A Comparison of the Outcomes of Two Existing Routine Clinical Therapies for Dental Prophylaxis
Condition: Gingivitis
MeSH terms: Gingivitis
Study type: Interventional

Summary: 
      Background: In most practices, conventional in-office prophylaxis starts immediately with
      scaling and polishing. Therefore, this project was designed to challenge tradition by
      comparing plaque removal efficacy of rubber cup and air polishing in two scenarios, one where
      plaque was disclosed prior to treatment and the other where plaque was not disclosed.

      Methods: In this randomized, single blind, split-mouth design clinical trial, healthy,
      non-smoking participants with poor oral hygiene were recruited. Quadrants in each participant
      were randomly assigned to 4 treatment groups, which were plaque disclosure with rubber cup
      polishing, no plaque disclosure with rubber cup polishing, plaque disclosure with air
      polishing, and no plaque disclosure with air polishing. Examiners were calibrated and masked
      to the treatment rendered in each quadrant. Post treatment satisfaction questionnaires for
      both participants and operators were completed. Plaque scores for each quadrant and treatment
      time were the recorded outcome measures.
    

Detailed description: 
      According to the literature search, there was no preceding study, which compared the efficacy
      of conventional routine of rubber cup or air powder polishing with or without prior plaque
      disclosure. Therefore, this study was designed to test the hypotheses that (1) disclosing
      plaque prior to dental polishing was more effective than dental polishing alone, (2) air
      polishing was more efficient than rubber cup polishing, and (3) operators and patients prefer
      air polishing to rubber cup polishing.

      In order to evaluate the hypotheses raised, a single blind, randomised controlled clinical
      trial with a split mouth design was conducted. The control groups had conventional dental
      prophylaxis regime of mechanical plaque removal with either fine air powder polishing or
      rubber cup polishing using fine grit prophylaxis paste. The test groups had plaque disclosure
      prior to mechanical plaque removal as described for the control groups. In total, there were
      4 study groups: (1) rubber cup polishing without prior plaque disclosure (RC-NPD) (negative
      control), (2) rubber cup polishing with prior plaque disclosure (RC-PD) (positive control),
      (3) air polishing without prior plaque disclosure (AF-NPD) (negative test), and (4) air
      polishing with prior plaque disclosure (AF-PD) (positive test).

      The quadrant that was assigned to receive RC-NPD was treated first followed by the quadrant
      assigned to receive AF-NPD. Plaque was disclosed in all 4 quadrants and the assigned
      calibrated examiner proceeded to chart the FMPS. Next, the quadrant assigned to receive RC-PD
      was treated, followed by the quadrant assigned to receive AF-PD; subsequently FMPS was
      charted. Any aberrant findings in occlusion, tooth alignment, extra/missing teeth were also
      noted. A digital stopwatch was used to time the treatment duration for each quadrant. Both
      participant and clinician completed a post prophylaxis satisfaction questionnaire. The
      treatment workflow used in this study was illustrated in figure 1. The primary outcome
      measure was the post treatment FMPS and the secondary outcomes measures were the treatment
      duration.

      Descriptive statistics (mean and standard deviations) was used to summarize the plaque score
      and treatment duration for each study group. Two-way repeated measure ANOVA test was employed
      to examine the study hypotheses that air polishing was more effective in removing plaque
      compared to rubber cup polishing and disclosing plaque prior to prophylaxis increased the
      thoroughness of the prophylaxis. Two-way repeated measure ANOVA test was also performed to
      study the treatment duration between the 2 polishing methods and treatment regimens of with
      or without plaque disclosure prior to prophylaxis. In a secondary analysis, interactions were
      tested to study if there were differences among the 4 operators. Paired T-test and Pearson's
      Chi-Square tests were used to study the participant's and operator's preference for each
      treatment modality based on various yardsticks and overall, respectively. The level of
      significance was set at p-value<0.05. All statistical analyses were carried out using a
      statistical package.
    

Intervention name(s): Plaque disclosed with air flow; Plaque disclosed with rubber cup; Non plaque disclosed air flow; Non plaque disclosed rubber cup
Intervention type(s): Procedure; Procedure; Procedure; Procedure
Intervention description(s): air polishing with prior plaque disclosing; rubber cup polishing with prior plaque disclosing; air polishing with no prior plaque disclosing; rubber cup polishing with no prior plaque disclosing
Other intervention name(s): EMS; Slow speed handpiece; EMS; Slow speed handpiece
Intervention MeSH terms: Methamphetamine
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: In each subject, his/her right and left dentition will be randomized into Plaque Disclosed (PD) and Non Plaque Disclosed (NPD) groups. Subsequently, the upper and lower jaws will be randomized into Air Flow (AF) and Rubber Cup (RC).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: plaque removal