## 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  
Figure 6: Funnel plot without added studies illustrating the publication bias analysis. (**A**) Probing depth. (**B**) Bleeding on probing. (**C**) Alveolar bone level. 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 erythroid are commonly used in air-abrasion therapy due to their fine particle size and biocompatibility [47; 48]. Tricalcium phosphate powder or apatite bioecamic powders consisting of 95% hydroxyapatite + 5% calcium oxide or 90% hydroxyapatite + 10% calcium oxide have been used for implant-related diseases [50; 51].