Read Lynn Pencek's first article about the survey.

With implant maintenance, the use of air polishing has been presented as the gold standard for biofilm removal. Traditional methods of debriding implant surfaces, such as hand scaling with metal instruments or polishing with abrasive polish, may cause surface changes, increase roughness, and biofilm adhesion.¹

Air polishing has emerged as a less invasive alternative that uses fine abrasive powders and pressurized air to remove biofilm without causing significant damage to the implant surface.² Different types of abrasive powders are used in air polishing, including glycine, sodium bicarbonate, and erythritol. Each powder has unique properties that may affect the surface texture and biocompatibility of the dental implant surface.³

Here I'll explore dental hygienists' knowledge on using air polishers on dental implants.

Formal implant maintenance training, past and present

The dental implant industry has witnessed tremendous growth in recent years, driven by technological advancements that enhance precision, affordability, and accessibility. In the US, the dental implant market was valued at $4.43 billion in 2023 and is projected to reach $5.89 billion by 2029, growing at a 4.86% CAGR. That’s a projected five million dental implants to be placed per year.⁴

Study implementation

A digital survey was sent out to hygienists through email, social media, and during continuing education events taught by me across diverse US regions.

The survey represented dental hygienists living in the Northeast, South, West Coast, and Midwest. These professionals reported receiving their formal dental hygiene training between 1959 and 2024. Participants reflected varied practice settings, including general practice and periodontal offices. Participants reported seeing a variety of patient volumes. In this survey, participants were asked to share their experiences with air-polish and air-abrasive methods for implant maintenance.

Education for implant maintenance is rising. Of the 604 who completed the 2024 survey, 42.6% reported lacking implant maintenance training, while 57.4% of respondents reported receiving formal implant maintenance training.

Detailed breakdown

• Air-polish/air-flow devices: Of the 413 who responded to the survey about use of air-polishing, 25%, 103 hygienists, reported using air polishers for professional biofilm removal on dental implants. 75%, or 310, reported they do not use air polishers on dental implants.
• Of the 103 air polisher users, when asked about their effectiveness in the removal of biofilm, a compelling 99%, 102 respondents, found use of air polishing effective in removing biofilm around dental implants, compared to 1%, 1 out of 103, reporting use of air polisher not effective.

Comparison with historical data

The inspiration for this 2024 survey was to compare data and demonstrate the growth of trends for implant maintenance. A 2020 survey conducted by Ivy Zelmer reported that 5%, 82 of the 1,646 hygienists who responded to this survey reported using air polishers, with 71%, 58 of the 82 of respondents who used air polishers, finding the use of air polishers effective.⁵  

The 2024 data marks a significant shift from 2020. In 2020, respondents reported higher concentration on the use of plastic scalers and limited air polisher use to a broader, highly effective use of air-abrasives. This change was driven by education and technology.

We asked the 413 users of air polishers what powder agent they use in their air polisher

Sodium bicarbonate/baking soda: 22%, 90 hygienists, reported using sodium bicarbonate as an air-abrasive powder agent. Of the 90 hygienists who reported using sodium bicarbonate on dental implant patients, 97%, 87 respondents, reported finding sodium bicarbonate effective in removing biofilm, and 3%, three respondents, found it not effective in removing biofilm.

Erythritol: 31%, 128 hygienists, reported using erythritol as the air-flow agent on dental implants. Of the 128 respondents who reported using erythritol, 98%, 125 hygienists, found use of erythritol to be effective, and 2%, three of the respondents, found it not effective,  

Glycine: 36%, 149 hygienists, reported use of low-abrasive powder glycine, the most popular air-abrasive used. Of the 149 hygienists reported using glycine, 97%, 145 people, reported use of glycine to be effective, and 3%, four of the respondents, found it not effective in removing biofilm,

Benefits of agents chosen

Maintaining the smoothness of the implant abutment surface is important as increased roughness can facilitate bacterial colonization and biofilm formation, which leads to a higher risk of peri-implant complications.³ Glycine and erythritol are fine, low-abrasive powders that have been shown to effectively remove biofilm without significantly altering the implant surface roughness.⁶ In contrast, sodium bicarbonate, a coarser abrasive, may cause surface alterations that increase roughness and potentially enhance bacterial adhesion.⁷

In 2024, Sah et al. compared the effect of 20-second use of glycine, erythritol, and sodium bicarbonate on dental implant abutments.³ The air polisher pressure used 60 psi and a nozzle distance of 5 mm. Results revealed that the implant abutments' surface roughness changed very little after air polishing with erythritol and glycine powders. However, sodium bicarbonate powder dramatically increased surface roughness. Concerns here are that this increased roughness would raise the possibility of biofilm formation affecting the implants' long-term success.

Prevalence of the use of sodium bicarbonate

The variety of products used can be related to the length of time air polishers have been on the market. The original Dentsply Prophy Jet, featuring sodium bicarbonate, was first introduced to the dental profession in the late 1970s.⁸

Air polishers, like cars, are a significant investment that can last for years as long as they are functioning correctly or the owner recognizes it’s time for an upgrade.

Benefits of erythritol and glycine

Erythritol air-polishing shows promising results for professional oral hygiene in implant-supported restorations and is effective and safe for removing biofilm from titanium dental implants.⁹ Erythritol air-polishing promotes a favorable biological response without causing significant damage to the implant surface or peri-implant tissues. Erythritol is an artificial sweetener and a food additive. It is a chemically neutral, nontoxic, water-soluble polyol. It has a small particle size, is reported to lower the counts of Porphyromonas gingivalis, and there’s no significant damage to soft or hard tissue after using erythritol powder.

Glycine is an amino acid, nontoxic, biocompatible organic salt crystal. It has slow solubility in water and is 80% less abrasive than NaHCO₃, The particle size glycine powder ranges 45–60 µm. Glycine produces less soft tissue damage. Glycine powder demonstrated a reduction in probing pocket depth and bleeding on probing in 12-month studies.⁹ Rarely have emphysemas been reported as an adverse reaction.^10,11

Conclusion

The dental implant industry is rapidly evolving with advancements in air-polishing and safe air-abrasive agents, and they’re enhancing patient care. Adoption can be hindered by a lack of communication between surgical, restorative, and hygiene teams. Often, those in the office who purchase equipment may not attend the same training sessions as the dental hygiene team, resulting in missed opportunities to collectively learn about and implement safe and effective implant maintenance protocols.

The 2024 survey reveals a positive shift—dental hygienists are increasingly embracing air-polishing as part of their implant maintenance routine. Education and access to updated techniques have played a significant role in promoting better care practices and aligning the efforts of dental teams.

References

1. Schwarz F, Rothamel D, Sculean A, Georg T, Scherbaum W, Becker J. Effects of an Er:YAG laser and the Vector ultrasonic system on the biocompatibility of titanium implants in cultures of human osteoblast-like cells. Clin Oral Implants Res. 2003;14:784-792. doi:10.1046/j.0905-7161.2003.00954.x

2. Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Clin Periodontol. 2018;45(Suppl 20):S246-S266. doi:10.1111/jcpe.12954

3. Sah N, Bamusa B, Mehrotra N, Pradhan A, Mishra S, Goyal S. Effect of air polishing on surface roughness in implant abutments. Bioinformation. 2024;20(11):1667-1670. doi:10.6026/9732063002001667

4. Dental implants market focused insights 2024-2029, featuring key vendor profiles of Straumann, Dentsply Sirona, Zimmer Biomet, Henry Schein, Envista, Dentium and Osstem Implant. Business Wire. January 7, 2025. https://www.businesswire.com/news/home/20250107164258/en/Dental-Implants-Market-Focused-Insights-2024-2029-Featuring-Key-Vendor-Profiles-of-Straumann-Dentsply-Sirona-Zimmer-Biomet-Henry-Schein-Envista-Dentium-and-Osstem-Implant---ResearchAndMarkets.com 

5. Zellmer IH, Couch ET, Berens L, Curtis DA. Dental hygienists’ knowledge regarding dental implant maintenance care: a national survey. J Dent Hyg. 2020;94(6):6-15

6. Moëne R, Décaillet F, Andersen E, Mombelli A. Subgingival plaque removal using a new air-polishing device. J Periodontol. 2010;81(1):79-88. doi:10.1902/jop.2009.090394

7. Müller N, Moëne R, Cancela JA, Mombelli A. Subgingival air-polishing with erythritol during periodontal maintenance: randomized clinical trial of twelve months. J Clin Periodontol. 2014;41(9):883-889. doi:10.1111/jcpe.12289

8. Graumann SJ, Sensat ML, Stoltenberg JL. Air polishing: a review of current literature. J Dent Hyg. 2013;87(4):173-180

9. Delucchi F, Ingegnieros L, Pesce P, et al. Efficacy and safety of erythritol air-polishing in implant dentistry: a systematic review. Int J Dent Hyg. 2025;23(1):44-62. doi:10.1111/idh.12836

10. Shrivastava D, Natoli V, Srivastava KC, et al. Novel approach to dental biofilm management through guided biofilm therapy (GBT): a review. Microorganisms. 2021;9(9):1966. doi:10.3390/microorganisms9091966

11. Munro IC, Berndt W., Borzelleca JF, et al. Erythritol: an interpretive summary of biochemical, metabolic, toxicological and clinical data. Food Chem Toxicol. 1998;36:1139-1174. doi:10.1016/S0278-6915(98)00091-X