Does adjunctive air polishing improve the outcomes of non-surgical periodontal therapy?

Based on the indexed literature, the evidence is nuanced and depends on pocket depth and context.

In a split-mouth RCT of 21 patients with Stages 2 and 3 grade B periodontitis, adjunctive erythritol powder air-polishing (EPAP) added to conventional hand and ultrasonic instrumentation produced a significantly greater number of initially deep pockets (PPD ≥ 5.5 mm) reduced to shallow depth, and greater attachment gain at 6 months compared to conventional instrumentation alone ^[1]. However, no statistically significant microbiological differences were found between the adjunctive EPAP group and the control group, suggesting the clinical benefit does not extend to the microbial level ^[1]. A systematic review of RCTs on erythritol air-polishing confirmed these findings across active and supportive periodontal therapy contexts, noting improvements in probing depth, CAL, and BOP in several included trials ^[2].

For supportive periodontal therapy specifically, multiple systematic reviews and a meta-analysis found no significant difference between subgingival air polishing as monotherapy and conventional scaling in terms of PD, CAL, BOP, and plaque index ^[3][4][5]. Air polishing devices did, however, show better patient comfort, faster treatment times, and possibly improved antimicrobial behaviour compared to hand or ultrasonic instrumentation ^[6][5].

In summary, adjunctive air polishing during initial non-surgical therapy may offer a meaningful clinical benefit in deeper pockets (PPD ≥ 5.5 mm), but as a standalone or adjunct approach in maintenance, outcomes appear equivalent to conventional debridement ^[1][3][4][5].