Main Content
Some treatments in dentistry become popular overnight. Others quietly evolve for years before gaining the spotlight. Subgingival air polishing belongs to the second category. It is gentle, comfortable for patients, and increasingly used during non-surgical periodontal therapy. But with so many powders available today, the question naturally comes up: Does one powder actually work better than the others?
A new systematic review and network meta-analysis finally gives us a clear, research-backed answer—and surprisingly, it is not dramatic. All three commonly used powders perform almost the same, with only a very small edge for erythritol.
Let us break it down in a simple, chairside-friendly way.
What the researchers examined
The review included only strong-quality studies:
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Randomised controlled trials
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English language publications
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Minimum three months follow-up
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Confirmed diagnosis of periodontitis based on the 2018 European Federation of Periodontology and American Academy of Periodontology classification
After screening, only nine clinical trials with 462 patients qualified. This alone tells us something: although air polishing is widely used, high-quality long-term research is still limited.
The powders studied were the three most popular low-abrasive options:
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Glycine powder – a soft, water-soluble amino acid-based powder
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Erythritol powder – a very fine, smooth sugar alcohol-based powder
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Trehalose powder – a non-cariogenic disaccharide used as a gentle polishing agent
The outcomes analysed were the three pillars of periodontal healing:
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Reduction in pocket depth
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Gain in clinical attachment
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Reduction in bleeding on gentle probing
What the results actually showed
The main finding is extremely simple:
There was no meaningful difference among glycine, erythritol, and trehalose in improving clinical attachment, reducing pocket depth, or decreasing bleeding.
In other words:
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All three powders work.
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All three are gentle.
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All three are safe for root surfaces and soft tissues.
The difference lies only in fine, microscopic tendencies.
When the researchers arranged the results using a statistical ranking method, erythritol showed a small advantage for pocket depth reduction. This advantage was not large enough to change clinical decisions completely, but it does give erythritol a subtle lead.
Why might this happen?
Possibly because erythritol has the smallest particle size among the three powders. Its fine particles can flow deeper into narrow areas, disturb biofilm more efficiently, and cause the least abrasion.
How this translates to daily practice
This is the part that truly matters. Research is useful only when it helps us treat our patients better.
Here is the practical, real-world interpretation:
Glycine powder
Reliable, well studied, comfortable for patients, and excellent for most periodontal sites. Some laboratory studies suggest it may interfere slightly with early wound healing, but this has not been confirmed consistently in human clinical studies.
Erythritol powder
The smallest particle size, the least abrasive, and possibly the best option for deeper periodontal pockets or sensitive patients. It also shows antimicrobial activity against certain harmful bacteria. In the analysis, it ranked highest for pocket depth reduction.
Trehalose powder
Gentle, non-cariogenic, and comparable to glycine in performance. It may have slightly lower antibacterial impact than glycine or erythritol, but clinically, the difference is minimal.
Hence all three low-abrasive powders—glycine, erythritol, and trehalose—are safe and effective for cleaning periodontal pockets, but erythritol may offer a small advantage in reducing deeper pockets.
While current evidence gives us good direction, we still need larger, more uniform clinical trials to make strong, guideline-level recommendations.
