Cleaning performance of electric toothbrushes around brackets applying different brushing forces: an in-vitro study

Throughout treatment with fixed orthodontic appliances, effective plaque control is crucial to maintaining dental health. This in-vitro study evaluated the cleaning performance of eleven different brush heads of seven electric toothbrushes (oscillating-rotating and sonic motions) and varying brushing forces around orthodontic brackets. Six Mini Diamond® Twin brackets were placed on black-stained front teeth. Teeth were coated with white titanium oxide and brushed in a machine six times for one minute with two different brushing forces (1 N and 1.5 N). Eleven different brush heads were evaluated (either oscillating-rotating or sonic movements). The teeth were scanned and planimetrically evaluated after brushing. Three detailed plaque areas (DPAs) were created: proximal (< 1 mm to bracket), mid-tier (1-2 mm to bracket), and distant (> 2 mm to bracket). The proportion of contaminated proximal, mid-tier, and distant surfaces (white regions) in relation to the respective DPA was calculated. Independent of brushing forces, places with a higher distance (> 2 mm) to the orthodontic bracket had the least amount of residual contamination, followed by areas with a minor (1-2 mm) and proximal distance (< 1 mm). In all of the brushes tested and for both estimated brushing forces, the region with the highest residual contamination was the proximal area. The brush heads of the Paro® Sonic toothbrush left the least amount of residual contamination. The cleaning performance of electric toothbrushes around brackets on upper incisors varied across the brushes examined. The proximal area has the most residual contamination. Furthermore, 9 out of 11 toothbrushes cleaned more successfully with 1.5 N than with 1 N brushing force.

Randomized multicenter study on the plaque removal efficacy of 2 interdental brushes around the base of orthodontic brackets

INTRODUCTION

The objective of this multicenter study was to analyze the efficacy of cleaning 2 interdental brushes (IDBs) around brackets in patients with fixed orthodontic appliances.

METHODS

The study design was a multicenter, randomized, examiner-blinded crossover study with 3 interventions, the first of which was a baseline intervention. This study included 20 patients (12 females, 8 males) aged 12-18 years with fixed orthodontic devices examined at the Department of Orthodontics, University Medical Center of the Johannes Gutenberg University Mainz, and the Children's Dental Clinic St. Gallen. The outcome was a conventional, cylindrically shaped IDB (IDBG-S [IB]; Top Caredent GmbH, Schönau, Germany) was examined in comparison with an innovative waist-shaped IDB (Circum, CDB-8 [CB]; Top Caredent GmbH). The participants did not use the IDB themselves. The brushing procedure was performed professionally by 1 operator (C.E.). Each buccal tooth surface with a bracket was split into 8 areas, the main areas being 1 and 8. These main areas, which were difficult for toothbrushes to reach, were mesial (area 1) and distal (area 8) of the bracket edges in the gingival direction. Plaque index (PI) scores were assessed at 2 examinations before and after the cleaning procedure on 8 tooth surfaces in the area with orthodontic brackets. A computer-generated program randomly allocated the IDB sequence to the participants. Examiners (L.Z.-G. and Y.W.) assessing the outcomes were blinded to the intervention and the randomized allocation of participants to the different IDBs.

RESULTS

Both IDBs showed a plaque removal effect (CB, 0.68 [interquartile range, 0.63-0.77]; IB, 0.43 [interquartile range, 0.33-0.55]). The difference between the 2 IDB was statistically significant (P = 0.002). In particular, the CB yielded a higher plaque removal efficacy (CB effect, 0.68; IB effect, 0.21) at the main areas 1 and 8, which were difficult to reach. Ten participants were randomized to each sequence, and all 20 completed the study. No side effects or adverse events were reported or observed.

CONCLUSION

The waist-shaped brush head of the CB significantly enhanced plaque reduction in total and particularly in problem areas.

REGISTRATION

This trial was registered at the German Clinical Trials Registry (no. DRKS00014088; https://www.drks.de/drks_web/navigate.xxdo?navigationId=trial.HTML&TRIAL_ID=DRKS00014088) PROTOCOL: The protocol was not published before trial commencement.

FUNDING

This study was supported by the manufacturer Top Caredent GmbH, Schönau, Germany, which provided all interdental brushes used in this study.

Effectiveness of Tooth Brushes on Gingival Health in Patients undergoing Orthodontic Treatment

Aim: To evaluate and compare the effectiveness of two different manual toothbrushes on gingival health among patients undergoing orthodontic treatment. Methodology: In the present randomized cross-over controlled trial, 60 subjects were recruited, to receive either crisscross or multilevel bristle design. Modified Gingival Index (MGI), Modified Silness and Loe Plaque Index, and Gingival Bleeding Index (GBI) and were assessed for 120 days. Statistical analysis was done using SPSS version 21 (SPSS; Chicago, IL, USA). Owing to the ordinal nature of the indices, non-parametric tests of significance were used. Results: The efficacy of the two-bristle design brush showed an overall reduction in the mean score. Overall significant differences were seen in the efficacy of the two different bristle designs. Both the study groups showed a reduction in the mean MGI, PL, and GBI with a P value less than 0.001 which was statistically significant. Conclusion: In the present study, the criss-cross bristle design was found to be significantly more effective as compared to the multilevel toothbrush design for reducing MGI, PL, and GBI scores.      

Effectiveness of Super Floss and Water Flosser in Plaque Removal for Patients Undergoing Orthodontic Treatment: A Randomized Controlled Trial

Objectives

This study aimed to compare the effectiveness of super floss and water flosser in plaque removal for patients undergoing orthodontic treatment.

Methods

A single-blind, randomized, controlled, parallel clinical trial with a split-mouth protocol was conducted on young adult orthodontic patients who were recruited from Riyadh Specialized Dental Center in Riyadh, Saudi Arabia. The type of floss used was randomly assigned to each side of the oral cavity; Super-Floss® (Oral-B) was used on one side, while the Waterpik® water flosser was used on the other. Patients' plaque level was assessed using Rustogi et al. modified navy plaque index (RMNPI) at baseline and immediately after cleaning.

Results

A total of 62 subjects were screened; however, only 34 subjects were enrolled in the study with an equal number of males and females. Overall, the plaque score was significantly reduced from 0.56 ± 0.35 to 0.13 ± 0.26 in the super floss group and from 0.61 ± 0.35 to 0.13 ± 0.28 in the water flosser group. There was no significant difference between the mean difference of super floss and water flosser (p=0.951). On the other hand, there was no significant difference between both groups in terms of the preintervention plaque score (p=0.379). The water flosser had a greater effect size on plaque removal compared to super floss on distal interproximal surface of the molar tooth with a mean difference of (−0.21, 95% CI: 00.37 to −0.04, p=0.033).

Conclusions

The use of super floss or water flosser as interproximal aids for plaque removal in patients undergoing orthodontic treatment are both effective. Trial registration. ISRCTN, ISRCTN83875016. Registered 12 September 2021-retrospectively registered, https://www.isrctn.com/ISRCTN83875016.

Deciphering Black Extrinsic Tooth Stain Composition in Children Using Metaproteomics

The present study focuses on the use of a metaproteomic approach to analyze Black Extrinsic Tooth Stains, a specific type of pigmented extrinsic substance. Metaproteomics is a powerful emerging technology that successfully enabled human protein and bacterial identification of this specific dental biofilm using high-resolution tandem mass spectrometry. A total of 1600 bacterial proteins were identified in black stain (BS) samples and 2058 proteins in dental plaque (DP) samples, whereas 607 and 582 human proteins were identified in BS and DP samples, respectively. A large diversity of bacteria genera (142) in BS and DP was identified, showing a high prevalence of Rothia, Kingella, Neisseria, and Pseudopropionibacterium in black stain samples. In this work, the high diversity of the dental microbiota and its proteome is highlighted, including significant differences between black stain and dental plaque samples.

Comparative in vitro study of the cleaning efficacy of AirFloss ultra and I-Prox Sulcus brushes in an orthodontic phantom model

Preventing biofilm-related risks such as gingivitis and white spot lesions during orthodontic treatments is very challenging. The cleaning efficiencies of AirFloss Ultra and I-Prox P sulcus brushes were evaluated using an orthodontic phantom model. After attaching brackets onto black-coated maxillary KaVo teeth, a plaque substitute was applied. The evaluated tooth surfaces were divided into two areas. Cleaning was performed with an AirFloss Ultra with two (A-2) or four (A-4) sprays or an I-Prox P for two (I-2) or four (I-4) seconds. Images before and after cleaning were digitally subtracted, and the percentage of fully cleaned surfaces was determined (Adobe Photoshop CS5, ImageJ). Statistical analysis was performed by ANOVA and post hoc tests with Bonferroni correction (SPSS 25, p < 0.05). The mean values of total cleaning efficacy were 26.87% for I-2, 43.73% for I-4, 34.93%, for A-2 and 56.78% for A-4. The efficacy was significantly higher for A-4 than for A-2, I-4, and I-2. There were significant differences between the four groups. Repeated cleaning led to an improved result. Within the study limitations, the AirFloss Ultra with four sprays proved to be more efficient than the sulcus brush I-Prox P for cleaning.

Impact of interdental brush shape on interpapillary cleaning efficacy - a clinical trial

This study aimed to investigate whether interdental brush shape influences cleaning efficacy, by comparing a waist-shaped interdental brush (W-IDB) with a cylindrical IDB (C-IDB); both provided with the same bristle texture. Cleaning efficacy of differently shaped IDBs was measured in proximal surfaces of teeth in a split-mouth cross-over design. Twenty-eight patients abolished oral hygiene for 4 d. Line angle plaque area was scanned with an intraoral camera after use of disclosing dye in baseline and after IDB application and analyzed planimetrically. Additionally, bacterial load in the IDBs was analyzed after usage by colony forming units (cfu). A Wilcoxon signed-rank test with continuity correction was used to compare the results of the waist-shaped and the cylindrically-shaped IDBs. The waist-shaped IDBs cleaned significantly better than their cylindrically-shaped counterparts (area cleaned: 23.1% vs. 18.3%), when applied at same interdental spaces (p < 0.001). However, no significant differences were found in comparison of bacterial load on the IDBs (median cfu counts: 2.3E9 vs. 2.7E9, p = 0.93). Irrespective of bristle texture or size, IDB shape have impact on cleaning efficacy. Waist-shaped IDBs are more effective in cleaning of the line angle area than cylindrically-shaped IDBs.

Clinical validation of robot simulation of toothbrushing--comparative plaque removal efficacy

BACKGROUND

Clinical validation of laboratory toothbrushing tests has important advantages. It was, therefore, the aim to demonstrate correlation of tooth cleaning efficiency of a new robot brushing simulation technique with clinical plaque removal.

METHODS

Clinical programme: 27 subjects received dental cleaning prior to 3-day-plaque-regrowth-interval. Plaque was stained, photographically documented and scored using planimetrical index. Subjects brushed teeth 33-47 with three techniques (horizontal, rotating, vertical), each for 20s buccally and for 20s orally in 3 consecutive intervals. The force was calibrated, the brushing technique was video supported. Two different brushes were randomly assigned to the subject. Robot programme: Clinical brushing programmes were transfered to a 6-axis-robot. Artificial teeth 33-47 were covered with plaque-simulating substrate. All brushing techniques were repeated 7 times, results were scored according to clinical planimetry. All data underwent statistical analysis by t-test, U-test and multivariate analysis.

RESULTS

The individual clinical cleaning patterns are well reproduced by the robot programmes. Differences in plaque removal are statistically significant for the two brushes, reproduced in clinical and robot data. Multivariate analysis confirms the higher cleaning efficiency for anterior teeth and for the buccal sites.

CONCLUSIONS

The robot tooth brushing simulation programme showed good correlation with clinically standardized tooth brushing.This new robot brushing simulation programme can be used for rapid, reproducible laboratory testing of tooth cleaning.

The prevalence of approximal caries in patients after fixed orthodontic treatment and in untreated subjects: a retrospective, cross-sectional study on bitewing radiographs

OBJECTIVE

The aim of this retrospective, cross-sectional study was to investigate the prevalence of approximal carious lesions in patients after fixed multibracket therapy and in subjects without orthodontics on bitewing radiographs.

MATERIAL AND METHODS

Bitewing radiographs of 104 orthodontically treated patients with fixed multibracket appliances were compared to those of 111 untreated subjects. The individuals in both groups were between 15 and 16.25 years of age when radiographs were taken. The test group with orthodontics was recruited from the archive of the Department of Orthodontics at the University of Zürich. The untreated control group was selected randomly from 16 communities in the Canton of Zürich. The approximal surfaces of the permanent premolars and molars of all subjects were assessed by two calibrated investigators.

RESULTS

The average number of enamel lesions in the test group after fixed orthodontic treatment was lower than in the control group (0.57 vs. 1.85, p < 0.001). The same was found for dentin lesions (0.06 vs. 0.49, p < 0.001). The distribution of lesions was similar in both groups.

CONCLUSION

Fewer approximal carious lesions were detected in the test group after fixed multibracket appliances than in the age-matched control group without orthodontic treatment.

In vitro tooth cleaning efficacy of electric toothbrushes around brackets

This in vitro study assessed the cleaning efficacy of different electric toothbrushes around upper incisor brackets. Standard and Mini Diamond brackets were fixed on black-stained teeth. The teeth were coated with white titanium oxide and brushed in a machine twice for 1 minute each. Twelve different brush heads with either a wiping or an oscillating-rotating action were tested. After brushing, the teeth were scanned, the black surfaces were assessed planimetrically and a modified plaque index for orthodontic patients (PIOP) was introduced. Tooth areas, which were black again after brushing indicated tooth surface contact of the filaments and were expressed as a percentage of total area. The remaining white areas around the brackets indicated 'plaque-retentive' niches. Analysis of variance was used for individual comparison of the brush types. Bonferroni/Dunn adjustment was applied for multiple testing. The Sonicare toothbrush handle with the brush head 'Compact ProResults' (81.7 per cent) and the brush head 'Standard ProResults' (80.8 per cent), as well as the sonic Waterpik toothbrush SR 800E with the standard brush head (78.2 per cent), showed statistically significantly better cleaning efficacy than all others. The poorest cleaning efficacy was observed for the oscillating-rotating Braun Oral-B Professional Care with the brush head 'Ortho' (less than 50 per cent). The planimetric findings were in correspondence with the results of the PIOP assessment. Cleaning efficacy of electric toothbrushes around brackets on upper incisors was different between the tested brushes. The PIOP was practicable, effective, and easy to use, although it has to be verified in a clinical study.

Oral bacterial adhesion forces to biomaterial surfaces constituting the bracket-adhesive-enamel junction in orthodontic treatment

Bacterial adhesion to biomaterial surfaces constituting the bracket-adhesive-enamel junction represents a growing problem in orthodontics, because bacteria can adversely affect treatment by causing demineralization of the enamel surface around the brackets. It is important to know the forces with which bacteria adhere to the surfaces of these junction materials, as the strength of these forces will determine how easy it will be to remove the bacteria. We compared the adhesion forces of five initially colonizing and four cariogenic strains of bacteria to an orthodontic adhesive, stainless steel, and enamel, with and without a salivary conditioning film. Adhesion forces were determined using atomic force microscopy and a bacterial probe. In the absence of a salivary conditioning film, the strongest bacterial adhesion forces occurred to the adhesive surface (-2.9 to -6.9 nN), while adhesion forces to the enamel surfaces were lowest (-0.8 to -2.7 nN). In the presence of a salivary conditioning film, adhesion forces were reduced strongly, to less than 1 nN, and the differences between the various materials were reduced. Generally, however, initial colonizers of dental hard surfaces presented stronger adhesion forces to the different materials (-4.7 and -0.6 nN in the absence and presence of a salivary conditioning film, respectively) than cariogenic strains (-1.8 and -0.5 nN).