Comparative Effectiveness of Air Purifiers and High-Volume Evacuation in Reducing Aerosols in a Real Dental Clinic Setting

Objective To compare the effects of high-volume evacuation (HVE), the air purifier, and their combination during two types of periodontal treatment – ultrasonic scaling and root planing – on the effectiveness of control measures. Methods In a prospective, 2 × 2 × 2 factorial experimental study (N = 24 total runs), aerosol concentration increments (0.30-10.00 μm) at a fixed piont (1.0m heighet) in the clinician’s breathing zone were measured in an active dental clinic across eight intervention scenarios. Differences across conditions were analyzed using non-parametric Mann-Whitney U tests on untransformed increments, while three-way ANOVA was conducted on log-transformed concentration data to evaluate main and interaction effects. Results Three-way ANOVA confirmed a predominant main effect for the air purifier (F = 48.138, P < .001, η p 2 = 0.751), achieving a 96% median reduction efficiency (8.99-0.37 #/cm 3 , P < .001), particularly for submicron particles. Conversely, the evaluated HVE showed a non-significant 20% reduction ( P = .961). Aerosol generation was comparable between ultrasonic scaling (4.38 #/cm 3 ) and root planing (3.19 #/cm 3 , P = .495). No significant two-way or three-way interactions were observed ( P > .05). Conclusions Air purifiers demonstrated greater aerosol reduction than the evaluated HVE system under the study conditions, particularly for submicron particles. This supports a two-layered aerosol management strategy combining localized source containment with ambient filtration, optimizing environmental safety in enclosed operatories with limited natural ventilation. Clinical significance This evidence supports a two-layered aerosol management strategy: using localized HVE for source containment of large splatter, and ambient air purification for continuous clearance of escaping submicron particles to lower inhalation doses in enclosed operatories.