Plaque removal with a novel manual toothbrush (X-Active) and the Braun Oral-B 3D Plaque Remover

The study was designed to test the efficacy in plaque removal of three toothbrushes: two manual brushes, the Butler GUM 311 and the Dr Best X-Active, and one electric toothbrush the Braun Oral-B 3D Plaque Remover (3D).

The study was a split-mouth, single-blind, randomized clinical study consisting of three identical experiments testing three combinations of toothbrushes (experiment 1: 3D versus Butler; experiment 2: 3D versus Dr Best; experiment 3: Butler versus Dr Best), in which the teeth of the panellists were brushed by a dental hygienist. In a fourth experiment, the panellists brushed their own teeth (3D versus Dr Best). Thirty-five subjects participated in the study and received a professional prophylaxis prior to the first experiment. They were requested to refrain from brushing their teeth for 48 h prior to each experiment. Plaque was assessed according to the Silness & Löe plaque index at six sites per tooth. Next, the dental hygienist (experiments 1-3) or the panellist (experiment 4) brushed for 60 s with their first assigned brush in two randomly selected contralateral quadrants. Brushing was repeated (60 s) with the second brush in the opposing two contralateral quadrants. Prior to experiment 4, panellists were given two thorough hands-on professional instructions in the use of the 3D and the Dr Best toothbrushes.

In experiment 1, the 3D showed a mean plaque reduction of 72% compared to 63% with the Butler (P<0.01). In experiment 2, the 3D showed a mean plaque reduction of 79% and the Dr Best 76% (P<0.05). In experiment 3, the Butler showed a mean plaque reduction of 81% and the Dr Best 85% (P=0.01). In the hands of the panellists (experiment 4), the 3D showed a mean plaque reduction of 88% and the Dr Best 84% (P<0.05).

A 5-week training period with repeated hands-on instruction gives panellists the skill to perform brushing with efficacy comparable to that of professional brushing. In agreement with a previous study, the 3D was more effective than a flat-trimmed manual toothbrush (Van der Weijden et al. 1994). Brushing with the criss-cross resulted in small statistical differences with the 3D and the flat-trimmed manual toothbrush. The clinical relevance of these statistically significant results should be the subject of a longitudinal study.