Air polishing or hand and/or power-driven instruments in supportive periodontal therapy


Following an active period of treatment for periodontal disease a maintenance period of supporting periodontal therapy (SPT) tailored to the patients’ individual risk level is recommended. Typically, this involves debridement by hand and/or ultrasonic instruments to remove biofilm. Alternatively, the use of air polishing devices may be appropriate.

The aim of this review was to compare the effectiveness of repeated periodontal therapy with air polishing devices (APDs) in comparison with hand instruments and/or power-driven instruments in SPT and implant maintenance.


The review was registered in PROSPERO. Searches were conducted in the Cochrane library, Medline, Embase, Web of Science, Dentistry and Oral Sciences Source, and OpenGrey supplemented by hand searches of the journals, Journal of Clinical Periodontology, Journal of Periodontology, Clinical Implant Dentistry and Related Research, and Clinical Oral Implant Research. Randomised controlled clinical trials (RCTs) in patients ≥ 18 years of age with minimum 6 months follow-up published in English between 01 January 2000 to 30 April 2020 were considered.  The primary outcomes were pocket probing depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Two reviewers independently screened, selected studies, and extracted data from the studies. The Cochrane Risk-of-Bias tool (RoB 2) was used to assess quality. meta-analysis was conducted presented as weighted mean difference (WMD) and 95% confidence intervals (CI).


  • 6 RCTs were included ,4 studies (159 patients) for supportive periodontal treatment (SPT) and 2 studies (108 patients) for implant maintenance (IM).
  • 1 study was conducted in 7 dental practices the remainder in a university setting.
  • 4 studies were at high risk of bias and 2 had some concerns.
  • All SPT studies reported a statistically significant PPD reduction after APDs after 6 or 12 months.
  • For IM one study reported significantly reduce PPD with APDs while the other study reported increased PPD with APDs.
  • Meta-analysis showed no significant difference for PPD at 6 months, WMD= 0.11 (95%CI; −0.01 to 0.22) [ 3 studies].
  • CAL was reported in 4 studies, 2 trials reported a statistically significant gain in CAL for APDs and control treatment groups between baseline and at 6 months visits. While1 study reported no significant CAL gain in the APD group. One IM study showed a non-significant CAL gain at 3 and 6 months.
  • Meta-analysis showed no significant difference for CAL at 6 months, WMD = 0.08 (95%CI; −0.10 to 0.25) [ 3 studies].
  • 3 SPT studies found a statistically significant intra-group reduction of BOP percentage in test and control groups at 6 and 12 months.


The authors concluded: –

Within the limitations of this systematic review and meta-analysis, repeated subgingival debridement using air polishing devices in supportive periodontal treatment resulted in similar clinical outcomes but better patients’ comfort when compared to the conventional interventions. For implant maintenance, there is limited evidence to show that repeated application of air polishing devices  leads to improved clinical outcomes when compared to conventional treatments.


The authors have searched a good range of databases supplements by handsearching of some journals. However, they have employed a restricted time frame and only included English language studies which could have resulted in the exclusion of some relevant studies. Only 4 studies were included for SPT and 2 for IM and a majority of the studies (4) were considered to be at high risk of bias. While the review summaries the available evidence comparing APDs and conventional therapy for SPT it also highlights the limited quality of what is available. Therefore, there is a need for high quality well conducted studies with medium to long term outcomes to properly compare these two treatment methods for supportive periodontal treatment and implant maintenance.


Primary Paper

Tan SL, Grewal GK, Mohamed Nazari NS, Mohd-Dom TN, Baharuddin NA. Efficacy of air polishing in comparison with hand instruments and/or power-driven instruments in supportive periodontal therapy and implant maintenance: a systematic review and meta-analysis. BMC Oral Health. 2022 Mar 23;22(1):85. doi: 10.1186/s12903-022-02120-6. PMID: 35321688; PMCID: PMC8944123.

Review protocol on PROSPERO

Other references

Dental Elf – 26th Oct 2015

Peri-implant disease: Limited evidence for the use of air polishing

Dental Elf – 8th Jan 2018

Periodontitis- supportive periodontal treatment

Dental Elf – 6th Sep 2019

Peri-implant disease: Does supportive periodontal treatment improve implant survival?




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