BACKGROUND: There is insufficient clinical and microbiological evidence to support the use of diode laser and air-polishing with erythritol as supplements to scaling and root planning(SRP). The aim of the current study is to evaluate the clinical and microbiologic efficacy of erythritol subgingival air polishing and diode laser in treatment of periodontitis.
METHODS: The study encompassed twenty-four individuals seeking periodontal therapy and diagnosed with stage I and stage II periodontitis. Eight patients simply underwent SRP. Eight more patients had SRP followed by erythritol subgingival air polishing, and eight patients had SRP followed by diode laser application. At baseline and six weeks, clinical periodontal parameters were measured, including Plaque Index (PI), Gingival Index (GI), periodontal Probing Depth (PPD), and Clinical Attachment Level (CAL). The bacterial count of Aggregatibacter actinomycetemcomitans(A.A), Porphyromonas gingivalis (P.G) was evaluated at different points of time.
RESULTS: The microbiological assessment revealed significant differences in the count of A.A. between the laser and erythritol groups immediately after treatment, indicating a potential impact on microbial levels. However, the microbial levels showed fluctuations over the subsequent weeks, without statistically significant differences. Plaque indices significantly decreased post-treatment in all groups, with no significant inter-group differences. Gingival indices decreased, and the laser group showed lower values than erythritol and control groups. PPD and CAL decreased significantly across all groups, with the laser group exhibiting the lowest values.
CONCLUSIONS: The supplementary use of diode laser and erythritol air polishing, alongside SRP, represents an expedited periodontal treatment modality. This approach leads to a reduction in bacteria and improvement in periodontal health.
BACKGROUND: This clinical trial was registered on Clinical Trials.gov (Registration ID: NCT06209554) and released on 08/01/2024.

This ex vivo study aimed to investigate surface roughness and substance loss after treatment with different professional cleaning methods and to determine whether subsequent polishing with a rubber cup and polishing paste is necessary. Samples (flat and natural surfaces) of human enamel and dentin were prepared (baseline) and treated with either a curette, air-polishing with erythritol, a rubber cup and polishing paste, or a combination thereof (treatment). Subsequently, all samples were immersed in an ultrasonic bath (ultrasonic) to remove residues from the treatment procedures. The surface roughness values sRa and sRz as well as tissue loss were measured profilometrically. Linear regression models were used to compare group differences (roughness and loss) considering the corresponding baseline value. The significance level was set at p<0.05. sRa increased significantly after treatment with curettes or air-polishing with erythritol in both enamel (p<0.001) and dentin (p<0.001) of flat samples. The same effect was observed for sRz in dentin (p<0.001) but not for enamel compared to negative control. Polishing with a rubber cup and paste alone had no significant effect on roughness values. When combined with other treatments, the effect of curette or air-polishing with erythritol dominated the effect. In enamel, none of the tested methods led to measurable tissue loss. In dentin, air-polishing with erythritol caused ≤50% tissue loss compared to the curette. Conclusively, for enamel, treatment effects on roughness were measurable but of limited clinical relevance. For dentin, air-polishing resulted in a smaller but insignificant roughness increase and less tissue loss compared to the curette. Polishing with a rubber cup and paste did not affect surface roughness. Regarding the clinical application, the use of air-polishing seems to be a less invasive procedure than using a curette; polishing with rubber cup and paste offers no advantage in terms of reducing roughness as a final procedure.

BACKGROUND: Sugar alcohols (also called polyols) are regarded as a \"healthy\" sugar substitute. One of the possible reasons for their safe use in pregnant women is their natural origin and the presence of polyols in maternal and fetal samples during normal human gestation. But little is known about the association between circulating sugar alcohols levels and maternal metabolic disorders during pregnancy.
OBJECTIVE: We aimed to detect the concentration of the polyols in participants with and without gestational diabetes mellitus (GDM), and to investigate the association between maternal serum levels of polyols and GDM, as well as newborn outcomes.
METHODS: A nested population-based case-control study was conducted in 109 women with and without GDM. Maternal concentrations of serum erythritol, sorbitol, and xylitol in the fasting state were quantified using a time of flight mass spectrometry system.
RESULTS: In women with GDM, serum concentrations of erythritol and sorbitol were higher, but serum concentrations of xylitol were lower than those in women without GDM. Per 1-SD increment of Box-Cox-transformed concentrations of erythritol and sorbitol were associated with the increased odds of GDM by 43% and 155% (95% CI 1.07-1.92 and 95% CI 1.77-3.69), while decreased odds were found for xylitol by 25% (95% CI 0.57-1.00). Additionally, per 1-SD increase of Box-Cox-transformed concentrations of serum sorbitol was associated with a 52% increased odds of large for gestational age newborns controlling for possible confounders (95% CI 1.00-2.30).
CONCLUSIONS: Maternal circulating sugar alcohols levels during pregnancy were significantly associated with GDM. These findings provide the potential roles of polyols on maternal metabolic health during pregnancy.

UNASSIGNED: Diabetes is a major cause of death worldwide and Nigeria is not an exception. The quest to lower sugar levels has become a major factor in the management of diabetes; this has occasioned the use of substitutes for refined sugar in beverages. Erythritol is a natural sweetener gaining immense interest in recent times. Like metformin, erythritol has shown hydroxyl radical scavenging ability and has metabolic profile suitable for diabetics. Therefore, the blood glucose-lowering and anti-oxidant properties of erythritol under in vitro and in vivo systems were accessed.
UNASSIGNED: Radical scavenging assay (ABTS and DPPH) and inhibition of carbohydrate digestive enzymes (alpha-amylase and alpha-glucosidase) were employed to determine in vitro anti-oxidant and glucose regulatory function of erythritol respectively. Molecular docking studies were performed between 3D structures of human pancreatic alpha-amylase and alpha-glucosidase, isomaltase from saccharomyces cerevisiae with erythritol. The drug-like activity of erythritol was also assessed.Thereafter, we investigated the effect of erythritol on blood glucose and antioxidant status of normal and streptozocin- nicotinamide-induced diabetes rats which were grouped into five (n = 5); Normal, Ery (normal and administered erythritol), Db (diabetic control), Db + Ery (diabetic and administered erythritol), and Db + Met (diabetic and administered metformin).
UNASSIGNED: Erythritol showed a considerable radical scavenging activity and an ability to inhibit alpha-amylase and alpha-glucosidase in vitro. Also, a significant reduction in glucose intolerance, blood glucose and hemoglobin A1c levels and improved antioxidant level was seen in erythritol-treated diabetic rats.
UNASSIGNED: Erythritol showed anti-oxidant activity, alpha amylase and glucosidase enzyme inhibition property, improved antioxidant status and ameliorated blood glucose, HbA1c, and glucose intolerance following diabetes.

Trifluoromethyl analogues of methylerythritol phosphate (MEP) and 2-C-methyl-erythritol 2,4-cyclodiphosphate (MEcPP), natural substrates of key enzymes from the MEP pathway, were prepared starting from d-glucose as the chiral template to secure absolute configurations. The obligate trifluoromethyl group was inserted with complete diastereoselectivity using the Ruppert-Prakash nucleophile. Target compounds were assayed against the corresponding enzymes showing that trifluoro-MEP did not disrupt IspD activity, whereas trifluoro-MEcPP induced 40% inhibition of IspG at 1 mM.

BACKGROUND: Technical complications, including abutment fracture, are a clinical reality. After retrieving failed components, re-establishing a reliable implant-abutment connection is essential, but recommendations on how to clean the interface are lacking.
OBJECTIVE: The purpose of this in vitro study was to evaluate different clinical debridement strategies for removing titanium powder from an implant-abutment interface with regard to their efficacy and associated risk of damaging the interface.
METHODS: Specimens (n=5) were assembled from previously cut implant halves, which were then contaminated by placing titanium powder inside the implant-abutment connection. Activated rinsing, airflow, and an ultrasound scaler, as well as combinations thereof, were then used to clean the implant-abutment connections. Both parts of each specimen were rated under a light microscope with respect to contamination and damage. In addition, abutments were placed in intact implants (n=10), which had previously been contaminated and cleaned, to record torque curves and abutment stability. Statistical analysis of ratings was based on Kruskal-Wallis tests and the Nemenyi All Pairs test with single-step P value correction, while abutment stability and torque were analyzed using analysis of variance and Tukey HSD tests (α=.05).
RESULTS: Erythritol as an abrasive medium led to significantly greater contamination than the scaler (P=.002), activated rinsing (P=.021), and airflow with sodium bicarbonate combined with either conventional (P=.002) or activated rinsing (P=.007). Greater damage was also observed with erythritol because of accumulations of the abrasive media, while scratches were seen after scaler application. Airflow using sodium bicarbonate in combination with activated rinsing showed the lowest level of damage (versus scaler P=.030). Using conventional (P=.010) or activated (P=.029) rinsing, airflow treatment led to a significant reduction in contamination. The scaler led to a significant decrease in abutment stability (P=.048), while activated rinsing and the combination of airflow and activated rinsing did not significantly affect abutment stability. Abutments placed in implants previously contaminated and cleaned required greater torque as compared with original implants (versus activated rinsing, P=.009).
CONCLUSIONS: Activated rinsing constituted the best technique for cleaning implant-abutment connections. Cleaning efficiency can be enhanced with airflow using sodium bicarbonate as an abrasive medium.

OBJECTIVE: To assess the efficacy of Er:YAG laser (ERL) and erythritol powder air-polishing (AP) in addition to the submarginal instrumentation in the non-surgical treatment of peri-implant mucositis (PM).
METHODS: Patients with at least one implant diagnosed with PM were included in the present 6-month randomized clinical trial (RCT). Implants were randomly assigned to one of the three treatment groups after submarginal instrumentation: AP (test 1 group), ERL (test 2 group) or no adjunctive methods (control group). The primary and secondary outcomes were, respectively, bleeding on probing (BoP) reduction and, complete disease resolution (total absence of BoP) and probing pocket depth (PPD) changes. The patient and the implant were considered the statistical unit. A multivariate logistic regression analysis was performed.
RESULTS: A total of 75 patients were enrolled in the study. At each time point, significant BoP and PPD reductions were observed within each group. Intergroup analysis did not show statistically significant differences. Complete disease resolution ranged between 29% and 31%. The logistic regression showed that supramucosal restoration margin, PPD < 4 mm and vestibular keratinized mucosa (KM) significantly influenced the probability to obtain treatment success.
CONCLUSIONS: The adjunctive use of AP and ERL in PM non-surgical therapy does not seem to provide any significant or clinically relevant benefit in terms of BoP and PPD reductions and complete disease resolution, over the use of submarginal instrumentation alone. Baseline PPD < 4 mm, presence of buccal KM and supramucosal restoration margin may play a role in the complete resolution of PM.

OBJECTIVE: The aim of this in vitro study was to quantify and compare changes of the enamel surface caused by periodical use of different air-polishing powders during multibracket therapy.
METHODS: Bovine high-gloss polished enamel specimens were air-polished using an AIR-FLOW® Master Piezon with maximum powder and water settings. Each specimen was blasted with sodium bicarbonate (AIR-FLOW® Powder Classic, Electro Medical Systems, Munich, Germany) and erythritol (AIR-FLOW® Powder Plus, Electro Medical Systems). Blasting duration was adapted to the powders\' cleaning efficacy and corresponded to 25 air-polishing treatments in a patient with braces. A spindle apparatus ensured uniform guidance at a distance of 4 mm and a 90° angle. Qualitative and quantitative assessments were performed with the use of low vacuum scanning electron microscopy. Following external filtering and image processing, arithmetical square height (Sa) and root mean square height (Sq) were determined.
RESULTS: Both prophy powders caused a significant increase in enamel roughness. Surfaces blasted with sodium bicarbonate (Sa = 64.35 ± 36.65 nm; Sq = 80.14 ± 44.80 nm) showed significantly (p < 0.001) higher roughness than samples treated with erythritol (Sa = 24.40 ± 7.42 nm; Sq = 30.86 ± 9.30 nm). The observed defects in enamel structure caused by sodium bicarbonate extended across prism boundaries. Prism structure remained intact after air-polishing with erythritol.
CONCLUSIONS: Both applied air-polishing powders led to surface alterations. Despite shorter treatment times, sodium bicarbonate was significantly more abrasive than erythritol. Clinicians must compromise between saving time and abrasively removing healthy enamel.
UNASSIGNED: ZIEL: Das Ziel dieser In-vitro-Studie war es, Veränderungen der Schmelzoberfläche, die durch die periodische Verwendung verschiedener Air-Polishing-Pulver während der Multibracket-Therapie verursacht wurden, zu quantifizieren und zu vergleichen.
METHODS: Hochglanzpolierte Rinderschmelzproben wurden mit einem AIR-FLOW® Master Piezon mit maximalen Pulver- und Wassereinstellungen bestrahlt. Jede Probe wurde mit AIR-FLOW® Pulver Classic (Natriumbikarbonat) und AIR-FLOW® Pulver Plus (Erythritol) gestrahlt. Die Strahldauer wurde an die Reinigungswirkung der Pulver angepasst und entsprach 25 Pulver-Wasserstrahl-Behandlungen bei einem Patienten mit Brackets. Eine Spindelvorrichtung gewährleistete eine gleichmäßige Führung des Handstücks im Abstand von 4 mm und einem Winkel von 90°. Mithilfe eines Rasterelektronenmikroskops wurden qualitative und quantitative Bewertungen durchgeführt. Nach externer Filterung und Bildbearbeitung wurden die mittlere arithmetische Höhe (Sa) und die mittlere quadratische Höhe (Sq) bestimmt.
UNASSIGNED: Beide Air-Polishing-Pulver verursachten eine signifikante Zunahme der Schmelzrauheit. Mit bikarbonathaltigem Pulver (Sa = 64,35 ± 36,65 nm; Sq = 80,14 ± 44,80 nm) bestrahlte Oberflächen zeigten eine signifikant (p < 0,001) höhere Rauheit als mit erythritolhaltigem Pulver (Sa = 24,40 ± 7,42 nm; Sq = 30,86 ± 9,30 nm) behandelte Proben. Die beobachteten Defekte in der Schmelzstruktur, die durch das bikarbonathaltige Pulver verursacht wurden, überschritten die Prismengrenzen. Nach dem Einsatz von erythritolhaltigem Pulver blieb die Prismenstruktur intakt.
UNASSIGNED: Beide getesteten Air-Polishing-Pulver führten zu Oberflächenveränderungen. Trotz kürzerer Behandlungszeiten zeigte sich das bikarbonathaltige Pulver deutlich abrasiver als das erythritolhaltige. Kliniker müssen einen Kompromiss zwischen Zeitersparnis und abrasivem Entfernen von gesundem Zahnschmelz eingehen.

A variety of interventions have been explored in the non-surgical management of peri-implantitis. In spite of extensive testing of various study protocols, effective treatments largely remain unavailable. The objective of the present 12-month single-centre, examiner-masked, randomized controlled clinical trial was to explore whether a low-abrasive erythritol air-polishing system produces added clinical benefit when used adjunctive to conventional non-surgical management of peri-implantitis and to record any associated patient-centered outcomes.
Forty-three patients with mild to severe peri-implantitis including at least one implant either received ultrasonic/curette subgingival instrumentation and erythritol air-polishing (test) or ultrasonic/curette instrumentation only (control) at baseline and at 3, 6, 9, and 12 months. Probing depth (PD), bleeding on probing (BoP), dental plaque, suppuration (SUP), crestal bone level (CBL), and peri-implant crevicular fluid (PCF) were recorded at baseline, 6 and 12 months. Visual Analogue Scale (VAS) scores were collected immediately following subgingival interventions at all time-points.
A reduction in PD was observed from baseline to 6 months for the test (p = 0.006) and control (p < 0.001) and from baseline to 12 months for the control (p < 0.001). No intergroup differences were observed for primary outcome variables PD or CBL over time (p > 0.05). At 6 months, a intergroup difference in PCF was observed in favor of the test (p = 0.042). Moreover, a reduction in SUP from baseline to 6 and 12 months was observed in the test (p = 0.019). Overall, patients in the control group experienced less pain/discomfort compared with the test (p < 0.05), females reporting more pain/discomfort than males (p = 0.005).
This study confirms that conventional non-surgical management of peri-implantitis produces limited clinical improvement. It is shown that an erythritol air-polishing system may not produce added clinical benefits when used adjunctive to conventional non-surgical management. In other words, neither approach effectively resolved peri-implantitis. Moreover, the erythritol air-polishing system produced added pain/discomfort particularly in female patients.
The clinical trial was prospectively registered in ClinicalTrials.gov with registration NCT04152668 (05/11/2019).

OBJECTIVE: To date, scarce evidence exists around the application of subgingival air-polishing during treatment of severe periodontitis. The aim of this study was to evaluate the effect on the health-related and periodontitis-related subgingival microbiome of air-polishing during non-surgical treatment of deep bleeding pockets in stage III-IV periodontitis patients.
METHODS: Forty patients with stage III-IV periodontitis were selected, and pockets with probing depth (PD) 5-9 mm and bleeding on probing were selected as experimental sites. All patients underwent a full-mouth session of erythritol powder supragingival air-polishing and ultrasonic instrumentation. Test group received additional subgingival air-polishing at experimental sites. Subgingival microbial samples were taken from the maxillary experimental site showing the deepest PD at baseline. Primary outcome of the first part of the present study was the 3-month change in the number of experimental sites. Additional analysis of periodontal pathogens and other sub-gingival plaque bacteria sampled at one experimental site at baseline and 3 months following treatment was performed through a real-time quantitative PCR microarray.
RESULTS: In the test group, a statistical increase of some health-related species was observed (Abiotropha defectiva, Capnocytophaga sputigena, and Lautropia mirabilis), together with the decrease of pathogens such as of Actinomyces israelii, Catonella morbi, Filifactor alocis, Porphyromonas endodontalis, Sele-nomonas sputigena, Tannerella forsythia, Treponema denticola, and Treponema socranskii. In the control group, statistical significance was found only in the decrease of Filifactor alocis, Tannerella forsythia, and Treponema socranskii.
CONCLUSIONS: The addition of erythritol-chlorhexidine powder seems to cause a shift of the periodontal micro-biome toward a more eubiotic condition compared to a conventional treatment. The study was registered on Clinical Trials.gov (NCT04264624).
CONCLUSIONS: Subgingival air-polishing could help re-establishing a eubiotic microbioma in deep bleeding periodontal pockets after initial non-surgical treatment.