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Kaneyasu Y, Shigeishi H, Niitani Y, Takemoto T, Sugiyama M, Ohta K. Manual toothbrushes, self-toothbrushing, and replacement duration to remove dental plaque and improve gingival health: A scoping review from recent research. J Dent 2024; 148:105240. [PMID: 39038528 DOI: 10.1016/j.jdent.2024.105240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/04/2024] [Accepted: 07/12/2024] [Indexed: 07/24/2024] Open
Abstract
OBJECTIVE To investigate characteristics of manual toothbrushes, self-toothbrushing methods, and replacement duration of manual toothbrushes that effectively remove dental plaque, reduce gingivitis, and promote gingival health. STUDY DATA AND SOURCES PubMed-MEDLINE, Scopus and Central Register Cochrane of Controlled trials (CENTRAL) were searched for randomized control trials (RCTs) from 01 January 2018 to 12 December 2023. Articles were subjected for including participants aged six years and older with a study duration of at least four weeks to investigate the efficacy of manual toothbrushes used self-toothbrushing. To investigate the appropriate time to replace manual toothbrushes, this study was focused on the physical properties of the bristles and changes in the microorganisms present in the bristles over time. STUDY SELECTION Of 1520 retrieved articles, 26 studies were included after screening. The total number of manual toothbrushes was 40 and 5 kinds of self-toothbrushing techniques were selected in the review. 4 studies investigated the changes the physical properties bristles of manual toothbrushes. CONCLUSIONS Among manual toothbrushes, the cross-angle and indicator bristles were found to significantly improve dental plaque index and gingival condition. Most toothbrushes with soft bristles had a trend of superior dental plaque removal and gingivitis improvement efficacy. Toothbrush with end-round shape bristles tip has tended to reduce the dental plaque and gingival index scores. Studies reported that brushing twice a day for at least two minutes using the Bass method had a positive effect on the dental plaque and gingival index. Further research is required to investigate the relationships between property physical bristle and clinical intraoral indices to clarify the replacement duration of manual toothbrushes. CLINICAL SIGNIFICANCE The findings of this study could guide people's daily self-brushing habits, thereby aiding the prevention of periodontal disease. Moreover, our findings suggest the need for strategic clinical trial designs to verify the ideal timing to replace manual toothbrushes.
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Affiliation(s)
- Yoshino Kaneyasu
- Department of Public Oral Health, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan.
| | - Hideo Shigeishi
- Department of Public Oral Health, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
| | - Yoshie Niitani
- Department of Oral Health Management, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Toshinobu Takemoto
- Department of Oral Health Management, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Masaru Sugiyama
- Department of Oral Health Sciences, Faculty of Health Care Sciences, Takarazuka University of Medical and Health Care, Japan
| | - Kouji Ohta
- Department of Public Oral Health, Program of Oral Health Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan
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Glenny AM, Walsh T, Iwasaki M, Kateeb E, Braga MM, Riley P, Melo P. Development of Tooth Brushing Recommendations Through Professional Consensus. Int Dent J 2024; 74:526-535. [PMID: 38052700 PMCID: PMC11123540 DOI: 10.1016/j.identj.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION Despite being a largely preventable disease, untreated caries of permanent teeth is estimated to affect almost 2 billion people worldwide, which is followed by severe periodontal disease. The aim of this work was to provide a professional consensus on tooth brushing methods and associated oral hygiene behaviours and develop evidence-informed recommendations. METHODS An initial scoping search was undertaken to identify systematic reviews of relevance and key questions. This was followed by comprehensive evidence mapping of the literature focussing on systematic reviews and clinical guidelines. Electronic searches of several databases including MEDLINE (via Ovid), Embase (via Ovid), Epistemonikos, and The Cochrane Library were undertaken from 2000 to May 2022, alongside a guideline repository search. Considered Judgement Forms were developed detailing the underpinning evidence, balance between benefits and harms, potential impact on the population, and feasibility of implementation. An online survey comprising 22 draft recommendations was distributed to international members of all FDI committees, including the FDI Council. Participants were asked to indicate to what level they agreed or disagreed with for each recommendation and to provide feedback. The Considered Judgement Forms were provided for reference. RESULTS Three hundred ten records were identified and mapped to different aspects of tooth brushing methods and associated behaviours. Research literature informed 7 Considered Judgement Forms comprising 12 questions with draft recommendations. Twenty-five participants from Asia, Europe, North and South America, Africa, and Australia provided feedback on the recommendations. More than 70% of respondents showed agreement with 21 of the 22 draft recommendations. Final recommendations were drafted with associated strength of recommendation. CONCLUSION Using a robust methodology and an international professional consensus, a set of evidence-informed recommendations was developed. These recommendations provide clinicians with practical guidance to facilitate communications with patients that may help to reinforce individual-level preventive strategies.
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Affiliation(s)
- Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, University of Manchester, UK.
| | - Tanya Walsh
- Division of Dentistry, School of Medical Sciences, University of Manchester, UK.
| | | | - Elham Kateeb
- Oral Health Research and Promotion Unit, Al-Quds University, Jerusalem, State of Palestine
| | | | - Philip Riley
- Division of Dentistry, School of Medical Sciences, University of Manchester, UK
| | - Paulo Melo
- Faculty of Dental Medicine, Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Portugal
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Montevecchi M, Valeriani L, Bellanova L, Stefanini M, Zucchelli G. In-vitro comparison of two different toothbrush bristles about peri-implant sulcus penetration. Int J Dent Hyg 2024; 22:465-470. [PMID: 37721091 DOI: 10.1111/idh.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 08/11/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE The aim of this preclinical study was to compare the ability of tapered and cylindrical bristles to penetrate the peri-implant sulcus. METHODS A full mandibular dental arch was reproduced in plaster cast. In site #3.6 a hollow glass cylinder was positioned simulating a 4 mm diameter implant and the gingival component was recreated by using dedicated silicone. A Bass brushing technique was performed from the vestibular side in humid environment. During it, the penetration of the bristles between the gum and the implant was recorded by mean of an optic fibre fixed inside the cylinder. The protocol included 5 toothbrushes per group and 10 tests per toothbrush, for a total of 50 assessments for each of the two groups. A scale of 5 grades for bristle penetration was defined: grade 0 (× < 2 mm), grade 1 (2 ≤ × < 3 mm), grade 2 (3 ≤ × < 4 mm), grade 3 (4 ≤ × < 5 mm) and grade 4 (5 ≤ × < 8 mm). From the video recordings the highest value of penetration was identified for each test. RESULTS The tapered bristles showed an 8 times greater penetration capacity (p = 0.001) in respect to the cylindrical bristles (multilevel analysis). The percentage of tests reaching depths ≥3 mm was 86% for tapered group and 28% for the cylindrical group. CONCLUSION This preclinical study shows a clear and superior penetration capacity of the tapered bristles in respect to traditional cylindrical ones. For tapered bristles, a potentially greater hygienic efficacy around dental implants is suggested.
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Affiliation(s)
- Marco Montevecchi
- Division of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry and Dental Hygiene, University of Bologna, Bologna, Italy
| | - Leoluca Valeriani
- Division of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry and Dental Hygiene, University of Bologna, Bologna, Italy
| | - Leonardo Bellanova
- Department of Biomedical and Neuromotor Sciences, School of Dentistry and Dental Hygiene, University of Bologna, Bologna, Italy
| | - Martina Stefanini
- Division of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry and Dental Hygiene, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Division of Periodontology and Implantology, Department of Biomedical and Neuromotor Sciences, School of Dentistry and Dental Hygiene, University of Bologna, Bologna, Italy
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Pereira TP, Vieira TAF, Júnior WLDS, Bezerra SJC, Sobral MÂP, Scaramucci T. Influence of different ultra-soft toothbrushes on erosive tooth wear. J Dent 2023; 132:104502. [PMID: 36997084 DOI: 10.1016/j.jdent.2023.104502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE To investigate the influence of different ultra-soft toothbrushes on the progression of erosive tooth wear (ETW). METHODS Bovine enamel and dentin specimens (n=10) were submitted to a 5-day erosive-abrasive cycling model (0.3% citric acid for 5min, artificial saliva for 60min, 4x/day). Toothbrushing was carried out 2x/day for 15s, with the different toothbrushes tested (A- Edel White: flexible handle, tapered bristles; B- Oral-B Gengiva Detox: regular handle, criss-cross tapered bristles; C- Colgate Gengiva Therapy: flexible handle, tapered bristles, high tuft density; D- Oral-B Expert Gengiva Sensi: regular handle, round bristles, high tuft density; E- Oral-B Indicator Plus: soft brush, round end bristles (control). Surface loss (SL, in μm) was assessed by optical profilometry. The toothbrush characteristics were evaluated by surgical microscope. Data were statistically analyzed (α=0.05). RESULTS For enamel, toothbrush C showed the highest SL (means±SD: 9.86±1.28) and it did not differ significantly from A (8.60±0.50), both with flexible handle. The lowest SL was observed for the toothbrush Control E (6.76±0.63), which differed significantly from A and C, but not from the other toothbrushes. For dentin, the highest SL was found for toothbrush D (6.97±1.05) and it did not differ significantly from E (6.23±0.71). The lowest SL was observed for B (4.61±0.71) and C (4.85+0.83), without significant differences from A (5.01±1.24). CONCLUSIONS The ultra-soft toothbrushes had different impacts on the progression of ETW on the dental substrates. On enamel, higher ETW values were observed for the flexible handle toothbrushes, while for dentin, round-end bristles (ultra-soft and soft) caused more ETW. CLINICAL SIGNIFICANCE Knowledge about the effect of different ultra-soft toothbrushes on ETW can help clinicians to recommend the most suitable types for their patients, bearing in mind that toothbrushes can impact enamel and dentin differently.
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Hamza B, Svellenti L, Körner P, Attin T, Wegehaupt FJ. Effect of tapered-end and round-end bristles on the abrasive dentine wear applying increasing brushing forces. Acta Odontol Scand 2022; 80:465-469. [PMID: 35147472 DOI: 10.1080/00016357.2022.2035816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To investigate the effect of toothbrush bristles end configuration on the abrasive dentine wear at different brushing forces. MATERIAL AND METHODS One hundred and sixty bovine dentine samples were randomized into eight groups (n = 20). Groups (1 to 4) were brushed with tapered-end bristles at 1-, 2-, 3-, and 4-N brushing forces, respectively. Groups (5 to 8) were brushed with round-end bristles with the same brushing forces. The brushing sequence was carried out using an abrasive slurry (RDA = 121) for 25 min. Profiles were recorded using a contact profilometer. Mean and standard deviation were calculated for the abrasive dentine wear in each group. Two-way ANOVA was used to locate any significance. The significance values were corrected after Tukey (α = 0.05). RESULTS Brushing with tapered-end bristles resulted in statistically significantly less abrasive dentine wear than round-end bristles regardless of the applied brushing force (1 N: 4.4 ± 1.5 vs. 7.7 ± 2.0 µm; 2 N: 7.7 ± 2.1 vs. 12.2 ± 2.7 µm; 3 N: 11.3 ± 2.6 vs. 19.4 ± 3.7 µm; 4 N: 11.2 ± 2.1 vs. 25.3 ± 4.8 µm). The interaction between bristle configuration and brushing force was statistically significantly (p < 0.001). CONCLUSION Tapered-end toothbrushes might be a safer choice for patients, especially when showing signs of non-carious cervical lesion. However, other toothbrush properties should also be considered.
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Affiliation(s)
- Blend Hamza
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Leonardo Svellenti
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Philipp Körner
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Thomas Attin
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Florian J Wegehaupt
- Clinic of Conservative and Preventive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Riad A, Põld A, Olak J, Howaldt HP, Klugar M, Krsek M, Attia S. Estonian Dental Students' Oral Health-Related Knowledge, Attitudes and Behaviours (KAB): National Survey-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1908. [PMID: 35162930 PMCID: PMC8834781 DOI: 10.3390/ijerph19031908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 02/06/2023]
Abstract
The strategic plan for dentistry and oral health in Estonia of 2030 focuses on oral health promotion and disease prevention through undergraduate dental curricula and fostering public health-oriented research among students. The present study was designed as a descriptive cross-sectional study to evaluate oral health-related knowledge, attitudes, and behaviours (KAB) of dental students in Estonia. The study was carried out in the spring semester of 2020, and it used a modified version of the Hiroshima University Dental Behavioural Inventory (HU-DBI). A total of 129 students responded to the survey, constituting a response rate of 93.5% due to the total population sampling (census) technique used in this study and the small target population size. Out of the 124 students included in the final analysis, 79% were females, 62.1% were clinical students, 11.3% reported smoking tobacco at least once a week, and 86.3% reported problematic internet use. The present study found that mean HU-DBI score of Estonian dental students was 8.09 ± 1.22 which is so far the highest recorded HU-DBI score in Europe. There was no significant difference between female vs. male or preclinical vs. clinical students in terms of HU-DBI score. While clinical students reported less faulty oral hygiene practices, such as hard toothbrush use and aggressive toothbrushing, preclinical students reported a slightly higher mean HU-DBI score. Smoking behaviour was more common among male and clinical students, and it was also associated with alcohol drinking and worry about teeth colour and halitosis.
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Affiliation(s)
- Abanoub Riad
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (M.K.); (M.K.)
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 625 00 Brno, Czech Republic
| | - Ave Põld
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Ravila 19, 50411 Tartu, Estonia;
| | - Jana Olak
- Institute of Dentistry, Faculty of Medicine, University of Tartu, Ravila 19, 50411 Tartu, Estonia;
| | - Hans-Peter Howaldt
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany;
| | - Miloslav Klugar
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (M.K.); (M.K.)
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 625 00 Brno, Czech Republic
| | - Martin Krsek
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 62500 Brno, Czech Republic; (M.K.); (M.K.)
| | - Sameh Attia
- Department of Oral and Maxillofacial Surgery, Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany;
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Gennai S, Marco N, Perić M, Marhl U, Izzetti R, Tonelli M, Petrini M, Graziani F. Interdental plaque reduction after use of different devices in patients with periodontitis and interdental recession: A randomized clinical trial. Int J Dent Hyg 2022; 20:308-317. [PMID: 35014192 PMCID: PMC9305873 DOI: 10.1111/idh.12578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/12/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the efficacy of four different oral hygiene protocols involving adjunctive interdental devices in terms of plaque and bleeding scores in periodontitis-affected patients. MATERIAL AND METHODS This was a randomized clinical trial with a 5-week follow-up, including previously treated periodontitis-patients not undergoing any supportive care. Patients were randomly allocated to 4 groups: manual toothbrush (group TB); toothbrush plus dental floss (group TB/F); toothbrush plus interdental brushes (group TB/IDB); toothbrush plus rubber interdental picks (group TB/RIDB). Oral hygiene instructions (OHI) were provided at baseline (T-7) and at T0 (1-week) then bi-weekly (T14/T28). At T0 (supragingival professional cleaning was delivered. Plaque and bleeding indexes were taken at all time-points by a single calibrated examiner, blind to group allocation. RESULTS At T-7 patients were comparable for age, body mass index (BMI), and all clinical parameters, exceptions for the Interdental Angulated Bleeding Index. At T28, significant reductions of plaque and gingival inflammation were noted in all groups (p<0.001) and within the expected ranges. Intergroup comparisons identified that group TB/IDB and group TB/RIDB achieved lower levels of plaque and inflammation than group TB (p<0.05). Group TB/IDB and group TB/RIDB showed lower levels of plaque and lower inflammation as measured by angulated bleeding index than group TB/RIDB (p<0.05). CONCLUSION Interdental brushes and rubber interdental picks were more efficient than toothbrushing alone and toothbrushing and floss in reducing plaque and gingival inflammation measured in a periodontitis-affected population.
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Affiliation(s)
- Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Nisi Marco
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Marina Perić
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Urska Marhl
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Matteo Tonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
| | - Morena Petrini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy.,University of Chieti, Department of Medical, Oral and Biotechnological Science
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Sub-Unit of Periodontology, Halitosis and Periodontal Medicine, University Hospital of Pisa, Pisa, Italy
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Effectiveness of interdental cleaning devices with active substances: a systematic review. Clin Oral Investig 2022; 26:2253-2267. [PMID: 34999990 DOI: 10.1007/s00784-021-04327-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/29/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To systematically review the literature on the efficacy of interdental cleaning devices (ICDs) used with active substances, as adjuncts to toothbrushing, in comparison with toothbrushing alone or with ICDs without active substances. MATERIALS AND METHODS Searches for randomized clinical trials were performed in PubMed, Embase, Scopus, Cochrane (CENTRAL), and Web of Science. Two independent researchers performed study selection, data extraction, and risk-of-bias assessment; a third one resolved any disagreement. Meta-analysis was not feasible, and a narrative approach was used to synthesize the evidence. RESULTS Seven studies were included. Dental floss with chlorhexidine was used in five studies, whereas interdental brushes with chlorhexidine and cetylpyridinium chloride were used in one study each. ICDs with active substances resulted in significantly higher antiplaque and antigingivitis efficacies than without ICDs (n = 3). ICDs with and without active substances demonstrated contrasting results. For this comparison, six studies were included for each outcome. Significantly higher antigingivitis efficacy of ICDs with active substances was noted in four studies, whereas significantly higher antiplaque efficacy of ICDs with active substances was reported in three studies. All comparisons demonstrated a very low certainty of evidence. CONCLUSIONS There is no robust evidence for the additional clinical efficacy of ICDs with active substances regarding their antiplaque and antigingivitis efficacies. These devices may have additional clinical efficacy when compared with the absence of interproximal hygiene. CLINICAL RELEVANCE The use of ICDs helps maintain or achieve periodontal health. However, the adjunct use of active substances may not provide additional benefits.
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