Clinical Evaluation of an Electric and a Manual Toothbrush in Removal of Dental Plaque
Condition: Plaque, Dental
MeSH terms: Dental Plaque
Study type: Interventional

Summary: 
      The study aimed to evaluate the efficacy of manual and electric toothbrush on dental plaque
      removal by using various intraoral imaging systems. Thirty healthy individuals using the same
      type of toothbrush for at least 2 years participated in the study. 12 teeth of each
      individual, including upper and lower anteriors, were examined. Group 1 including volunteers
      who used to use manual toothbrushes (MT) started to use an electric toothbrush (ET) and Group
      2 including volunteers who used to use an ET and started to use a MT for 1 month with the
      same daily brushing routines. Following the clinical intraoral examination, plaque (PI) and
      gingival index (GI) measurements were performed 5 hours after brushing. The GI was evaluated
      through Sillness&Löe Gingival Index. The PI was evaluated according to Quigley and Hein's
      Plaque Index criteria and was scored clinically on visual inspection and digital imaging
      systems including FluoreCam, DSLR Camera, D-Light Pro, Smile Lite MDP, iTero Element Flex.
      The data was evaluated under p<0.005 significant level.
    

Detailed description: 
      Patient and teeth selection criteria Ten healthy individuals between the ages of 20 and 30
      years with no systemic disease, restoration or caries, and whom have the criteria for using
      the same type of toothbrush for 2 years (15 of them use manual toothbrushes and 15 of them
      use electric toothbrushes) participated in the study. 12 teeth of each individual, including
      upper and lower anteriors, were examined. The researchers supplied the volunteers with a
      manual toothbrush (Oral-B toothbrush Pro Expert Complete, Procter&Gamble, USA), an electronic
      toothbrush with replacement head (Oral-B Cross Action toothbrush replacement head,
      Procter&Gamble, USA), and a toothpaste (Oral-B Professional Toothpaste and Enamel Pro Repair
      Toothpaste, Procter&Gamble, USA).

      Changing the Type of Toothbrush The first group (Group 1) includes volunteers who used to use
      manual toothbrushes and started to use an electric toothbrush for 1 month with the same daily
      brushing routine. The second group (Group 2) includes volunteers who used to use an electric
      toothbrush and started to use a manual toothbrush for 1 month with the same daily brushing
      routines.

      Plaque and gingival index measurements Following the clinical intraoral examination of the
      volunteers in both groups, plaque and gingival index measurements were performed 5 hours
      after brushing. Regarding the plaque detection, a special 3-tone plaque staining product, Tri
      Plaque ID gel (GC Corp., Tokyo, Japan), was used to demonstrate the quantity and quality of
      the plaques on teeth' surfaces. The staining gel was applied onto buccal surfaces of upper
      and lower anterior teeth. The plaque and gingival indexes were both evaluated initially, 1
      week, and 1 month after the toothbrush changes. The plaque index was evaluated according to
      Quigley and Hein's Plaque Index criteria. The gingival index was evaluated through Sillness &
      Löe Gingival Index and was scored clinically on visual inspection, digitally on dental
      photographs and digital imaging systems.

      Quigley ve Hein Plaque Index 0 -> No plaque 1 -> Flecks of stain of the gingival margin 2 ->
      Definitive line of plaque on gingival margin 3 -> Gingival third of surface 4 -> Two-thirds
      of surface 5 -> Greater then 2/3rd of the surface Sillness & Löe Gingival Index 0 -> Healthy
      gingiva 1 -> Slight change in color and mild inflammation, no bleeding 2 -> Redness, moderate
      inflammation, bleeding on probing/pressure 3 -> Marked redness, severe inflammation,
      spontaneous bleeding Monitorization with intraoral dental photography The stained and
      unstained photographs of the teeth were taken initially, one week, and one month after the
      toothbrush changes. A camera (Nikon D7100), a macro lens (Nikon, 105mm VR macro lens), and a
      TTL dual macro flashlight (Meike MK-MT24N) was used for the DSLR photography. The camera
      parameters were set to ISO 400, diaphragm f/25, and shutter speed 1/125. A mobile dental
      photography device, Smile Lite MDP, was also used in combination with a smart phone (iPhone
      12 Mini, Apple Inc, CA, USA) as an alternative photography technique. CP filter was used for
      all the photographs taken with Smart Lite MDP. The photographs with and without CP were taken
      without calibrating the white balance (WB) in auto white balance (AWB) mode. Additionally, a
      led curing unit D-Light Pro was used in detection mode in combination with the DSLR camera to
      enhance the visualization of the stained plaque. ISO was set at 1600 and diaphragm f/11 for
      photography with the D-Light Pro. The quantity of the plaque on tooth surfaces was scored
      through the photographic analysis.

      Monitorization with digital imaging systems The stained and unstained measurements were
      performed initially, one week, and one month after the toothbrush changes by using FluoreCam
      and iTero Flex devices. After the plaque was stained, it was distinguished from healthy
      enamel tissue in terms of both color and fluorescence properties. FluoreCam device was used
      as one of the methods to determine the amount of dental plaque visually and numerically in
      this study. The stained plaque areas were automatically marked and recorded in the FluoreCam
      software, simultaneously with the visualization of fluorescence images of upper and lower
      anterior teeth on the screen. Size and intensity values of stained plaque were obtained from
      FluoreCam software. Size values represent the area of the plaque, meanwhile intensity values
      demonstrate the amount of mineral loss and were always represented as a negative number.
      Decreasing values in intensity (e.g., from -15 to -10) signify that the lesion (mineral
      content) had slightly improved.

      The images of the anterior teeth were also taken by using a real-time intraoral scanner,
      iTero Element Flex (AlignTech, Carlstadt, USA) to digitalize and distinguish the plaque dye
      to provide clear 3D images and better visual assessment.

      Plaque measurements and gingival index scores at initial, one week, and one month after the
      toothbrush change; for Group 1 and Group 2 were evaluated statistically using Mann Whitney U
      test. Additionally, the images obtained by the FluoreCam device were compared on the system
      software and evaluated statistically using Mann Whitney U and Wilcoxon tests.
    

Intervention name(s): Manual toothbrush; Electric toothbrush
Intervention type(s): Diagnostic Test; Diagnostic Test
Intervention description(s): volunteers who used manual toothbrush for at least 2 years; volunteers who used electric toothbrush for at least 2 years
Allocation: Non-Randomized
Intervention model: Crossover Assignment
Masking: Single (Participant)
Primary purpose: Screening
Keywords: manual toothbrush; electric toothbrush; fluorescence; intraoral scanner; FluoreCam