Air polishing as an adjunct to or replacement for conventional instrumentation in non-surgical peri-implantitis treatment: a systematic review and meta-analysis.

OBJECTIVES

To address the focus question: in adults with peri-implantitis, does air polishing, used as an adjunct to or a replacement for non-surgical instrumentation, improve disease resolution and probing pocket depth (PPD) compared with instrumentation alone?

DATA AND SOURCES: MEDLINE (PubMed), Web of Science, Scopus, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to 15 July 2026.

METHODS

Randomized and non-randomized comparative studies were eligible if the case definition required bleeding and/or suppuration on probing and radiographic bone loss. PPD and bleeding on probing (BOP) were pooled in a random-effects model with therapeutic role as a pre-specified subgroup, using Hartung-Knapp-Sidik-Jonkman intervals and adjustment for clustering of implants within patients. Other outcomes were synthesized without meta-analysis (SWiM), and certainty was rated with GRADE.

RESULTS

Fourteen studies were included, ten in the meta-analysis. At six months, the mean difference in PPD change was -0.03 mm (95% CI -0.38 to 0.31) for adjunctive and +0.04 mm (95% CI -0.52 to 0.59) for replacement use, with no subgroup difference (p = 0.78) and negligible heterogeneity (I² = 3.4%). No significant differences were found at other timepoints or for BOP. Certainty was low for adjunctive PPD change and very low for all other outcomes.

CONCLUSIONS

Low to very low certainty evidence does not show a clinically meaningful PPD benefit when air polishing is added to conventional instrumentation. For its use as a replacement, the evidence is too imprecise to establish superiority, equivalence or inferiority.

CLINICAL SIGNIFICANCE: Adding air polishing to non-surgical peri-implantitis therapy has not been shown to improve outcomes beyond conventional instrumentation, and evidence on its use as a replacement is inconclusive. Given the low certainty of the evidence, well-designed trials with standardized endpoints are needed before firm recommendations can be made. PROSPERO Registration: CRD42023447967.