I have a 120 FOWRL with aragonite sand (very coarse). I use a gravel cleaner/vacuum (basically smaller siphon hose into a much larger diameter pipe) and clean the gravel about once a month. It's not a big job and I do most areas that I can reach when I do it. The fish (mixed angels, butterfly, tang and some small guys) eat quite a bit and I don’t feed too sparingly. The cleaning seems to do the trick, as the water quality is stable, nitrates low (but not zero), and the fish happy. While I skim a lot, I think if you didn't clean the sand bed/gravel the accumulated waste would become problematic over time. Even with a bare bottom it seems to me that you have to physically remove some proteinaceous material from the system at some point.
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