Clinically controlled study of plaque reduction and inflammation control of the gingiva with the ultrasonic toothbrush emmi ® -dent
Executive Summary
Witten 2011
ORMED Institute for Oral Medicine at the University of Witten/Herdecke
Study director: Prof. Dr. Dr. hc P. Gängler
Dr. Thomas Lang
Investigator: Sigrun Charlotte Denda
on behalf of: emmi EMAG AG, 64546 Mörfelden-Walldorf
Dental caries and periodontal disease are the two main bacterial diseases of the oral cavity and remain extremely widespread. In addition to microbiological, immunological, and genetic factors in the defense against infection, personal oral hygiene with toothbrushes and fluoride dentifrices is the mainstay of prevention. However, long-term use of abrasive brushes and pastes carries the risk of mechanical damage to teeth and gums. Therefore, the investigation of alternative biophysical methods for the abrasion-free removal of bacterial plaque is a high priority. The generation of ultrasound at a selected frequency is a plausible approach.
Therefore, in a clinically controlled crossover study, the effectiveness of plaque control with the Emmi ® -dental Professional ultrasonic toothbrush (EMAG AG, Mörfelden-Walldorf) was compared in 16 subjects aged 20 to 34 years. The reduction of plaque on all surfaces of the teeth was documented intraorally photographically and evaluated planimetrically in a blinded manner using the modified Navy Plaque Index.
The health status of the gingiva was also assessed clinically on all surfaces of all teeth using the Gingival Index. The study was approved by the responsible ethics committee at the University of Witten/Herdecke and the subjects' informed consent was obtained.
The study period comprised 28 days for each tested toothbrush following prior professional tooth cleaning, divided into a 4-day training phase with the assigned toothbrush, a 3-day oral hygiene abstinence phase to allow for plaque accumulation (3-day plaque regrowth), and subsequent index assessments after 7 and 21 days. According to the manufacturer, the Emmi ® -dental toothbrush is activated exclusively by ultrasound. This study is therefore the first investigation of this biophysical principle. All previous investigations have concerned combined sonic/ultrasonic toothbrushes. The ultrasonic test toothbrush Emmi ® -dental Professional showed a significant reduction in dental plaque based on the planimetry of the plaque index, which was the same in 16 test subjects using a crossover protocol after 4 days of training and a further 3 days of oral hygiene abstinence.
Plaque reduction across all tooth surfaces after a single application was over 20%, measured on unbrushed teeth. Over the course of the study, after 7 and 21 days, plaque reductions of over 45% were achieved.
Plaque reduction was more pronounced on the anterior teeth than on the posterior teeth. The upper teeth, however, were cleaned equally well as the lower teeth.
The individual examination of plaque control at the gum line and in the interdental spaces showed a significant reduction in these areas of the teeth that are at risk for caries or gingivitis.
The parallel assessment of gum health using the Gingiva Index resulted in extremely low values throughout the study period, meaning that the vast majority of all examined sites remained free of inflammation on all teeth. Consequently, the toothbrush contributes to maintaining healthy gingiva.
Studies on ultrasonic toothbrushes included in meta-analyses have so far only considered combined sonic/ultrasound models (Cochrane Review 2005, 2010). Therefore, the present clinically controlled trial of the effectiveness of a purely ultrasonic toothbrush is the only one of its kind. It demonstrates clinically effective plaque control.
The particular advantage is that the brush is guided over the individual groups of teeth in a completely abrasion-free manner, which means that brushing-related damage to the tooth structure can be ruled out with continuous use.
This provides a new biophysical dimension of effective tooth cleaning with the control of bacterial biofilm formation, which fundamentally avoids brushing movements with mechanical abrasion.
Clinical conclusion
The tested, ultrasonic-activated toothbrush safely removes plaque. It ensures the maintenance of healthy gums and completely eliminates abrasive brushing movements. This eliminates the risk of abrasive damage to teeth and gums.
