline and during follow-up visits over a period of 24 months. Maintenance visits will be performed every 6 months. At each maintenance visit, a complete periodontal examination will be performed. Periodontal clinical parameters will include probing pocket depth, clinical attachment level, bleeding on probing, and plaque index. The primary outcome of the study will be patient-perceived pain associated with supportive periodontal therapy. Immediately after treatment, perceived pain will be assessed using a visual analogue scale (VAS). Secondary outcomes will include patient experience, adherence to the periodontal maintenance program, treatment duration, and periodontal clinical outcomes. Adherence will be evaluated according to attendance at scheduled maintenance visits throughout the follow-up period. Data will be prospectively collected using a specific electronic data collection form, including demographic and clinical variables as well as patient-experience questionnaires. Investigators responsible for clinical examinations will undergo calibration before participant recruitment. Statistical analyses will be conducted according to the intention-to-treat principle, with patient-perceived pain considered the primary outcome variable. The study is designed to determine whether the use of air polishing with trehalose powder provides a superior patient experience, particularly in terms of perceived pain, compared with conventional ultrasonic instrumentation, while also assessing whether both approaches provide comparable periodontal clinical outcomes over time. The study will be conducted at the University of Barcelona Dental Hospital (Hospital Odontològic Universitat de Barcelona), in the clinical facilities of the Master's Degree in Periodontology and Peri-implantology. Recruitment, diagnosis, and treatment of participants will be performed by residents of the Master's program under the supervision of the study investigators. By simultaneously evaluating patient-reported outcomes, adherence, treatment efficiency, and periodontal clinical parameters, this study seeks to determine whether air polishing with trehalose powder may represent a more comfortable and patient-centered approach to supportive periodontal therapy without compromising periodontal stability. If improved comfort is associated with better adherence to scheduled maintenance visits, this approach could contribute to optimizing long-term periodontal maintenance protocols.