Efficacy, Safety and Patient Preference of Knotted Floss Technique in Type II Gingival Embrasures

Purpose: The purpose of this crossover clinical trial was to compare the changes in scores of plaque biofilm accumulation, gingival inflammation, gingival bleeding and gingival trauma in patients who used conventional flossing (CFt), knotted floss (KFt) and an interdental brush (IBt) for 6-weeks each in Type II gingival embrasures.Methods: Sixty healthy, tooth-brushing adults with at least one Type II gingival embrasure were randomly assigned to perform any of above interdental cleaning techniques in each phase of six weeks. Crossover to another technique was undertaken after washout of 2 weeks. Test-sites were scored at baseline, 3 and 6 weeks for Rustogi Modification of Navy Plaque Index (RMNPI), Modified Gingival Index (MGI), Modified Papillary Bleeding Index (MPBI), and Carter-Hanson scoring for gingival trauma. Acceptability of each technique was evaluated by subjects' responses to the post-trial questionnaire.Results: Analysis of data showed a significant improvement in RMNPI, MGl and MPBI scores within all three groups over the time-period of 6-weeks from baseline. RMNPI and MGI scores were significantly more in the CFt group when compared to KFt and IBt and there was no difference in KFt and IBt. Additionally, no significant gingival trauma was recorded in any test group. Equal percentages of participants selected KFt or IBt for its ability to clean and preference to continue to use.Conclusion: Use of a KFt and IBt are statistically similar in safety and efficacy for reducing plaque biofilm accumulation, gingival inflammation, and bleeding in Type II gingival embrasures, when either is used as an interdental cleaning aid in conjunction with regular tooth-brushing. KFt and IBt demonstrated better efficacy than CFt.