Can subgingival air polishing replace ultrasonic debridement in supportive periodontal therapy?

Based on the indexed literature, subgingival air polishing (SubAP) can serve as an effective alternative to ultrasonic debridement in supportive periodontal therapy (SPT), but "replace" requires some nuance.

Multiple systematic reviews and meta-analyses consistently show no significant difference between air polishing and ultrasonic or hand instrumentation for key clinical outcomes including probing depth, clinical attachment level, bleeding on probing, and plaque index ^[1][2][3][4]. One meta-analysis of 12 RCTs specifically confirmed equivalence across these parameters ^[1], and another review of 14 RCTs reached the same conclusion ^[4].

Air polishing does appear to offer some advantages over conventional debridement: patients report less discomfort ^[1][4], treatment is faster and less labour-intensive ^[4][5], and there is evidence of improved antimicrobial outcomes ^[4]. Repeated conventional instrumentation over the long SPT process can cause cementum damage and sensitivity, which air polishing may mitigate ^[6][5].

However, important caveats apply. Most included studies carry varying degrees of risk of bias ^[1][2][3], follow-up periods are often short ^[2], and industry funding is a noted concern in some trials ^[2]. Evidence for single- and multi-rooted teeth without furcation involvement is more established; generalisation beyond this is less certain ^[3]. For deeper pockets specifically, tip design affects efficacy, with specialised subgingival nozzles needed to reach pocket depths effectively ^[7].

In summary, the literature supports using subgingival air polishing as a clinically equivalent alternative to ultrasonic debridement in SPT, particularly where patient comfort and tissue preservation are priorities, but clinicians should exercise judgement given the methodological limitations of available evidence ^[1][2][3][4].