Erythritol vs Glycine Powder: Clinical Evidence from Recent Trials

Introduction

Air polishing with low-abrasivity powders has become central to modern prophylaxis and nonsurgical periodontal treatment. Two powders dominate current practice: erythritol and glycine. Both are amino acid or sugar-alcohol based and are marketed as gentler than traditional sodium bicarbonate, but clinicians often ask which evidence better supports their use. This review examines the clinical evidence comparing these two agents — for a practical decision framework, see how to choose a prophy powder, or compare specific SKUs in our erythritol powder brand comparison.

What Are These Powders?

Erythritol

Erythritol is a naturally occurring sugar alcohol used in air polishing as a low-abrasivity powder. Particle size varies by manufacturer — consult the manufacturer's spec sheet for the specific product in use. Erythritol is marketed for both supragingival and subgingival applications.

Glycine

Glycine is the simplest amino acid. It was among the first low-abrasivity alternatives to sodium bicarbonate introduced in dental air polishing and remains widely used in periodontal maintenance and implant therapy. Particle size varies by brand.

What the Evidence Shows

Meta-Analysis: Direct Comparison

The most recent systematic review with network meta-analysis directly comparing erythritol, glycine, and trehalose was conducted by Yuan Zi-le et al. in 2025 (PMID 40791830), published in Frontiers in Physiology. This study synthesized 9 randomized controlled trials involving 462 patients undergoing nonsurgical subgingival air polishing.

Using SUCRA (Surface Under the Cumulative Ranking Curve) analysis—a method that ranks interventions by their probability of superiority—the authors reported:

• Erythritol: SUCRA 84.1 (highest probable efficacy for probing pocket depth reduction)
• Trehalose: SUCRA 48.0
• Glycine: SUCRA 28.5 (lowest rank among the three)

However, the analysis found no statistically significant direct differences in clinical outcomes between these agents. The SUCRA rankings suggest a trend favoring erythritol, but the authors concluded that clinicians can select based on availability, patient tolerance, and local practice patterns.

Implant Surface Safety

Sah et al. (2024, PMID 40162446) in Bioinformation evaluated how erythritol and glycine affect titanium implant abutment surfaces. Their study of 30 implant abutments found that both erythritol and glycine produced minimal surface roughness changes, preserving abutment integrity. In contrast, sodium bicarbonate caused significant surface roughening, suggesting it is less suitable for implant therapy. This finding supports the use of both erythritol and glycine on implant-supported restorations. For detailed guidance on implant safety across prophy modalities, clinicians should consult the comprehensive subgingival air polishing guide.

Surface Effects on Composite Materials

Atagün and Kalyoncuoğlu (2025, PMID 40241042), writing in BMC Oral Health, tested erythritol, glycine, and sodium bicarbonate on gingiva-colored composite discs at varying power levels, angulations, and durations. Erythritol exhibited the lowest abrasive properties, with the least hardness loss and roughness increase. Glycine performed intermediately, while sodium bicarbonate caused the highest surface roughness — a finding echoed in the wider sodium bicarbonate on implants evidence review. These results suggest erythritol may be preferable when treating composite restorations, though both are substantially safer than bicarbonate.

Clinical Efficacy in Practice

Maiorani et al. (2025, PMID 40559138), in Dentistry Journal, conducted a randomized controlled trial of 120 patients comparing erythritol-based air polishing against ultrasonic instrumentation with PEEK inserts for peri-implant maintenance over 12 months. The erythritol group recorded reductions of 21.62% in probing pocket depth, 86.62% in bleeding on probing, and 90.74% in plaque index. The ultrasonic group recorded 14.86%, 78.69%, and 64.86% respectively. The authors concluded that both modalities produced statistically significant reductions over 12 months with no significant differences between groups, and that efficacy was independent of prosthetic crown material. These outcomes reinforce why patient comfort and evidence-based technique selection matter equally in choosing prophylaxis modalities.

The broader 2022–2023 evidence base

Beyond the recent 2024–2025 trials covered above, five peer-reviewed papers from 2022–2023 form the prior evidence layer that any honest comparison should acknowledge.

Hatz et al. 2022 — an umbrella review of 10 underlying systematic reviews on low-abrasive air-powder water-jet technology (APWJT) — found that in supportive periodontal therapy, APWJT delivers comparable clinical outcomes with enhanced patient perception and shorter clinical time versus conventional methods. In active periodontitis, APWJT as adjunct to SRP yields outcomes similar to SRP alone. In peri-implantitis active treatment, four systematic reviews could not show improved clinical outcome for APWJT adjunctively — a nuance often missed in vendor-led comfort claims. Applied Sciences 2022, DOI: 10.3390/app12147203.

Onisor et al. 2022 — a PRISMA-guided, PROSPERO-registered systematic review of 7 RCTs on erythritol air polishing in non-surgical periodontal therapy. Across active periodontal therapy (6 months follow-up) and supportive periodontal therapy (3 months follow-up), erythritol did not show statistically significant improvements over comparator therapies for probing depth, clinical attachment level, or bleeding on probing. Authors call for larger RCTs with longer follow-up. Medicina 2022, DOI: 10.3390/medicina58070866.

Mensi et al. 2021/2022 RCT (Parts I and II) — a multicentre, single-examiner-blinded RCT of 40 patients with stages III–IV periodontitis. Both groups received full-mouth supragingival GBT-style protocol plus ultrasonic instrumentation; the test group additionally received subgingival Perioflow erythritol. Part I (clinical): non-bleeding closed pockets at 3 months were 47.9% (test) vs 44.7% (control) — no statistically significant clinical advantage for adding subgingival air polishing on top of ultrasonic in initial deep-pocket treatment. Part II (microbiome): the test group showed a significant shift toward a more eubiotic microbiome (more health-related species, fewer pathogens). Editorial framing: clinically comparable, microbiologically more eubiotic — present both together. EMS-funded; flagged transparently. Clinical Oral Investigations 2021 (DOI: 10.1007/s00784-020-03648-z) and 2022 (DOI: 10.1007/s00784-022-04811-4).

Reinhart et al. 2022 — an independent, non-EMS-funded in vitro study compared EMS AirFlow Plus erythritol (with the AIRFLOW Prophylaxis Master) against rubber-cup + Cleanic prophy paste across four restorative materials, simulating a 10-year recall interval. Erythritol caused significantly less surface abrasion than rubber-cup polishing on composite, ceramic, and cast gold; rubber-cup was significantly less abrasive on glass ionomer cement. This paper is also the peer-reviewed source for the widely cited 14 μm erythritol particle size. PLoS ONE 17(7): e0270938, 2022.

Francis et al. 2023 — an in vitro pilot study comparing six powder formulations (sodium bicarbonate at 65 μm and 40 μm, glycine, erythritol, erythritol + cetylpyridinium chloride, calcium carbonate) on 74 contaminated titanium discs. Remaining biofilm ranged from 10.7%–18.3% (rough discs) to 11.4%–28.4% (machined discs); reductions up to ~89%. All powders were statistically superior to calcium carbonate — useful editorial note for the NSK Flash Pearl and Acteon Pearl powders both being calcium-carbonate formulations. None of the tested powders rendered surfaces biofilm-free, reinforcing that combined mechanical and chemical decontamination remains the recommended approach for peri-implantitis treatment. Applied Sciences 2023, DOI: 10.3390/app13031301.

Powder-by-Powder Notes

Erythritol

• Network meta-analysis suggests a trend toward slightly higher efficacy in pocket depth reduction, though the difference is not statistically significant.
• Produces minimal surface roughness on implant abutments and composite restorations.
• Effective in routine peri-implant and periodontal maintenance over 12 months.
• Primary evidence base: 9 RCTs (meta-analysis) and two recent 2025 clinical trials.

Glycine

• Ranked lower than erythritol in the network meta-analysis, but with overlapping confidence intervals (no statistically significant difference).
• Preserves implant abutment surfaces comparably to erythritol.
• Causes more surface roughness than erythritol on composite restorations but substantially less than sodium bicarbonate.
• Long clinical history and wide availability across devices and regions.

Clinical Takeaways

1. Both are low-abrasivity options. Erythritol and glycine are both substantially safer for implants and composite restorations than sodium bicarbonate on implants and are appropriate for routine prophylaxis.
2. Evidence of efficacy exists for both. The 2025 meta-analysis found no statistically significant difference in clinical endpoints between them. Practitioners can select based on equipment availability, patient preference, and cost.
3. Erythritol shows a trend toward greater pocket depth reduction, but the confidence intervals overlap, and the clinical significance is unclear. Choice between them need not be driven by efficacy alone.
4. Surface preservation favors erythritol on composites. If treating composite restorations regularly, erythritol offers a slight advantage, though both are acceptable.
5. Long-term safety data is emerging. Studies from 2024 and 2025 show both maintain clinical gains over 12 months with no unexpected safety signals.

Open Questions

While the evidence base has strengthened, gaps remain:

• Longer-term (>12 month) clinical outcomes comparing the two directly are sparse.
• Patient-centered outcomes (pain, discomfort, patient preference) have not been systematically compared in head-to-head trials.
• Cost-effectiveness and device-powder compatibility vary by region and manufacturer — see our 2026 air polisher buyers guide for device-level detail.
• Subgroup analyses (e.g., by implant surface type, patient age, or periodontitis severity) would help tailor recommendations.

Conclusion

Current evidence supports both erythritol and glycine as effective, safe low-abrasivity air polishing powders for prophylaxis and nonsurgical periodontal treatment. A 2025 meta-analysis of 9 RCTs suggests erythritol may have a slight advantage in pocket depth reduction, but the difference is not statistically significant. On implant and composite surfaces, both preserve integrity far better than sodium bicarbonate. Clinical choice can reasonably be based on equipment compatibility, local availability, cost, and patient tolerance. As the evidence base grows, head-to-head trials on patient comfort, long-term durability, and device integration will further refine clinical guidance.