Subcutaneous Emphysema Following Subgingival Polishing Using an Air Polishing System With Subgingival Nozzle: A Case...

Subcutaneous facial emphysema (SFE) is a rare but potentially serious complication of dental procedures involving pressurised air. While most historically reported cases were associated with air-driven handpieces, more recent literature has also implicated air-polishing systems. However, reports related to the use of subgingival air-polishing nozzles in periodontal pockets remain limited.

The presented case demonstrates an SFE that occurred following the use of an air-polishing system in a deep periodontal pocket. A glycine-based air-powder abrasion was used in a 5 mm deep periodontal pocket for biofilm eradication. After which, a periorbital and right cheek swelling arose. Hospitalisation was essential for close surveillance, and antibiotics were administered to control microbial spread. After 3 days, the patient was discharged in a stable condition and without any further complications.

SFE may occur during subgingival air polishing, even during supportive periodontal therapy and at sites without bleeding on probing or suppuration. This case highlights that the safety of subgingival air-polishing procedures should not be generalised across all devices and protocols. Careful case selection, strict adherence to device-specific instructions, and early recognition of swelling and crepitus are essential for prompt diagnosis and management.