Is subgingival air polishing effective in periodontal pockets?

Subgingival air polishing (SubGAP) appears to be clinically effective in periodontal pockets, with outcomes comparable to conventional hand or ultrasonic instrumentation. A systematic review of 13 clinical studies confirmed comparable efficacy in biofilm control and reduction of periodontal inflammation when air polishing was compared to hand or ultrasonic instruments ^[1]. A further systematic review found that most studies showed no statistically significant difference in pocket-depth reduction between SubGAP and ultrasonic debridement during periodontal maintenance, though neither modality was shown to be clearly superior ^[2].

In randomised controlled trials, both subgingival air polishing and sonic scaling produced significant reductions in probing depth, clinical attachment level, and bleeding on probing, with no statistically significant intergroup differences ^[3]. When erythritol powder air polishing was used as an adjunct to conventional instrumentation during initial non-surgical therapy, a significantly larger proportion of initially deep pockets (PPD ≥ 5.5 mm) were reduced to shallow pockets, and greater attachment gain was observed at 6 months compared to instrumentation alone ^[4]. At the microbiome level, the addition of subgingival erythritol air polishing produced a broader shift toward health-related species and a greater reduction of periodontal pathogens compared to conventional treatment alone ^[5].

Patient comfort is consistently more favourable with air polishing than with sonic or hand instrumentation ^[3][2][1]. Overall, current evidence supports SubGAP as a viable alternative or adjunct for subgingival biofilm removal, though long-term data beyond one year remain limited ^[2][1].