TL;DR: A systematic review and meta-analysis published online in the Journal of Dentistry on October 20, 2026 found that the evidence does not show a clinically meaningful reduction in probing pocket depth when air polishing is added to conventional non-surgical instrumentation for peri-implantitis. Evidence on air polishing as a replacement for instrumentation was too imprecise to call, and the authors rated the certainty of the evidence as low to very low.
Air polishing devices have become a familiar sight in hygiene operatories, and some clinicians use them on implants showing bleeding, suppuration and bone loss. A new review asks a simple question: does it actually change the outcome? As of October 2026, this review's pooled answer is that adding air polishing to standard non-surgical peri-implantitis therapy has not been shown to improve pocket depth or bleeding beyond what instrumentation alone achieves.
For dental practices in Toronto and across the GTA that manage implant patients, the finding matters less as a verdict on any device and more as a reminder of how thin the comparative evidence still is.
Who Did the Study and What Did It Ask?
The review was written by P. Kamnoedboon, E. Thaqi, D. Nantanapiboon and M. Srinivasan, whose listed affiliations include the Clinic of Gerodontology and Special Care Geriatric Dentistry at the University of Zurich's Center for Dental Medicine and the Faculty of Dentistry at Chulalongkorn University in Bangkok. It appeared online in the Journal of Dentistry on October 20, 2026.
The authors framed one focus question: in adults with peri-implantitis, does air polishing, used either as an adjunct to or as a replacement for non-surgical instrumentation, improve disease resolution and probing pocket depth (PPD) compared with instrumentation alone? The review protocol was registered with PROSPERO (CRD42023447967).
How Was the Evidence Gathered?
The team searched MEDLINE (PubMed), Web of Science, Scopus, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July 15, 2026. Both randomized and non-randomized comparative studies were eligible, but only if their case definition of peri-implantitis required bleeding and/or suppuration on probing plus radiographic bone loss. That inclusion rule should keep peri-implant mucositis cases, which by definition lack bone loss, out of the pool.
Several methodological choices are worth noting for anyone who reads implant literature critically:
- Random-effects pooling of PPD and bleeding on probing (BOP), with the therapeutic role of air polishing (adjunct versus replacement) set as a pre-specified subgroup.
- Hartung-Knapp-Sidik-Jonkman intervals, a more conservative method of calculating confidence intervals.
- Adjustment for clustering of implants within patients, since one patient often contributes several implants.
- Synthesis without meta-analysis (SWiM) for the other outcomes, and GRADE ratings for the certainty of each outcome.
Pro Tip: When a rep or a course cites a single implant-maintenance study, ask two questions: did it count implants or patients, and did it require radiographic bone loss in its case definition? Those two details change what the result means for your patients.
What Did the Meta-Analysis Find?
Fourteen studies met the criteria, and ten of them contributed to the meta-analysis. At six months, the mean difference in PPD change was:
- Adjunctive use (air polishing added to instrumentation): −0.03 mm (95% CI −0.38 to 0.31)
- Replacement use (air polishing instead of instrumentation): +0.04 mm (95% CI −0.52 to 0.59)
There was no difference between the two subgroups (p = 0.78), and heterogeneity was negligible (I² = 3.4%). The authors also report no significant differences at other timepoints or for BOP.
How Certain Is the Evidence?
Not very. Using GRADE, the authors rated certainty as low for the adjunctive PPD outcome and very low for every other outcome. Their conclusion is carefully worded: low to very low certainty evidence does not show a clinically meaningful PPD benefit when air polishing is added to conventional instrumentation, and for replacement use the evidence is too imprecise to establish superiority, equivalence or inferiority.
That last phrase deserves attention. "Not shown to be better" is not the same as "shown to be equal." For replacement use, the confidence interval runs from about half a millimetre worse to about half a millimetre better, so the data simply cannot settle the question either way. The authors call for well-designed trials with standardized endpoints before firm recommendations are made.
What Does This Mean for Canadian Dental Practices?
The review's abstract does not report on harms, and the review does not address peri-implant mucositis or long-term maintenance of healthy implants. Its scope is non-surgical treatment of established peri-implantitis. Within that scope, a few practical points follow for clinicians in Ontario and across Canada.
Keep instrumentation at the centre of non-surgical therapy
The comparator in every pooled analysis was conventional non-surgical instrumentation. The review gives no evidence-based reason to drop it in favour of air polishing alone. If your team has drifted toward air polishing as the main tool on diseased implants, this is a good moment to revisit your protocol.
Be careful how you describe adjuncts to patients
Describing air polishing as something that "improves results" is hard to defend when this review's pooled evidence does not show a clinically meaningful pocket-depth benefit. Plain, accurate explanations protect both your patient relationship and your informed-consent record.
Pro Tip: Record baseline PPD, BOP and suppuration at six sites per implant, plus a radiograph, before non-surgical therapy. Re-measure at the same sites at six months. Without consistent baselines, you cannot tell whether any added step is earning its chair time.
Watch for the trials the authors are asking for
The review's own conclusion is that better trials are needed. Until they arrive, decisions about air polishing in peri-implantitis rest on judgement rather than strong comparative data. Practices that track their own peri-implantitis outcomes will be best placed to interpret new evidence when it lands.
Sources
- Kamnoedboon P, Thaqi E, Nantanapiboon D, Srinivasan M. "Air polishing as an adjunct to or replacement for conventional instrumentation in non-surgical peri-implantitis treatment: a systematic review and meta-analysis." Journal of Dentistry, published online October 20, 2026. doi:10.1016/j.jdent.2026.107125 (PMID 42901264; record via Europe PMC)
Frequently Asked Questions
Q: Does air polishing improve peri-implantitis treatment results?
Not on current evidence. A 2026 meta-analysis in the Journal of Dentistry found that low to very low certainty evidence does not show a clinically meaningful improvement in probing pocket depth when air polishing is added to conventional non-surgical instrumentation, and no significant difference in bleeding on probing. The certainty of that evidence was rated low to very low.
Q: Can air polishing replace scaling instruments for peri-implantitis?
The evidence cannot answer that yet. For replacement use, the review's estimate was +0.04 mm with a 95% confidence interval from −0.52 to 0.59 mm, which the authors describe as too imprecise to establish superiority, equivalence or inferiority.
Q: How many studies did the air polishing review include?
Fourteen studies were included, and ten of them were pooled in the meta-analysis. The searches covered MEDLINE, Web of Science, Scopus, EMBASE and CENTRAL up to July 15, 2026.
EBIKO Dental will continue monitoring peri-implantitis research and will report when new trials with standardized endpoints are published. For more dental news for Canadian practices, visit EBIKO Dental.