Efficacy of an interdental brush in cleaning artificial plaque on a 3D-printed model base

Evaluation of the effects of using an interdental brush dipped in 0.2% hyaluronic acid gel on clinical periodontal parameters among patients with periodontitis: a randomized controlled trial

BACKGROUND

The additional use of agents with antibacterial and anti-inflammatory activities, such as hyaluronic acid in treating periodontal disease, has recently become popular. This study aimed to evaluate the effects of using an interdental brush dipped in 0.2% HA gel on clinical periodontal parameters.

METHODS

This randomized controlled trial was conducted among 60 patients with stages II/III grades A/B periodontitis. After full-mouth scaling root planning and oral hygiene training, the patients were divided into two groups; the test group was asked to use an interdental brush dipped in 0.2% HA, while the control group was asked to use a regular interdental brush. Clinical periodontal parameters [ gingival index (GI), plaque index (PI), papillary bleeding index (PBI), pocket depth (PD), and clinical attachment loss (CAL) ] were assessed at baseline and in the 1st and 3rd months after treatment.

RESULTS

Clinical periodontal parameters were improved in control and test groups at the 1 and 3-month compared to baseline (p < 0.05). The 1st- and 3rd-month PBIs were significantly lower in the test group (p < 0.05). There was no significant difference between the test and control groups regarding PI, PD, GI, and CAL between the follow-up times.

CONCLUSIONS

Although the clinical efficacy of the tested methods of interdental brush use was similar, it can be concluded that the use of an interdental brush dipped in HA may contribute to the reduction of gingival bleeding in the early period.

CLINICAL SIGNIFICANCE

Incorporating HA into the oral hygiene regime after periodontitis treatment using an interdental brush is a useful and practical method. NAME OF THE REGISTRY: https://clinicaltrials.gov/ TRIAL REGISTRATION NUMBER: NCT06309797.

DATE OF REGISTRATION

07/03/2024 "Retrospectively registered". URL: https://clinicaltrials.gov/study/NCT06309797.

In-vitro simulation methods for mechanical plaque removal: a systematic scoping review of current techniques and future directions

BACKGROUND AND OBJECTIVES

Different methods to simulate plaque in order to test the efficacy of oral cleaning methods have been published. This scoping review aims to provide an overview of the existing models and to highlight their respective benefits and limitations.

MATERIAL AND METHODS

Following the recommended scoping review methodology the scientific literature was systematically searched electronically (PubMed and Scopus) and by hand search up to July 2024, using combinations of search items related to oral plaque simulation, periodontitis or peri-implantitis. Retrieved study titles and abstracts were screened for possible inclusion. Finally, data from included fulltexts was extracted by two independent reviewers. Nine different characteristics for proper plaque simulation method were defined and each existing method evaluated and rated accordingly, and an overall rating was calculated for each method.

RESULTS

Initially, 1787 records were identified. After abstract and title screening and fulltext revision, 25 fulltexts describing 7 different simulation methods, were included. The assessed methods of simulation were ink (12), varnish (5), calcium phosphate (1), calcium carbonate (1), occlusal spray (3), aluminum (1), commercially distributed and prepared artificial plaque (2). Even though some materials achieved good results in the assessment for individual criteria like water solubility, big differences could be found concerning practicability and production time, no simulation method was rated "very good" or even "good" in the overall evaluation. While ink and varnish were considered simulation materials of moderate quality for oral plaque simulation, all other techniques were assessed as weak simulation materials.

CONCLUSION

Among the different published methods for the simulation of mechanical plaque removal, none seems to sufficiently simulate the essential characteristics of oral plaque, while some simulation methods may be useful to feature single properties of plaque in in-vitro studies sufficiently. Nevertheless, advanced models reflecting the diverse features of dental plaque more comprehensively are needed.

Design and Efficacy of Custom-Made Cleaning Splints for the Approximal Plaque Removal-A Laboratory Study

Objectives: Cleaning splints (CSs) can facilitate interdental brush (IDB) insertion and guide IDBs during cleaning movement. Cleaning efficacy with and without CSs was to be assessed and compared for a fully dentate (FD) and a partially edentulous (PE) situation. Methods: For two maxillary typodont models simulating either an FD situation or a PE situation with every second tooth missing, suitable IDBs were selected and each cleaning splint was designed and fabricated by 3D-printing. Before and after standardized cleaning, model teeth were photographed at three timepoints: (T1) clean surface, (T2) surface coated with artificial plaque, and (T3) after IDB cleaning. For each of the four test groups differing in dental status (FD, PE) and CS use (without, with), n = 10 tests/group were completed. After aligning corresponding photographs, pixel-based color difference ratios (T2-T3)/(T2-T1) were calculated. Approximal cleaning efficacy was set as the mean value over predefined regions of interest. Effects of CS use and dental status were analyzed with two-way ANOVA (α = 0.05). Results: CS use significantly improved mean approximal cleaning efficacy for the PE model (p = 0.001), whereas no difference was found with the FD model (p = 0.381). Improved cleaning efficacy with the PE model was only found in combination with a CS (factor combination model × CS use: p = 0.003). Conclusions: Cleaning splints might have the potential to improve interproximal hygiene and can be recommended for clinical use. Clinical studies should validate the results of this in vitro study and clarify if CSs could be beneficial for patients with restricted manual skills.

Plaque cleaning efficacy of waist-shaped interdental brushes among individuals with open interproximal spaces: a systematic review

BACKGROUND

The shape and design of interdental brushes are crucial for appropriate adaptation to the interproximal areas, despite their excellent cleaning efficacy. The aim of this review is to assess and compare the available data on the plaque cleaning efficacy of waist-shaped interdental brushes with any other shaped-interdental brushes among patients with wide interdental spaces.

METHODS

Scopus, PubMed, Cochrane, Science Direct, EBSCO Host, Lilacs, Science Direct, Web of Science, and Google Scholar were searched from the earliest available year (2011) till May 15, 2024. PICO Strategy: P: Individuals with open interproximal spaces; I: Waist-shaped interdental brushes; C: Any other shaped interdental brushes; O: Interproximal plaque cleaning efficacy. The review only comprised randomized controlled trials. The risk of bias assessment and quality of evidence was assessed using the RoB-2 Tool and GRADE Tool respectively.

RESULTS

Three full-text publications that met the requirements for eligibility underwent additional processing for data extraction. The overall results of the review suggest that the plaque cleaning efficacy of waist-shaped interdental brushes is better than straight/cylindrical-shaped interdental brushes in patients with open interdental spaces; especially on the buccal and lingual line angles. However, the pooling of data was not possible due to the high heterogeneity between the studies.

CONCLUSION

The current review suggests that the plaque cleaning efficacy of waist-shaped interdental brushes could be better than straight or cylindrical shaped-interdental brushes in patients with open interproximal spaces, especially in buccal and lingual line angles. However, further research should focus on appropriate methodological techniques to increase overall reporting quality and limit the possibility of bias.

The influence of artificial saliva on the cleaning force of interdental rubber picks: an in-vitro comparison

BACKGROUND

The familiar aids for interdental cleaning such as dental floss or interdental brushes (IDB) are often associated with difficult handling or an increased potential for trauma. Interdental picks (IRP), which have no metal core and silicone flaps instead of nylon brushes, offer the alternative. However, in-vitro studies found a lower cleaning effectiveness combined with higher forces for cleaning compared with conventional IDBs. The aim of this in-vitro study was to measure the experimental cleaning forces (ECF) using IRP with versus without an artificial saliva (AS; GUM Hydral, Sunstar Suisse SA, Etoy, Switzerland).

METHODS

The test set-up was developed to investigate the cleaning of 3D-printed interdental area (IDR) mimicking human teeth (Form 2, Formlabs Sommerville, MA, USA) under standardized conditions. Three different morphologies (isosceles triangle, convex, concave) and three different sizes (1.0 mm,1.1 mm,1.3 mm) were used. Two different IRPs (GUM Soft-picks Advanced: SPA versus GUM Soft-picks Advanced Plus: SPA+, Sunstar Suisse SA, Etoy, Switzerland) in three sizes (small, regular, large), were used with versus without AS. ECF during ten cleaning cycles were recorded by a load cell [N].

RESULTS

Using AS leaded to significant lower values for ECF than without (1.04 ± 0.66 N versus 1.97 ± 1.01 N, p < 0.001). In general, a lower ECF was recorded for convex IDR compared to isosceles triangle and concave morphologies (p < 0.001) as well as for gap sizes of 1.3 mm compared to the smaller sizes (p < 0.001). For SPA+ we found significantly higher force values than for SPA (1.67 ± 0.93 N versus 1.31 ± 0.97 N, p < 0.001) independent of the use of AS.

CONCLUSION

Within the study´s in-vitro limitations, we found AS reduced ECF of IRPs by half and allowed using larger diameters interdentally, which could be associated with (1) a higher cleaning effectiveness and (2) a higher acceptance e.g. of patients with dry mouth. This has to be confirmed by further clinical investigations.