Interdental Plaque Reduction and Periodontitis

Interdental Plaque Reduction After Use of Different Devices in Patients With Periodontitis: a Randomized Clinical Trial

To determine the efficacy of four different oral hygiene protocols involving adjunctive interdental cleaning devices in periodontal patients in terms of plaque and gingival inflammatory scores.

Patients included in the study will undergo a thorough clinical examination aiming at collecting all the data desired: periodontal parameters of Probing Pocket Depth (PPD), presence of recession of the gingival margin (Rec) and full mouth plaque score (FMPS) will be recorded on six sites/tooth by a single calibrated examiner using a University of North Carolina (UNC) 15-mm periodontal probe by a calibrated examiner blind to group allocation. Gingival index (GI) and angulated bleeding score (AngBS) will be recorded at four sites/tooth. For GI the following scale will be used: 0 normal appearance of gingiva, no bleeding, no inflammation; slight change and moderate edema with slight change in texture, no bleeding, mild inflammation; redness hypertrophy, or edema and glazing, bleeding on probing, moderate inflammation; marked redness, hypertrophy, or edema, ulceration, spontaneous bleeding, severe inflammation. For AngBS the following scale will be used: 0: no bleeding; bleeding upon probe stimulation; spontaneous bleeding Consequently, interdental plaque score (IPS), interdental gingival index (IGI), and interdental angulated bleeding score (IAngBI) will be calculated. Patients will be followed through a five-week period. The timepoints will be the following: T -7 (oral hygiene instructions), T0 (professional supragingival scaling and polishing), T14, T28.

Center will enroll probands, assigning a unique study subject number and allocating an opaque randomization envelope.

15 patients receiving oral hygiene instructions as determined by their group allocation (use of manual toothbrush alone)

15 patients receiving oral hygiene instructions as determined by their group allocation (manual toothbrush plus dental floss)

15 patients receiving oral hygiene instructions as determined by their group allocation (manual toothbrush plus interdental brushes)

15 patients receiving oral hygiene instructions as determined by their group allocation (manual toothbrush plus rubber interdental picks)

Int-OHI will be given focusing on the interdental device of the allocated group for each patient and will be given only once at timepoint T-7. No further formal Int-OH instructions will be given, unless specifically asked by the patient. Int-OHI will be delivered by trained dental hygienist/periodontist.

A session of professional supragingival scaling and polishing: instrumentation will be performed by a trained dental hygienist/periodontist with great care in performing exclusively coronal maneuver. No instrumentation or exploring of the gingival crevice/ sulcus will be performed.

OHI will be given focusing on manual toothbrushing and will be given only once at timepoint T-7. No further formal OH instructions will be given, unless specifically asked by the patient. OHI will be delivered by trained dental hygienist/periodontist.

Changes in GI, measured orally through clinical examination. Unit of measure: scale from 0 (normal) to 3 (Marked redness, hypertrophy, or edema, ulceration)

Changes in AngBS, measured orally through clinical examination. Unit of measure: scale from 0 (no bleeding), 1 (bleeding upon probe stimulation) to 2 (spontaneous bleeding).

Inclusion Criteria: males or females of age range between 18 and 70 years, good health status, presence of at least 20 natural teeth residual periodontal pockets with PPD≥4mm, in need of specific oral hygiene regimen. Exclusion Criteria: pregnancy or breast-feeding, indication to antibiotic therapy prior to treatment, chronic infections, systemic diseases (including cardiovascular, pulmonary, cerebral, and metabolic diseases), not willing to give a consent