Can You Use Air Polishing on Implants?

Yes — air polishing is safe and evidence-supported on dental implants when the correct powder is used. Glycine and erythritol cause no clinically meaningful damage to titanium surfaces or peri-implant tissues in published studies. Sodium bicarbonate, in contrast, should not be used directly on implants because it is more abrasive and alters titanium surfaces in vitro. This article summarises the 2023–2025 systematic-review evidence, the powder-selection rule that follows from it, and a few practical points on equipment and EU-specific powder availability.

Why powder choice matters on titanium

Titanium implant surfaces are engineered — machined, sandblasted, acid-etched, or anodised — to promote osseointegration. Anything that scratches, pits, or alters the oxide layer of that surface risks two things: reduced re-integration potential in surgical peri-implantitis care, and retention of bacterial plaque in newly roughened topography. Powder hardness, particle morphology, and delivery pressure therefore matter far more than on enamel.

As covered in our companion piece on erythritol versus glycine clinical evidence, glycine (Mohs hardness ~2) and erythritol (Mohs hardness ~2.5) are both softer than titanium oxide, which gives them a mechanical margin of safety. Sodium bicarbonate (Mohs ~3.5) is harder and leaves measurable surface changes when applied to titanium in vitro — the specifics are covered in our review of sodium bicarbonate on implant surfaces.

What the 2023–2025 evidence says

Two recent systematic reviews frame the current evidence picture.

Delucchi et al. 2025 — erythritol on implants

Delucchi and colleagues published a systematic review in the International Journal of Dental Hygiene (PMID 38825804) assessing erythritol air polishing in implant dentistry. Across the 15 included articles, the authors concluded that erythritol air polishing appeared significantly more effective at reducing biofilm compared with comparator treatments, without causing significant damage to either the implant surface or the peri-implant tissues. This is the strongest current synthesis pointing to erythritol specifically as a safe and effective powder in this indication.

Bi et al. 2023 — air polishing in peri-implantitis management

Bi and colleagues (Journal of Oral Implantology, PMID 38258587) published a meta-analysis of 12 studies examining air polishing across non-surgical and surgical peri-implantitis care. Their finding was more measured: air polishing produced outcomes broadly comparable to ultrasonic scaling for bleeding on probing and probing depth reduction in non-surgical cases, and comparable to mechanical cleaning as a surgical adjunct. No more favourable outcomes overall — but no worse either, meaning air polishing is a reasonable, evidence-supported option among several.

Taken together

The combined signal from these reviews is straightforward. Air polishing with glycine or erythritol is a safe, effective, and well-tolerated option for implant maintenance and as one component of peri-implantitis management. It is not a demonstrated silver bullet — but it performs at least on par with alternatives and, for erythritol specifically, with a favourable biofilm-reduction signal in the Delucchi synthesis. A pre-registered head-to-head protocol comparing erythritol and glycine in peri-implantitis is tracked on our research page; head-to-head superiority remains an open question.

Maintenance versus peri-implantitis — two different use cases

It's worth separating the two clinical contexts where air polishing comes up around implants, because the rationale and the technique differ.

Routine peri-implant maintenance (healthy or mucositis)

For supportive peri-implant therapy on a stable implant — clean abutment, no bone loss, no active inflammation or with mucositis only — low-abrasivity air polishing replaces or complements rubber-cup polishing and hand instrumentation. Glycine or erythritol are the powders of choice. Delivery is typically supra-gingival or shallowly sub-gingival with a standard nozzle. Our subgingival air polishing guide covers the nozzle-angulation and pressure-control specifics that keep the procedure safe.

Peri-implantitis decontamination (as adjunct)

When a pocket is >4–5 mm with bleeding and radiographic bone loss, air polishing becomes one decontamination option among several — ultrasonic scaling, titanium curettes, lasers, chemical adjuncts, and mechanical cleaning with brushes or gauze. The Bi 2023 meta-analysis is the relevant evidence here: air polishing is not demonstrated as superior to alternatives in this setting. It is a reasonable choice, particularly where biofilm access into the pocket is a priority and a sub-gingival nozzle is available, but it is not the default. For a broader comparison of the protocol families that include air polishing in their decontamination step, see prophylaxis protocols compared.

The sodium bicarbonate rule — and why it matters

The practical implication: if a single device in the clinic is used for mixed natural-dentition and implant patients, clinicians need a reliable workflow for swapping the powder chamber (or using separate powder chambers) between indications. Our how to choose the right prophylaxis powder article lays out the decision framework.

A European-specific note on erythritol availability

In the European Union, EMS holds the patent on erythritol as an air-polishing powder. This has a direct consequence for powder selection: non-EMS air polishers sold in the EU — including devices from Acteon, Mectron, NSK, and Woodpecker — cannot be supplied or used with erythritol powder. They run glycine or sodium bicarbonate (or, for some devices, a branded glycine formulation). Woodpecker's "Super Powder" sold in Europe, for instance, is a glycine formulation, not erythritol, despite superficial similarities in marketing.

What this means in practice: if a clinician wants erythritol specifically for the biofilm-reduction signal in Delucchi 2025, the device must be an EMS system — AIRFLOW Prophylaxis Master or equivalent — at least for the foreseeable future of the patent term. For every other EU-sold air polisher, the working powder on implants is glycine. Fortunately, glycine is itself well-supported by the broader literature on implant surface safety and soft-tissue tolerability, so the clinical outcome gap is narrower than the marketing sometimes suggests. A deeper look at specific powder brands and particle characteristics is in our erythritol powder brand comparison.

Practical clinical protocol

A practical, evidence-aligned protocol for air polishing around implants:

• Screen for contraindications first. Aerosol-generating procedure rules apply as with any air polishing — respiratory disease screening, PPE, high-volume evacuation. More detail in is air polishing safe.
• Select powder by indication. Glycine or erythritol for the implant itself. Sodium bicarbonate only on sound enamel elsewhere in the same mouth, and only if supragingival.
• Keep the nozzle angle correct. 60–90° on the implant surface, with the tip 3–5 mm away. Avoid directing the stream straight into the sulcus at full pressure.
• Use a sub-gingival nozzle for pocketed implants. If a peri-implantitis pocket is being decontaminated, a purpose-designed sub-gingival nozzle controls depth and pressure. Moving freehand with a standard supragingival nozzle into a 5 mm+ pocket is how iatrogenic emphysema and tissue injury have historically occurred.
• Document surface and tissue status before and after. Peri-implantitis management is iterative. A baseline reading on BOP, PPD, and radiographic bone level allows assessment of whether the air-polishing adjunct is contributing.

Equipment considerations

Not every air polisher is equally suited to implant work. A few practical criteria separate strong implant-maintenance tools from weaker ones:

• Sub-gingival nozzle availability. For peri-implantitis decontamination, a purpose-designed sub-gingival nozzle is the safer choice. Several systems offer one as an optional accessory; others do not.
• Powder compatibility with titanium-safe formulations. Any device that accepts glycine is serviceable for implant maintenance. EMS systems additionally accept erythritol, which is the relevant difference in the EU market.
• Pressure regulation. Consistent, low-to-moderate pressure delivery matters more than peak output for implant applications. Devices with clinician-adjustable pressure settings offer more control.
• Combined vs handpiece-only architecture. Combined tabletop systems that integrate ultrasonic scaling and air polishing in one unit simplify the workflow for implant-maintenance appointments, where both modalities are often used in sequence. Handpiece-only air polishers are lighter and cheaper but typically run glycine or sodium bicarbonate only.

For a detailed comparison of devices suitable for implant-maintenance workflows, see our 2026 air polisher buyer's guide.

Where the evidence is still open

Three questions remain genuinely open and worth watching:

• Erythritol versus glycine head-to-head on implants. Delucchi 2025 points to erythritol's biofilm-reduction signal, but direct comparative trials in implant maintenance with clinically relevant endpoints (BOP, PPD, bone level) are still limited. Our pre-registered protocol tracks this question.
• Long-term surface-integrity data. Most in vitro studies are short-duration. How repeated air-polishing cycles across years of supportive therapy affect titanium surface topography is less well mapped than a single-episode study.
• Peri-implantitis treatment superiority. Bi 2023 showed equivalence with alternatives, not superiority. Whether air polishing — alone or combined with other decontamination methods — ever becomes the first-line standard for peri-implantitis management is still an active research question.

Conclusion

Air polishing is safe and evidence-supported on dental implants when glycine or erythritol powders are used with appropriate technique. Sodium bicarbonate is not appropriate directly on implant surfaces and should be reserved for supragingival enamel prophylaxis elsewhere in the same patient. The 2023–2025 systematic-review evidence supports air polishing as comparable to — and, for erythritol specifically, favourable on biofilm endpoints versus — alternative approaches in peri-implant care. In Europe, clinicians working with non-EMS air polishers will use glycine as the working powder on implants, which is itself well-supported. The practical discipline is powder selection, nozzle angulation, and pressure control; the evidence for the clinical value of the procedure is there.