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State-of-the-art prophylaxis is only possible in accordance with Guided Biofilm Therapy’s (GBT) clinical protocol. Why this is so and why more than 11.000 practices worldwide are already GBT-certified was impressively demonstrated at the second GBT Summit in Munich, Germany, on June 17, 2023. In the packed event arena of BMW World, practitioners reported in detail how they implement GBT very successfully in economic terms too. This was accompanied by a technical update presented by experts from science and practice backgrounds.

Prophylaxis has become an important pillar of the therapy spectrum for many dental practices. For example, Dr. Schlotmann's practices (located in Dorsten) performed over 10,000 GBT treatments on 5,000 patients in 2022. With his brother, Dr. Lennart Schlotmann, family dentist Luca Schlotmann operates four locations, all with separate areas for prophylaxis (“Dental Spa”) and children (“Kids Club”). Schlotmann consistently relies on the effective and at the same time, very gentle Guided Biofilm Therapy with high-performance AIRFLOW^® Prophylaxis Master devices from EMS: “Prevention with GBT protects our patients from diseases and saves them unnecessary treatments and costs. They are directors of their own oral health. And GBT is very often perceived as pure relaxation.” According to Schlotmann, success is based on emotional bonding - within the practice team as well as with the patients.

Herzlich willkommen beim zweiten GBT Summit, diesmal in der Münchner BMW-Welt: Prof. Dr. Bettina Dannewitz, niedergelassene Parodontologin und Past-Präsidentin der DG Paro, und Torsten Fremerey, Geschäftsführer EMS für Deutschland, Österreich, Schweiz und Niederlande begrüßen das interessierte Auditorium. / Welcome to the second GBT Summit, which took place in BMW-World in Munich. Prof. Dr. Bettina Dannewitz, periodontist and past president of DG Paro (the German Society of Periodontology), and Torsten Fremerey, Managing Director of EMS Germany, Austria, Switzerland and Netherlands, greet the attentive delegates. © EMS

„Wir behandeln alle Patienten wie Familienmitglieder.“ Für Zahnarzt Luca Schlotmann basiert der Praxiserfolg auf Emotionen. / “We treat every patient as a family member.” For dentist Luca Schlotmann, practice success is based on emotions. © EMS

Erfolgsgeschichten live auf der Bühne: Dr. Petra Volz, Dr. Arndt Höhne und Dr. Nina Zeitler verraten, wie sie ihre Patienten für Prophylaxe mit der Guided Biofilm Therapy gewinnen. / Success stories live on stage: Dr. Petra Volz, Dr. Arndt Höhne and Dr. Nina Zeitler reveal how they attract patients with prophylaxis and Guided Biofilm Therapy. © EMS

„Verlangen Sie für Aufklärung und Motivation einen angemessenen Preis.“ Die Steuerberaterin Dr. Ann-Kathrin Arp empfiehlt, Prophylaxe betriebswirtschaftlich zu berechnen. / “Demand a reasonable price for education and motivation.” Tax adviser, Dr. Ann-Kathrin Arp, recommended calculating prophylaxis on the basis of business economics. © EMS

„Das Bild Ihrer Praxis entsteht im Kopf der Zielgruppe.“ Prof. Dr. Thomas Sander präsentierte eine erfolgreiche Schalke-04-Praxis in Gelsenkirchen als konsequente Marke. / “The image of your practice is created in the mind of your target group.” Prof. Dr. Thomas Sander presented a successful Schalke-04 themed practice in Gelsenkirchen as a strong and consistent brand. © EMS

„Sie sollten in Ihrer Praxis etwas ändern, wenn neue Methoden überlegen sind.“ Dr. Klaus-Dieter Bastendorf begründete ausführlich, warum GBT im Gegensatz zu konventionellen Methoden dem Stand der Erkenntnisse entspricht. / “You should change something in your practice if new methods are superior.” Dr. Klaus-Dieter Bastendorf explained in detail why GBT, in contrast to conventional methods, is state of the art. © EMS

„Nach dem AIR-FLOWING® von Dentinoberflächen kann auf eine Politur mit Pasten verzichtet werden.“ Die Parodontologin Dr. Anne Kruse präsentierte aktuelle Forschungsergebnisse ihrer Arbeitsgruppe. / "After AIR-FLOWING® on dentine surfaces, polishing with pastes can be omitted." Periodontist, Dr. Anne Kruse, presented current research results from her working group © EMS

Das Auditorium der BMW-Welt war komplett ausgebucht. Davon kamen 60 Prozent aus (noch) nicht GBT-zertifizierten Praxen, um mehr über das GBT-Konzept zu erfahren. / The auditorium of BMW World was completely booked. Of these, 60 per cent came from practices that were not (yet) GBT-certified to learn more about the GBT concept. © EMS

„Beim Lesen von Studien den klinischen Menschenverstand anwenden.“ Prof. Dr. Moritz Kebschull, zukünftiger Präsident der European Federation of Periodontology (EFP) erklärte, warum an Leitlinien Patientengruppen und zahlreiche Fachgesellschaften beteiligt werden. / "Use clinical common sense when reading studies." Prof. Dr. Moritz Kebschull, President-elect of the European Federation of Periodontology (EFP), explained why guidelines involve patient groups and numerous professional societies. © EMS

„Die Bearbeitung mit Pulver-Strahlern zeigt auch an den Unterseiten der Implantatgewinde bessere Ergebnisse als Hand- und Ultraschallinstrumente.“ Privatdozent Dr. Philipp Sahrmann ist PERIOFLOW® diskutierte den Stand von Praxis und Wissenschaft in der Mukositis- und Periimplantitis-Therapie. / “The treatment with powder jets also shows better results on the undersides of the implant threads than hand and ultrasonic instruments." Private lecturer, Dr Philipp Sahrmann, discussed the role of practice and science in mucositis and peri-implantitis therapy. © EMS

Hands-on: An den GBT-Stationen konnten Summit-Besucher den AIRFLOW® Prophylaxis Master unter fachkundiger Anleitung selbst ausprobieren. / Hands-on: at the GBT stations, Summit visitors were able to try out the AIRFLOW® Prophylaxis Master for themselves under expert guidance © EMS

Freude an der Prophylaxe: Die BMW-Welt war der optimale Rahmen für ein Event, bei dem neueste Technik, viel Wissen und eine Lösung für die tägliche präventive Praxis präsentiert wurden. / The joy of prophylaxis: BMW World was the perfect setting for an event that presented the latest technology, a wealth of knowledge, and a solution for daily preventive practice. © EMS

Es begann mit stundenlangem Spinning im Fitness-Studio: Denise Schindler, mehrfache Medaillengewinnerin bei Paralympic Games im Bahnradfahren, entwickelte sich nach einer Unterschenkel-Amputation im frühen Kindesalter zu einer großartigen Sportlerin und Persönlichkeit. / It started with hours of spinning in the gym: Denise Schindler, multiple medallist at the Paralympic Games in track cycling, developed into a great athlete and public figure after a lower leg amputation in early childhood. © EMS

„Wofür brennst du?“ Wenige Tage nach einem schweren Sturz im Abschluss-Training unterbot Denise Schindler bei den Paralympics 2021 in Tokio ihre Bestzeit und gewann die Bronzemedaille in der 3000-m-Bahn-Verfolgung. / "What are you burning for?" A few days after a heavy fall in the final training session, Denise Schindler beat her best time at the 2021 Paralympics in Tokyo and won the bronze medal in the 3,000m track pursuit. © EMS

Danke für die Teilnahme am GBT Summit 2023 und auf Wiedersehen bei der Konferenzreihe im nächsten Jahr (von links: Bettina Dannewitz, Thomas Sander, Petra Volz, Christof Sander und Arndt Höhne). / Thank you for attending GBT Summit 2023 and see you again at next year's conference series. (From left to right: Bettina Dannewitz, Thomas Sander, Petra Volz, Christof Sander and Arndt Höhne.) © EMS

Success only in a team

Emotions are also close to Dr. Petra Volz’s (Garmisch-Partenkirchen) heart. The dentist, who is also known via social media (“fotzn'spanglerei”), took her own route from dental hygienist (ZFA) to doctor of dentistry. She runs two practices with three prophylaxis rooms and is herself trained in GBT for good reason. It is true that in Germany today around 75 percent of patients visit their dentist for check-ups and 60 percent go for professional prophylaxis at least once a year.^{1, 2} But for some patients, Dr. Volz and her team still have some convincing to do. Those who go for GBT are then rewarded not only with a special prophylaxis experience. He or she also gets to choose their own favourite music, for example heavy metal.

In addition to Schlotmann and Volz, general practitioner, prosthodontist, and implantologist Dr. Arndt Christian Höhne (Neunkirchen and Luxembourg) showed that prevention also works very well in the countryside. His two GBT lounges, treatment units specially designed for prophylaxis according to the GBT protocol, were the first in Saarland and are located on a separate floor. Höhne had them designed by his team, who are also involved in the rest of their patients' treatments: “They should see the result and be proud of it.”

Convincing with “fairy dust”

Like his patients and team, Dr. Höhne is delighted with the design, ergonomics, and functionality of the GBT Lounge prophylaxis units with integrated AIRFLOW^® Prophylaxis Master devices: “No dentist element is required. It simplifies daily hygiene procedures and installation is a breeze.”  Meanwhile ten treatment rooms are available in “Seasmile,” a practice specializing in pediatric and adolescent dentistry run by Dr. Nina Zeitler, MSc. MSc., in Erlangen: "Prophylaxis is our recipe for success. We start with GBT and “fairy dust” (AIRFLOW^® PLUS Powder) in children from around three years of age, often with just one tooth at the first appointment. This is the basis for lifelong oral health."

Pricing and positioning

“Prophylaxis is a medically necessary therapy. And it means a passive income for which you have to do little yourself on an ongoing basis.”  Ann-Kathrin Arp, MBA, (Preetz), PhD, tax consultant, therefore, recommends focusing on real economic success instead of a secondary income. “Dare to calculate an appropriate fee for your individual prophylaxis as well. Depending updon expenditure and the length of consultation, that can be over 200 euros.”  Patients should be made aware of supplementary insurances, which often cover a large part of the costs.

There are fewer and fewer practices and those that remain are getting larger, yet currently 82 percent are still solo practices. According to Dr. Thomas Sander, Professor of Practice Economics, clear positioning is necessary in order to raise patient awareness: “The image of your practice is created in the mind of the target group.”  Sander therefore recommends positioning your own practice as clearly as possible as a brand. How this can be supported with Search Engine Advertising and Optimization was explained by Christof Sander, son of Thomas Sander and owner of the marketing agency Sander Concept in Berlin and Bremerhaven. The usability of content on the practice's website and in social media is key; content should be interactive, relevant and entertaining, and regularly updated.

GBT as a treatment standard

As early as antiquity, the physician and philosopher Hippocrates defined prevention as the highest goal of medical intervention. Dr. Klaus-Dieter Bastendorf (Eislingen), the Nestor of professional oral prophylaxis, described its path up to the current biological biofilm findings.³ The stained biofilm, as the cause of oral diseases, is first removed with AIR-FLOWING^®, followed by the removal of the calculus as mineralised biofilm. This is not the cause of oral diseases, but rather promotes the accumulation of biofilm and thus complicates oral hygiene. As a further development of the Axelsson system, Bastendorf explained Guided Biofilm Therapy as a patient-individualised, modular and evidence-based concept.^{4, 5}

According to Bastendorf, the current version of the PIZEON® piezo-ceramic ultrasound system which has been available since 1981 is the only one with dynamic power adjustment NO PAIN^®. When used correctly, it works with minimal invasiveness and is almost painless.^{6, 7} The AIRFLOW^® system, introduced a year later and continuously developed since then, today with the MAX handpiece and as part of the AIRFLOW^® Prophylaxis Master, is the only system with a continuous laminar powder flow.⁸ AIR-FLOWING^® as the method of choice is, according to numerous high-quality studies, particularly gentle on tissue, with better patient acceptance and efficiency.^{9, 10} This applies in comparison to conventional tooth cleaning with pastes and hand instruments - and in supra- as well as subgingival application.^11-13

Ineffective polishing

For Dr. Bastendorf, perfect biofilm removal in fixed orthodontic treatment can only be successfully performed with AIR-FLOWING^®. Furthermore, according to current clinical research, staining prior to biofilm removal leads to significantly better results, higher patient satisfaction and saves time.¹⁴ He contradicted the widespread assumption that “polishing” after biofilm removal produces smoother enamel or dentin surfaces on the basis of two studies by the University of Freiburg.^{15, 16} On the very hard enamel surfaces, which are 300 to 400 HV (Vickers hardness), none of the usual cleaning methods changes the roughness values in a clinically relevant way.

In Munich, periodontology specialist Dr. Anne Kruse added to a randomized study submitted for publication by her working group, which also showed no clinically significant efficacy of paste application after AIR-FLOWING^® for dentin surfaces. To control the effect, possible paste residues were removed with a sonic toothbrush in both groups before the roughness measurement.

Guidelines versus experience?

According to a literature review by Dr. Kruse, the non-surgical use of AIR-FLOWING^® and PERIOFLOW^® in UPT is just as effective as ultrasonic or hand instruments, but at the same time simpler, more time-efficient and more patient-friendly.^10,17-19 The fact that patient acceptance, among other factors, should be taken into account when developing clinical guidelines was emphasised by the future president of the European Federation of Periodontology (EFP), Prof. Dr. Moritz Kebschull (University of Birmingham, England). Moreover, those who evaluate clinical studies should not disregard their own clinical judegment.

According to associate professor Dr. Philipp Sahrmann (University of Basel), the newly published EFP consensus on the therapy of mucositis and peri-implantitis did not find a significantly better clinical benefit for AIR-FLOWING^® compared to other established procedures.²⁰ However, an in vitro study by Sahrmann's group shows that the method using the PERIOFLOW^® handpiece with associated attachments has the best cleaning effect compared to hand or ultrasonic instruments without altering the implant surface.^{21, 22}

Only the best - for patient and practice

Guided Biofilm Therapy is on everyone's lips and is now the gold standard for clinical prophylaxis and preventive therapy. Under the competent moderation of Prof. Dr. Bettina Dannewitz (Weilburg and University of Frankfurt), the second GBT Summit also provided convincing arguments in favour of this. With their success stories, practice owners showed, in a galvanizing manner, how the method can be implemented for the best possible long-term dental health, highly engaging additional income, and a lot of joy and motivation for the entire team. Anyone who wants to care for their patients according to the latest clinical findings while making their practice fit for the future has the best chance of success with Guided Biofilm Therapy. But shhh, don't tell anyone!

^Literature

1. ^{Jordan A, Micheelis W. Fünfte Deutsche Mundgesundheitsstudie DMS V. Köln, 2016.}
2. ^{Direkt C. Repräsentative Umfrage "Zahngesundheit" des Meinungsforschungsinstituts forsa im Auftrag von CosmosDirekt. 2019.}
3. ^{Marsh PD. Plaque as a biofilm: pharmacological principles of drug delivery and action in the sub- and supragingival environment. Oral diseases 2003;9 Suppl 1:16-22.}
4. ^{Axelsson P. Preventive materials, methods and programs: Quintessence Publishing, 2004.}
5. ^{Bastendorf K, Strafela-Bastendorf N. Auf das klinische Protokoll kommt es an – PZR, UPT und GBT. Quintessenz 2020;71:1380-1389.}
6. ^{Hägi TT, Klemensberger S, Bereiter R, Nietzsche S, Cosgarea R, Flury S, et al. A Biofilm Pocket Model to Evaluate Different Non-Surgical Periodontal Treatment Modalities in Terms of Biofilm Removal and Reformation, Surface Alterations and Attachment of Periodontal Ligament Fibroblasts. PLoS One 2015;10:e0131056.}
7. ^{Müller S, Huber H, Goebel G, Wimmer G, Kapferer-Seebacher I. Pain perception during debridement of hypersensitive teeth elicited by two ultrasonic scalers. Clin Oral Investig 2017;21:1559-1564.}
8. ^{Donnet M, Fournier M, Schmidlin PR, Lussi A. A Novel Method to Measure the Powder Consumption of Dental Air-Polishing Devices. Applied Sciences 2021;11:1101.}
9. ^{Buhler J, Amato M, Weiger R, Walter C. A systematic review on the patient perception of periodontal treatment using air polishing devices. International journal of dental hygiene 2016;14:4-14.}
10. ^{Abdulbaqi HR, Shaikh MS, Abdulkareem AA, Zafar MS, Gul SS, Sha AM. Efficacy of erythritol powder air-polishing in active and supportive periodontal therapy: A systematic review and meta-analysis. International journal of dental hygiene 2022;20:62-74.}
11. ^{Furrer C, Battig R, Votta I, Bastendorf KD, Schmidlin PR. Patientenakzeptanz nach Umstellung auf «Guided Biofilm Therapy». Swiss Dent J 2021;131:229-234.}
12. ^{Wolgin M, Frankenhauser A, Shakavets N, Bastendorf KD, Lussi A, Kielbassa AM. A randomized controlled trial on the plaque-removing efficacy of a low-abrasive air-polishing system to improve oral health care. Quintessence Int 2021;52:752-762.}
13. ^{Albonni H, Alseirafi W, Tekleh H, Abo Orabi F, Alhaj M, Almasri D, et al. Clinical outcomes of using erythritol powder by means of air polishing with ultrasonic debridement in the treatment of initial periodontal pockets in hand of dental students: A split-mouth, randomized, comparative, controlled study. Part I. International journal of dental hygiene 2021;19:262-272.}
14. ^{Fu JH, Wong LB, Tong HJ, Sim YF. Conventional versus comprehensive dental prophylaxis: comparing the clinical outcomes between rubber cup and air polishing and the importance of plaque disclosure. Quintessence Int 2021;0:0.}
15. ^{Burkhardt ASea. Effect of air-polishing using erythritol on surface roughness of enamel and dentine compared to conventional methods. Poster presented at the EuroPerio, Copenhagen 2022. 2022.}
16. ^{Fortmeier S. Effect of professional cleaning procedures on tissue loss in dentine and enamel- an ex-vivo study. Poster presented at the EuroPerio, Copenhagen 2022. 2022.}
17. ^{Kruse AB, Wölki BJ, Woelber JP, Frisch E, Vach K, Ratka-Krüger P. Subgingival air polishing with trehalose powder during supportive periodontal therapy: use of a conical shaped tip during a randomized clinical trial. BMC Oral Health 2022;22:70.}
18. ^{Vouros I, Antonoglou GN, Anoixiadou S, Kalfas S. A novel biofilm removal approach (Guided Biofilm Therapy) utilizing erythritol air-polishing and ultrasonic piezo instrumentation: A randomized controlled trial. International journal of dental hygiene 2021;n/a.}
19. ^{Flemmig TF, Arushanov D, Daubert D, Rothen M, Mueller G, Leroux BG. Randomized controlled trial assessing efficacy and safety of glycine powder air polishing in moderate-to-deep periodontal pockets. J Periodontol 2012;83:444-452.}
20. ^{Herrera D, Berglundh T, Schwarz F, Chapple I, Jepsen S, Sculean A, et al. Prevention and treatment of peri-implant diseases-The EFP S3 level clinical practice guideline. Journal of clinical periodontology 2023.}
21. ^{Ronay V, Merlini A, Attin T, Schmidlin PR, Sahrmann P. In vitro cleaning potential of three implant debridement methods. Simulation of the non-surgical approach. Clin Oral Implants Res 2017;28:151-155.}
22. ^{Sahrmann P, Ronay V, Sener B, Jung RE, Attin T, Schmidlin PR. Cleaning potential of glycine air-flow application in an in vitro peri-implantitis model. Clin Oral Implants Res 2013;24:666-670.}

Quelle: EMS