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13.09.2017 | Original Article | Ausgabe 3/2018

Clinical Oral Investigations 3/2018

No difference between manual and different power toothbrushes with and without specific instructions in young, oral healthy adults—results of a randomized clinical trial

Clinical Oral Investigations > Ausgabe 3/2018
Gerhard Schmalz, Katharina Kiehl, Jan Schmickler, Sven Rinke, Jana Schmidt, Felix Krause, Rainer Haak, Dirk Ziebolz
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00784-017-2200-5) contains supplementary material, which is available to authorized users.
Gerhard Schmalz and Katharina Kiehl contributed equally as the first author
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00784-017-2306-9.



The aim of this randomized clinical study was to detect the effect of an instruction within a group using oscillating-rotating (OR), sonic-active (SA), or manual toothbrushes (MTB) in young, oral healthy adults.


One hundred fifty participants were randomly assigned into six groups (n = 25): with (OR-I, SA-I, MTB-I) and without instruction (OR-NI, SA-NI, MTB-NI). Participants in I subgroups received one standardized instruction of the toothbrush system. At baseline (t0), after 2 (t1), 4 (t2), and 12 weeks (t3), plaque indices including modified Quigley–Hein Index (QHI) and Marginal Plaque Index (MPI) as well as inflammation indices including Papilla Bleeding Index (PBI) and Gingival Index (GI) were assessed. Kruskal–Wallis test, Friedman test, and chi-square or Fisher’s exact test (p < 0.05) were used for statistical analysis.


One hundred thirty-one participants completed the follow-up and were analyzed: OR-I = 21, OR-NI = 22, SA-I = 22, SA-NI = 22, MTB-I = 22, and MTB-NI = 22. Within groups between t0 and t3, OR and SA systems showed a significant plaque reduction, irrespective of instruction (p i < 0.05). In MTB-I and in SA-NI subgroups, a reduction of GI was detected, while an improvement in PBI within SA-I was found (p i < 0.05). Thereby, after 12 weeks, gingival inflammation and plaque indices were comparable between all subgroups (p i > 0.05). Irrespective of the toothbrush system used, only QHI was positively influenced by instruction (p < 0.01).


The used toothbrush as well as the presence or absence of a single brush-specific instruction has no influence on plaque removal and reduction of gingival inflammation in young, oral healthy adults in an observation period of 12 weeks.

Clinical relevance

A single instruction might bring no benefit in this patient group, independently of the used toothbrush system.

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