Comparison of Air Abrasion and Mechanical Decontamination for Managing Inflammatory Reactions around Dental Implants: A Systematic Review and Meta-Analysis

Abstract

Background: A number of mechanical decontamination methods have been proposed, however, there is no agreed-upon gold standard among them. This study aims to conduct a meta-analysis to assess the differences in the management of an inflammatory reaction around dental implants between air abrasion and mechanical decontamination. Methods: A comprehensive search strategy was employed, incorporating controlled vocabulary (MeSH) and free-text terms. This search was conducted by two reviewers to identify published systematic reviews. Three major electronic databases, namely, Medline via PubMed, the Cochrane database, and Embase, were searched up to May 2024. Results: Initially, 300 articles were identified. After conducting a comprehensive search and applying strict inclusion criteria, a total of 13 studies were deemed eligible for inclusion in the meta-analysis. The results showed that the mean difference in probing depth between air abrasion and other mechanical decontamination was 0.28 (95% confidence interval, −0.20 to 0.76). The mean difference in probing depth of air abrasion compared with other mechanical decontamination in maintenance purposes was 1.05 (95% confidence interval, 0.18 to 1.91). The mean difference in bleeding on probing between air abrasion and other mechanical decontamination was 0.51 (95% confidence interval, 0.07 to 0.95). The mean difference in alveolar bone loss between air abrasion and other mechanical decontamination was −0.14 (95% confidence interval, −0.77 to 0.48). The mean difference in alveolar bone loss for surgical approaches of air abrasion compared with other mechanical decontamination was 0.32 (95% confidence interval, 0.03 to 0.61). Conclusions: The findings of the study indicate that the use of air abrasion was just as effective as other mechanical decontamination methods in reducing probing depth and alveolar bone loss. The subgroup analysis showed that air abrasion was less effective in reducing probing depth in maintenance purposes. Additionally, air abrasion was less effective in reducing alveolar bone loss in surgical approaches.

1. Introduction

Dental implants are used to replace missing teeth [1]. These implants are designed to integrate with the bone, mimicking the root of a tooth. Dental implants serve as artificial tooth roots, providing a permanent base for fixed, replacement teeth [2]. The tooth is secured to the alveolar bone and gingiva via the periodontal ligament and superior soft tissue fibers [3]. However, hard and soft tissues surrounding the implant are somewhat different from the tooth and the interface between the connective tissue and the implant is devoid of fibers [4]. Within the peri-implant mucosa, collagen fibers are oriented parallel to the implant’s long axis [5]. Furthermore, the mucosal region in the dental implant is characterized by a low vascular density [6]. The osteotomy procedure performed during implant placement induces tissue damage, precipitating a series of biological responses within the bone, which includes bone remodeling [7]. The subsequent weeks witness a process of modeling and remodeling of the hard tissue around the implant, culminating in the formation of new bone that surrounds the implant, a phenomenon known as osseointegration [8].

Peri-implantitis is essentially the counterpart to periodontitis [9]. Peri-implant mucositis is defined as the inflammation of the soft tissues surrounding a dental implant, whereas peri-implantitis is characterized by inflammation of the peri-implant soft tissues accompanied by bone loss around the implant [10]. A healthy peri-implant mucosa exhibits neither edema nor redness and is devoid of inflammatory markers, such as bleeding upon palpation. Both the mucosa and the superior aspect of the tooth or implant are integral components of the oral milieu, perpetually exposed to a diverse array of microorganisms [11]. Unlike the oral mucosa, which can shed epithelial cells to mitigate microbial colonization, implants and teeth lack this capability. Consequently, implants present a particularly conducive environment for bacterial adherence and biofilm formation within the grooves of the adjacent mucosa [12]. The manifestations of peri-implantitis frequently remain asymptomatic, typically identified during routine examinations through bleeding upon probing, a consistent indicator of peri-implant disease, although this may not be observed in some smokers [13]. Additional clinical indicators of this condition include suppuration, an increased probing depth compared to baseline measurements, mucosal retraction, the formation of draining sinuses, and swelling of the peri-implant mucosa [14]. Without prompt diagnosis and effective management, peri-implant disease can lead to the loss of osseointegration and ultimately, the failure of the implant [15].

The primary objective in the management of dental peri-implantitis is to mitigate the peri-implantitis lesion, thereby arresting the progression of bone support loss [16]. The treatment aims are analogous to those for periodontitis, where a successfully treated peri-implantitis site should exhibit an absence of periodontal pockets and bleeding upon probing [17]. Nevertheless, the efficacy of such treatments may be contingent upon the successful removal of biofilm from the implant surface and the accessibility of the contaminated implant surface for treatment [18]. Non-surgical approaches to biofilm removal are typically employed in conjunction with care of the upper peri-implant mucosal region [19]. Providing patients with detailed information and guidance on self-managing the infection is crucial to the overall management of peri-implant diseases in dentistry [20]. However, in instances of severe dental peri-implantitis, non-surgical methods alone may prove insufficient, necessitating a surgical intervention. Surgical modalities are employed to remediate connective tissue lesions, incorporating various mechanical techniques for biofilm elimination from the implant surface [21]. The evidence from prospective and retrospective case series, as well as randomized controlled clinical trials, supports the potential for achieving and sustaining successful outcomes over extended periods. Depending on the clinicians, the preference leans towards surgical interventions.

The potential challenge in non-surgically managing peri-implantitis and improving the condition therapeutically has arisen. Various mechanical instrumentations have been implemented for the management of peri-implantitis [22]. However, there is no universally accepted gold standard among them [23]. Air abrasion is reported to effectively remove the bacterial biofilm from the implant surface and peri-implant tissues, which is a primary etiological factor in peri-implantitis [24]. Air abrasion helps in cleaning the micro-roughened surfaces of the implant, which are prone to biofilm accumulation [25]. The use of air abrasion showed that the plaque index showed improvement post-treatment. The technique using air abrasion is less invasive compared to mechanical debridement with curettes or ultrasonic scalers, causing less damage to the implant surface and surrounding tissues [26]. Thus, air abrasion therapy may be more beneficial as it minimizes the damages to the surface and helps in maintaining the roughness necessary while removing the biofilm. Therefore, this study aims to conduct a meta-analysis to evaluate the differences in managing the inflammatory response around dental implants between air abrasion and mechanical decontamination. The null hypothesis posits that there will be no significant difference in treating the inflammatory response around dental implants between air abrasion and other mechanical decontamination techniques.

2. Materials and Methods

2.1. Protocol and Eligibility Criteria

The present systematic review follows the guidelines specified in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement, as detailed in reference [27]. Through the meticulous alignment of our research methodologies with the PRISMA Statement, we have established our systematic review as a model exemplifying meticulous planning, exhaustive data collection, rigorous analysis, and transparent reporting, leading to comprehensive and objective evaluation of the subject under scrutiny. The protocol of this systematic review was not registered in a public registry.

The eligibility criteria are as follows.

Question: Is there a difference in the treatment of peri-implantitis between air abrasion and other mechanical decontamination methods.

Participants: Patients who received treatment for peri-implantitis.

Interventions: The use of air abrasion techniques.

Comparisons: Mechanical decontamination methods.

The primary outcomes measured were probing depth, bleeding on probing, and alveolar bone loss. We excluded in vitro and animal studies, microbiological studies, and review articles. Moreover, literature reviews, interviews, case reports, case-control studies, retrospective study designs, and studies published in languages other than English were excluded.

2.2. Information Sources and Search Strategy

An expert reviewer named NJK, who was associated with a library, carried out a comprehensive search using a combination of controlled vocabulary (MeSH) and free-text terms to identify published studies. Two additional reviewers, KJJ and AL, performed extensive searches of three major electronic databases, namely, Medline via PubMed, Cochrane database, and Embase, up to 14 May 2024. They used EndNote reference management software (Version 21, Clarivate, Philadelphia, PA, USA) to carefully deduplicate the search results, which was crucial to maintain the credibility of the research findings. To enhance the accuracy and relevance of our search, the customized search strategy was thoughtfully designed to align with the specific criteria and intricacies of each database. This strategic approach allowed us to fully utilize the capabilities of each database, maximizing the retrieval of pertinent and valuable information for our research objectives, which are presented in Appendix A 

Table A1. Search strategy of the online database.

Database	Search	Search Strategy
PubMed	#1	“Titanium”[Mesh]
	#2	“Titanium”[TW] OR “titanium surface”[TW] OR “titanium surfaces”[TW] OR “rough surface”[TW]
	#3	“Peri-Implantitis”[Mesh]
	#4	“Peri-Implantitis”[TW] OR “Peri Implantitis”[TW] OR “Peri-Implantitides”[TW] OR “Periimplantitis”[TW] OR “Periimplantitides”[TW]
	#5	“Prostheses and Implants”[Mesh]
	#6	“Prostheses and Implants”[TW] OR “Implants and Prostheses”[TW] OR “Prosthetic Implants”[TW] OR “Prostheses and Implant”[TW] OR “Implant and Prostheses”[TW] OR “Prosthetic Implant”[TW] OR “Implant, Prosthetic”[TW] OR “Implants, Prosthetic”[TW] OR “Endoprosthesis”[TW] OR “Endoprostheses”[TW] OR “Prostheses”[TW] OR “Prosthesis”[TW] OR “Implants, Artificial”[TW] OR “Artificial Implant”[TW] OR “Artificial Implants”[TW] OR “Implant, Artificial”[TW]
	#7 Combine	#1 OR #2 OR #3 OR #4 OR #5 OR #6
	#8	“Air Abrasion, Dental”[Mesh]
	#9	“Air Abrasion, Dental”[TW] OR “Abrasion, Dental Air”[TW] OR “Abrasions, Dental Air”[TW] OR “Air Abrasions, Dental”[TW] OR “Dental Air Abrasions”[TW] OR “Dental Air Abrasion”[TW] OR “air abrasive”[TW] OR “air polishing”[TW] OR “abrasive powder”[TW]
	#10 Combine	#8 OR #9
	#11	“Periodontal Index”[Mesh]
	#12	“Periodontal Index”[TW] OR “Index, Periodontal”[TW] OR “Indices, Periodontal”[TW] OR “Periodontal Indices”[TW] OR “Periodontal Indexes”[TW] OR “Indexes, Periodontal”[TW] OR “Community Periodontal Index of Treatment Needs”[TW] OR “CPITN”[TW] OR “Bleeding on Probing, Gingival”[TW] OR “Gingival Bleeding on Probing”[TW] OR “Gingival Index”[TW] OR “Gingival Indices”[TW] OR “Index, Gingival”[TW] OR “Indices, Gingival”[TW] OR “Gingival Indexes”[TW] OR “Indexes, Gingival”[TW]
	#13	“bleeding on probing”[TW] OR “BOP”[TW] OR “probing pocket depth”[TW] OR “PPD”[TW] OR “bone level”[TW]
	#14	“Dental Plaque Index”[Mesh]
	#15	“Indexes, Dental Plaque”[TW] OR “Indices, Dental Plaque”[TW] OR “Dental Plaque Indexes”[TW] OR “Dental Plaque Indices”[TW] OR “Index, Dental Plaque”[TW] OR “Plaque index”[TW]
	#16 Combine	#11 OR #12 OR #13 OR #14 OR #15
	#17 Combine	#7 AND #10 AND #16
	#18 Limit	#17 AND (randomizedcontrolledtrial[Filter])
	#19 Limit	#17 AND (“Randomized Controlled Trial” [Publication Type] OR “Controlled Clinical Trial” [Publication Type] OR “Randomized Controlled Trials as Topic”[Mesh] OR “Random Allocation”[Mesh] OR “Double-Blind Method”[Mesh] OR “Single-Blind Method”[Mesh] OR “Clinical Trial” [Publication Type] OR “Clinical Trials as Topic”[Mesh] OR “Clinical Trial”[TW] OR ((singl*[TW] OR doubl*[TW] OR trebl*[TW] OR tripl*[TW]) AND (mask*[TW] OR blind*[TW])) OR “Placebos”[Mesh] OR placebo*[TW] OR random*[TW] OR “Research Design”[Mesh:NoExp]) NOT (“Animals”[Mesh] NOT “Humans”[Mesh])
	#20 Combine	#18 OR #19
	#20 Limit	#20 NOT “In Vitro Techniques”[Mesh]
EMBASE	#1	“titanium”/exp
	#2	“Titanium”:ti,ab,kw,de OR “titanium surface”:ti,ab,kw,de OR “titanium surfaces”:ti,ab,kw,de OR “rough surface”:ti,ab,kw,de
	#3	“periimplantitis”/exp
	#4	“Peri-Implantitis”:ti,ab,kw,de OR “Peri Implantitis”:ti,ab,kw,de OR “Peri-Implantitides”:ti,ab,kw,de OR “Periimplantitis”:ti,ab,kw,de OR “Periimplantitides”:ti,ab,kw,de
	#5	“prostheses and orthoses”/exp
	#6	“Prostheses and Implants”:ti,ab,kw,de OR “Implants and Prostheses”:ti,ab,kw,de OR “Prosthetic Implants”:ti,ab,kw,de OR “Prostheses and Implant”:ti,ab,kw,de OR “Implant and Prostheses”:ti,ab,kw,de OR “Prosthetic Implant”:ti,ab,kw,de OR “Implant, Prosthetic”:ti,ab,kw,de OR “Implants, Prosthetic”:ti,ab,kw,de OR “Endoprosthesis”:ti,ab,kw,de OR “Endoprostheses”:ti,ab,kw,de OR “Prostheses”:ti,ab,kw,de OR “Prosthesis”:ti,ab,kw,de OR “Implants, Artificial”:ti,ab,kw,de OR “Artificial Implant”:ti,ab,kw,de OR “Artificial Implants”:ti,ab,kw,de OR “Implant, Artificial”:ti,ab,kw,de
	#7 Combine	#1 OR #2 OR #3 OR #4 OR #5 OR #6
	#8	“dental surgery”/exp
	#9	“Air Abrasion, Dental”:ti,ab,kw,de OR “Abrasion, Dental Air”:ti,ab,kw,de OR “Abrasions, Dental Air”:ti,ab,kw,de OR “Air Abrasions, Dental”:ti,ab,kw,de OR “Dental Air Abrasions”:ti,ab,kw,de OR “Dental Air Abrasion”:ti,ab,kw,de OR “air abrasive”:ti,ab,kw,de OR “air polishing”:ti,ab,kw,de OR “abrasive powder”:ti,ab,kw,de OR “dental surgery”:ti,ab,kw,de
	#10 Combine	#8 OR #9
	#11	“periodontal index”/exp
	#12	“Periodontal Index”:ti,ab,kw,de OR “Index, Periodontal”:ti,ab,kw,de OR “Indices, Periodontal”:ti,ab,kw,de OR “Periodontal Indices”:ti,ab,kw,de OR “Periodontal Indexes”:ti,ab,kw,de OR “Indexes, Periodontal”:ti,ab,kw,de OR “Community Periodontal Index of Treatment Needs”:ti,ab,kw,de OR “CPITN”:ti,ab,kw,de OR “Bleeding on Probing, Gingival”:ti,ab,kw,de OR “Gingival Bleeding on Probing”:ti,ab,kw,de OR “Gingival Index”:ti,ab,kw,de OR “Gingival Indices”:ti,ab,kw,de OR “Index, Gingival”:ti,ab,kw,de OR “Indices, Gingival”:ti,ab,kw,de OR “Gingival Indexes”:ti,ab,kw,de OR “Indexes, Gingival”:ti,ab,kw,de
	#13	“bleeding on probing”/exp OR “periodontal pocket depth”/exp
	#14	“bleeding on probing”:ti,ab,kw,de OR “BOP”:ti,ab,kw,de OR “probing pocket depth”:ti,ab,kw,de OR “PPD”:ti,ab,kw,de OR “bleed on probing”:ti,ab,kw,de OR “bleeding on probe”:ti,ab,kw,de OR “BoP (bleeding on probing)”:ti,ab,kw,de OR “depth of periodontal pocket”:ti,ab,kw,de OR “periodontal probe depth”:ti,ab,kw,de OR “periodontal probing depth”:ti,ab,kw,de OR “pocket depth (periodontal)”:ti,ab,kw,de OR “pocket probing depth”:ti,ab,kw,de OR “probing depth (periodontal)”:ti,ab,kw,de OR “probing pocket depth”:ti,ab,kw,de OR “periodontal pocket depth”:ti,ab,kw,de
	#15	“bone level”/exp OR “bone level”:ti,ab,kw,de
	#16	“plaque index”/exp
	#17	“Indexes, Dental Plaque”:ti,ab,kw,de OR “Indices, Dental Plaque”:ti,ab,kw,de OR “Dental Plaque Indexes”:ti,ab,kw,de OR “Dental Plaque Indices”:ti,ab,kw,de OR “Index, Dental Plaque”:ti,ab,kw,de OR “Plaque index”:ti,ab,kw,de
	#18 Combine	#11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17
	#19 Combine	#7 AND #10 AND #18
	#20 Limit	#19 AND [randomized controlled trial]/lim
	#21 Limit	#20 NOT ‘in vitro study’/exp
Cochrane Library	#1	[mh “Titanium”]
	#2	“Titanium”:ti,ab,kw OR “titanium surface”:ti,ab,kw OR “titanium surfaces”:ti,ab,kw OR “rough surface”:ti,ab,kw
	#3	[mh “Peri-Implantitis”]
	#4	“Peri-Implantitis”:ti,ab,kw OR “Peri Implantitis”:ti,ab,kw OR “Peri-Implantitides”:ti,ab,kw OR “Periimplantitis”:ti,ab,kw OR “Periimplantitides”:ti,ab,kw
	#5	[mh “Prostheses and Implants”]
	#6	“Prostheses and Implants”:ti,ab,kw OR “Implants and Prostheses”:ti,ab,kw OR “Prosthetic Implants”:ti,ab,kw OR “Prostheses and Implant”:ti,ab,kw OR “Implant and Prostheses”:ti,ab,kw OR “Prosthetic Implant”:ti,ab,kw OR “Implant, Prosthetic”:ti,ab,kw OR “Implants, Prosthetic”:ti,ab,kw OR “Endoprosthesis”:ti,ab,kw OR “Endoprostheses”:ti,ab,kw OR “Prostheses”:ti,ab,kw OR “Prosthesis”:ti,ab,kw OR “Implants, Artificial”:ti,ab,kw OR “Artificial Implant”:ti,ab,kw OR “Artificial Implants”:ti,ab,kw OR “Implant, Artificial”:ti,ab,kw
	#7 Combine	#1 OR #2 OR #3 OR #4 OR #5 OR #6
	#8	[mh “Air Abrasion, Dental”]
	#9	“Air Abrasion, Dental”:ti,ab,kw OR “Abrasion, Dental Air”:ti,ab,kw OR “Abrasions, Dental Air”:ti,ab,kw OR “Air Abrasions, Dental”:ti,ab,kw OR “Dental Air Abrasions”:ti,ab,kw OR “Dental Air Abrasion”:ti,ab,kw OR “air abrasive”:ti,ab,kw OR “air polishing”:ti,ab,kw OR “abrasive powder”:ti,ab,kw
	#10 Combine	#8 OR #9
	#11	[mh “Periodontal Index”]
	#12	“Periodontal Index”:ti,ab,kw OR “Index, Periodontal”:ti,ab,kw OR “Indices, Periodontal”:ti,ab,kw OR “Periodontal Indices”:ti,ab,kw OR “Periodontal Indexes”:ti,ab,kw OR “Indexes, Periodontal”:ti,ab,kw OR “Community Periodontal Index of Treatment Needs”:ti,ab,kw OR “CPITN”:ti,ab,kw OR “Bleeding on Probing, Gingival”:ti,ab,kw OR “Gingival Bleeding on Probing”:ti,ab,kw OR “Gingival Index”:ti,ab,kw OR “Gingival Indices”:ti,ab,kw OR “Index, Gingival”:ti,ab,kw OR “Indices, Gingival”:ti,ab,kw OR “Gingival Indexes”:ti,ab,kw OR “Indexes, Gingival”:ti,ab,kw
	#13	“bleeding on probing”:ti,ab,kw OR “BOP”:ti,ab,kw OR “probing pocket depth”:ti,ab,kw OR “PPD”:ti,ab,kw OR “bone level”:ti,ab,kw
	#14	[mh “Dental Plaque Index”]
	#15	“Indexes, Dental Plaque”:ti,ab,kw OR “Indices, Dental Plaque”:ti,ab,kw OR “Dental Plaque Indexes”:ti,ab,kw OR “Dental Plaque Indices”:ti,ab,kw OR “Index, Dental Plaque”:ti,ab,kw OR “Plaque index”:ti,ab,kw
	#16 Combine	#11 OR #12 OR #13 OR #14 OR #15
	#17 Combine	#7 AND #10 AND #16

.

2.3. Study Selection and Data Extraction

Two independent reviewers, KJJ and AL, screened the eligibility criteria of the retrieved papers in a blinded manner. Any discrepancies were resolved through discussion with a third author, WJP. The full text of the remaining articles was then assessed independently and in duplicate by KJJ and AL before final inclusion. The data extracted from the included studies were then organized according to the PICOS question and arranged in fields, including general information, such as author name and publication year; participant information, such as the number of patients and implants; intervention or comparison information, such as the type of treatment; and outcome information, such as probing depth, bleeding on probing, and alveolar bone level. Two authors, KJJ and AL, primarily conducted the data extraction, with additional support from authors SSH and WJP.

2.4. Risk-of-Bias Assessment

The reviewers utilized the Cochrane Risk-Of-Bias (ROB 2.0) tool to evaluate the randomized studies. The checklist included questions about the randomization process, variations from the planned interventions, missing outcome data, the measurement of the outcome, the selection of the reported result, and overall bias. The level of bias for the selected studies was assessed as low, some concerns, or high. The quality of the eligible studies was assessed by two reviewers, KJJ and AL.

2.5. Data Synthesis and Analysis

A meta-analysis was carried out using the R software (version 3.5.0; R Project for Statistical Computing). In this analysis, the mean difference (MD) and the 95% confidence interval (CI) were employed as summary statistics. A random-effects model was applied with a significance level of 0.05. To evaluate the variability among the studies, both the I² static and the chi-square test were conducted.

3. Results

3.1. Study Selection and Data Extraction

The literature search initially yielded 300 articles. Following the exclusion of 56 duplicates, the titles and abstracts of the remaining 244 articles were assessed, resulting in the exclusion of 220 articles that did not meet the inclusion criteria. Thereafter, the full-text versions of the 24 articles that remained were evaluated based on the eligibility. Of these, eight articles were found to be ineligible for further analysis (two due to insufficient data, four for being irrelevant to the topic, and one for having different follow-up periods in the same study), leaving 13 studies that were assessed for eligibility. The flowchart depicting the screening process is presented in Figure 1.

Table 1. Main characteristics of the included studies regarding intervention and control.

Study (Country, Year)	Groups	Intervention Device	Test Powder for Intervention	Control Group
Nicola, D., et al., Italy (2024) [28]	Participants in the test group were treated with an additional debridement using a glycine powder air polishing device (StarJet®, Mectron, Carasco, Italy) at each of the experimental sites (mesial, lingual, distal, and buccal) for 5 s with a subgingival nozzle, following the manufacturer’s instructions.	Glycine powder air polishing device (StarJet®, Mectron)	Glycine powder (Glycine Powder, Mectron)	Both groups underwent comprehensive full-mouth ultrasonic debridement using a magnetostrictive device (Cavitron Select SPS®, a product of Dentsply Sirona) that featured fine ultrasonic tips and a silicone insert (SlimLine 30 k insert, SofTip implant 30 k insert, also from Dentsply).
Selimović, A., et al., Norway (2023) [29]	The test subjects were also given a low-abrasive erythritol powder (Air-flow Plus, EMS, Nyon, Switzerland; particle size of 14 μm) through a PerioFlow handpiece that included an airflow unit (Airflow One, EMS, Nyon, Switzerland). The handpiece had a special nozzle designed for sub-mucosal peri-implant delivery that directed the air jet perpendicularly to the implant surface from the nozzle’s tip (PerioFlow nozzle, EMS, Nyon, Switzerland).	Airflow unit (Airflow One®, EMS, Nyon, Switzerland)	Low abrasive erythritol powder (Air-flow® Plus, EMS, Nyon, Switzerland; particle size 14 μm)	Conventional ultrasonic/curette instrumentation only
Luengo, F., et al., Spain (2023) [30]	The use of an ultrasonic instrument with a PEEK tip (Instrument PI, EMS, Nyon, Switzerland) was employed for decontaminating the implant surface both above and below the mucosal layer for a period of one minute. Following this, the implant surface was refined with the aid of a glycine powder air-polishing device, specifically the Perio AIR-flow® and Airflow Master Piezon® (EMS).	Glycine powder air-polishing device (Perio AIR-flow® and Airflow Master Piezon®, EMS)	Glycine powder	Patients employed the identical implant debridement approach, with polishing being performed using a rubber cup and polishing paste (Detartrine®, Septodont, Saint Maur, France).
Clementini, M., et al., Italy (2023) [31]	In the test group, the Perio-Flow nozzle (AIR-FLOW Master Piezon; EMS) was placed at each site of the peri-implant pocket (mesial, oral, distal, and buccal), enabling the erythritol powder (AIR-FLOW Powder PERIO; EMS) to exit for a duration of 5 s at an angle ranging from 60 to 90 degrees.	Perio-Flow nozzle (AIR-FLOW Master Piezon; EMS)	Erythritol powder (AIR-FLOW Powder PERIO; EMS)	Mechanical instrumentation of implant surfaces was performed using titanium curettes (Hu-Friedy) in all treatment groups (Appendix A Table A1). After that, subjects were randomly assigned to one of three treatment groups: no adjunctive methods (control group).
Hentenaar, D. et al., Netherlands (2022) [32]	The Airflow® Master Piezon® device, which is manufactured by EMS and based in Nyon, Switzerland, was used to treat the implant surface with an erythritol-based powder containing 0.3% chlorhexidine. This powder had a particle size of 14 μm and was marketed under the brand name PLUS Powder by EMS. The treatment was performed using the Airflow® device to achieve a higher quality surface finish.	Airflow®, using the Airflow Master Piezon® device, EMS, Nyon, Switzerland	Erythritol-based powder containing 0.3% chlorhexidine (14 μm, PLUS Powder, EMS)	Mechanically cleaned with gauzes soaked in saline.
Hentenaar, D. et al., Netherlands (2021) [33]	The air powder was applied subgingivally through a handpiece with a plastic nozzle.	N/A	Erythritol-based powder (grain size 14 μm) containing 0.3% chlorhexidine (PLUS® powder, Electro Medical Systems (EMS), Nyon, Switzerland)	Treated once using a piezoelectric ultrasonic scaler with a PEEK-coated plastic tip (PI instrument, EMS).
Lasserre, J. et al., Belgium (2020) [34]	The Air-Flow Perio system (Air-Flow Handy 3.0 Perio, EMS) was used to treat contaminated implant surfaces in the glycine air-polishing group, utilizing amino acid glycine powder (Ø 25 μm) (Air-Flow Perio powder, EMS). A special plastic nozzle (1.7 cm in length, with a 0.8 mm tip diameter) was connected to a dedicated handpiece (Air-Flow EL-542/A, EMS) and applied in a non-contact mode using a circular motion that moved from the coronal to the apical and tangential to the implant surface. The treatment time for each implant aspect was 15 s, and a high-speed aspiration system was used to prevent powder accumulation in the tissues and on the implant surface.	Air-Flow Perio (Air-Flow Handy 3.0 Perio, EMS); The specially designed plastic nozzle (length 1.7 cm; Ø 0.8 mm at the tip) was fixed on a dedicated handpiece (Air-Flow EL-542/A, EMS)	Amino acid glycine powder (Ø 25 µm) (Air-Flow Perio powder, EMS)	In the implantoplasty group, exposed and accessible titanium surfaces were treated with a resective approach, the aim of which was to polish the macro- and microtopography of the implant to remove the microbial biofilm mechanically. To limit tissue recession, the supra- and intrabony components of the contaminated implants were treated without osteoplasty. Round diamond burs (particle size, 30 μm) of various diameters (1.8, 2.3, and 3.5 mm) (Komet, Gerb. Brasseler, Lemgo, Germany) were assembled on a handpiece (KaVo Dental, Allgan, Germany) working at 15,000 rpm under copious saline irrigation. Small-diameter burs were necessary for adequate access to narrow intrabony defects. The whole implantoplasty procedure lasted approximately 5 min.
Aloy-Prósper, A. et al., Spain (2020) [35]	The instructions provided by the manufacturer were adhered to, and an abrasive air polisher was utilized on each implant surface for a duration of 5 s.	EMS Air-Flow Master Piezon® System (E.M.S. Electro Medical Systems S.A, Nyon, Switzerland)	Glycine powder	Mechanical debridement using titanium curettes in every case.
Toma, S. et al.,. Belgium (2019) [36]	Utilizing a specialized nozzle aligned parallel to the implant surface at each angle, from the coronal to the apical, with a 5-s duration of non-contact mode circular movement, followed by sterile saline flushing.	Perio-Flow® device (Perio-Flow Handy, Perio-Flow nozzle; EMS Medical, Nyon, Switzerland)	Amino acid glycine powder (Air-Flow Perio Powder, EMS Medical)	Treated using the Ti-Brush®, a plastic curette developed by the Straumann company based in Basel, Switzerland.
Ziebolz, D., et al., Germany (2017) [37]	Utilizing manual curettes and an air polishing system (Air-Flow Master, EMS) containing glycine powder (Perio-Flow, EMS) for therapeutic purposes.	Air polishing system (Air-Flow Master)	Glycine powder (Perio-Flow)	Plaque removal was performed by using manual curettes, a sonic-driven scaler, and a prophylaxis brush.
Lupi, S. M., et al., Italy (2017) [38]	The Perio-Flow nozzle, which is manufactured by EMS in Nyon, Switzerland, was utilized for 5 s on each of the lingual, distal, mesial, and palatal sides, as suggested by the manufacturer.	Air-abrasive device (AIR-FLOW Master 4; EMS)	Glycine powder (AIR-FLOW Powder SOFT; EMS)	Using plastic curettes (Implant Deplaquers, Kerr) and following with pocket irrigation using a 0.1% chlorhexidine digluconate solution (Corsodyls; GlaxoSmithKline Consumer Healthcare, Brentford, Middlesex, United Kingdom) (CHX) and sub-mucosal application of 1% CHX gel (Corsodyls Gel; GlaxoSmithKline Consumer Healthcare, Brentford, Middlesex, UK) was used to perform mechanical debridement.
John, G., et al., Germany (2015) [39]	A circular motion with the Hand-piece (Air-Flow® EL-308/A, EMS) was performed from coronal to apical parallel to the implant surface in a non-contact manner. The time allocated for each aspect, including mesial, distal, vestibular, and oral, was limited to 5 s.	AIR-FLOW Master®; PERIO-FLOW® nozzle, EMS, Nyon Switzerland	Amino acid glycine powder (Air-Flow® Perio Powder, EMS) (dv10 = 5 μm, dv50 = 20 μm, dv90 = 63 μm; corresponding to the size below which is 10, 50 (median particle size) and 90% of the total material volume, respectively)	Treated with carbon curettes (Straumann, Waldenburg, Switzerland) followed by pocket irrigation with a 0.1% chlorhexidine digluconate solution (Corsodyl®, GlaxoSmithKline Consumer Healthcare, Bühl, Germany) (CHX) and sub-mucosal application of 1% CHX gel (Corsodyl® Gel, GlaxoSmithKline Consumer Healthcare, Bühl, Germany) until the operator felt that the implant surfaces were adequately cleaned.
Sahm, N., et al., Germany (2011) [40]	The Air Flows EL-308/A handpiece (EMS) was moved in a circular motion from the coronal to the apical region, parallel to the implant surface, in a non-contact mode. The instrumentation time at each aspect, including the mesial, distal, vestibular, and oral regions, was limited to 5 s.	Air Flow Masters, Perio-Flows nozzle, EMS	Amino acid glycine powder (Air-Flows Perio Powder, EMS) (dv10: 5 mm, dv50: 20 mm, dv90: 63 mm; corresponding to the size below which is 10%, 50% (median particle size), and 90% of the total material volume, respectively)	Treated with carbon curettes (Straumann, Waldenburg, Switzerland) in conjunction with pocket irrigation using a 0.1% chlorhexidine digluconate solution (Corsodyls, GlaxoSmithKline Consumer Healthcare, Bühl, Germany) (CHX) and sublingual application of 1% CHX gel (Corsodyls Gel, GlaxoSmithKline Consumer Healthcare).

and

Table 2. Main characteristics of the included studies regarding parameters.

Study (Country, Year)	Peri-Implant Disease Diagnosis Parameter	Study Population	Follow-Up Period	Outcome	Results
Nicola, D., et al., Italy (2024) [28]	The presence of an implant in place for at least one year prior to the patient’s referral, as well as the presence of bleeding from multiple sites and/or suppuration after gentle probing.	Initial: n = 52; 157 implants F(t:69%, c:84%), M(t:31%, c:15%) Final: test: n = 25; 69 implants; control: n = 22; 68 implants. Mean age: test: 57.92; control: 60.96	3, 12 months	BOP, mPI, PPD, REC	Glycine powder air polishing does not provide a significant additional benefit over full-mouth ultrasonic debridement alone in resolving peri-implant mucositis. The higher the initial level of bleeding and probing depth, the lower the likelihood of disease resolution.
Selimović, A., et al., Norway (2023) [29]	Progress bone loss (CBL loss ≥ 2 mm) PD ≥ 4 mm BOP(+), SOP(+)	Initial: n = 43, 62 implants (22F, 21M) Final: t: n = 23, 31 implants; c: n = 20, 31 implants. Mean age: t65.8 ± 11.6, c64.5 ± 13.6	Baseline and 3, 6, 9, and 12 months	BOP, plaque (%), PD, KMW, crestal bone level	The study concluded that adjunctive erythritol air polishing did not provide a significant additional benefit over conventional non-surgical management in peri-implantitis. Both treatments failed to effectively resolve peri-implantitis, highlighting the need for ongoing management strategies and more effective non-surgical treatments.
Luengo, F., et al., Spain (2023) [30]	Bone loss > 2 mm BOP(+), SOP(+) PD ≥ 5 mm	Initial: n = 30 (12M, 18F) Final: t; n = 15; c: n = 15. Mean age: t62.2, c65.5	12 months	BOP, PI, PD, REC, RBL	Adding glycine powder air polishing to supportive peri-implant care protocol resulted in better clinical outcomes, including reduced probing depth, compared to conventional methods.
Clementini, M., et al., Italy (2023) [31]	Bone loss < 2 mm BOP(+), SOP(+)	Initial: n = 75 (39M, 36F) Final: T1: n = 25, 62 implants, T2: n = 25, 59 implants C: n = 25, 58 implants. Mean age: T1: 58.2 ± 9.6, T2: 57.5 ± 9.8 C: 55.7 ± 10.1	6 months	BOP, PI, PD	The utilization of air polishing and erythritol in non-surgical PM therapy appears to offer no substantial or clinically relevant advantages over the use of submarginal curettes alone in terms of reducing BOP and PPD, as well as achieving complete disease resolution. Baseline PPD of less than 4 mm, the presence of oral KM, and the presence of submucosal restorative margins are critical factors in achieving complete resolution of peri-implant mucositis.
Hentenaar, D., et al., Netherlands (2022) [32]	Probing pocket depth (PPD) ≥ 5 mm with concomitant bleeding and/or suppuration on probing (BOP/SOP) and progressive loss of marginal bone (MBL) ≥2 mm	Initial: n = 58 (33M, 25F) Final: T: n = 27, 54 implants C: n = 31, 40 implants. Mean age: T: 59.6; C: 59.3	At baseline and 3, 6, 9, and 12 months after intervention	BOP, PI, PPD, MBL	Erythritol air polishing was not more effective than saline irrigation in clinical, radiographic, and microbiological parameters for peri-implantitis surgical treatment. Both treatments resulted in low treatment success.
Hentenaar, D., et al., Netherlands (2021) [33]	Bone loss ≥ 2 mm BOP(+), SOP (+) PD ≥ 5 mm	Initial: n = 80, 139 implants (45M, 35F) Final: T: n = 40, 66 implants, C: n = 39, 73 implants. Mean age: T: 62 ± 8.9, C: 55 ± 14.1	3 months (successful cases up to 6, 9, 12 months)	BOP, peri-implant SOP (%), Plq (%), PPD, MBL	Erythritol air polishing and piezoelectric ultrasonic scaling seem to be equally effective when it comes to treating peri-implantitis non-surgically, as they show similar results in clinical, radiographic, and microbiological aspects. However, neither of these therapies can completely resolve peri-implantitis, which means that most patients will require additional surgical treatment. Fortunately, non-surgical maintenance was successful for a period of 12 months in the cases that were successful.
Lasserre, J., et al., Belgium (2020) [34]	PPD ≥ 5 mm Bone loss ≥ 2 mm BOP(+), SOP(+)	Initial: n = 31, 42 implants (9M, 22F) Final: T: n = 15 (20 implants); C: n = 16 (22 implants). Mean age: T: 71, C: 62.3	3, 6 months	PI, BOP, PPD, CAL, REC, BL	According to a six-month follow-up study, implantoplasty is as successful as glycine air polishing in addressing peri-implantitis during surgical treatment.
Aloy-Prósper, A., et al., Spain (2020) [35]	None	Initial: n = 34, 70 implants (18M, 16F) Final: T: n = 17 (32 implants); C: n = 17 (38 implants). Mean age: 58.4 ± 9.9	3 weeks	PI, BOP, PPD, CAL, REC, BL, mod. GI	Although the specific technique of debridement appears to have little impact, the initial stage still manages to lessen inflammation, which enables the tissues to be more prepared for the surgical intervention.
Toma, S., et al.,. Belgium (2019) [36]	PPD ≥ 5 mm Bone loss ≥ 2 mm No mobility	Initial: n = 47, 70 implants (8M, 39F) Final: PC: n = 15, 25 implants; PF: n = 16, 22 implants; TB: n = 16, 23 implants. Mean age: PC: 68.9 ± 15.8; PF: 67.5 ± 12.9; TB: 61.7 ± 13.4	3, 6 months	PI, BOP, GI, PPD, RAL, BL	Titanium brush and glycine air polishing exhibited superior effectiveness compared to other methods; however, the treatment success rate remained relatively low. To enhance the effectiveness of these procedures, incorporating antimicrobials and/or antibiotics may prove to be a more promising approach, and further investigation is warranted to explore this potential.
Ziebolz, D., et al., Germany (2017) [37]	None	Initial: n = 105, 167 implants (35M, 27F) Final: total n = 62, 101 implants; A (cu, us, br) n = 17, 24 implants; B (cu, ap, br) n = 15, 26 implants; C (cu, us, br, chx) n = 16, 30 implants, D (cu, ap, br, chx) n = 14, 21 implants. Mean age: 55.21 ± 11.3	12 months	BOP, PPD, MR	All strategies employed were effective in preventing peri-implant inflammation.
Lupi, S. M., et al., Italy (2017) [38]	Probing depth (PD) ≥ 4 mm, suppuration (+), bone resorption ≥ 30% compared to the initial situation	Initial: n = 46, 88 implants (35PE, 11TE) Final: T: n = 24, 51 implants; C: n = 22, 37 implants. Mean age: T: 54.58 ± 15.52; C: 53.77 ± 12.28	3, 6 months	BOP, PI, CAL, PD, BS	The use of glycine appears to be a more effective and suitable choice for maintaining peri-implant health compared to traditional treatments involving plastic curettes and chlorhexidine.
John, G., et al., Germany (2015) [39]	Probing depth ≥ 4 mm, BOP (+), suppuration (+), radiographic (loss of supporting bone ≤ 30% compared to the situation after implant placement)	Initial: n = 25, 36 implants (11M, 14F) Final: T: n = 12, 18 implants; C: n = 13, 18 implants. Mean age: 62.0 ± 13.2	Baseline, 12 months	BOP, PI, PD, MR, CAL	Both air-abrasive device and mechanical debridement are effective in the non-surgical management of peri-implantitis, with the air-abrasive device particularly effective in reducing inflammation as measured by BOP. Both methods are part of an effective management strategy for peri-implantitis.
Sahm, N., et al., Germany (2011) [40]	Probing depth ≥ 4 mm, BOP and suppuration, radiographic (loss of supporting bone 30% compared with the situation after implant placement)	Initial: n = 32, 43 implants (12M, 20F) Final: T: n = 15, 22 implants; C: n = 15, 19 implants. Mean age: 60.6 ± 38.6	Baseline, 3, 6 months	BOP, PI, PD, MR, CAL	This study found that both the air-abrasive device and mechanical debridement treatments resulted in similar improvements in clinical attachment levels and probing depths, but the air-abrasive device was more effective in reducing bleeding on probing. The results suggest that both treatments may be effective, but air-abrasive device may better control inflammation in the short term.

BOP, bleeding on probing; CAL, clinical attachment loss; PD, probing depth; PI, plaque index; MR, mucosal recession; BL, bone loss; IPS, implant plaque score; SOP, suppuration on probing.

offer an overview of the key characteristics of the studies that were ultimately included in this analysis.

3.2. Risk of Bias Assessment

The summarized results of the risk of bias assessment for each study in the included articles are presented in Figure 2. Figure 2A illustrated the risk of bias for each domain in each study, with green representing low risk of bias, yellow indicating unclear risk of bias, and red denoting high risk of bias. This evaluation revealed that the majority of studies exhibit a low risk of bias across many domains. Twelve studies were rated as low risk for randomization and deviation from the intended intervention. All studies were rated as low risk for missing outcome data. Three studies showed some concerns in the measurement and selection domains and one study demonstrated high risk in selection of the reported result. Figure 2B displays the overall risk of bias for each domain, with the length of the green rectangle indicating the number of studies assessed as low risk of bias. Six studies showed low risk of bias, while the other half had some concerns or high risk. This evaluation highlighted that certain areas, such as the selection of reported results and the measurement of outcomes, warrant caution.

3.3. Meta-Analysis

A total of fourteen articles (Nicola, D., et al., (2024) [28]; Selimović, A., et al., (2023) [29]; Luengo, F., et al., (2023) [30]; Clementini, M., et al., (2023) [31]; Hentenaar, D., et al., (2022) [32]; Hentenaar, D., et al., (2021) [33]; Lasserre, J., et al., (2020) [34]; Aloy-Prósper, A., et al., (2020) [35]; Toma, S., et al., (2019) [36]; Ziebolz, D., et al., (2017) [37]; Lupi, S., et al., (2017) [38]; John, G., et al., (2015) [39]; and Sahm, N., et al., (2011) [40]) were examined in a study to explore the differences in the treatment of peri-implantitis between air abrasion and mechanical decontamination.

3.3.1. Probing Depth

A random effects model was utilized, and the I² value at a low level of 93% (p < 0.01) signified substantial heterogeneity among the studies. The forest plot of meta-analysis showed the mean difference in probing depth was 0.28 (95% confidence interval, −0.20 to 0.76) (Figure 3). There was no significant difference between air abrasion and mechanical decontamination in general. The use of instruments in the non-surgical approach showed that the mean difference in probing depth was 0.13 (95% confidence interval, −0.50 to 0.76). The forest plot of meta-analysis showed that the mean difference in probing depth was 0.77 (95% confidence interval, −0.22 to 0.75) for the surgical approaches. The forest plot of meta-analysis showed that the mean difference in probing depth for the combined use of air abrasion and titanium curette compared with other mechanical decontamination was −0.79 (95% confidence interval, −1.75 to 0.17). Interestingly, the mean difference in probing depth of air abrasion compared with other mechanical decontamination methods in maintenance purposes was 1.05 (95% confidence interval, 0.18 to 1.91).

3.3.2. Bleeding on Probing

A random effects model was implemented, and the I² value of 81% (p < 0.01) demonstrated substantial variability among the studies, indicating a significant level of heterogeneity. The forest plot of meta-analysis showed the mean difference in bleeding on probing was 0.51 (95% confidence interval, 0.07 to 0.95) (Figure 4). There was significant difference in bleeding on probing between air abrasion and mechanical decontamination. The use of instruments in the non-surgical approach showed that the mean difference in bleeding on probing was 0.46 (95% confidence interval, −0.29 to 1.21). No significant difference was noted between air abrasion and mechanical decontamination. The forest plot of the meta-analysis showed that the mean difference in bleeding on probing was 0.70 (95% confidence interval, −0.18 to 1.57) for the surgical approaches. There was no significant difference between air abrasion and mechanical decontamination. The mean difference in bleeding on probing for air abrasion compared with other mechanical decontamination methods for maintenance purposes was 0.39 (95% confidence interval, −0.69 to 1.47).

3.3.3. Alveolar Bone Level

A random effects model was utilized, and the I² value was found to be 87% (p < 0.01), suggesting considerable heterogeneity among the studies. The forest plot of the meta-analysis showed the mean difference in alveolar bone level was −0.14 (95% confidence interval, −0.77 to 0.48) (Figure 5). There was no significant difference between air abrasion and mechanical decontamination. The use of instruments in the non-surgical approach showed that the mean difference in alveolar bone level was 0.04 (95% confidence interval, −0.23 to 0.31). The forest plot of the meta-analysis showed that the mean difference in alveolar bone level for surgical approaches of air abrasion compared with other mechanical decontamination was 0.32 (95% confidence interval, 0.03 to 0.61). The mean difference in air abrasion compared with other mechanical decontamination methods for maintenance purposes was 0.00 (95% confidence interval, −0.72 to 0.72).

3.4. Publication Bias Analysis

The analysis of publication bias was illustrated in Figure 6 using a funnel plot that includes probing depth, bleeding on probing, and alveolar bone level. Asymmetry was observed in all three plots. In the case of bleeding on probing, studies with small sample sizes and large standardized mean difference (SMD) values were observed in the lower right corner, indicating the possibility that publication bias may have influenced the results. To statistically verify the asymmetry of the funnel plot, Egger’s regression test was performed. While the results were not statistically significant for pocket depth and bone level, BOP showed statistical significance with a p-value of 0.02, as shown in Appendix A 

Table A2. Analyses for publication bias.

		PD	BOP	Bone Level
Original analysis	SMD (95% CI)	0.28 (−0.20 to 0.76)	0.51 (0.07 to 0.95)	−0.14 (−0.77 to 0.48)
	p-value	p < 0.01	p < 0.01	p < 0.01
Trim-and-Fill analysis	SMD (95% CI)	−0.19 (−0.76 to 0.38)	0.12 (−0.44 to 0.68)	−0.14 (−0.77 to 0.48)
	Filled studies /total studies	5/22	3/12	0/7
Egger’s regression test	t-value	1.76	3.15	−0.81
	df	15	7	5
	p-value	0.10	0.02	0.45
	Bias estimate	5.85 (SE = 3.32)	5.65 (SE = 1.67)	−3.51 (SE = 4.31)

PD, probing depth; BOP, bleeding on probing; CI, confidence of interval; df, degree of freedom; SE, standard error.

, confirming the potential presence of publication bias. To assess the extent of this bias, a trim-and-fill analysis was conducted. For BOP, it was estimated that three studies were missing, and when these were included, the SMD was analyzed as 0.12 (−0.44 to 0.68), which was not statistically significant, suggesting that publication bias likely influenced the study results. In the case of pocket depth, five additional studies were added, resulting in an SMD of −0.19 (−0.76 to 0.38). Although this value was reduced compared to the original results, it did not significantly impact the overall study findings.

4. Discussion

The aim of this systematic review and meta-analysis was to evaluate and contrast the differences in managing inflammatory responses around dental implants using air abrasion and mechanical decontamination techniques. The results of the study showed that air abrasion was just as effective as other mechanical decontamination methods in general. The results of the subgroup analysis showed that air abrasion was less effective in reducing probing depth in maintenance purposes. Additionally, air abrasion was less effective in reducing alveolar bone loss in surgical approaches.

Despite the limited overall efficacy of non-surgical therapies, a non-surgical treatment phase is essential in the comprehensive treatment strategy for peri-implantitis [41]. The previous reports showed that the non-surgical treatment of mild to moderate peri-implantitis resulted in a significant reduction in probing depth, bleeding index, and pus at the 12-month follow up [42]. The successful results from the non-surgical treatment may provide the benefit to the patients to the extent that no further surgical intervention is necessary. However, in addressing peri-implantitis, the limitations of non-surgical treatment lead to interest in therapeutic strategy that involves a surgical modality [43]. This procedure entails the removal of the upper prosthesis, followed by flap debridement to excise granulation tissue [44]. Subsequently, mechanical decontamination methods are employed to cleanse the implant surface of any contaminants. This study showed that the effects of air abrasion or other mechanical decontamination did not differ much between non-surgical methods or surgical methods in general. The decontamination efficacy differed for alveolar bone.

Air abrasions are considered the preferred instruments when it is necessary to preserve the surface integrity of rough titanium surfaces [45]. In a similar way, air-abrasion devices have been proven to be effective and safe for the purpose of decontaminating zirconia implants due to their ability to preserve the integrity of the implant surface [46]. The utilization of air-abrasion powders presents a potential alternative to adjunctive treatments using antiseptics for the removal of biofilms [47]. Air abrasion therapy has been shown to significantly reduce periodontal probing depths in peri-implantitis cases [39]. The reduction in probing depth indicated an improvement in peri-implant health, likely due to the removal of biofilm and reduction in inflammation. The application of an air-abrasion device in conjunction with glycine powder during surgical intervention for peri-implantitis led to more favorable outcomes in terms of periodontal probing depth when the implant was analyzed statistically [48]. The results using air abrasion led to improvement in bleeding on probing, suggesting a positive effect on peri-implant health [49]. This study clearly demonstrated that the use of air abrasion was just as effective as other mechanical decontamination methods for the reduction of probing depth, bleeding on probing and alveolar bone loss.

There are several things to consider when applying air abrasion for the peri-implantitis. Treatment protocols, duration, and treatment interval may vary depending on the severity of the condition and the type of the defect, leading to different results. The type of power used in the study may vary. Glycine and erythritol are commonly used in air-abrasion therapy due to their fine particle size and biocompatibility [47,48]. Tricalcium phosphate powder or apatite bioceramic powders consisting of 95% hydroxyapatite + 5% calcium oxide or 90% hydroxyapatite + 10% calcium oxide have been used for implant-related diseases [50,51]. The use of hydroxyapatite and calcium oxide bioceramics in air abrasion has been found to result in the deposition of powder on treated implant surfaces, which may affect the healing of implants affected by peri-implantitis. It is important to consider this potential impact when using air abrasion with these bioceramics [51]. The distance between the air abrasion nozzle and the implant surface may be important for effective decontamination and preventing damage to the tissues. Chemotherapeutic agents are also commonly used in the treatment regimens for peri-implantitis [52]. The additional use of chlorhexidine was applied in the previous research, and this may have beneficial effects in the treatment of peri-implantitis [53]. Conversely, in the previous research, it was recommended to avoid using chlorhexidine on titanium surfaces, as it may impair the biocompatibility of these surfaces and compromise the effectiveness of implants [54].

Our meta-analysis employed a comprehensive search strategy and followed the PRISMA guidelines with great precision. However, it is important to acknowledge some limitations that should be taken into account. The findings of the present study should be interpreted with caution, taking into account the types of studies included, their heterogeneity, and the risk of bias. The effectiveness of air abrasion as a decontamination method is generally comparable to other mechanical techniques, and additional research is necessary to confirm these findings.

5. Conclusions

The findings of the study indicate that the use of air abrasion was just as effective as other mechanical decontamination methods in reducing probing depth and alveolar bone loss. The results of the subgroup analysis showed that air abrasion was less effective in reducing probing depth in maintenance purposes. Additionally, air abrasion was less effective in reducing alveolar bone loss in surgical approaches.