Biofilm as the basis of pathogenesis
The leading factor in the development of dental caries and periodontal diseases is poor oral hygiene. A key role in pathogenesis is played by biofilm—a conglomerate of microorganism colonies embedded in an extracellular matrix and tightly attached to the tooth surface. The matrix is represented by exopolysaccharides secreted by the microorganisms themselves to create a favorable living environment. The biofilm is penetrated by channels that allow the influx of nutrients and the washout of metabolic waste products.
There are five stages of biofilm formation:
- Initial reversible attachment of microorganisms to the pellicle.
- Irreversible attachment and colony formation.
- Maturation with the secretion of exopolysaccharides and matrix formation.
- Full maturation with a stable structure.
- Dispersion: detachment of some microorganisms and reattachment on a new surface.
Guided Biofilm Therapy concept
GBT (Guided Biofilm Therapy) is a modern Swiss professional oral hygiene protocol aimed at effective biofilm management. The protocol consists of eight consecutive steps replacing traditional cleaning with rotating brushes and abrasive pastes.
Assessment, disclosure, and motivation
Step 1 — assessment and control. The clinician performs an examination to detect caries, determine the level of hygiene, and check for the presence of plaque and calculus.
Step 2 — plaque disclosure. Solutions, chewable tablets, or indicator-soaked sponges are used. Modern disclosing agents (e.g., Curaprox) differentiate plaque by age: fresh plaque stains pink, while structured, aged plaque stains purple-blue. Patients are recommended to perform plaque disclosure at home once every three days.
Step 3 — motivation and education. Patients are shown uncleaned areas in a mirror, taught proper brushing techniques, and guided on selecting oral hygiene aids: interdental brushes, single-tuft brushes, irrigators, dental floss, manual or sonic toothbrushes.
Airflow: air-powder polishing
Step 4 — Airflow. The device delivers an air-water mixture with powder, removing biofilm from tooth surfaces, interdental spaces, orthodontic and prosthetic structures, and implants. The nozzle is positioned at a distance of 3–5 mm from the surface at an angle of 30–60° away from the gingiva. A perpendicular direction and excessive pressure can lead to subcutaneous emphysema with characteristic crepitus upon palpation; in such cases, antibiotic therapy is prescribed to prevent infection, and the emphysema resolves within 24–48 hours.
Types of powders:
- Airflow Plus — erythritol-based, particle size 14 µm, minimal abrasiveness; suitable in 95% of cases, removes plaque from hard tissues and the tongue.
- Airflow Classic — sodium bicarbonate-based, 65 µm particles, abrasive; used for smoker's plaque, contraindicated on restorations. Classic Comfort has particles up to 40 µm.
- Airflow Soft — glycine-based, 65 µm particles, less abrasive.
After using abrasive powders, Airflow Plus polishing is mandatory.
Perioflow and ultrasonic treatment
Step 5 — Perioflow. Biofilm removal from periodontal pockets up to 9 mm deep using a graduated nozzle and erythritol-based powder. The method is applicable in the furcation area and around implants.
Step 6 — Piezon. Ultrasonic removal of residual dental calculus, predominantly subgingival mineralized deposits. Special tips are used (e.g., Piezon No Pain). Work is performed with the lateral edges of the tip at a distance of 1–2 mm from the tip end; separate tips are provided for implants that do not damage the titanium surface.
Control, fluoridation, and recall visit
Step 7 — control. A photo protocol is recommended: initial state, after disclosure, after cleaning. The result is demonstrated to the patient visually and tactually.
Step 8 — tooth protection. Fluoridation is performed using gels or foams (e.g., Sherbet) in custom trays for 1–4 minutes according to the instructions. The patient must refrain from water for 20 minutes, and from eating and smoking for 2 hours.
Recall visit. Professional hygiene is a regular procedure. Frequency:
- Healthy adults and children — every 6 months.
- Patients with orthodontic and prosthetic structures — every 3 months.
- Patients with periodontal diseases — every 3–4 months.
- Pregnant women — every trimester.
- Elderly patients — every 3–6 months depending on the clinical situation.
Key points
- Biofilm is the primary etiological factor for caries and periodontal diseases.
- The GBT protocol includes 8 consecutive steps of professional hygiene.
- Plaque disclosure is essential for patient motivation and quality control.
- Erythritol-based Airflow Plus is suitable in 95% of cases and preserves enamel structure.
- Perioflow treats periodontal pockets up to 9 mm deep.
- Piezon ultrasound is used only for residual and mineralized calculus.
- The Airflow nozzle angle of 30–60° from the gingiva prevents subcutaneous emphysema.
- Hygiene frequency is individualized: from 3 to 6 months depending on oral cavity status.