Dr Metke, what happens if patients with multi-bracket appliances do not receive adequate preventive treatment?
Dr Metke: Home care is more difficult with a fixed appliance, and biofilm can thus accumulate, which is difficult for the patient to remove on his or her own. Consequently, white spots or even caries can develop on the surfaces of the teeth around the brackets. If gingivitis develops—accompanied by swelling of the gingiva, bleeding and pain—it complicates caring for the patient and makes the treatment less pleasant. We hope to avoid this through thorough patient education about home care and regular professional dental prophylaxis. Tooth movement is more dangerous in inflamed tissue and can cause permanent damage to the tooth. Gingivitis during multi-bracket treatment is reversible in adolescents, but adults face an increased risk of bone loss if the gingivitis progresses to periodontitis.

It is important for us to work in close collaboration with our patients’ family dentists. We maintain regular communication and make joint decisions about which preventive measures will be carried out and when. Individual preventive treatment is generally still performed by family dentists because we cannot logistically integrate this into our clinical workflows. However, we perform orthodontic preventive treatment, including professional dental prophylaxis during treatment with fixed appliances. Many of our colleagues appreciate that we perform the orthodontic preventive treatments, especially if their general dentistry practice is already at capacity.

Do family dentists have any reservations about these orthodontic preventive treatments?
Dr Metke: We only perform the preventive treatment for a very limited time and only for patients with fixed appliances. We also consider the preventive treatment we perform as supportive of the quality of our care. This way, we ensure that teeth, which are difficult to clean during orthodontic treatment, remain undamaged. Young patients are also introduced to high-quality preventive treatment and learn to value its importance.

Dr Mengel: This is a win–win situation. We help patients establish good systematic preventive habits and then send them to their family dentists highly motivated.

Are patients or their parents willing to pay for the cost of GBT during orthodontic treatment?
Dr Mengel: Our practice model is structured to make it easy to motivate parents. After evaluating the orthodontic findings, we conduct a very detailed consultation that can take up to 45 minutes. During this time, we discuss the entire orthodontic context and describe in detail the possible risks and side effects as well as the advantages of systematic preventive care during treatment with fixed appliances. By using digital tools and photos, we can clearly show parents the consequences of inadequate prevention and home oral hygiene. If you take the time and explain the details to the children and their parents clearly and vividly, prevention becomes a priority for them.

Dr Metke: After the consultation, the preventive treatment package is agreed upon as part of the treatment plan. For most, this is not an issue.

Which devices do you use for tooth cleaning and which powder do you prefer?
Berghöfer: We work only with the AIRFLOW Prophylaxis Master from EMS and primarily use AIRFLOW PLUS powder. We reserve AIRFLOW CLASSIC COMFORT powder for cases of severe discoloration. Using the booster function, which automatically shifts the device to Level 8, we can clean almost everything with PLUS powder. That makes our work much easier, and PLUS powder is clearly more pleasant for the patient.

Is it difficult to clean under archwires and around ligatures with the AIRFLOW device?
Berghöfer: The AIRFLOW MAX handpiece, being lightweight and ergonomic and having a narrow tip, allows me to reach all areas easily. I can manoeuvre it around brackets, between interdental spaces under the archwire and in the delicate sulcular area. With the older method using brushes, it was impossible to clean these areas adequately.

The biofilm is removed first to improve visibility of the calculus, making its removal easier. What has you experience been with the EMS PIEZON NO PAIN ultrasonic system in orthodontic prevention?
Berghöfer: This ultrasonic device oscillates in a linear path, and the NO PAIN module automatically adjusts its output as soon as it detects resistance on the surface, such as calculus. Before using the PIEZON, the more unwieldy and larger ultrasonic tips sometimes debonded brackets, but we have not had this problem since switching to GBT.

What do you think are the most important differences between GBT and your previous prevention method?
Dr Metke: One thing is clear: if you work with brushes, you have to remove the archwire to access the tooth surfaces properly. Previously, preventive treatment was always performed when the archwire was changed and probably also needed more time. Using the AIRFLOW handpiece and PLUS powder allows us to thoroughly clean between the bracket and the sulcus, even if the gingiva is swollen. This area is difficult to reach using brushes, and it is very unpleasant if you need to work very close to the gingiva with the brushes. We also were not always able to remove all biofilm from around brackets using brushes, especially ceramic brackets. With the AIRFLOW, we can clean everything, and it’s much more comfortable for patients.

Did your prevention team complete GBT training? Was it helpful?
Dr Mengel: Our entire practice team underwent GBT training. This gave us the opportunity to test the equipment and familiarise ourselves with the protocol, and it was very helpful. We learned how to handle and maintain the delicate equipment properly and how to use the powder on patients, clean the handpiece and clean the sulcus. Undertaking the training makes perfect sense, and I’d recommend it to every practice.