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J Orofac Orthop. 2005 Jan;66(1):20-38.

Plaque and gingivitis reduction in patients undergoing orthodontic treatment with fixed appliances-comparison of toothbrushes and interdental cleaning aids. A 6-month clinical single-blind trial.

[Article in English, German]

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Department of Orthodontics and Dentofacial Orthopedics, Center for Dentistry, Charité-Universitätsmedizin, Berlin, Germany.



Comparison of the efficacy of different oral cleaning devices to improve dental hygiene in patients with multibracket appliances.


In a single-blind four-way crossover clinical trial, the following toothbrushes and cleaning aids were tested over 6 months to determine their efficacy in removing plaque and preventing gingivitis: the (A) manual interX short brush-head toothbrush (elmex), the (B) Sonic Speed SR-100E sonic toothbrush (Water Pik), the (C) Sonic Speed toothbrush in conjunction with the electric interdental cleaning device Flosser FL-110 (Water Pik), and (D) the Sonic Speed sonic toothbrush in conjunction with multi-floss 3-phase dental floss (elmex). Forty patients were randomly split up into four groups. Each group brushed their teeth for 4 weeks using cleaning aids/combinations A, B, C or D in different orders. The trial organization was controlled by a computer system that also assisted in recording the modified Quigley Hein Index (mQHI) and Papillary Bleeding Index (PBI) every two weeks using voice control.


Initial improvement was observed with all cleaning aids/combinations, but after 4 weeks of application, conditions deteriorated again--except one. After 4 weeks of application, only cleaning involving the combined use of the sonic toothbrush and the Flosser FL-110 (C) was found to be significantly more effective than cleaning with the manual toothbrush (A), and that was mainly attributed to the flosser. In patients with good oral hygiene (mQHI(initial) < or = 1.4), no improvement was observed with any of the cleaning aids (A-D).


Plaque and gingivitis can be reduced--especially in patients with poor oral hygiene (mQHI(initial) > or = 1.5)-by using an interdental cleaning aid. In the long run, the Flosser FL-110 is more effective than multi-floss 3-phase dental floss.

[Indexed for MEDLINE]

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