Crestal bone loss associated with different implant surfaces in the posterior mandible in patients with a history of periodontitis. A retrospective study.

OBJECTIVE: To retrospectively assess the interproximal bone loss (CBL) in external hexagon implants (EHI), with different surface micro-topography, placed in the posterior mandible in patients with a history of periodontitis undergoing supportive periodontal care. MATERIAL AND METHODS: 268 consecutive patients received 755 EHI implants in the mandibular molar region between 2007 and 2015 with the following surface characteristics: 72 turned, 145 hybrids (double acid-etched/turned), and 538 anodized. CBL was yearly evaluated by analysing calibrated digital periapical radiographs, with a follow-up of 1-6 years. Data on implant survival were also calculated. RESULTS: At 6 years (53 patients), the mean CBL was 1.34/1.42 mm at patient/implant level, respectively (range: 0-5.2 mm). Significantly higher CBL was detected in anodized implants than in turned and hybrid implants (1.92/1.46/1.02 mm) (p < .01). The maximum CBL values were found in 2 anodized implants at 4 years (6.3 and 8.1 mm). CBL ≥2 mm was detected in 18% of implants at 3 years and 35% at 6 (p < 2.2 × 10-16 ), this prevalence being 2.6 times higher in the anodized than in the hybrid and turned group (40%/15.6%, p < .0094). At 6 years, 25 anodized implants presented CBL ≥3 mm (18%). 6 anodized implants (5 patients) were removed between 4 and 5 years. CONCLUSION: A significant higher CBL was observed in anodized, compared to hybrid and turned implants, when placed in the mandibular molar region of periodontal patients, with a follow-up of 1 to 6 years.

European Association for Osseointegration Delphi study on the trends in Implant Dentistry in Europe for the year 2030.

OBJECTIVES: To assess the potential trends for the year 2030 in dental implant dentistry in Europe using the Delphi methodology. MATERIAL AND METHODS: A steering committee and a management team of experts in implant dentistry were created and validated a questionnaire including 60 questions, divided in eight topics. The survey was conducted in two rounds using an anonymous questionnaire, which provided the participants in the second round with the results of the first. Each question had three possible answers, and the results were expressed as percentages. RESULTS: A total of 138 experts were invited to participate in the survey. From all the invited experts, 52 answered in both the first and second rounds. Three different consensus categories were established based on the percentage of agreement: no consensus (<65%); moderate consensus (65%-85%); and high consensus (≥86%). Within the topic categories, a consensus was reached (mainly moderate consensus) for the majority of questions discussed among experts during a face to face consensus meeting. However, consensus was not reached for a small number of questions/topics. CONCLUSIONS: About 82% of the questions reached consensus. The consensus points towards a lower number of implants to replace chewing units, with implants surfaces made of bioactive materials with reduced micro-roughness using mainly customized abutments with polished surfaces and an internal implant-abutment connection (85%). CBCT-3D technologies will be the main tool for pre-surgical implant placement diagnosis together with direct digital restorative workflows. There will be an increase in the incidence of peri-implantitis, although there will be more efficient interventions its treatment and prevention.

Drugs and diseases: Summary and consensus statements of group 1. The 5th EAO Consensus Conference 2018.

OBJECTIVES: The task of this working group was to update the knowledge about the use of drugs and biologicals affecting healing of soft tissue and bone during implant treatment or procedures associated with it. Moreover, the impact of titanium particles and biocorrosion on complications and implant survival has been analysed. MATERIALS AND METHODS: The literature in the areas of interest (platelet concentrates, antiresorptive drugs as well as implant-host interaction) was screened using systematic reviews for the former two areas, whereas a narrative critical review was performed for the latter topic. Two manuscripts on platelet concentrates, one manuscript on antiresorptive drugs and one manuscript on the effects of biocorrosion, were presented for group analysis with subsequent discussion in the plenum and final consensus approval. RESULTS: Results and conclusions of the individual reviews of the three topics are presented in the respective papers. Conclusions of the group on strengths and weaknesses of available evidence as well as consensus statements and directions for further research are provided in this study. The following papers were subject to group discussions and formed the basis for the consensus statements: Stähli A, Strauss FJ, Gruber R. () The use of platelet-rich-plasma to enhance the outcomes of implant-related therapies: a systematic review Strauss FJ, Stähli A, Gruber R. (2018) The use of platelet-rich-fibrin to enhance the outcomes of implant-related therapies: a systematic review Mombelli A, Hashim D, Cionca N. () What is the impact of titanium particles and bio-corrosion on implant survival and complications? A critical review Stavropoulos A, Bertl K, Pietschmann P, Pandis N, Morten Schiødt, Klinge B. () The effect of antiresorptive drugs on implant therapy: a systematic review.

A retrospective study on the crestal bone loss associated with different implant surfaces in chronic periodontitis patients under maintenance.

OBJECTIVE: To analyze retrospectively interproximal crestal bone loss (CBL) on external-hex "non-identical" (NI) dental implants with different surface topography, when placed in the same intra-oral location in patients with a history of chronic periodontitis following maintenance care. MATERIAL AND METHODS: The patient population consisted of 206 consecutive patients with a history of chronic periodontitis who underwent implant surgery between 2007 and 2010; 755 NI implants with different implant surfaces were placed at posterior mandibular sites: 72 machined, 145 acid-etched/machined (hybrid), and 538 anodized. Crestal bone loss measurements were carried out analyzing the calibrated digital X-rays taken at 1-year intervals as part of the maintenance program, being the time of this retrospective examination from 1 to 3 years. RESULTS: At 3 years (51 patients), the mean CBL was 1.36/1.35 mm at implant/patient level (range: 0-6 mm). A higher CBL was observed at anodized surface implants, when compared to machined and hybrid implants, being the mean CBL 1.48, 0.96, and 0.77 mm, respectively (p = .005). CBL between 2 and 3.9 mm was found in 10.6% of the implants at 3 years (95% CI: 6%-15%), ≥4 mm in 5% (95% CI: 2%-8%). Anodized surface implants had CBL >2 mm at 2 years of 9% (95% CI: 6%-12%) and at 3 years of 18% (95% CI: 12%-24%), which were 2.5 times higher than hybrid implants with 3.6% (95% CI: 0.8%-4%) and 7.4% (95% CI: 0%-17%), respectively. CONCLUSIONS: A higher CBL was observed in the anodized surface implants group, when compared to the hybrid implants group in patients with a history of chronic periodontitis followed during 1-3 years.

Long-term stability of peri-implant tissues after bone or soft tissue augmentation. Effect of zirconia or titanium abutments on peri-implant soft tissues. Summary and consensus statements. The 4th EAO Consensus Conference 2015.

INTRODUCTION: Several surgical techniques and prosthetic devices have been developed in the last decades, aiming to improve aesthetic, hygienic and functional outcomes that may affect the peri-implant tissues, such as procedures of bone and soft tissue augmentation and the use of custom-made abutments of titanium and zirconium. MATERIALS AND METHODS: Three systematic reviews, based on randomized clinical trials and prospective studies covering the above reported topics were analysed, and the detected evidence was exposed to interactive experts' discussion during the group's and general assembly's meetings of the 4th EAO Consensus Conference. The results are reported using the following abbreviations: S-T: short-term evidence, M-T: medium-term evidence; L-T: long-term evidence; LE: limited evidence. RESULTS: Soft tissue augmentation procedures may be indicated for the increase of soft tissue thickness and keratinized tissue, the reduction of interproximal peri-implant bone loss, and the coverage of shallow peri-implant soft tissue recessions (S-T, LE), L-T is lacking. Guided bone regeneration approaches (GBR) showed efficacy when used for ridge reconstruction after the complete healing of the soft tissues (S-T & L-T), and the stability of the augmented bone may play a role in the maintenance of the soft tissue position and dimensions (LE). No significant differences were observed between titanium and zirconia abutments when evaluating probing pocket depth, bleeding on probing, marginal bone levels and mucosal recessions. Zirconia abutments were associated with more biological complications but demonstrated superiority in terms of achieving natural soft tissue colour (S-T).

ACL reconstruction with single tibial tunnel: single versus double bundle.

Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction is designed with the aim of reproducing the anatomy and the function of a healthy knee. This can be done by creating two femoral tunnels and one tibial tunnel (DB-3T), or two femoral and two tibial tunnels (DB-4T), There is very little comparative information regarding DB-3T, which is supposed to be more anatomical than DB-4T, and single bundle (SB). DB-3T reconstruction produces greater joint stability and clinical behavior than SB. Consecutive patients with a unilateral rupture of the ACL treated with the DB-3T technique, and a control group of 36 nonconcurrent patients, with similar conditions, treated with the SB technique were followed during 2 years. Anterior/posterior translation (APT), pivot-shift test, one-leg hop, and IKDC (International Knee Documentation Committee) subjective evaluations were performed. There were no significant differences in the reduction of APT. However, there was a significant improvement in the remaining parameters in the DB-3T group: greater reduction in rotational instability, greater one-leg hop capacity, and greater subjective evaluation. At the 2-year follow-up, patients having undergone ACL reconstruction using hamstring tendons by means of a DB technique with a single tibial tunnel showed greater rotational stability, greater one-legged hop capacity, and a greater subjective evaluation than those having undergone SB reconstruction.

Computer-guided implant therapy and soft- and hard-tissue aspects. The Third EAO Consensus Conference 2012.

INTRODUCTION: The objectives of this working group were to update the existing knowledge base in computer-guided implant treatment (accuracy and clinical advantages), to search for scientific evidence on the need for keratinized tissue around implants, and to review recent literature in the search for new insights into ridge preservation after tooth extraction. MATERIAL AND METHODS: The literature was systematically searched and critically reviewed. Four manuscripts were prepared, three systematic and one narrative review, that allowed the group to develop evidence-based conclusions, as well as clinical implications and recommendations for future research. RESULTS: The results and conclusions of the reviews were presented in the following papers: Van Assche et al. (2012) Accuracy of computer-aided implant placement. Hultin et al. (2012) Clinical advantages of computer-guided implant placement: a systematic review. Wennström & Derks (2012) Is there a need for keratinized mucosa around implants to maintain health and tissue stability? Wang & Lang () Ridge preservation after tooth extraction. The group's consensus statements, clinical implications and implications for future research are presented in this article.

Kibble-Zurek mechanism and infinitely slow annealing through critical points.

We revisit the Kibble-Zurek mechanism by analyzing the dynamics of phase ordering systems during an infinitely slow annealing across a second-order phase transition. We elucidate the time and cooling rate dependence of the typical growing length, and we use it to predict the number of topological defects left over in the symmetry broken phase as a function of time, both close and far from the critical region. Our results extend the Kibble-Zurek mechanism and reveal its limitations.

Clinical performance of provisional screw-retained metal-free acrylic restorations in an immediate loading implant protocol: a 242 consecutive patients' report.

OBJECTIVE: To evaluate the clinical performance of provisional screw-retained metal-free acrylic restorations in an immediate loading implant protocol. MATERIAL AND METHODS: Two hundred and forty-two consecutive patients were selected retrospectively, who received 1011 implants and 311 immediate provisional screw-retained implant restorations (2-4 h after implant surgery). The patients were monitored for a period of 2-3 months, until they were referred for a final restoration. The primary variables recorded include the survival time and the appearance of fractures in the provisional restoration, and the independent variables included age, sex, dental arch, type of restoration, type of attachment and components used, as well as cantilevers and opposing dentition. A survival analysis (Kaplan-Meier) and a Cox regression analysis were performed. RESULTS: Twenty-three restorations in 20 patients (8.26%, 95% CI 4.8-11.7) showed at least one fracture (7.39%). More than half of the new fractures (52%, 12 cases) occurred in the first 4 weeks. The cumulative survival probability observed was greater in mandible (P=0.05) and non-cantilever restorations (P=0.001), and in those opposed by full restorations or natural teeth (P=0.001). With an opposing implant-supported prosthesis, the risk of fracture was multiplied by 4.7, and the use of cantilevers as well as the location of the restoration in the maxilla multiply the risk by 3.4-3.5. CONCLUSIONS: Immediate provisional screw-retained metal-free implant-supported restorations can be considered a reliable restoration (92.6% remain intact) for the healing period of 3 months.

Curvature-driven coarsening in the two-dimensional Potts model.

We study the geometric properties of polymixtures after a sudden quench in temperature. We mimic these systems with the q -states Potts model on a square lattice with and without weak quenched disorder, and their evolution with Monte Carlo simulations with nonconserved order parameter. We analyze the distribution of hull-enclosed areas for different initial conditions and compare our results with recent exact and numerical findings for q=2 (Ising) case. Our results demonstrate the memory of the presence or absence of long-range correlations in the initial state during the coarsening regime and exhibit superuniversality properties.

Geometry of phase separation.

We study the domain geometry during spinodal decomposition of a 50:50 binary mixture in two dimensions. Extending arguments developed to treat nonconserved coarsening, we obtain approximate analytic results for the distribution of domain areas and perimeters during the dynamics. The main approximation is to regard the interfaces separating domains as moving independently. While this is true in the nonconserved case, it is not in the conserved one. Our results can therefore be considered as a "first-order" approximation for the distributions. In contrast to the celebrated Lifshitz-Slyozov-Wagner distribution of structures of the minority phase in the limit of very small concentration, the distribution of domain areas in the 50:50 case does not have a cutoff. Large structures (areas or perimeters) retain the morphology of a percolative or critical initial condition, for quenches from high temperatures or the critical point, respectively. The corresponding distributions are described by a cA-tau tail, where c and tau are exactly known. With increasing time, small structures tend to have a spherical shape with a smooth surface before evaporating by diffusion. In this regime, the number density of domains with area A scales as A1/2 , as in the Lifshitz-Slyozov-Wagner theory. The threshold between the small and large regimes is determined by the characteristic area A approximately t2/3. Finally, we study the relation between perimeters and areas and the distribution of boundary lengths, finding results that are consistent with the ones summarized above. We test our predictions with Monte Carlo simulations of the two-dimensional Ising model.

Immediate efficacy of diode laser application in the treatment of dentine hypersensitivity in periodontal maintenance patients: a randomized clinical trial.

BACKGROUND: To evaluate the immediate efficacy in the reduction of dentine hypersensitivity (DH) when applying an 810 nm diode laser (DL), and a 10% potassium nitrate bioadhesive gel (NK10%). MATERIAL AND METHODS: Forty-five consecutive periodontal maintenance patients of both sexes, with a DH >or= 2 on the verbal rating scale (VRS) in one or more teeth, were randomly allocated into three equal groups: 15 patients received DL and placebo gel; 15 patients were tested with a placebo laser and NK10%; and the remaining 15 received a placebo laser and placebo gel. The DH was evaluated at the start of the study, 15 and 30 min. after the laser application, and on days 2, 4, 7, 14, 30 and 60 by a blind examiner. RESULTS: After 15 min., observations showed a reduction in DH after an evaporative stimulus (ES) of 36.9% (0.86), three times greater than that of the control group (0.23) (p=0.008). After 14 days, this effect was even greater [DL 71.7% (1.67)/NK10% 36.3% (1.73)/control 28.1% (0.73); p=0.004], and lasted until day 60 [65.7% (1.53)/30.4% (0.73)/25.8% (0.67); p=0.01]. CONCLUSIONS: The DL and NK10% gel were proven effective in the treatment of DH. A significantly greater immediate response was observed with DL.

Experimental test of curvature-driven dynamics in the phase ordering of a two dimensional liquid crystal.

We study electric field driven deracemization in an achiral liquid crystal through the formation and coarsening of chiral domains. It is proposed that deracemization in this system is a curvature-driven process. We test this prediction using the recently obtained exact result for the distribution of hull-enclosed areas in two-dimensional coarsening with nonconserved scalar order parameter dynamics [J. J. Arenzon et al., Phys. Rev. Lett. 98, 145701 (2007)]. The experimental data are in very good agreement with the theory. We thus demonstrate that deracemization in such bent-core liquid crystals belongs to the Allen-Cahn universality class, and that the exact formula, which gives us the statistics of domain sizes during coarsening, can also be used as a strict test for this dynamic universality class.

Titanium allergy in dental implant patients: a clinical study on 1500 consecutive patients.

BACKGROUND: In dentistry, allergic reactions to Ti implants have not been studied, nor considered by professionals. Placing permanent metal dental implants in allergic patients can provoke type IV or I reactions. Several symptoms have been described, from skin rashes and implant failure, to non-specific immune suppression. OBJECTIVE: Our objective was to evaluate the presence of titanium allergy by the anamnesis and examination of patients, together with the selective use of cutaneous and epicutaneous testing, in patients treated with or intending to receive dental implants of such material. MATERIAL AND METHODS: Thirty-five subjects out of 1500 implant patients treated and/or examined (2002-2004) were selected for Ti allergy analysis. Sixteen presented allergic symptoms after implant placement or unexplained implant failures [allergy compatible response group (ACRG)], while 19 had a history of other allergies, or were heavily Ti exposed during implant surgeries or had explained implant failures [predisposing factors group (PFG)]. Thirty-five controls were randomly selected (CG) in the Allergy Centre. Cutaneous and epicutaneous tests were carried out. RESULTS: Nine out of the 1500 patients displayed positive (+) reactions to Ti allergy tests (0.6%): eight in the ACRG (50%), one in the PFG (5.3%)(P=0.009) and zero in the control group. Five positives were unexplained implant failures (five out of eight). CONCLUSIONS: Ti allergy can be detected in dental implant patients, even though its estimated prevalence is low (0.6%). A significantly higher risk of positive allergic reaction was found in patients showing post-op allergy compatible response (ACRG), in which cases allergy tests could be recommended.

Exact results for curvature-driven coarsening in two dimensions.

We consider the statistics of the areas enclosed by domain boundaries ("hulls") during the curvature-driven coarsening dynamics of a two-dimensional nonconserved scalar field from a disordered initial state. We show that the number of hulls per unit area that enclose an area greater than A has, for large time t, the scaling form Nh(A,t)=2c/(A+lambdat), demonstrating the validity of dynamical scaling in this system, where c=1/8pisquare root 3 is a universal constant. Domain areas (regions of aligned spins) have a similar distribution up to very large values of A/lambdat. Identical forms are obtained for coarsening from a critical initial state, but with c replaced by c/2.

Domain growth morphology in curvature-driven two-dimensional coarsening.

We study the distribution of domain areas, areas enclosed by domain boundaries ("hulls"), and perimeters for curvature-driven two-dimensional coarsening, employing a combination of exact analysis and numerical studies, for various initial conditions. We show that the number of hulls per unit area, n_{h}(A,t)dA , with enclosed area in the interval (A,A+dA) , is described, for a disordered initial condition, by the scaling function n_{h}(A,t)=2c_{h}(A+lambda_{h}t);{2} , where c_{h}=18pi sqrt[3] approximately 0.023 is a universal constant and lambda_{h} is a material parameter. For a critical initial condition, the same form is obtained, with the same lambda_{h} but with c_{h} replaced by c_{h}2 . For the distribution of domain areas, we argue that the corresponding scaling function has, for random initial conditions, the form n_{d}(A,t)=2c_{d}(lambda_{d}t);{tau'-2}(A+lambda_{d}t);{tau'} , where c_{d} and lambda_{d} are numerically very close to c_{h} and lambda_{h} , respectively, and tau'=18791 approximately 2.055 . For critical initial conditions, one replaces c_{d} by c_{d}2 and the exponent is tau=379187 approximately 2.027 . These results are extended to describe the number density of the length of hulls and domain walls surrounding connected clusters of aligned spins. These predictions are supported by extensive numerical simulations. We also study numerically the geometric properties of the boundaries and areas.

Treatment of intrabony defects with enamel matrix proteins or barrier membranes: results from a multicenter practice-based clinical trial.

BACKGROUND: This prospective multicenter, randomized, controlled clinical trial compared the clinical outcomes of enamel matrix proteins (EMD) versus placement of a bioabsorbable membrane in conjunction with guided tissue regeneration (GTR). METHODS: Seventy-five patients with advanced chronic periodontitis were recruited in seven centers in three countries. All patients had at least one intrabony defect of > or = 3 mm. Heavy smokers (> or = 20 cigarettes/day) were excluded. The surgical procedures included access for root instrumentation using the simplified papilla preservation flap and either the application of EMD or the placement of a GTR membrane. At baseline and 1 year following the interventions, clinical attachment levels (CAL), probing depths (PD), recession (REC), full-mouth plaque scores, and full-mouth bleeding scores were assessed. A total of 67 patients completed the study. RESULTS: At 1 year, the EMD defects gained 3.1 +/- 1.8 mm of CAL, versus 2.5 +/- 1.9 mm for GTR defects. Probing depth reduction was 3.8 +/- 1.5 mm and 3.3 +/- 1.5 mm, respectively. A multivariate analysis indicated that the differences between EMD and GTR treatments were not significant while a center effect and baseline PD significantly influenced CAL gains. No significant differences in terms of frequency distribution of the outcomes were observed. All cases treated with GTR presented at least one surgical complication, mostly membrane exposure, while only 6% of EMD treated sites displayed complications (P < 0.0001). CONCLUSIONS: The results of this trial failed to demonstrate superiority of one treatment modality over the other. GTR outcomes in this trial were lower than anticipated based on previous evidence. This was attributed to the high prevalence of post-surgical complications in the GTR group.

A sorbent tube for oral malodour monitoring.

Volatile sulphur compounds (VSCs) and particularly hydrogen sulphide are considered as the predominant gases causing oral malodour. In this paper, a simple alarm sensor has been developed for VSCs determination in mouth air. The device consists of a glass tube packed with a solid sensing phase. The VSCs react with the sensing phase to produce a change in the colour of the sensor visible with a naked eye. Different "reagents" were investigated to develop the sensing phase (neocuproine + Cu(II), bathocuproine + Cu(II), resazurin, 2,6-dichlorophenolindophenol and lead acetate), finding the neocuproine + Cu(II) as the best for our purposes. Also, different substrates such as Amberlite XAD-4 and XAD-7 and different trademarks of silica gel were tested as solid supports, being selected the silica gel. A device consisting of a glass tube packed with the sensing phase was optimized and tested with halitosis patients as a rapid illness test and the results compared with those obtained with a commercially available instrument, the Halimetertrade mark, used for the determination of VSCs in mouth air. The results exhibited acceptable agreement between the proposed "qualitative" alarm sensor and a commercially available technique selected as reference, showing the possibility of using this "visual sensor" to control the halitosis and its evolution with an eventual treatment, by the own patient.

Evaluation of the efficacy of two potassium nitrate bioadhesive gels (5% and 10%) in the treatment of dentine hypersensitivity. A randomised clinical trial.

AIM: A randomised clinical trial was designed to compare the immediate efficacy (48-96 h) of two treatments with bioadhesive gels with different concentrations of potassium nitrate (NK 5% versus NK 10%) on dentine hypersensitivity (DH). We evaluated DH by means of the use of the evaporative stimulus (ES), as the main outcome, using a placebo control group as reference. PATIENTS AND METHODS: Forty-five consecutive patients who, after stimulation with a blast of air, had at least one tooth with DH > or = 2 according to the verbal ratings scale (VRS) scale were selected. They were randomly treated with a bioadhesive gel with 5% NK, 10% NK or a placebo gel without NK. The DH was evaluated at baseline, days 2, 4, 7 and 14 by an examiner blind to the procedure. The response to the ES with a blast of air, to the tactile stimulation with a probe and the subjective evaluation of the patient measured on the VRS scale were recorded. Statistical analysis was made using the Kruskal-Wallis test. RESULTS: A greater reduction of DH after ES was observed after 48 h of treatment in the NK10% group (35.8%) compared to the NK5% group and placebo group (11.8% and 13.4%, respectively). This difference increased significantly at 96 h (p=0.003). No significant differences were observed for the other variables. These preliminary results may support the usefulness of an NK 10% gel to reduce the DH after stimulation with a blast of air during the first 4 days of its appearance.

Home oral hygiene revisited. Options and evidence.

In regard to the limited literature on the subject, and the contradictions observed, we can not conclude that the types of manual brushes produce clinically important effects on the patients' gingival health, or that these effects can be detected consistently. However, the best results have been obtained with new brush designs, and future studies are necessary to clarify the existing contradictions. There is a clear need of long-term studies which comparatively evaluate the ability to reduce gingivitis and plaque with the newly designed brushes. On the other hand, there is evidence that supports the use of powered toothbrushes in the general population, especially those of the oscillating-rotating and counter-rotational type, as they have shown their ability to reduce gingival bleeding or inflammation, and dental plaque with greater efficacy than manual brushes. There is a clear need of long-term trials on the efficacy of powered brushes in orthodontic patients. With the existing studies we can conclude that there is limited evidence that orthodontic patients using a powered toothbrush show a slight, but significant, reduction of bleeding, compared with users of manual brushes. No conclusion can be made concerning the type of brush to be used. The techniques of interproximal oral hygiene, fundamentally the use of dental floss and interproximal brushes, appear to add additional benefits, in terms of plaque reduction, when they are associated with conventional manual brushes. Further long-term studies are necessary to confirm their efficacy in the reduction of gingival bleeding or inflammation. The choice of the type of technique must be made in relation to the characteristics of the patient: dental floss could be indicated in individuals with closed interdental spaces, and inter-proximal brushes in periodontal patients, or in those with open embrasures.