Guided Biofilm Therapy (GBT) explained

What GBT is

GBT is a trademarked protocol developed and documented by EMS (Electro Medical Systems, Switzerland). It organizes a prophylaxis appointment into a fixed sequence: make the biofilm visible, remove it with low-abrasive air polishing above and below the gumline, then remove remaining calculus with ultrasonic instrumentation. The aim is a standardized, repeatable appointment rather than a new clinical technique.

The 8 steps

1. Assessment — clinical and periodontal assessment.
2. Disclose — biofilm is stained with a disclosing agent so clinician and patient can see where it is.
3. Motivate — patient education and oral hygiene instruction, informed by what the disclosing showed.
4. AIRFLOW — supragingival biofilm and stain removal with erythritol powder (EMS PLUS Powder). Sodium bicarbonate (CLASSIC) can be used for heavy stain at the clinician's discretion.
5. PERIOFLOW — subgingival biofilm management with the PERIOFLOW nozzle and erythritol. EMS documents it for 4–9 mm periodontal and peri-implant pockets.
6. PIEZON — ultrasonic removal of any remaining calculus.
7. Check — re-evaluation, caries check and restorative review.
8. Recall — the next appointment is scheduled according to individual risk.

Who it is used for

• General prophylaxis in adults and adolescents.
• Peri-implant maintenance (mucositis management and supportive therapy).
• High-risk periodontal patients in supportive periodontal therapy.

Equipment

GBT is run on EMS combined tabletop systems: the GBT Machine (launched IDS 2025) or the predecessor AIRFLOW Prophylaxis Master, which is still sold in some markets. Both integrate the AIRFLOW, PERIOFLOW and PIEZON components.

Training and certification

"GBT-certified" clinics have completed EMS training and certification. Certification is one signal among many: the protocol can be carried out by any trained clinician with the right equipment. Ask the distributor what training is included when you buy.

Other structured approaches

GBT is not the only structured approach. Conventional prophylaxis remains the most widespread, and iTOP (Curaprox) is an education-focused, low-equipment program. Some manufacturers also use their own protocol labels, such as NSK's MIT and Woodpecker's ABC.

What the evidence shows

• GBT vs scaling and root planing (Mensi et al., 2024). Split-mouth randomized trial, 31 patients with stage III–IV periodontitis in initial therapy. Pocket closure was 77.9% vs 80.1% at 6 weeks and 84.1% vs 84.4% at 3 months, with no statistically or clinically significant difference. Several authors reported fees or support from EMS.
• GBT vs conventional instrumentation (Graetz et al., 2024). Split-mouth randomized trial, 60 patients with stage III–IV periodontitis treated by supervised dental students. Outcomes were comparable after about 5 months (PPD reduction of diseased surfaces 57.0% vs 58.7%), and treatment time was significantly shorter with GBT (30.3 vs 34.6 minutes).
• Adding subgingival erythritol in initial treatment (Mensi et al., 2021). Adding subgingival erythritol air polishing to ultrasonic debridement gave no significant clinical advantage in stage III–IV periodontitis (closed pockets 47.9% vs 44.7% at 3 months). A second analysis of the same trial reported a shift towards a healthier subgingival microbiome (Mensi et al., 2022). Both were funded by EMS.
• Low-abrasive air polishing overall (Hatz et al., 2022). This umbrella review found similar results to scaling and root planing alone in active periodontitis, comparable clinical outcomes with better patient perception and shorter treatment time in supportive therapy, and no improved outcome as an adjunct in peri-implant disease.
• Supportive periodontal care (Nascimento et al., 2021; Martins et al., 2022). Both systematic reviews found no difference in clinical efficacy between air polishing and hand/ultrasonic instruments; Martins et al. reported better patient-centerd outcomes.

Limitations: many evaluations of GBT components are manufacturer-sponsored, and most follow-ups are short. The fair reading is that GBT performs comparably to conventional instrumentation, with possible advantages in comfort and time, rather than producing better clinical outcomes.

Frequently asked questions

References

1. Mensi M, et al. Clinical Comparison of Guided Biofilm Therapy and Scaling and Root Planing in the Active Phase of Periodontitis Management. Eur J Dent. 2024;19(2):482–492. doi:10.1055/s-0044-1791221
2. Graetz C, et al. Guided biofilm therapy versus conventional protocol — clinical outcomes in non-surgical periodontal therapy. BMC Oral Health. 2024. doi:10.1186/s12903-024-04898-z
3. Mensi M, Scotti E, Sordillo A, et al. Efficacy of the additional use of subgingival air polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Clin Oral Investig. 2021. doi:10.1007/s00784-020-03648-z
4. Mensi M, Caselli E, D'Accolti M, et al. Efficacy of the additional use of subgingival air-polishing with erythritol powder in the treatment of periodontitis patients: a randomized controlled clinical trial. Part II: effect on sub-gingival microbiome. Clin Oral Investig. 2022. doi:10.1007/s00784-022-04811-4
5. Hatz CR, Janson TM, Solderer A, Bastendorf KD, Schmidlin PR, Liu CC. An Umbrella Review on Low-Abrasive Air Powder Water Jet Technology in Periodontitis and Peri-Implantitis Patients. Applied Sciences. 2022;12:7203. doi:10.3390/app12147203
6. Nascimento GG, Leite FRM, Pennisi PRC, López R, Paranhos LR. Use of air polishing for supra- and subgingival biofilm removal for treatment of residual periodontal pockets and supportive periodontal care: a systematic review. Clin Oral Investig. 2021;25:779–795. doi:10.1007/s00784-020-03762-y
7. Martins O, Costa A, Silva D. The efficacy of air polishing devices in supportive periodontal therapy: clinical, microbiological and patient-centerd outcomes. A systematic review. Int J Dent Hyg. 2022. doi:10.1111/idh.12635