Comparative Evaluation of Cleaning Efficacy of Interdental Brush and Interdental Floss in Orthodontics Patients From Vidarbha Region: An Interventional Study

Background Plaque and dental caries are the primary agents causing gingival and periodontal diseases, eventually progressing into tooth loss. If oral hygiene practice is poor, plaque easily accumulates on the tooth surface, especially in interproximal areas. To maintain a good oral environment, it is mandatory to remove or at least reduce the percentage of plaque formation from the oral cavity. To achieve this, interdental aids should be used along with toothbrushes, as cleansing the teeth only with a toothbrush is not effective. Various interdental aids, like interdental brushes, floss, toothpicks, etc., are now available on the market. The objective of the current survey was to rate knowledge as well as make a comparison between the cleaning effectiveness of interdental brushes and interdental floss to determine which was better at reducing plaque accumulation and, subsequently, dental caries. The survey was accessed by measuring individual plaque and gingival index before and after using interdental cleaning aids. Methodology The objective of the survey was to evaluate and analyze the efficiency of interdental brushes and interdental floss in maintaining oral hygiene among orthodontic patients residing in the Vidarbha region. After receiving approval from the Ethical Committee DMIHER(DU)/IEC/2023/721, a study was conducted over a 30-day period, focusing on a group of 100 individuals aged between 15 and 30 years, and their assessments were analyzed. The patient was briefed about the study and asked to make use of an interdental brush and interdental floss. The gingival index and plaque index were calculated on the same patients before and after the use of the interdental brush and interdental floss to determine which was better at reducing plaque accumulation on the surface of teeth. Descriptive analysis, unpaired for intergroup comparison, and paired T-tests for intragroup comparison were used. The software used was SPSS 24.0 (IBM Corp., Armonk, NY) and GraphPad Prism 7.0 (GraphPad Software, Inc., La Jolla, CA). Result Everyone's tooth surfaces naturally develop a thin layer of plaque biofilm, but the presence of heavy plaque deposits on teeth indicates poor dental hygiene, which can lead to various oral health issues. Failure to improve dental hygiene status can result in problems such as halitosis, gingival issues, periodontal disease, and eventually tooth loss. Dentists play a crucial role in raising awareness about these concerns among their patients and providing education on effective oral care practices, including the use of interdental aids in conjunction with toothbrushes. When comparing the effectiveness of interdental brushes and dental floss in removing plaque, interdental brushes have been found to be more efficient. They not only excel in plaque removal but also contribute to a reduction in gingival problems. The statistical analysis supports this, with a significant p-value of less than 0.01 for both the plaque index and gingival index when using interdental brushes, indicating their superior performance in maintaining oral health. Conclusion The study will help every individual improve their oral hygiene status with the help of an interdental aid and a toothbrush. This will reduce the chances of having gingival and periodontal diseases and eventually reduce the risk of tooth loss.

Oral symptoms and oral hygiene behaviors among patients with type 2 diabetes at a hospital in Japan: A Cross-Sectional Study

OBJECTIVES

Effective daily oral hygiene behavior will prevent periodontal disease. This study aimed to examine the oral symptoms, oral hygiene behaviors, and factors contributing to oral hygiene behaviors among patients with type 2 diabetes in a hospital in Japan.

METHODS

A cross-sectional survey was conducted with 198 patients with type 2 diabetes. Oral symptoms were assessed using a dichotomous scale based on clinical guidelines. Oral hygiene behaviors were assessed based on the frequency of daily tooth brushing and the use of interdental cleaning aids. Chi-square tests and logistic regression analyses were also performed.

RESULTS

Overall, 71.2% of the participants had oral symptoms. Of the participants, 80.3% performed twice daily tooth brushing and 61.1% did not perform interdental cleaning on a daily basis. Logistic regression analysis revealed that tooth brushing behavior was negatively associated with male patients (odds ratio [OR] = 0.45, 95% confidence interval [CI]: 0.25-0.80), difficulty with mastication (OR = 0.63, CI: 0.43-0.92), and tooth loss (OR = 0.68, CI: 0.46-1.00) and positively associated with periodontal disease (OR = 1.73, CI: 1.10-2.72). There were no significant variables related to the use of interdental cleaning aids.

CONCLUSIONS

Patients need to learn about the necessity for regular oral hygiene behaviors and the appropriate way. In particular, support for male patients, those who have difficulty with mastication, those who have experienced natural tooth loss, and those who have not been diagnosed with periodontal disease are needed.

The Use of Interdental Care Products in Korean Adults Aged 30 Years and Older and Factors Affecting Their Use: 4th to 7th Korean National Health and Nutrition Examination Survey

This study aimed to review the use of interdental care products (ICPs) among adults in Korea, reconfirm their relevance to periodontal health, and identify factors affecting the use of ICPs. Data from 2007 to 2018 from the National Health Nutrition Survey (KNHANES) were used, and 43,069 adults (18,412 men, 24,657 women) aged 30 years or older were included. The frequency and percentage of ICP use according to the characteristics of the subjects are presented. In addition, multivariate logistic regression analysis identified the factors affecting ICP use. The ICP usage rate of participants in the KNHANES phase gradually increased to 22.8% in the 4th, 26.4% in the 5th, and 38.0% in the 6th phase and then decreased to 36.3% in the 7th phase. The adjusted OR values for periodontal health in ICP users were 0.721 for gingivitis and 0.642 for periodontitis, confirming that ICP was associated with a lower prevalence of these conditions. Sex, age, educational level, household income, toothbrushing, and dental check-ups were related to ICP use in all phases. ICP was associated with improved periodontal health, but its use rate was very low. Therefore, oral health professionals should educate adults on the use of ICP, particularly interdental brushing.

Efficacy, Safety and Patient Preference of Knotted Floss Technique in Type II Gingival Embrasures

Purpose: The purpose of this crossover clinical trial was to compare the changes in scores of plaque biofilm accumulation, gingival inflammation, gingival bleeding and gingival trauma in patients who used conventional flossing (CFt), knotted floss (KFt) and an interdental brush (IBt) for 6-weeks each in Type II gingival embrasures.Methods: Sixty healthy, tooth-brushing adults with at least one Type II gingival embrasure were randomly assigned to perform any of above interdental cleaning techniques in each phase of six weeks. Crossover to another technique was undertaken after washout of 2 weeks. Test-sites were scored at baseline, 3 and 6 weeks for Rustogi Modification of Navy Plaque Index (RMNPI), Modified Gingival Index (MGI), Modified Papillary Bleeding Index (MPBI), and Carter-Hanson scoring for gingival trauma. Acceptability of each technique was evaluated by subjects' responses to the post-trial questionnaire.Results: Analysis of data showed a significant improvement in RMNPI, MGl and MPBI scores within all three groups over the time-period of 6-weeks from baseline. RMNPI and MGI scores were significantly more in the CFt group when compared to KFt and IBt and there was no difference in KFt and IBt. Additionally, no significant gingival trauma was recorded in any test group. Equal percentages of participants selected KFt or IBt for its ability to clean and preference to continue to use.Conclusion: Use of a KFt and IBt are statistically similar in safety and efficacy for reducing plaque biofilm accumulation, gingival inflammation, and bleeding in Type II gingival embrasures, when either is used as an interdental cleaning aid in conjunction with regular tooth-brushing. KFt and IBt demonstrated better efficacy than CFt.

Effect of Triweekly Interdental Brushing on Bleeding Reduction in Adults: A Six-Month Retrospective Study

This study assessed the effect of triweekly interdental brushing for a period of 6 months using the bleeding on full-mouth interdental brushing (BOFIB) index. All participants answered questionnaires and were instructed to clean all interdental areas using an interdental brush at least every second day. A dentist assessed the BOFIB index of 28 participants at baseline and at 3- and 6-month follow-up visits. We stratified the participants into three groups: IB-NN, those who used the interdental brush less than three times per week both before and after this program; IB-NY, those who used the interdental brush less than three times per week before the program but at least three times per week after the program; and IB-YY, those who used it at least three times per week both before and after the program. Owing to the weekly number of interdental brushings, the IB-YY and the other two groups showed a significant difference at baseline. At the 6-month follow-up, the weekly number of interdental brushings led to a significant difference between the IB-NN and the other two groups. The BOFIB index was lower among the compliant participants than among the noncompliant participants after 3 and 6 months of triweekly interdental brushing.

Comparative evaluation of efficacy and patient-reported outcome measures of oral hygiene instruction methods for calibrated interdental brush

OBJECTIVES

To compare the efficacy and patient-reported outcome measures of oral hygiene instruction methods for calibrated interdental brush.

MATERIALS AND METHODS

A total of 60 participants, with 30 each in control and test group, participated in the study. Clinical examination included gingival index, full mouth bleeding scores and approximal plaque index. Supragingival scaling was performed. Interdental access probe was used to assess the size of interdental brush and corresponding interdental brush were given to the participants. For the control group, oral hygiene instructions were given through demonstration with model and video. For the test group, oral hygiene instructions were given through 'Touch-to-Teach' method. At 4-week follow-up, oral hygiene instructions were repeated to respective groups. After 3 months, clinical examination was done and exit survey on patient-reported outcome measures was administered. Statistical analysis was done.

RESULTS

Intergroup comparison of gingival index, full mouth bleeding index and approximal plaque index showed statistically significant difference between test and control group. 'Touch-to-Teach' method of oral hygiene instruction was found to be 'Good'. Acceptance of interdental brush was regarded to be 'Good'.

CONCLUSION

Within limitations of the study, Touch-to-Teach method of oral hygiene instruction method was found to be effective and more acceptable and participants used the interdental brush regularly.

The Effect of Proximal Cleaning Devices on Periodontal Status in Korean Adults between 2016 and 2018

Removal of the biofilm from the proximal space is essential for preventing periodontal disease. This study aimed to prove the association between the use of proximal cleaning devices, such as dental floss and interdental brushes, and periodontal health among nationally representative Korean adults. Data collected from the 7th National Health Nutrition Survey (KNHANES VII: 2016-2018) were used for this purpose. A total of 11,359 participants aged 19 years or older who participated in KNHANES were reviewed. The response variable was the prevalence of high CPI (CPI of 3-4), and the explanatory variables were dental floss and interdental brush. A multivariable logistic regression analysis was performed to adjust for potential confounding factors and to analyze the association between periodontal disease and proximal cleaning devices. It was found that 63.1% of the participants did not use proximal cleaning devices at all, 17.5% used dental floss alone, 11.9% used an interdental brush, and 7.5% used both. Subjects who used both dental floss and interdental brush had a high CPI rate nearly half that of all the models for those who did not. In particular, for those using dental floss, the aOR of high CPI was 0.681 in Model 1, 0.714 in Model 2, and 0.737 in Model 3. Dental hygiene products for cleaning the proximal space, such as dental floss, are essential for removing the dental biofilm as a basic tool along with toothbrushes. Teaching and explaining the need to use these devices well are important for oral health care and maintenance.

Mechanical plaque control of the interdental space with the "Heidelberg set"

<p>At present, the most important criterion for the size selection of interdental brushes is the PHD-value (passage hole diameter) according to the ISO standard for interdental brushes ISO 16409:2016. The PHD size range of commercially available products currently lies between 0.6 and 5.2 mm. With the exceptions of special situations, a range between 0.7 and 2.9 mm is sufficient for clinical routine. As most products have longer filaments nowadays, one brush can often be applied for two PHD intervals. Consequently, adequate patient counseling and the individual selection of the appropriate interdental brushes can generally be achieved with an assortment of 12 systematically arranged interdental brush sizes. An application example is the "Heidelberg set" described herein. It is crucial that the correct choice of size is based upon continuously rising PHD-values, and not upon parameters such as stem size, outer diameter of filaments, or similar, as these do not allow for a reliable conclusion regarding the interdental passage. The usage of ISO sizes is also not recommendable due to their insufficient size differentiation. (Quintessence Int 2021;52: 176-186; doi: 10.3290/j.qi.b872241; Revised from an article originally published (in German) in Parodontologie 2020;31(1)37-49)</p>.

The Effectiveness of Waist-Shaped and Straight-Shaped Interdental Brushes in Cleaning Implant Overdenture Attachments: A Self-Controlled Clinical Trial

Elderly patients often find it challenging to remove plaque accumulated on the attachments of implant overdentures (IODs) using conventional cleaning instruments. Further, excessive plaque accumulation can lead to peri-implant diseases and occasionally to respiratory diseases. Therefore, here, we aimed to compare the effectiveness of waist-shaped interdental brushes (WIBs) with that of straight-shaped interdental brushes (SIBs) in plaque removal from the locator attachments of IODs. Twenty participants with 2 locator attachments retaining mandibular IODs participated in this study. After the baseline cleaning, the participants refrained from oral hygiene maintenance for 3 days. A dentist cleaned 1 of the attachments using the WIB and the other attachment using the SIB. The pre- and post-cleaning modified plaque index (mPLI) scores were recorded. After another 3 days free from oral hygiene maintenance, the trained participants repeated the same cleaning procedure using the WIB and SIB. Pre- and post-cleaning mPLI scores were recorded. Regardless of the type of brush used, the post-cleaning mPLI scores were lower than the pre-cleaning scores. After the cleaning procedure, the overall mean mPLI score was lower in the WIB group than in the SIB group. The post-cleaning mPLI scores at the line angles and on the axial surfaces of the attachments were also lower in the WIB group than in the SIB group. There was no difference in the cleaning effectiveness between the dentist and participants when they used the same type of interdental brush. The WIB was significantly more efficient in plaque removal than the SIB, especially at the line-angle sites.

Mapping the Product Range of Interdental Brushes: Sizes, Shapes, and Forces

PURPOSE

Preventive dentistry aims to improve oral hygiene, including the use of interdental cleansing aids. Clear and simple classifications may positively impact patient communication and motivate oral health behaviour. To date, there is no comparative analysis of interdental brush classifications and sizes.

MATERIALS AND METHODS

A total of 2320 interdental brush samples by 24 manufacturers was examined regarding their passage hole diameter (PHD) according to the ISO standard for interdental brushes (ISO16409:2016), and their current classifications were evaluated. Inter- and intrarater reliability of the ISO size classification were determined based on 20 raters and 10 interdental brushes. The insertion force for these interdental brushes was analysed in vitro.

RESULTS

Excellent intra- and interrater reliability was achieved (intraclass correlation coefficient (ICC) ≥ 0.973) overall, although greater variance was observed for bigger brush sizes. Insertion forces varied depending on size and form of the brushes, amounting to 1.58 N (SD = 1.27 N) for cylindric and tapered brushes, and to 2.31 N (SD = 0.81 N) for waist-shaped brushes. The size range of commercially available products was 0.6-5.2 mm PHD, 90% presenting with a PHD ≤ 2.0 mm. Size intervals were unsystematic. The ISO size was indicated by 33% of all manufacturers, the exact PHD by 25%.

CONCLUSIONS

The determination of the PHD is a reproducible instrument for most brushes currently on the market. In vitro, forces developed based on this classification are mostly moderate, thus unlikely to cause periodontal trauma. Given the discontinuous range and unclear labelling of available products, the development of a simplified classification system by usage of the PHD may benefit the practitioner and patient alike by contributing to improve oral hygiene behaviours.

[Comparison of interdental oral hygiene aids efficiency in patients with healthy periodontium: a split-mouth study]

AIM

Comparison of different interdental aids efficiency in patients with healthy periodontium.

METHODS

A non-randomized controlled split-mouth study was carried out in 25 young adults with healthy periodontium. The mouth was divided into 4 quadrants. All the participants used manual toothbrush. Additional hygienic aids included SPS prime (Curaprox) interdental in quadrant 1 brushes, dental floss (Curaprox) in quadrant 2, unituft toothbrush (Curaprox) in quadrant 3, no interdental aids were used in quadrant 4. The oral hygiene efficiency was assessed after 4 weeks with Silness-Loe Plaque Index (PI) and Rustogi et al. Modified Navy Plaque Index (RMNPI).

RESULTS

After 4 weeks the mean value of PI decreased from 1.2±0.27 to 0.7±0.28, the mean value of RMNPI decreased from 0.7±0.11 to 0.5±0.16. At the primary examination, there was no statistically significant difference of PI and RMNPI values between the quadrants. After 4 weeks, ANOVA test demonstrated significant difference between the quadrants. The minimal PI and RMNPI values were determined in quadrant 1 (0.4±0.16 and 0.3±0.11, respectively). The maximal PI and RMNPI values were determined in quadrant 4 (1.0±0.21 and 0.6±0.14, respectively). There was no significant difference between quadrants 2 and 3.

CONCLUSION

In limitations of this study, the maximal oral hygiene efficiency was achieved with use of manual toothbrush combined with interdental brush.

Efficacy of a rubber bristles interdental cleaner compared to an interdental brush on dental plaque, gingival bleeding and gingival abrasion: A randomized clinical trial

AIM

To determine the efficacy of a rubber bristles interdental cleaner (RBIC) compared to an interdental brush (IDB) in reducing gingivitis and additionally to evaluate participants' attitudes and possible side effects.

MATERIAL AND METHODS

The study was a 2-treatment, parallel, split-mouth, examiner-blind RCT, evaluating the reversal of experimental gingivitis. In total, 42 systemically healthy volunteers were recruited that were currently non-users of interdental cleaning devices. After familiarization and prophylaxis, participants refrained from brushing mandibular teeth for 21 days, followed by 4-week product use of the assigned interdental cleaning device as adjunct to manual toothbrushing. Bleeding on marginal probing (BOMP), dental plaque index score (PI) and gingival abrasion score (GAs) were assessed in the lower jaw.

RESULTS

Overall, no statistically significant differences between the RBIC and IDB in reducing BOMP and PI were obtained. Analysing the sites that were accessible for the RBIC/IDB only showed that the sites treated with the RBIC had significantly less BOMP after 4 weeks (P = .009). The RBIC also caused less GAs (P => .016) and was considered more pleasurable to use by the participants (P = .0001).

CONCLUSIONS

In accessible sites, the RBIC, in conjunction with manual toothbrushing, was found to be more effective in reducing gingival inflammation after 4 weeks. The RBIC caused less abrasion of the gingiva and was appreciated more by the participants.

Comparison of two interdental cleaning aids: A randomized clinical trial

AIM

The aim of this study was a comparison of the handling and acceptance of two kinds of interdental brushes (interdental brush with a handle [HB] and a newly invented interdental cleaning device [NB]).

METHODS AND MATERIALS

In a randomized crossover trial, 40 test subjects with an average number of 23.5 interdental areas were examined. At two appointments with a "washout" period of one week, the volunteers tried out both cleaning tools (HB and NB). They were asked to clean as many interdental spaces as possible. The percentage of spaces, which could be reached, is the IRI (Interdental Reachability Index). Furthermore, subjective impressions were determined.

RESULTS

The average IRI using HB was 64% compared to 80% using of NB (P<.001); 62.5% of the volunteers found the cleaning with HB painful and 15% the cleaning with NB. The subjective feeling after cleaning was 1.75 with NB compared to 2.2 with HB (P=.015), grading the feeling, from 1 for "very good" to 5 for "poor." The acceptance of regular interdental hygiene was rated 1.95 in the case of the NB and 2.85 in the case of the HB. After both appointments, the test subjects declared that they would use the NB 3.05 times and the HB 1.78 times a week.

CONCLUSION

This study shows that the test subjects reached more interdental spaces with NB than with the HB. NB can improve the usage of interdental brushes. Regarding subjective comfort, participants also favoured NB over HB.

Comparison of Water Flosser and Interdental Brush on Reduction of Gingival Bleeding and Plaque: A Randomized Controlled Pilot Study

OBJECTIVES

The purpose of this randomized, two-week, single blind, two-group parallel pilot study was to compare the reduction in gingival bleeding and plaque in subjects using a water flosser or interdental brush, each combined with a manual toothbrush.

METHODS

Twenty-eight subjects completed the study. Subjects were randomly assigned to one of two groups: Waterpik® Water Flosser (WF) plus manual toothbrush or interdental brushes (IDBs) plus a manual toothbrush. Bleeding on probing (BOP) was measured at six sites and reported for whole mouth, lingual, facial, and interproximal areas. Plaque data were measured using the Rustogi Modification of the Navy Plaque Index (RMNPI) and were reported for whole mouth, approximal, marginal, facial, and lingual areas. Subjects received verbal and written instructions on the use of their interdental product and demonstrated proficiency prior to starting the study.

RESULTS

There were no differences between the groups for BOP or RMNPI at baseline. Both groups demonstrated a significant reduction in BOP and RMNPI for all regions and areas measured from baseline to two weeks. The WF was more effective than the IDBs for BOP whole mouth (56%), facial (44%), approximal whole mouth (53%), and approximal facial (41%). Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between groups for lingual and marginal assessments for BOP or any area for RMNPI.

CONCLUSIONS

The Waterpik Water Flosser is more effective than IDBs for reducing gingival bleeding over two weeks.

Comparison of Water Flosser and Interdental Brush on Plaque Removal: A Single-Use Pilot Study

OBJECTIVES

The purpose of this randomized, single-use, single-blind, two-group, parallel pilot study was to compare the plaque removal ability of a water flosser and interdental brush when used in combination with a manual toothbrush.

METHODS

Twenty-eight (28) subjects completed the study. Subjects were randomly assigned to one of two groups: Waterpik®Water Flosser (WF) plus manual tooth brushing or interdental brushes (IDB) plus manual tooth brushing. Pre-cleaning plaque scores were obtained using the Rustogi Modification of the Navy Plaque Index (RMNPI). Subjects were instructed on the use of their interdental product. Post-cleaning scores were obtained after a supervised brushing and use of the interdental device. Scores were recorded for whole mouth, marginal, approximal, facial, and lingual regions for each subject.

RESULTS

There were no differences between the groups for pre-cleaning plaque scores for whole mouth, marginal, approximal, facial, or lingual regions. Both groups showed significant reductions in plaque from baseline for all areas measured (p < 0.001). The WF group was significantly more effective than the IDB group for removing plaque from all areas measured. Specifically, the WF was 18% more effective for whole mouth and marginal areas, 20% for approximal areas, 11% for facial areas, and 29% for lingual areas.

CONCLUSIONS

The Waterpik Water Flosser and manual toothbrush removes significantly more plaque from tooth surfaces (whole mouth, marginal, approximal, facial, and lingual) than interdental brushes and a manual toothbrush after a single use.

The effectiveness of conically shaped compared with cylindrically shaped interdental brushes - a randomized controlled clinical trial

AIM

The purpose of this study was to compare the effectiveness of conically shaped versus cylindrically shaped interdental brushes (IDB) in patients receiving supportive periodontal therapy.

MATERIALS AND METHODS

Periodontal maintenance patients volunteered to be enrolled into this randomized controlled examiner-blind parallel study. At baseline and after 3 months, plaque scores, bleeding upon pocket probing scores and probing pocket depth (PPD) were assessed. The type of IDB (conical or cylindrical) was randomly assigned to each patient and individual instruction was provided regarding the method of use and the appropriate size. Only those approximal sites that had sufficient space for the IDB were eligible, and for those sites the data were analysed separately. Analyses were performed for all eligible approximal surfaces and a sub-analysis was performed for vestibular and lingual surfaces.

RESULTS

In total, 51 participants attended the baseline and the 3-month clinical appointments. Overall, there was no difference between conical and cylindrical IDBs. However, the conical IDB showed significantly higher plaque and bleeding scores at the lingual approximal sites. The cause of this difference was an increase in plaque and bleeding scores compared with baseline. With respect to the PPD, no difference between the IDBs was observed.

CONCLUSION

Within the limitations of this experiment, the conical IDBs are less effective than cylindrical IDBs with respect to lingual approximal plaque removal. Thus, in patients receiving supportive periodontal therapy, the cylindrical shape should be the first choice of IDB to obtain and maintain gingival health around natural teeth.

A Colorimetric Interdental Probe as a Standard Method to Evaluate Interdental Efficiency of Interdental Brush

The aim of this study is to evaluate the concordance between the empirical choice of interdental brushes of different diameters compared to the gold standard, the IAP CURAPROX(©) calibrating colorimetric probe. It is carried out with the aim of facilitating the consensus development of best practices. All the subjects' interproximal spaces were evaluated using the reference technique (colorimetric probe), then after a time lapse of 1.2 ± 0.2 hours, using the empirical clinical technique (brushes) by the same examiner. Each examiner explored 3 subjects. The order the patients were examined with the colorimetric interdental probe (CIP) was random. 446 sites were selected in the study out of 468 potential sites. The correspondence of scores between interdental bushes vs. colorimetric probe is 43.0% [95%-CI: 38.5-47.6]. In 33.41% of the 446 sites, the brush is inferior to the probe; in 23.54% of cases, the brush is superior to the probe. Among the discrepancies there is thus a tendency for the subjects to use brushes with smaller diameter than that recommended by the colorimetric probe. This review has found very high-quality evidence that colorimetric probes plus interdental brushing is more beneficial than interdental brushing alone for increase the concordance between the empirical choice of interdental brushes of different diameters compared to the gold standard. Uncertainties remain and further research is required to provide detailed data on user satisfaction.