Plaque removal efficacy of oscillating-rotating power toothbrushes: review of six comparative clinical trials.

PURPOSE: This review of six clinical trials provides a comprehensive overview of the results of statistical analyses to explore between-brush differences, specifically in the lingual, gingival marginal, and approximal ("hard-to-clean") areas, in post-brushing plaque removal of oscillating-rotating (O-R) power toothbrushes compared to either a marketed sonic power toothbrush or a manual toothbrush control. METHODS: All studies were single-center, randomized and controlled, and examiner-blind. Four trials were four-period crossover design with replicate single-use brushing, while two studies were parallel group investigations (4 or 12 weeks) with multiple brushings and assessments at each visit. Generally healthy subjects were enrolled. Plaque evaluations were via the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI) or the Rustogi Modification of the Navy Plaque Index (RMNPI). At each evaluation visit, subjects brushed with either the randomly assigned O-R power brush [Oral-B Professional Care Series 4000 (Triumph) or Oral-B Vitality with Floss Action or Precision Clean brush head] or a control brush [Sonicare FlexCare with ProResults brush head (three trials) or an American Dental Association (ADA) reference manual toothbrush (three trials)]. ANCOVA and ANOVA analyses subsequently evaluated specifically the 'hard-to-clean' tooth surfaces for between-brush differences. RESULTS: In total, 462 subjects completed the trials and were evaluable. While all toothbrushes provided significant post-brushing versus baseline plaque removal efficacy, the magnitude of the reduction was consistently superior for the O-R brush compared to either the sonic power or manual brush control in all the 'hard-to-clean" region-specific analyses. Adjusted mean RMNPI or TMQHPI benefits favoring the O-R brush relative to the sonic brush control were collectively 18% to 34% greater on lingual surfaces (P < or = 0.044), 32% to 49% greater on lingual approximal surfaces (P < 0.001), and 32% and 31% greater in lingual mandibular and lingual mandibular anterior regions, respectively (P < or = 0.005). Post-brushing whole mouth adjusted mean reduction RMNPI or TMQHPI benefits favoring the O-R brush compared to the manual brush control were collectively 31% to 206% greater on lingual surfaces (P < or = 0.001), 29% to 217% greater on lingual approximal surfaces (P < or = 0.001), and 67% to 526% greater in lingual gingival margin regions, respectively (P < or = 0.001). All study toothbrushes were well-tolerated.

A novel power toothbrush with multi-directional, triple zone cleaning technology.

PURPOSE: Numerous laboratory and clinical studies have proven that certain power toothbrush technologies are more effective in removal of dental plaque and reduction of gingivitis than regular manual toothbrushes. Regardless of this evidence, there is still a large group of individuals who prefer the experience of a manual-like toothbrush. Recently a novel multi-directional power brush has been developed as an alternative for those people who favor the traditional size and shape of a manual toothbrush and prefer the manual brushing technique, but would benefit from the greater cleaning efficiency of the power brush. METHODS: This unique multi-directional power toothbrush with triple-zone cleaning technology has been tested in multiple clinical trials. This special issue introduces the technical features of the brush and presents four clinical investigations conducted with this power toothbrush versus manual and sonic controls. RESULTS: The studies described in this issue demonstrate the superior efficacy of the multi-directional brush in plaque and gingivitis reduction relative to control brushes, even in the hard-to-reach interdental spaces and marginal areas.

Benefit of the power component of sonic and rotation-oscillation modes of action for plaque removal using power toothbrushes.

PURPOSE: To assess the benefit of the power component of two power toothbrushes, with sonic and rotation-oscillation mechanisms, on plaque removal efficacy. METHODS: Two independent studies with identical designs were used to assess the benefit of the power component of two power toothbrushes, with sonic and rotation-oscillation mechanisms, on plaque removal efficacy. Each brush was tested with the power 'On' relative to a control of the same brush with the power 'Off' used like a manual toothbrush. The studies were carried out independently at different sites, and each employed a replicate use, single brushing, two-treatment, four-period, examiner-blind, randomized, crossover design for assessing plaque removal. Study 1 compared rotation-oscillation action (Oral-B Triumph with FlossAction brush head), and Study 2 compared sonic action (Sonicare FlexCare with ProResults standard brush head) with power on versus off. The two treatments in each study consisted of (1) brushing teeth per manufacturer's instructions of the power toothbrush and (2) brushing without power by using the power toothbrush like a manual toothbrush. Prior to the treatment phase of each study, subjects exclusively used the assigned study toothbrush for 2 minutes twice per day according to the manufacturer's instructions (power on) during an acclimation period. Plaque was scored at prebrushing (baseline) and post-brushing on Visits 2, 3, 4 and 5 using the Turesky Modified Quigley-Hein Plaque Index (TMQHPI). A 2-day washout period separated each treatment period. RESULTS: 32 subjects were enrolled in each study; 28 subjects provided complete data for Study 1 and 32 subjects provided complete data for Study 2. The adjusted mean TMQHPI plaque removal scores for Study 1 were 0.793 for the rotation-oscillation 'On' regimen and 0.675 for the rotation-oscillation 'Off' regimen. This represents a statistically significantly (P<0.0001) greater plaque score reduction for the rotation-oscillation 'On' versus rotation-oscillation 'Off' treatment. The adjusted mean TMQHPI plaque removal scores for Study 2 were 1.042 for the sonic 'On' regimen and 1.007 for the sonic 'Off' regimen. This represents a nonsignificant (P=0.426) greater plaque score reduction for the difference between sonic 'On' versus sonic 'Off' regimen.

Replicate single-use comparative study of plaque removal with two contemporary manual toothbrushes.

PURPOSE: To compare the plaque removing efficacy of Oral-B Advantage 123 and Colgate 360 degrees manual toothbrushes on a single brushing after a 24-hour void in oral hygiene. METHODS: This study had a two-treatment (Advantage 123 versus Colgate 360 degrees), examiner-blind, randomized, four-period (visit) crossover design. At the first (baseline) visit, subjects received a plaque examination using the Rustogi Modified Navy Plaque Index (RMNPI) after which they were instructed to brush for 1 minute in their normal manner with their assigned toothbrush and a marketed dentifrice and unaided by access to a mirror. Post-brushing plaque was then assessed. At three further visits, each separated by a period of 3-8 days, brushes were assigned to subjects according to their treatment sequence and the same brushing and plaque grading procedure as at baseline was followed. RESULTS: 50 subjects were enrolled in the replicate single-use study; all were included in the analysis. Oral-B Advantage 123 was significantly better than Colgate 360 degrees at reducing whole mouth (P = 0.006), gingival margin (P = 0.010) and approximal (P = 0.040) plaque scores.

A randomized 12-week study to compare the gingivitis and plaque reduction benefits of a rotation-oscillation power toothbrush and a sonic power toothbrush.

OBJECTIVE: Sonic and rotation-oscillation power toothbrushes are popular and effective, but have been shown to differ in relative benefits. The objective of this 12-week investigation was to compare the efficacy of a rotation-oscillation powered toothbrush and a newly introduced sonic toothbrush in the reduction of gingivitis and dental plaque. METHODS: This was a randomized, controlled, examiner-blind, two-treatment, parallel-group study to assess gingivitis reduction and plaque reductions after twice-daily brushing with either the rotation-oscillation brush or the sonic toothbrush over 12 weeks. The Modified Gingival Index (MGI) and Gingival Bleeding Index (GBI) were used to determine gingivitis benefits at Week 6 and Week 12, and plaque was scored at these visits before and after supervised brushing using the Rustogi Modified Navy Plaque Index (RMNPI). RESULTS: In 171 evaluable subjects, gingivitis reduction benefits were significantly greater for the rotation-oscillation brush group than for those using the sonic toothbrush, with relative mean benefits favoring the rotation-oscillation brush of 29.4% for GBI and 8.2% for MGI at 12 weeks (p < or = 0.01). The rotation-oscillation brush produced significantly lower RMNPI plaque by 33.3% compared to the sonic toothbrush (p < 0.001) at Week 12. CONCLUSION: The rotation-oscillation power toothbrush was significantly more efficacious than the sonic toothbrush in removing plaque, in reducing gingivitis, and lowering the number of bleeding sites after 12 weeks of twice-daily brushing.

Comparison of rotation/oscillation and sonic power toothbrushes on plaque and gingivitis for 10 weeks.

PURPOSE: Although power toothbrushes provide valuable tools toward improving oral health, contrasting results are discerned in their efficiency. This 10-week study was conducted to compare the safety and efficacy of rotation/oscillation and sonic power toothbrushes in the reduction of plaque and gingivitis. METHODS: This two-treatment, parallel group, examiner-blind, randomized study had the subjects brush twice daily at home with their assigned rotation/oscillation or sonic toothbrush following manufacturer's instructions with center visits at baseline, and at 4 and 10 weeks following the baseline visit, for assessment of oral safety (all visits), plaque (baseline, Weeks 4 and 10), and gingivitis (baseline and Week 10). Gingivitis and number of bleeding sites were measured using the Löe-Silness Gingivitis Index, and plaque was measured using the Turesky Modification of the Quigley-Hein Plaque Index. RESULTS: At Week 10, 171 subjects were evaluable for plaque assessment (85 in Sonic group, 86 in rotation/oscillation group) and 165 subjects were evaluable for gingivitis and bleeding sites assessment (84 in sonic group, 81 in rotation/oscillation group). The rotation/oscillation group had statistically significantly lower gingivitis scores (by 3.5%) and statistically significantly fewer bleeding sites than the sonic group (by 16.1%) with P = 0.038 and 0.028, respectively, at Week 10. Compared to baseline, only the rotation/oscillation group showed a statistically significant improvement in gingivitis (P = 0.003) and bleeding (P < 0.001) at Week 10. At both Weeks 4 and 10, the rotation/oscillation group had directionally lower plaque scores than the sonic group (by approximately 3%), but treatment group differences were not statistically significant (P > 0.1) at either time point. Both groups showed statistically significantly lower plaque scores at Weeks 4 and 10 relative to baseline.

A study comparing the plaque removal efficacy of an advanced rotation-oscillation power toothbrush to a new sonic toothbrush.

OBJECTIVE: Recently, a new sonic power toothbrush has been marketed. The purpose of this study was to compare the plaque removal efficacy of a control rotation-oscillation power toothbrush (Oral-B Triumph) to this new sonic-powered toothbrush (Sonicare FlexCare) following a single brushing. METHODS: This study was a randomized, controlled, examiner-blind, two-treatment, four-period crossover design, which examined plaque removal with the two toothbrushes following replicate single uses in 48 subjects. Plaque was scored before and after brushing using the Turesky Modification of the Quigley-Hein Plaque Index (TMQHPI). RESULTS: Baseline plaque scores were 2.87 for the sonic toothbrush and 2.85 for the rotation-oscillation toothbrush treatment groups. With respect to all surfaces examined, the sonic toothbrush delivered an adjusted (via Analysis of Covariance) mean difference between baseline and post-brushing plaque scores of 0.95, while the rotation-oscillation toothbrush delivered an adjusted mean difference of 1.06. The difference between treatment groups was statistically significant (p = 0.003). CONCLUSION: The rotation-oscillation toothbrush delivered superior plaque removal by reducing plaque scores, on average, 12.1% more than the new sonic toothbrush.