Objectives Gingival recessions (GR) are often associated with dentin hypersensitivity (HYP) and can significantly affect patients’ oral health-related quality of life. This subgroup-analysis of a previously published study assesses the long-term effects of oscillating-rotating powered (PT) and manual toothbrushes (MT) on HYP in teeth with pre-existing GR and no interproximal attachment loss (RT1) over 36 months. Methods Ninety participants with RT1 were divided into PT-/MT-group (n=47/n=43). All participants brushed twice daily with the same fluoride toothpaste. HYP scores were reassessed for 180 index teeth (PT/MT: n=94/n=86); two teeth per participant. HYP was evaluated annually (T0(baseline), T1, T2 and T3) using tactile stimulus with a dental probe (HYP-S) and an air-jet (HYP-L) applied to the index teeth. Results At T3, HYP-L was significantly reduced in PT but not in MT (p=0.014). From T0 to T3, 60% of PT users showed a decrease in HYP-L, 6.4% remained stable, and 33% experienced an increase, whereas in MT, 36% showed a reduction, 18.6% remained stable, and 45.5% experienced an increase. This was consistent with the GR stabilization reported in the primary analysis. Between T0 to T3 smokers showed a significantly greater reduction in HYP-L than non-smokers (-1.17(1.49) vs. 0.10(2.27); p=0.006), regardless of toothbrush group. Male participants exhibited a more pronounced reduction in HYP-S compared to females (-0.09(1.85) vs. -0.04(1.11); p=0.021). Conclusions The tested powered toothbrush reduced HYP-L more than manual toothbrushing over 36 months; HYP-S was unaffected. Findings are exploratory and require confirmation. Clinical Significance Over 36 months, oscillating-rotating powered brushing was associated with a reduction in air-jet-induced dentin hypersensitivity at RT1-type gingival recession sites. The effect is small and exploratory; powered brushing appears safe in this population but should not be recommended on the basis of hypersensitivity reduction until confirmed in a trial prospectively powered for that endpoint. Trial registration This study was prospectively registered in the German Clinical Trials Register (DRKS00015133) on July 25, 2018.

Abstract Consolidation of preclinical subgingival instrumentation skills during early clinical exposure is poorly quantified, especially after the new German dental licensing regulation (nGDLR). Within a shared digitised training programme (DTP), we compared in vitro performance after preclinical training and after the first periodontal patient course under distributed (oGDLR; 7th semester, S7) versus massed (nGDLR; 6th semester, S6) schedules. In a non-randomised, sequential two-cohort design (a consequence of a 2020 curriculum change), 102 students (oGDLR, distributed/longitudinal schedule, n = 45; nGDLR, massed/block schedule, n = 57) provided 136 evaluations after preclinical DTP (nGDLR S6, oGDLR S7) and/or after the first periodontal patient course (S8). Because oGDLR training (S7) overlapped with first clinical contacts whereas nGDLR training (S6) preceded intensive patient care by ~ 1.5 semesters, schedule density and clinical proximity co-vary and cannot be fully separated. Only 34 students (oGDLR n = 22; nGDLR n = 12) were evaluated at both time points, so most comparisons are cross-sectional. Each student instrumented six teeth with Gracey curettes (GRA) and a sonic scaler (AIR) on periodontitis manikins. Effectiveness of simulated plaque removal (ESP), treatment time, calculus removal and an 8-item Likert self-assessment were analysed by non-parametric tests and multivariable regression with cluster-robust SE. oGDLR was associated with higher ESP (β=+5.16%, p = 0.001) and twofold higher calculus removal (adjusted OR 2.00, p < 0.001); treatment time was comparable. From post-DTP to S8 both cohorts became faster by ~ 60s/tooth (p < 0.001) while ESP declined (β=−4.26%, p = 0.002) — a speed–accuracy trade-off; the schedule×time interaction was non-significant. In the paired subgroup, the trade-off was confirmed in oGDLR (n = 22; ESP − 7.2%, p < 0.001) but power-limited in nGDLR (n = 12). Excluding magnifying-loupe users (concentrated in nGDLR) widened rather than narrowed the oGDLR ESP advantage (β=+6.02%, p < 0.001). nGDLR rated AIR more favourably (learnability OR 0.40; effectiveness OR 0.48). Pass rates (≥ 55% ESP) exceeded 86%. In this non-randomised cohort, the distributed schedule was associated with higher absolute performance, but the decline occurred similarly under both schedules. Because schedule density could not be separated from proximity to clinical exposure, and because the data are largely cross-sectional and derive from a manikin-based in vitro model, these associations should not be read as causal. The transition to first patient care is vulnerable: cleaning quality may erode as students prioritise speed. Distributed preclinical practice was associated with a higher absolute baseline, but the decline across the transition was similar in both schedules; structured reinforcement during the early clinical phase remains necessary to consolidate competence.

Aim To consolidate clinical and scientific evidence and develop personalised recommendations for the optimal use of interdental devices, addressing the diverse needs of patients with varying oral health conditions based on the outcomes of an expert meeting.Material and Methods A round table meeting was convened, gathering nine qualified experts from various European countries, including clinicians and researchers. Through tailored pre-formulated questions and facilitated group discussions, well-defined clinical recommendations and considerations for future research were developed, addressing general guidelines and specific interdental hygiene recommendations alongside potential barriers to implementation.Results General advice emphasises toothbrushing with fluoride toothpaste and integrating interdental cleaning into daily routines. Depending on early clinical signs and symptoms of caries and periodontal disease, interdental cleaning should become a consistent part of daily care. In general, interdental brushes are the preferred option. However, specific recommendations address conditions such as gingivitis, periodontitis, dental implants, caries, removable prostheses and orthodontic treatments. Recommendations also highlight various age groups, emphasising personalised approaches and prioritising interdental cleaning based on clinical indicators. In addition to the clinical situation, individual preferences and dexterity should be considered. For example, non-wired interdental cleaning devices may be more suitable for novice users, while an oral irrigator may be recommended for those with limited dexterity-for example, older adults or patients with special needs.Discussion and Conclusion Barriers to implementing interdental cleaning recommendations must be explored to provide practical solutions for the general population and dental care professionals. Strategies should include developing easily translatable educational content endorsed by professional societies to raise awareness, promoting behaviour change, tailoring care to individual needs, improving product usability, managing costs and addressing discomfort. It is also essential to align recommendations within the dental profession and prioritise interdental care in clinical practice, emphasising evidence-based guidelines and collaborative education efforts to ensure effective interdental hygiene practices are adopted.

OBJECTIVE:This two-centre, double-blind, randomized, parallel-group study compared the efficacy and safety of a novel powered full-mouth cleaning device system (FMCD) with habitual toothbrushing (CG) in patients with generalized gingivitis over 6 weeks. METHODS:Participants between 18 and 65 years with generalized plaque-induced gingivitis were randomly assigned to FMCD (n = 62) or CG (n = 61). At baseline and after 6 weeks, participants were clinically examined. The primary outcome parameter was the change of bleeding on marginal probing (BOMP). As secondary parameters, the extended Turesky modified Quigley Hein plaque index (PI), gingival abrasions (GA), pocket probing depth (PPD), clinical attachment level (CAL), gingival recessions (GR), oral health impact profile and motivational factors for toothbrushing were evaluated. RESULTS:BOMP did not differ significantly between FMCD and CG neither at baseline (FMCD: 66.90% ± 19.28%/CG: 64.13% ± 18.50%; p = 0.415) nor did the change after 6 weeks (FMCD: 0.17% ± 15.93%; -3.47% ± 14.01%; p = 0.181). PI did not differ significantly between groups at baseline (FMCD: 2.95 ± 0.45/CG: 2.96 ± 0.41; p = 0.948), but the change after 6 weeks differed statistically significantly between the groups (FMCD: 0.16 ± 0.41/CG: -0.06 ± 0.39; p = 0.003). GA and GR showed clinically minor though statistically significant differences between the groups that were not considered clinically relevant. No other secondary outcomes differed between groups. There were no serious adverse events. CONCLUSION:The FMCD seems to be equally effective compared to a habitually used toothbrush regarding parameters of gingivitis but slightly less effective with regard to parameters of plaque.

Abstract Background Plaque removal in interdental areas (IDR) remains limited when using powered toothbrushing (PT) alone. Although adjunctive interdental cleaning is widely recommended, quantitative data on the incremental benefit of bilateral interdental application are limited. This in vitro study evaluated cleaning potential following sequential interdental cleaning after PT and compared the bilateral incremental effect between interdental brushes (IDB) and elastomeric interdental picks (IDP). Methods A validated in vitro model (verified for reproducibility and standardised quantitative ECE measurement under controlled in vitro conditions) using a standardised artificial biofilm model to quantify interdental experimental cleaning efficacy (ECE, %). Replicated IDRs of different morphologies and sizes simulating open posterior IDR with reduced papillary support were cleaned sequentially using PT alone, PT followed by one-sided interdental application, and PT followed by bilateral interdental application. The primary outcome was the total incremental cleaning effect after PT (ΔECE2). The additional benefit of second-side application (ΔECE3) was analysed as endpoint. Data were analysed using non-parametric tests with Bonferroni correction. Results PT alone resulted in low interdental cleaning efficacy (IDB/ IDP series: 7.5 ± 2.7%/ 10.2 ± 4.1%; p < 0.001). Following bilateral interdental cleaning, overall ECE increased to 81.2 ± 18.3% for IDB (IDP: 54.7 ± 17.6%; p < 0.001). The total incremental effect after PT was significantly greater for IDB (ΔECE2 73.7 ± 17.8%) than for IDP (44.5 ± 20.6%; p < 0.001). In contrast, the additional benefit of second-side application was greater for IDP vs. IDB (ΔECE3: 21.4 ± 14.1% vs. 9.5 ± 12.2%; p < 0.001). The superiority of IDB in total cleaning efficacy was consistent across IDR morphologies and sizes. Conclusions Within the limitations of this in vitro study, PT alone was insufficient for effective cleaning of simulated open posterior interdental areas with reduced papillary support. Cylindric IDBs demonstrated superior overall performance across all tested conditions, while conical IDPs derived a comparatively greater relative benefit from bilateral access.

AIM:This systematic review synthesizes and evaluates the literature regarding the effect of manual toothbrushes (MTBs) with cross-angled bristle tufts (CA-TB) compared to flat-trim (FT-TB) configurations on plaque scores and parameters of gingival health in adult patients. MATERIALS AND METHODS:PubMed-MEDLINE and Cochrane-CENTRAL databases were searched, from their insertion up to August 1st, 2023, to detect appropriate papers. Clinical trials involving adult patients without periodontitis who performed self-brushing were eligible for inclusion. Primary outcome parameters included plaque, bleeding, and gingival scores. Secondary outcomes encompassed signs of soft and hard tissue abnormalities. A descriptive analysis was conducted. When feasible, a meta-analysis was performed using either the 'fixed' or 'random effects' model, as appropriate. RESULTS:Nine eligible papers were retrieved, presenting 20 comparisons. There was considerable heterogeneity in the clinical and methodological design aspects of the included studies. In the descriptive analysis, eight out of 12 comparisons demonstrated a difference in plaque removal performance in favour of the CA-TB. However, data regarding bleeding and gingival index scores were inconclusive. A meta-analysis was performed on plaque, bleeding, and gingival index scores, including different indices used for scoring. The meta-analysis of short-term studies showed a medium effect statistically significant difference in the reduction of plaque scores in favour of the CA-TB (SMD = 0.75; 95% CI (0.51; 0.99)), but this was not substantiated in longer-term studies (SMD = -0.06; 95% CI(-0.44; 0.31)). No adverse events were described in any group. CONCLUSION:Within the limitations of the present study design, short-term evaluations, as assessed with various plaque indices, show a weak certainty in favour of the cross-angled toothbrush over the flat-trim toothbrush. However, based on longer-term evaluations, there is insufficient support due to the inconsistent outcomes of the analysis.

Abstract Background Up to date, interdental brushes (IDB) are the first choice for interdental cleaning because of their cleaning efficacy. Cylindrical ones must be selected individually according to the size/morphology of the interdental area (IDR), whereas conical ones cover a larger variability of IDR. However, there is a trend on the part of patients towards interdental rubber picks (IRP) which are in general conically shaped, and which seem to be linked with lower cleaning efficacy. A new IRP with an Archimedes´ screw design was developed to overcome this limitation. Therefore, the in vitro study aimed to measure the experimental cleaning efficacy (ECE) and force (ECF) during interdental use of IDBs versus the new IRP type. Methods Three IRPs with different tapers (PHB angled: 0.039, PHB straight S: 0.027, Vitis straight M: 0.045; all Flexipicks, Dentaid, Cerdanyola del Vallès, Spain) were compared to one IDB (Interprox micro PHD 0.9, Dentaid, Cerdanyola del Vallès, Spain). IDR were reproduced by a 3D-printer (Form2, Formlabs Sommerville, MA, USA) according to human teeth and matched to equivalent pairs (isosceles triangle, concave, convex) in three different diameters (1.0 mm,1.1 mm,1.3 mm). Covered with simulated biofilm, pre-/ post-brushing situations of IDR (standardized, computer-aided ten cycles) were photographed and quantified by digital image subtraction to calculate ECE [%]. ECF were registered with a load cell [N]. Statistically significant differences were detected using the Mann-Whitney-U-test and the Kruskal-Wallis-test with Bonferroni correction for multiple testing. Results Overall, the ECE (mean ± SD) was higher for IDB micro 0.9 (45.95 ± 11.34%, p < 0.001) compared to all IRPs (PHB angled: 25.37 ± 15.29%; PHB straight: 22.28 ± 16.75%; Vitis straight: 25.24 ± 12.21%; p ≤ 0.001), whereat best ECE was achieved in isosceles triangle IDR of 1.0–1.1 mm (IDB micro 0.9: 70.7 ± 7.7%; PHB angled S: 57.30 ± 4.43%; p < 0.001). The highest ECF occurred for Vitis straight M with 2.11 ± 0.46 N, while IDB micro 0.9 showed lowest ECF values (0.64 ± 0.14 N; p < 0.001). Conclusions IRP with an Archimedes´ screw design and a higher taper were associated with advanced ECE but also higher ECF, nevertheless, ECE didn’t reach the cleaning efficacy of conventional IDBs.

BACKGROUND:The meaning of the toothbrushing technique for the effectivity of toothbrushing in terms of plaque removal and parameters of gingivitis is unknown. This systematic review and network meta-analysis (NMA) aimed to synthesize evidence from randomized controlled trials (RCTs). METHODS:We searched MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, and the Web of Science for RCTs that compared any self-applied manual toothbrushing technique to any other technique or control and assessed plaque after toothbrushing and gingivitis. Where intervention effects were recorded repeatedly, the last post-intervention assessment was treated as the primary outcome date (POD), and the assessment closest to the intervention as the secondary outcome date (SOD). Age restrictions were not imposed. Participants with fixed orthodontic appliances were excluded. The evidence was evaluated using the Confidence in Network Meta-Analyses (CINeMA) approach, which is based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS:Thirteen publications, including 15 studies, were identified. Ten studies assessing the Fones, Bass, and Scrub techniques provided data eligible for the NMA. The confidence rating of the evidence varied from very low to high in the case of plaque, and from very low to low in the case of gingivitis. Regarding PODs, Fones probably reduces plaque slightly compared with no training; the evidence is very uncertain that Fones may have little to no effect on gingivitis. Bass may result in little to no difference in plaque; the evidence that Bass may result in a slight increase in gingivitis is very uncertain. The evidence is very uncertain that Scrub may result in little to no difference in plaque at the SOD (no POD-data available) and that it may result in a slight increase in gingivitis. CONCLUSION:There is limited evidence regarding the effects of toothbrushing techniques on plaque after brushing or gingivitis.

OBJECTIVE:The objective of this long-term clinical study was to evaluate the influence of a newly developed powered toothbrush (PT) on the size and number of pre-existing gingival recessions (GR) in comparison to a manual toothbrush (MT). METHODS:This was a prospective, single-blind, parallel-group, randomized controlled clinical study. Participants without periodontitis, but with at least two teeth (index teeth) showing GR ≥2 mm were randomized to brush either twice daily with a MT or with a PT with a linear magnetic drive causing the round brush head to produce gentle micro vibrations along with oscillating-rotating movements. Primary outcome parameter was the mean change of GR at the index teeth over 36 months. RESULTS:Totally 87 out of 92 participants completed the study (MT/PT: n = 42/n = 45). At the 36-month evaluation the mean (standard deviation) change of GR at index teeth differed significantly between MT 0.17 (0.77) and PT -0.10 (0.63) (p = 0.013). Furthermore, the amount of GR sites which improved ≥1 mm or remained stable during the study period did not differ between MT and PT, but the number of sites worsened ≥1 mm was significantly in favour for PT (MT 23 (25.5%) versus PT 10 (10.6%); p = 0.009). A binary logistic regression identified tooth type (OR = 2.991 for pre-/molar (1.096 [95% CI 1.002-8.933]; p = 0.050)) and manual brushing (OR = 3.341 (1.206 [95% CI 1291-8648]; p = 0.013)) as risk factors for recession impairment at the index teeth. There were no differences between groups for adverse events. CONCLUSION:In a population with pre-existing gingival recessions and consequently a high risk of developing further recession the PT seems to be favourable with regard to further development of GR.

Die Nutzung von Zahnpasten ergänzend zur Zahnbürste hat eine lange Geschichte. Nach anfänglicher Anwendung von Spüllösungen etablierten sich zusehends Feststoffe, bis schließlich die erste Zahnpasta im heutigen Sinne im 19. Jahrhundert entwickelt wurde. Seitdem bilden Zahnpasten in untrennbarem Zusammenhang zum mechanischen Zähneputzen eine grundlegende Säule der häuslichen Biofilmkontrolle zur Prävention oraler Krankheiten. Bestandteile einer Zahnpasta sind neben Abrasivstoffen/Putzkörpern Inhaltstoffe, welche die Remineralisation von Zahnhartsubstanzen fördern (Fluoride) und antibakterielle Adjuvantien (z.B. Zinnfluorid, Zinkionen). Weitere Wirkstoffe sollen die Reinigung unterstützen (u. a. Tenside/Detergenzien/Schäumer). Andere Bestandteile sollen die Akzeptanz des Putzens erhöhen und bzw. zu einem Frischegefühl nach dem Putzen führen (Aroma-/Geschmack-/Konservierungsstoffe, Farbstoffe/Pigmente, Wasser). Insbesondere bei Kinderzahnpasten sollte darauf geachtet werden, dass bestimmte Inhaltsstoffe wie Titanoxide keine Verwendung finden.

The familiar aids for interdental cleaning such as dental floss or interdental brushes (IDB) are often associated with difficult handling or an increased potential for trauma. Interdental picks (IRP), which have no metal core and silicone flaps instead of nylon brushes, offer the alternative. However, in-vitro studies found a lower cleaning effectiveness combined with higher forces for cleaning compared with conventional IDBs. The aim of this in-vitro study was to measure the experimental cleaning forces (ECF) using IRP with versus without an artificial saliva (AS; GUM Hydral, Sunstar Suisse SA, Etoy, Switzerland). The test set-up was developed to investigate the cleaning of 3D-printed interdental area (IDR) mimicking human teeth (Form 2, Formlabs Sommerville, MA, USA) under standardized conditions. Three different morphologies (isosceles triangle, convex, concave) and three different sizes (1.0 mm,1.1 mm,1.3 mm) were used. Two different IRPs (GUM Soft-picks Advanced: SPA versus GUM Soft-picks Advanced Plus: SPA+, Sunstar Suisse SA, Etoy, Switzerland) in three sizes (small, regular, large), were used with versus without AS. ECF during ten cleaning cycles were recorded by a load cell [N]. Using AS leaded to significant lower values for ECF than without (1.04 ± 0.66 N versus 1.97 ± 1.01 N, p < 0.001). In general, a lower ECF was recorded for convex IDR compared to isosceles triangle and concave morphologies (p < 0.001) as well as for gap sizes of 1.3 mm compared to the smaller sizes (p < 0.001). For SPA+ we found significantly higher force values than for SPA (1.67 ± 0.93 N versus 1.31 ± 0.97 N, p < 0.001) independent of the use of AS. Within the study´s in-vitro limitations, we found AS reduced ECF of IRPs by half and allowed using larger diameters interdentally, which could be associated with (1) a higher cleaning effectiveness and (2) a higher acceptance e.g. of patients with dry mouth. This has to be confirmed by further clinical investigations.

Background Interdental brushes (IDB) are according to the actual evidence the first choice for cleaning interdental areas (IDR). Their size should be chosen individually according to the IDR morphology. However, interdental rubber picks (IRP) are appreciated better by the patients and are hence becoming more and more popular but the evidence regarding their efficacy is still limited. The aim of this in vitro study was to measure the experimental cleaning efficacy (ECE) and force (ECF) during the use of interdental brushes versus newer wireless types with rubber filaments (IRP), both fitted and non-fitted for different IDR. Methods The medium size of a conical IRP (regular, ISO 2) with elastomeric fingers versus four sizes (ISO 1, 2, 3, 4) of cylindric IDB with nylon filaments (all Sunstar Suisse SA, Etoy, Switzerland) were tested. Interdental tooth surfaces were reproduced by a 3D-printer (Form 2, Formlabs Sommerville, MA, USA) according to human teeth and matched to morphologically equivalent pairs (isosceles triangle, concave, convex) fitting to three different gap sizes (1.0 mm, 1.1 mm, 1.3 mm). The pre-/post brushing situations at IDR (standardized, computer aided ten cycles) were photographically recorded and quantified by digital image subtraction to calculate ECE [%]. ECF were registered with a load cell [N]. Results Overall, a higher ECE was recorded for IDB compared to IRP (58.3 ± 14.9% versus 18.4 ± 10.1%; p < 0.001). ECE significantly depended on the fitting of the IDB. ECE was significant higher in isosceles triangle compared to concave and convex IDR for both IDB and IRP ( p ≤ 0.001). ECF was lower for IDB (0.6 ± 0.4N) compared to IRP (0.8 ± 0.5N; p ≤ 0.001). ECE in relation to ECF increases with smaller IDB. For IRP highest values of ECF were found in the smallest IDR. Conclusions Within the limitations of an in vitro study, size fitted IDB cleaned more effectively at lower forces compared to conical IRP.

Objectives Whereas the key role of subgingival instrumentation in periodontal therapy is well known, the influence of operators’ experience/training with different devices on treatment results is yet uncertain. Therefore, we assessed untrained undergraduate students, working on manikins, as to how effectively they learn to use curettes (GRA) and sonic scalers (AIR); hypothesizing that AIR will result in higher relative cleaning efficacy (RCE) than GRA. Material and methods Before baseline evaluation (T0), 30 operators (9 males, 21 females) received a 2-h theoretical lesson for both instruments, followed by a 12-week period with a weekly digitized training program for 45 min. During three sessions (T1–T3), the operators had to instrument six equivalent test teeth with GRA and AIR. At T0–T3, treatment time, proportion of removed simulated biofilm (RCE-b), and hard deposits (RCE-d) were measured. Results At T0, RCE-b was in mean(SD) 64.18(25.74) % for GRA, 62.25(26.69) % for AIR; ( p = 0.172) and RCE-d 85.48(12.32) %/ 65.71(15.27) % ( p < 0.001). At T3, operators reached highest RCE-b in both groups (GRA/AIR 71.54(23.90) %/71.75(23.05)%; p = 0.864); RCE-d GRA/AIR: 84.68(16.84) %/77.85(13.98) %; p < 0.001). Both groups achieved shorter treatment times after training. At T3, using curettes was faster (GRA/AIR 16.67(3.31) min/19.80(4.52) min; p < 0.001). Conclusions After systematic digitized training, untrained operators were able to clean 70% of the root surfaces with curettes and sonic scalers. Clinical relevance It can be concluded that a systematic digitized and interactive training program in manikin heads is helpful in the training of root surface debridement.

It is well established that dental plaque on teeth leads to gingivitis and periodontitis, and that several mechanical and chemical methods of plaque control can prevent gingivitis. The aim of the current review is to summarize and synthesize the available scientific evidence supporting practices for mechanical oral hygiene to prevent periodontal diseases. Evidence for contemporary practices of mechanical oral hygiene to prevent periodontal disease relies on studies of gingivitis patients. General recommendations concerning the ideal oral hygiene devices and procedures are still inconclusive. However, toothbrushing and interdental cleaning remain the mainstays of prevention of periodontal diseases. The primary approach requires individually tailored instruction for implementation of a systematic oral hygiene regimen.

Background The current study evaluated whether a new digitized scaling training program (DTP: n = 30; supervisor-student-ratio 1:10) improves the performance of undergraduate dental student during a preclinical course in regard to two different instruments [sonic scalers (AIR) and Gracey curettes (GRA)] compared to a conventional training program (CTP: n = 19; supervisor-student-ratio 1:4). Methods All the participants received a two-hour lecture on both instruments, followed by a 12-week period with a weekly training program lasting 45 min (10 sessions); one group was supported by DTP. At the end of the training phase, all the participants performed the subgingival scaling of six equivalent test teeth using GRA and AIR. Treatment time, proportion of removed simulated biofilm (relative cleaning efficacy, RCE-b) and hard deposits (RCE-d) were recorded. By using a pseudonymized questionnaire with a 5-point Likert scale, self-assessment of scaling effort, handling, root surface roughness/destruction and effectiveness were evaluated. In addition, personal data such as age, gender, handedness, regularity of playing computer games/consoles and previous dental/technical or medical education were elevated and correlated with cleaning efficacy. Results The DTP participants showed higher effectiveness in RCE-b compared to those who used the CTP with GRA (71.54% vs. 67.23%, p = 0.004) and AIR (71.75% vs. 62.63%, p ≤ 0.001), and the DTP students were faster with both instruments (p ≤ 0.001). For RCE-d, there was no significant difference between the DTP and CTP groups (GRA p = 0.471; AIR p = 0.158), whereas DTP showed better RCE-d results with GRA versus AIR (84.68% vs. 77.85%, p < 0.001). According to the questionnaire, no significant differences were detected between the training groups in terms of self-assessment, handling, treatment time, root surface roughness/destruction or effectiveness of the instruments. The CTP group favored AIR compared to GRA regarding the fatigue effect. The CTP and playing computer games/consoles regularly was correlated with lower RCE-b, whereas previous education in medicine/dentistry was correlated with higher RCE-b values. Conclusions Within the limitations of the study, the DTP with a reduced supervision effort compared to the CTP resulted in higher effectiveness and lower instrumentation time for removing simulated biofilms.

Abstract Background Interdental rubber picks (IRP) have become a frequent and convenient alternative for interdental cleaning. However, only little evidence exists supporting the effectiveness of newer designs available on the market. Therefore, a new in vitro model was evaluated to measure the experimental cleaning efficacy (ECE), as well as the force needed for insertion and during the use of IRP, with high reproducibility. Methods Five different sizes of commercially marketed IRP with elastomeric fingers (IRP-F) (GUM SOFT-PICKS® Advanced, Sunstar Deutschland GmbH, Schönau, Germany) or slats (IRP-S) (TePe EasyPick™, TePe D-A-CH GmbH, Hamburg, Germany) were tested. Interdental tooth surfaces were reproduced by a 3D-printer (Form 2, Formlabs Sommerville, MA, USA) according to human teeth and matched to morphologically equivalent pairs (isosceles triangle, concave, convex) fitting to different gap sizes (1.0 mm, 1.1 mm, 1.3 mm). The pre−/post brushing situations at interdental areas (standardized cleaning, computer aided ten cycles) were photographically recorded and quantified by digital image subtraction to calculate ECE [%]. Forces were registered with a load cell [N]. Results IRP-F have to be inserted with significant higher forces of 3.2 ± 1.8 N compared to IRP-S (2.0 ± 1.6 N; p < 0.001) independent of the size and type of artificial interdental area. During cleaning process IRP-S showed significantly lower values for pushing/pulling (1.0 ± 0.8 N/0.5 ± 0.4 N) compared to IRP-F (1.6 ± 0.8 N/0.7 ± 0.3 N; p < 0.001) concomitant to significantly lower ECE (19.1 ± 9.8 vs. 21.7 ± 10.0%, p = 0.002). Highest ECE was measured with largest size of IRP-F/IRP-S independent the morphology of interdental area. Conclusions New interdental cleaning aids can be tested by the new experimental setup supported by 3D printing technology. Within the limitations of an in vitro study, IRP-F cleaned more effectively at higher forces compared to IRP-S.

There is uncertainty regarding the benefits of periodontal endoscopy (PE) for subgingival instrumentation. Moreover, the influence of operators’ experience and training with such a device on treatment results is unclear. Therefore, we compared in an in vitro study the use of PE for scaling and root planing (SRP) with the conventional non-surgical therapy, hypothesizing that using a PE allows to remove more simulated hard deposits than without (nPE), influenced by the operators’ experience and training. A sonic device and Gracey curettes were utilized by 11 operators (six dentists, five dental hygienists) in periodontitis manikins heads. The time required for treatment and the proportion of removed simulated hard deposits by SRP were measured. Using the PE led to a significant difference in removal of simulated hard deposits (%) (mean ± SD) irrespective of operators’ experience (PE 90.78 ± 12.10% (range 58.80–100%); nPE 79.98 ± 22.15% (range 38.10–100%, p < 0.001)), sub-analyses for different tooth types demonstrated a significant difference in favor of PE for front teeth (p < 0.001) and in the upper jaw independent of the tooth type (p < 0.001). Comparison of treatment times for two quadrants with and without PE showed a significantly longer treatment time with PE (∆22.27 ± 17.98 mins, p <0.001). Within the present pilot study, the use of PE led to more removal of simulated hard deposits but was concomitantly related to more time and financial effort. Using PE was most beneficial in the front area. PE may provide additional benefits for the removal of hard deposits compared to traditional SRP. The beneficial effect of PE seems not to be influenced by operators experience nor by pocket probing depth.

Die Instruktion der Mundhygiene stellt sich in der Praxis immer wieder als Herausforderung dar. Man mag es im Jahr 2020 kaum glauben, aber es gibt Mundhygiene-Mythen, auf die viele Menschen bis heute vertrauen, obwohl sie teils nicht der Wahrheit entsprechen. Somit wird unbewusst die eigene Zahngesundheit riskiert. Anhand der aktuellen Leitlinie zur mechanischen häuslichen Mundhygiene zeigt dieser Artikel, welche Instruktionen in der Praxis gegeben werden sollten.

OBJECTIVES:We aimed to assess how the 2018 and 1999 classifications of periodontal diseases reflect (a) patients' characteristics, (b) disease severity/extent/progression and (c) tooth loss (TL) during observation period.METHODS:A total of 251 patients were followed over 21.8 ± 6.2 years. For the 1999 classification, using clinical attachment level (CAL), patients were classified as localized/generalized, mild/moderate/severe and aggressive/chronic periodontitis. For the 2018 classification, patients were staged according to their CAL or bone loss (BL) and the number of lost teeth (stages I-IV). Further factors like probing pocket depths (PPD) or furcation involvement modified the stage. The extent was sub-classified as generalized/localized. Patients were graded according to the BL/age index, smoking and/or diabetes.RESULTS:According to the 1999 classification, most patients suffered from generalized severe chronic periodontitis (203/251) or generalized aggressive periodontitis (45/251). Patients with aggressive periodontitis were younger and less often female or smokers. They showed similar TL (0.25 ± 0.22 teeth/patient*year) as generalized severe chronic periodontitis patients (0.23 ± 0.25 teeth/patient*year). According to the 2018 classification, most patients were classified as generalized III-C (140/251), III-B (31/251) or IV-C (64/251). Patients' age, smoking status, CAL, PPD and BL were well reflected. TL differed between IV-C (0.36 ± 0.47), generalized III-C (0.21 ± 0.24) and localized forms (0.10-0.15).CONCLUSIONS:Patients' characteristics, disease severity/extent/progression and TL were well reflected by the 2018 classification.

Introduction: For the last 30 years, the central pathomechanical path of periodontitis has been described as a polymicrobial infection by an oral biofilm containing specific pathogens. Consequently, a combination of microbiological tests followed by systemic antibiotics has been used as an adjunct to me chanical removal of the biofilm. According to current knowledge, however, conversion of the originally physiological and symbiotic biofilm into a dysbiotic biofilm is crucial for the pathogenicity. Hence, testing for the presence of specific microorganisms is of less clinical relevance. Systemic administration of antibiotics after prior mechanical debridement undeniably has an added benefit in severe manifestations of periodontitis. In light of this, it is unclear how the decision to administer systemic antibiotics as part of peri odontitis therapy is made in dental practices. Evaluating this decision process was the subject of this study.