Biofilm are highly organized structure where bacteria are embedded in a self produced complex matrix made of extracellular polymeric substance. Dental biofilm plays a very crucial role in the etiopathogenesis of periodontal and periimplant diseases. Periodontal or peri-implant therapy usually begins with primarily removing the biofilm and is considered as non-surgical mechanical debridement. Although Scaling and Root Planning (SRP) is considered as the gold standard for mechanical plaque debridement, it also has some drawbacks, such as inaccessibility to deeper areas on the root surfaces and patient discomfort, including root hypersensitivity. To overcome these disadvantages, minimally invasive nonsurgical approaches have been introduced. One such novel alternative is Guided Biofilm Therapy (GBT), which uses a disclosing agent to visualize the biofilm before removing it with a specialized air abrasive powder and removing supra and subgingival calculus with specialized instruments. The various aspects of GBT in the management of periodontal diseases will be highlighted in this review.Biofilm are highly organized structure where bacteria are embedded in a self produced complex matrix made of extracellular polymeric substance. Dental biofilm plays a very crucial role in the etiopathogenesis of periodontal and periimplant diseases. Periodontal or peri-implant therapy usually begins with primarily removing the biofilm and is considered as non-surgical mechanical debridement. Although Scaling and Root Planning (SRP) is considered as the gold standard for mechanical plaque debridement, it also has some drawbacks, such as inaccessibility to deeper areas on the root surfaces and patient discomfort, including root hypersensitivity. To overcome these disadvantages, minimally invasive nonsurgical approaches have been introduced. One such novel alternative is Guided Biofilm Therapy (GBT), which uses a disclosing agent to visualize the biofilm before removing it with a specialized air abrasive powder and removing supra and subgingival calculus with specialized instruments. The various aspects of GBT in the management of periodontal diseases will be highlighted in this review.Biofilm are highly organized structure where bacteria are embedded in a self produced complex matrix made of extracellular polymeric substance. Dental biofilm plays a very crucial role in the etiopathogenesis of periodontal and periimplant diseases. Periodontal or peri-implant therapy usually begins with primarily removing the biofilm and is considered as non-surgical mechanical debridement. Although Scaling and Root Planning (SRP) is considered as the gold standard for mechanical plaque debridement, it also has some drawbacks, such as inaccessibility to deeper areas on the root surfaces and patient discomfort, including root hypersensitivity. To overcome these disadvantages, minimally invasive nonsurgical approaches have been introduced. One such novel alternative is Guided Biofilm

2. GBT is a newly emerged minimally invasive
nonsurgical management for supragingival and
subgingival biofilm removal that uses air-polishing
devices with air-abrasive powders to remove plaque
and calculus in a sequential manner by initially
detecting it with disclosing agents.
“Guided Biofilm Therapy” was developed together with
the company EMS in Nyon by the Swiss Dental
Academy (SDA).
Guided BiofilmTherapy (GBT) is based on the classic
long-term recall of the Swedish dentist Dr Per
Axelsson.

4. It includes 3 hand pieces –Airflow,
perioflow and peizon hand piece
Erythritol powder in combination
with 0.3% chlorhexidine.

5. Two types devices available are
1)Table top device
2)Hand held device

6. AIR-POLISHING DEVICES
 The concept is based on technology invented by Dr.
Robert Black in1945. He invented Air dent, a device
that uses compressed air, water, and high abrasive
powders.
 This technology became the basis of air polishing
and 1st marketed in1976.
 Prophy jet Mark IV introduced the 1st device

7. PRINCIPLE
They are based on 2 priciples:
1. The “venturi” powder chamber is the first principle, in
which the air-powder mixture is produced by carburetor
technique and swirling out of the bottom of the
chamber.
2. According to the second principle, the air-powder slurry
is produced by swirling pressurized air into the powder
chamber and reaching the outlet

8. ANGULATIONS

11. when disclosing is not
used before treatment
more that 20% of biofilm
still remains which is
invisible to the naked
eye.(Dr. Bastendorf )
When disclosing agent
was used, there was
less than 6% of biofilm
remaining
VALUE OF DISCLOSING AGENTS

12. WHY REMOVING BIOFILM FIRST?
 Biofilm removal allows for improved tactile feel and
visibility for calcified deposits
 Painless biofilm management on exposed roots.

13. Hashino, E., Kuboniwa, M., Alghamdi, S. A., Yamaguchi, M., Yamamoto, R.,Cho, H., & Amano, A.
(2013). Erythritol alters microstructure and metabolomic profiles of biofilm composed of Streptococcus
gordonii and Porphyromonas gingivalis. Molecular Oral Microbiology, 28(6), 435–451
natural sugar with low
gylcemic index
Has antimicrobial
effect
altering the microstructure and
metaboliv profilfe of biofilm
composed of Porphyromonas
gingivalis and streptococcus
gordonii
Dipeptides in Pgingivalis
Glu-Glu, Ser-Glu, Tyr-Glu,
Ala-Ala were significantly
reduced by erythritol

14. WHY GBT?
Better
visibility
Faster Less
Invasive
Less
Painful

15. ERGONOMIC BENEFITS OF GUIDED
BIOFILM THERAPY
 AIRFLOW equipment was 26% lighter than the
contra-angled equipment.
 The PERIOFLOW with flexible nozzle allows the clinician
to access challenging furcations and pockets without
overstretching or bending the wrist.
 The PIEZON with a PS tip effectively removes the
calculus by utilizing linear movement, and it can access
the pocket up to 10 mm without distending the tissues in
the pocket. GBT reduces the clinical appointment by 5–7
min

16. LIMITATIONS
Studies have shown that the efficacy
of the treatment is reduced after 3
months the same as SRP.
longer-term studies are needed to be
carried out to evaluate the clinical
results with the microbiological and
biochemical evaluation

17. A NOVEL BIOFILM REMOVAL APPROACH (GUIDED
BIOFILM THERAPY)UTILIZING ERYTHRITOL AIR-
POLISHING AND ULTRASONIC PIEZO
INSTRUMENTATION: A RANDOMIZED CONTROLLED
TRIAL
CONCLUSION-
Biofilm removal using erythritolAIRFLOW® and
ultrasonic piezo-electric instruments (GBT) can be
considered equally efficient compared with the
conventional SRP. Moreover, GBT seemed to require
shorter treatment time and to exhibit a more
favourable patient perception than the conventional
approach
Int J Dent Hygiene. 2021;00:1–10.