The clinical efficacy of subgingival debridement by ultrasonic instrumentation compared with subgingival air polishing during periodontal maintenance: a systematic review

Abstract Background To evaluate the effect of subgingival debridement by ultrasonic debridement (UD) in comparison with subgingival air polishing (SubGAP) during periodontal maintenance. Methods A systematic search of electronic databases was conducted to identify publications from 01/01/2000 to 21/12/2018. Publication selection, data extraction and risk of bias assessment were performed by two reviewers independently. The addressed PICO question was: : “For patients in periodontal maintenance phase, is SubGAP more likely to result in better clinical outcomes than UD?” Results From a total of 435 articles identified, 6 studies were included. Though none of them was evaluated as low risk of bias, overall, the main reason was blinding of personnel was almost impossible to achieve for the study design. Due to the heterogeneity, the data from included studies could not be synthesized. The majority of included studies suggested no statistical difference of pocket depth reduction, except for one showed UD was superior to SubGAP. In terms of clinical attachment loss and gingival regression, no treatment was indicated had more benefits than the other based on the present evidence. SubGAP had preferable comfort level compared to UD, as reported. It must be noted that none of included studies’ follow-up time was more than 1 year. Conclusion It remains inconclusive that the clinical efficacy of SubGAP compare to UD for periodontal maintenance on account of limited evidence. To date, neither SubGAP or UD showed superior clinical effect when put in comparison. High-quality, well-designed clinical studies are still needed to ascertain the long-term clinical stability.