Content uploaded by Giulio Rasperini
Author content
All content in this area was uploaded by Giulio Rasperini on Jan 11, 2014
Content may be subject to copyright.
PERIO 2008;5(2):111–114
n
111
CLINICAL REPORT
Objectives: The aim of this cohort study was to evaluate the safety and the acceptability of an
electric toothbrush used on the peri-implant mucosa of implants placed in the aesthetic area.
Methods: One hundred consecutive patients rehabilitated with implants positioned in the upper
aesthetic area were recruited. Implants had to be restored at least 6 months prior to baseline. At
baseline, subjects were provided with Oral-B Professional Care 7000 (Proctor and Gamble, Ohio,
USA) and received appropriate instructions to brush twice a day over a 12-month period. Papillary
bleeding index, recession and probing depth were measured at baseline and at 3, 6, and 12 months.
Results: Ninety-eight (98) patients completed the study. There was an overall reduction of recession
(mean 0.2 mm) of borderline statistical significance. All of the changes occurred at the first follow-
up visit (p=0.09) and persisted thereafter.The statistical analyses regarding the probing depth found
ahighly significant decrease over time (mean 0.3 mm). The bleeding score showed a gradual
decrease over time, with a reduction at 12 months by more than half (0.65) in comparison with the
baseline (1.50) and was shown to be highly significant (Wilcoxon sign-rank test: p<0.001). No
patient showed adverse effects such as ulcerations or desquamation. A high score of satisfaction by
the patients using the powered toothbrush was reported (94% would continue to use it).
Conclusion: The electric toothbrush Oral B Professional Care 7000 appears to be safe for patients
with fixed prosthesis on implants in aesthetic areas. Successive randomised clinical trials areneeded
to compare this instrument to other therapeutic devices for mechanical plaque control.
Giulio Rasperini, Gaia Pellegrini, Antonia Cortella, Isabella Rocchietta, Dario Consonni, Massimo Simion
The safety and acceptability of an electric toothbrush
on peri-implant mucosa in patients with oral implants
in aesthetic areas: a prospective cohort study
electric toothbrush, powered toothbrush, implant, maintenance,
peri-implant mucosa
Giulio Rasperini1
Research Professor
Gaia Pellegrini1
Antonia Cortella1
Isabella Rocchietta1
Dario Consonni2
Massimo Simion1
Associate Professor
1Department Of
Periodontology, Dental
Clinic, University of Milan,
Milan, Italy
2Unit of Epidemiology,
Dep. of Preventive
Medicine, Fondazione
IRCCS Ospedale
Maggiore Policlinico,
Mangiagalli e Regina
Elena, Milan, Italy
Correspondence to:
Dr Giulio Rasperini
Via xx Settembre
119 I-29100 Paicenza
Italy
Tel +39 (0523) 322955
Fax +39 (0523) 335523
e-mail:
giulio.rasperini@unimi.it
KEY WORDS
Source of Founding:
The study was self-supported, but Gillette, Oral-B Laboratories, provided free materials that
wereused in the study.
C
Co
on
nf
fl
li
ic
ct
t o
of
f i
in
nt
te
er
re
es
st
t:
:There is no conflict of interest for any of the authors.
n
Introduction
Titanium implants are well-established as a predict-
able treatment modality in edentulous areas of the
arch
1-3
. With the success criteria for osseointegrated
dental implants already established
4
, both early and
late implant failures have been reported
5
. A lack of
early osseointegration may result in consequent
implant failure. According to Esposito and co-
workers
6,7
, excessive surgical trauma, together with
an impaired healing ability, premature loading and
infection are likely to be the most common causes of
early implant losses, whereas progressive chronic
marginal infection and overload in conjunction with
host characteristics are the major aetiological agents
causing late failures. In the Proceedings of the 3rd
European Workshop on Periodontology
8
it was
suggested that late implant failures are often the
result of excessive load and/or infection. Further-
more, it appears that implant surface properties may
influence the failure pattern. Therefore, the long-
term success of an implant-supported prosthetic
rehabilitation may be improved by proper oral
hygiene measures. This would prevent plaque
accumulation around the transgingival part of the
implant or the abutment. Lekholm et al (1986)
9
showed a correlation between levels of plaque and
increased probing depth, both around natural teeth
and fixture abutments. The prostheses on implants
have contours that regularly render plaque removal
difficult. In addition, a lack of motivation and limited
manual dexterity can increase the risk of plaque
accumulation, hence producing inflammation of the
peri-implant mucosa
10
. Hellstadius et al (1993)
11
reported an increased compliance of periodontal
patients by switching from a manual conventional
oral hygiene procedure to a powered toothbrush.
Maintenance of reduced plaque over a period of 36
months was observed. Proper oral hygiene is parti-
cularly crucial around maxillary anterior implants to
maintain the aesthetic parameters and longevity of
the harmoniously scalloped soft tissue lines and nat-
ural contours. Several methods may be used for self-
performed plaque control in patients with implants.
The mechanical plaque control may involve the
use of manual or electric toothbrushes as well as
inter-proximal aids
12
. A limited number of studies
have evaluated the safety and effectiveness of
PERIO 2008;5(2):111–114
n
112
Rasperini et al Electric toothbrush – Implant maintenance
electric toothbrushes when used by patients who
have been rehabilitated with dental implants
13-16
.
Vanderkerckhove et al (1998)
17
showed that an
electric toothbrush was safe and comfortable to use
in partially or completely edentulous patients rehab-
ilitated with an implant-supported fixed prosthesis.
Moreover, data gathered over a 24-month period as
part of a large multi-centre investigation revealed
that a counter-rotational electric toothbrush was
significantly better at removing plaque and reducing
mucositis scores compared with a manual tooth-
brush
16
. Additionally, Wolff et al (1998)
14
showed
that in the short-term (4 weeks), a sonic toothbrush
achieved better plaque reduction compared with a
manual toothbrush, but this advantage did not hold
over the 6-month study. No information is available
in the literature regarding the effect of the post sur-
gical maintenance of the peri-implant soft tissue
contour around anterior implant restorations.
The aim of the study was, therefore, to evaluate
the safety and the patients’ satisfaction with an
electric toothbrush on peri-implant mucosa of
implants placed in the aesthetic area. Additional
aims were to evaluate the influence of gender and
smoking status on the final outcome.
n
Materials and methods
A total of one hundred consecutive patients
rehabilitated by means of implants (partially or full
with fixed prosthesis) were recruited from two
private practice offices to participate in this open
prospective study. Only subjects 16-years of age or
older and in good health, with implants positioned in
the upper aesthetic arches between the first bicus-
pids were included. Each implant was prosthetically
restored at least 6 months prior to the patient being
enrolled in the study. In the case of more than one
implant, one was casually selected. At baseline, sub-
jects were provided with Braun Oral-B Professional
Care 7000 (Proctor and Gamble, Ohio, USA) and
received appropriate instructions to brush twice a
day over a 12-month period. The subjects were
given new brush heads with normal bristles to
change every 3 months. Self-performed oral
hygiene preferences (manual only, electric only or
mixed) prior to baseline was recorded for each
subject. At baseline and at 3, 6, and 12 months the
following parameters were measured for all implant
sites:
• The presence or absence of ulceration or de-
squamation of the soft tissues (the tongue, hard
and soft palate, gingival and alveolar mucosa).
• Papillary bleeding index (PBI)18 was calculated
as the sum of bleeding sites of probing, with
values ranging from 0 to 4. PBI was then di-
chotomized and 2 further variables were created:
a) PBI1, a 0/1 variable that indicated no bleeding
(0), or bleeding at any of the sites (1) and b)
PBI4, a 0/1 variable indicating bleeding at 0 to 3
sites (0), or at each of the 4 sites (1). PBI1 indi-
cates the presence of bleeding, PBI4 the severity
of bleeding.
• Recession measurements (REC) taken by means
of a caliper from incisal edge (IE) to the Gingival
Margin (GM) on the buccal aspect.
• Mean Probing Depth (MPD) in mm, calculated
as the average of 4 probing depths.
Two examiners performed the clinical measure-
ments, one for each centre.
The REC takes the incisal edge as the reference
point owing to the obvious absence of the cemento-
enamel junction, which is present in natural teeth. The
distance from the IE to the GM represented the REC.
In addition, patient satisfaction and their im-
pressions of convenience were recorded. Subjects
were asked by the secretary to fill in a questionnaire
regarding their subjective experiences with the ele-
ctric toothbrush. Questions included overall accept-
ability, convenience of the device and a comparison
with their previous manual toothbrush. Answers
were given on numerical scales, on which ‘0’ repre-
sented a negative response and ‘10’ a positive
response. Finally, subjects were also asked whether
or not they intended to carry on using the electric
toothbrush rather than returning to the use of their
manual brushes. The protocol was in accordance
with the strobe statement for the cohort studies.
nInvestigator training
Before the start of the study the assessors were
required to attend training and calibration meetings.
Aims of the meeting were to review the protocol
and standardise the measurement techniques. A
calibration exercise on 10 patients was performed to
PERIO 2008;5(2):111–114
n
113
Rasperini et al Electric toothbrush – Implant maintenance
obtain acceptable intra-examiner and inter-examiner
reproducibility for all the measurements included
into the protocol. The reproducibility tolerance was
assessed at ±0.5 mm.
nPatient entry (informed consent, patient
registration)
Informed consent was obtained from all subjects
who entered the study. In obtaining the informed
consent and in the conduct of the study the prin-
ciples outlined in the Declaration of Helsinki on ex-
perimentation involving human subjects were
adhered to.
nStatistical analysis
The influence of selected individual characteristics
(gender, smoking, type of oral hygiene practices
before implant, site of implant, presence of kerati-
nised mucosa) on REC, MPD, and PBI at baseline
were assessed using parametric methods for inde-
pendent samples, (student’s ttest, analysis of vari-
ance [ANOVA]), or non-parametric methods (Mann-
Whitney-Wilcoxon, Kruskal-Wallis test).
To assess variation of REC and MPD over the
four visits the ANOVA for repeated measurements
was taken, which takes into account the correlation
of effects within subjects used.
Comparisons of REC, MPD, and PBI between
pairs of visits were performed by means of para-
metric and non-parametric tests for paired data
(student’s tand Wilcoxon sign rank test, respec-
tively). PBI1 and PBI4 were tested using the Mc-
Nemar chi-square test (a test for comparison of pro-
portions for paired data). For each variable two sets
of comparisons were performed: each visit versus
baseline, and each visit versus the previous one.
In order to simultaneously analyse the time
course of the periodontal indices over the four visits
while taking into account the correlation of effects
within subject and the influence of other covariates
on time trends the generalised estimation equation
(GEE) regression method was fitted with an
exchangeable correlation matrix
19
. The following co-
variates were considered: centre, gender, age (<50,
50 to 59, ″ 60); smoking; type of oral hygiene
practices before implant (manual, electrical/mixed),
site of implant (incisive/canine, premolar), presence/
absence of keratinized mucosa; the lowest category
served as the reference. Different models were fitted
depending on the distribution of the outcome, for
example linear for REC/MPD and logistic for PBI1/
PBI4. Inserting a product term into the models
assessed interaction of the covariates with time.
When performing ANOVA, parametric tests and
multivariate linear regression analyses, the depen-
dent variables were normalised when necessary,
using logarithmic (REC) or square-root (PDs)
transformation.
Linear regression models to analyse the relation-
ship between individual characteristics with ques-
tionnaire scores were used.
In every analysis the statistical unit was the
subject. Statistical analyses were performed using
the software Stata, version 8.2 (StataCorp. Stata
Statistical Software: Release 8.0. College Station,
Texas, USA).
n
Results
Of the original 100 subjects selected for the study,
only two patients left the study (one patient left the
country and the other dropped out for medical
reasons). No patients withdrew for reasons related
PERIO 2008;5(2):111–114
n
114
Rasperini et al Electric toothbrush – Implant maintenance
to the use of the electric toothbrush. Table 1 shows
the main characteristics of the 98 subjects and the
characteristics of the 98 selected sites with complete
data were included in the statistical analyses. The
majority of patients were female (61%); the mean
age was 56 years, with about one-third of subjects
in each of the <50, 50 to 59 and ″60 categories.
About one-third of patients were cigarette smokers.
Most (73%) performed manual only brushing, and
only 27% used electrical or mixed manual-electric
brushing. In 14% of the patients the presence of
alveolar mucosa adjacent to the crown margin was
observed. None of patients showed any ulceration
or desquamation of the soft tissues, and any evident
change was recorded for the tongue, hard and soft
palate, gingival and mucosa evaluation, both at
baseline and at the end of the study.
Table 1 shows the mean values of the peri-
odontal indices REC (mm), MPD (mm), and PBI at
the baseline examination, along with the results of
statistical tests. Males had higher average MPD (4.2
versus 3.6, p=0.005) and PBI (1.95 versus 1.22,
p=0.04) values. Age was positively associated with
REC (p=0.02; in particular, subjects over 60 years of
age had a mean REC of 12.7 mm). Smoking cigar-
ettes and the type of oral hygiene before interven-
tion showed no association with any of the peri-
MPD: mean of probing depth; PBI: papillary bleeding index; RED: recession; SD: standard deviation.
N% REC (mm) MPD (mm) PBI
Gender F 60 61% 11.7 (2.4) 3.6 (1.1) 1.2 (1.5)
M38 39 % 12.2 (2.6) 4.2 (1.1) 1.9 (1.7)
pvalue 0.44 0.005 0.04
Age < 50 29 30 % 11.2 (2.8) 3.5 (1.0) 1.4 (1.6)
50 to59 34 35 % 11.5 (2.3) 4.0 (1.4) 1.5 (1.7)
≤″60 35 36 % 12.7 (2.2) 4.0 (0.9) 1.5 (1.6)
P value 0.02 0.21 0.91
Smoking No 64 65 % 12.0 (2.6) 3.8 (1.0) 1.6 (1.6)
Yes 34 35 % 11.6 (2.2) 3.9 (1.3) 1.4 (1.6)
Pvalue 0.45 0.68 0.47
Oral hygiene Manual 71 73 % 12.1 (2.6) 3.8 (1.1) 1.5 (1.6)
Electric/mixed 27 27 % 11.4 (2.1) 4.0 (1.2) 1.6 (1.7)
Pvalue 0.27 0.36 0.71
Implant site Incisive/canine 44 44 % 13.1 (2.1) 3.9 (1.2) 1.4 (1.7)
Premolar 54 55 % 10.9 (2.3) 3.8 (1.0) 1.6 (1.6)
Pvalue < 0.001 0.71 0.52
Presence alveolar No 84 86 % 11.7 (2.5) 3.9 (1.2) 1.4 (1.6)
mucosa Yes 14 14 % 13.0 (2.0) 3.4 (0.8) 1.9 (1.6)
Pvalue 0.06 0.15 0.22
Table 1
Characteristics
of study subjects and
mean values (SD) on
recession, mean of prob-
ing depth and papillary
bleeding index at base-
line.
odontal indices. A premolar implant site was associ-
ated with a lower REC (p<0.001) and the presence
of only alveolar mucosa was associated with a
higher REC (p=0.06).
Table 2 shows summary statistics for REC at the
time of the 4 visits and the results of statistical ana-
lyses on log-transformed REC. There was an overall
reduction of REC of borderline statistical significance
at the conventional 0.05 level (ANOVA for repeated
measurements: P=0.06; student’s ttest for 12-
month versus baseline visit: P=0.10). All of the
changes (average and median reduction 0.2mm and
1mm, respectively) occurred at the first follow-up
visit (P=0.09) and persisted, but did not increase
thereafter (P=0.50 and p=0.41).
Table 3 presents descriptive statistics and the
results of statistical analyses regarding mean probing
depth. We found a highly significant decrease over
time (ANOVA: p<0.001; student’s ttest for every
post-intervention visit versus baseline visit:
PERIO 2008;5(2):?–?
n
115
Rasperini et al Electric toothbrush – Implant maintenance
p<0.001). The decrease in MPD (0.3mm) was
evident after 3 months and was substantially
maintained thereafter.
The pattern observed for MPD was seen at every
probing site. For each probing site, either on the
vestibular or the oral side, there was a decrease over
time, which was highly significant (ANOVA:
p<0.001 in all cases; student’s ttest for 12-month
versus baseline visit: p<0.001 to 0.003). In general,
most of the changes occurred during the first 3
months.
Table 4 presents the results regarding bleeding
score (ANOVA was not performed because it was
not possible to normalise the distribution). The
authors observed a gradual decrease over time, with
a PBI at 12 months reduced by more than half (0.65)
in comparison with the baseline (1.50) (highly
significant – Wilcoxon sign-rank test: p<0.001). The
changes were most pronounced at 3 and 12
months.
Table 4 also presents the proportion of subjects
with bleeding at any of the four probing sites (PBI1),
of subjects with bleeding at all the four probing sites
(PBI4), and results of the Mc-Nemar test. The results
confirm the pattern observed with bleeding score: in
fact the authors observed a clear decrease in
ANOVA: Analysis of variance; REC: Recession.
ANOVA: Analysis of variance.
PBI: papillary bleeding index; PBI1: bleeding; PBI4: severity of
bleeding.
Baseline 3 mo 6 mo 12 mo
Mean (SD) 11.9 (2.5) 11.7 (2.3) 11.7 (2.3) 11.7 (2.3)
Median 12 11 11 11
ANOVA p= 0.06
Student’s t test,
versus previous visit p=0.09 p=0.50 p=0.41
Versus baseline p=0.05 p=0.10
Baseline 3 mo 6 mo 12 mo
Mean (SD) 3.8 (1.1) 3.5 (1.2) 3.6 (1.1) 3.5 (1.2)
Median 3.75 3.5 3.5 3.5
ANOVA p<0.001
Student’s ttest,
versus previous visit p<0.001 p=0.10 p=0.05
Versus baseline p<0.001 p<0.001
Table 2
Trend of recession measurements over time. (ANOVA
for repeated measurements and student’s ttest were performed
on log [REC]).
Table 3
Trend of mean probing depth over time.
Table 4
Trend of bleeding score, bleeding and severity of
bleeding over time.
Baseline 3 mo 6 mo 12 mo
Bleeding Score (PBI)
Mean (SD) 1.5 (1.6) 1.0 (1.4) 0.8 (1.3) 0.7 (1.0)
Median 1 0 0 0
Wilcoxon test, versus
previous visit p<0.001 p<0.13 P=0.06
Versus baseline (p< 0.001)(p<0.001)
Percentage with
bleeding (PBI1) 55% 39% 37% 35%
McNemar-test, versus
previous visit p=0.001 p=0.68 p=0.67
Versus baseline p=0.002 p<0.001
Percentage with bleeding
at 4 sites (PBI4) 23% 14% 7% 3%
McNemar-test, versus
previous visit p=0.01 p=0.03 p=0.05
Versus baseline p<0.001 p=0.001
bleeding tendency at 3 months (39% of subjects
versus 55% at baseline), and a gradual decrease in
bleeding severity over the whole study period.
The results of multivariate GEE analyses
confirmed what the authors found with simpler
analyses, notably the improvement of all the out-
comes over time (REC: p=0.04; MPD, and bleeding
indices: p<0.001). Moreover, they suggested
interactions between REC and gender (p=0.07),
MPD and implant site (p=0.009), and PBI4 and
smoking (p=0.01). The following tables show the
related univariate results.
PERIO 2008;5(2):?–?
n
116
Rasperini et al Electric toothbrush – Implant maintenance
Table 5 shows the trend of REC over time by
gender: the improvement was only evident among
females.
Table 6 shows the trend of MPD over time by
implant site: slight improvement for incisive/canine
implant site was observed only at 3 months and not
thereafter, whereas the improvement at premolar
implant sites was more marked and was maintained
over the whole examination period.
Table 7 shows the trend of severity of bleeding
(PBI4) over time by smoking status: the improve-
ment was evident for both groups, but more marked
among non-smokers.
Table 8 shows results of questionnaire answers.
For each item, patients indicated a high average
score (from 7.6 to 8.9), well above the indifference
score of 5. In particular, the question enquiring
about future use of the electric toothbrush received
a very high score (mean: 8.9; median: 10), and 92
out of 98 patients (94%) reported a score of 6 or
higher (indicating they will continue to use the
electric toothbrush).
Multiple regression analyses of questionnaire
answers in relation to individual characteristics sug-
gested that the score for the level of comfort score
was slightly higher (+1.1) in patients already using
electrical brush at baseline (p=0.004) and that
patients <60 years of age reported a slightly lower
(–1.0) relative satisfaction (p=0.04).
n
Discussion
Oral hygiene has a vital role in the maintenance of
healthy tissues around implants. To that effort it is
important to recommend a toothbrush that can pro-
vide safe and efficient removal of plaque in these
sensitive areas. Recent systematic reviews have
reported that use of a power tooth with an oscil-
lating rotating motion provides an advantage
Table 8 Answers to the questionnaire.
Table 5
Trend of recession measurements over time, by gender.
Table 6
Trend of man probing depth over time, by implant site.
Baseline 3 mo 6 mo 12 mo
Females
Mean (SD) 11.7 (2.4) 11.5 (2.1) 11.4 (2.1) 11.4 (2.1)
Median 11 11 11 11
Males
Mean (SD) 12.2 (2.6) 12.1 (2.6) 12.1 (2.5) 12.2 (2.5)
Median 12 11.5 11.5 12
Baseline 3 mo 6 mo 12 mo
Incisor/Canine
Mean (SD) 3.9 (1.2) 3.8 (1.2) 3.8 (1.1) 3.8 (1.2)
Median 3.75 3.5 3.75 3.75
Premolar
Mean (SD) 3.8 (1.0) 3.3 (1.1) 3.4 (1.1) 3.3 (1.2)
Median 3.75 3.25 3.25 3.0
Table 7
Trend of bleeding score, bleeding, and severity of
bleeding over time.
Baseline 3 mo 6 mo 12 mo
% with bleeding at 4 sites (PBI4)
Non-Smokers 25% 13% 6% 0%
Smokers 21% 18% 9% 9%
Item N Min Mean (SD) Median Max
1. Level of comfort 98 3 7.8 (1.7) 8 10
2. Ease of use 98 3 8.2 (1.8) 8 10
3. Difference in brushing teeth/implants 94 0 7.6 (2.0) 8 10
4. Simpler hygiene of implants 97 5 7.9 (1.7) 8 10
5. Satisfaction 98 5 8.2 (1.5) 8 10
6. Satisfaction relative to other brush 98 2 8.1 (1.9) 8.5 10
7. Will continue to use electric toothbrush 98 1 8.9 (1.8) 10 10
compared with use of a manual toothbrush in the
long-term reduction of gingivitis in general popula-
tions
20,21
. The potential advantages of electric tooth-
brushes compared with the use of manual tooth-
brushes in implant populations have been studied by
several groups
14-16
. Wolf et al (1998)
14
showed
better plaque removal for a sonic brush at 4 weeks,
but no significant difference for manual brushing
was seen at 3 or 6 months. Truhlar et al (2000)
showed an advantage for the use of the counter
rotational electric brush compared with the use of
the manual toothbrush for both plaque and gingi-
vitis measures over a 2 year period. In a 6 week
crossover study on elderly patients with implant
supported overdentures, no difference in plaque
removal was observed between the power and
manual brushing methods
15
. These inconsistent
results led a recent Cochrane Review
22
to conclude
that, at present there is little evidence for deter-
mining one effective oral hygiene method for
implants maintenance and suggested more studies
be conducted in this area.
This 12-month prospective cohort study looked
at the safety and acceptability of a power tooth-
brush on the maintenance of peri-implant mucosal
health in patients with oral implants.
The change in REC (0.2 mm) measurements over
the 12 months in this study combined with the de-
creases in prevalence and severity of bleeding (55%
to 35% and 23% to 3%, respectively) provide evi-
dence of the safety of the power toothbrush used in
this population. Thus, recession measurements
remain an important clinical parameter in deter-
mining the stability of the gingival margin for any
oral hygiene method for long-term soft-tissue main-
tenance. Tissue integrity around the implant is of
great interest to the patient as well as the clinician.
The decrease of REC, MPD and the presence of
bleeding evident at 3months persisted thereafter
over the 12-month period. Bleeding severity
declined gradually over the whole period. This
improvement in the clinical parameters initially at
3months and sustained throughout the test period
would suggest that the effect of using a power
toothbrush did not effect the long term efficacy of
this oral hygiene device.
REC decreased only among females. MPD
decrease was more marked for premolar implant
PERIO 2008;5(2):?–?
n
117
Rasperini et al Electric toothbrush – Implant maintenance
sites. Bleeding decrease was stronger among non-
smokers. This study was designed as a prospective
cohort study so as to analyse a larger group of
patients. As a limit of this study was the absence of
a control group, which means it is not possible to
evaluate the efficacy.
Seventy-three percent of the subjects reported
use of a manual toothbrush prior to entry into the
study. The high level of comfort and satisfaction
reported by participants at the end of the study can
indicate a possible better compliance with the use of
the electric toothbrush. Ninety-four percent of
patients reported they will continue to use the
electric toothbrush.
n
Conclusions
The electric toothbrush Oral B Professional Care
7000 appears to be safe for patients with fixed
prosthesis on implants in the aesthetic area. Patients
reported high comfort and satisfaction in using the
electric toothbrush. Successive randomised clinical
trials are needed to compare this instrument with
other therapeutic devices for mechanical plaque
control.
n
Acknowledgements
The authors would like to thank Massimo Capitani
and MaryAnn Cugini from Oral-B Laboratories for
supplying the electric toothbrushes used in the study
and Sonia Formaleoni and Tamara Zambon for their
clinical assistance.
n
References
1. Adell R, Lekholm U, Rockler B , Brånemark PI. A 15-year
study of osseointegrated implants in the treatment of the
edentulous jaw. Int J Oral Surg 1981;10:387-416.
2. Adell R, Lekholm U, Gröndahl K, Brånemark PI, Lindström
J, Jacobsson M. Reconstruction of severely resorbed eden-
tulous maxillae using osseointegrated fixtures in immedi-
ate autogenous bone grafts. Int J Oral Maxillofac Implants
1990;5:233-46.
3. Van Steenberghe D, Lekholm U, Bolender C, Folmer T,
Henry P, Herrmann I, et al. Applicability of osseointegrat-
ed oral implants in the rehabilitation of partial edentulism:
a prospective multicenter study on 558 fixtures. Int J Oral
Maxillofac Implants1990;5:272-81.
4. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The
long-term efficacy of currently used dental implants: a re-
view and proposed criteria of success. Int J Oral Maxillofac
Implants 1986;1:11-25.
5. Schou S, Holmstrup P, Hjorting-Hansen E, Lang NP. Plaque-
induced marginal tissue reactions of osseointegrated oral
implants: a review of the literature. Clin Oral Impl Res
1992;3:149-161.
6. Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological
factors contributing to failures of osseointegrated oral im-
plants. (II). Etiopathogenesis. European J Oral Science
1998;106:721-764.
7. Esposito M, Thomsen P, Ericsson LE, Sennerby L, Lekholm
U. Histopathologic observations on late oral implant fail-
ures. Clin Implant Dent Rel Res 2000;2:18-32.
8. Flemmig TF and Renvert S Consensus report of session D.
Proceedings of the 3rd European Workshop on Periodon-
tology Implant Dentistry. Chicago: Quintessence Books
1999:347-351.
9. Lekholm U, Ericsson I, Adell R, Slots J. The condition of the
soft tissues at tooth and fixture abutments supporting
fixed bridges. A microbiological and histological study. J
Clin Periodontol 1986;13:558-562.
10. Lindquist LW, Rockler B, Carlsson GE. Bone resorption
around fixtures in edentulous patients treated with man-
dibular fixed tissue-integrated prostheses. J Prosth Dent
1988;59:59-63.
11. Hellstadius K, Asman B, Gustafsson A. Improved mainten-
ance of plaque control by electrical toothbrushing in peri-
odontitis patients with low compliance. J Clin Periodontol
1993;20:235-237.
12. Eskow RN, Sternberg V. Preventive peri-implant protocol.
Compendium of Continuing Education 1999;20:137-152.
13. Vanderkerckhove B, Quirynen M, Warren PR, Strate J, van
Steenberghe D. The safety and efficacy of a powered tooth-
brush on soft tissues in patients with implant-supported
fixed prostheses. Clin Oral Investigations 2004;8:206-210.
PERIO 2008;5(2):?–?
n
118
Rasperini et al Electric toothbrush – Implant maintenance
14. Wolff L, Kim A, Nunn M, Bakdash B, Hinrichs J.
Effectiveness of a sonic toothbrush in maintenance of den-
tal implants. J Clin Periodontol 1998;25:821-828.
15. Tawse-Smith A, Duncan W, Payne AGT, Thomson WM,
Wennstrom JL. Relative effectiveness of powered and
manual toothbrushes in elderly patients with implant-sup-
ported mandibular overdentures. J Clin Periodontol
2002;29:275-280.
16. Truhlar RS, Morris HF, Ochi S. The efficacy of a counter-
rotational powered toothbrush in the maintenance of endos-
seous dental implants. J Am Dent Ass 2000;31:101-107.
17 Vanderkerckhove B, Quirynen M, Warren PR, van
Steenberghe D. Safety of electric toothbrush in patients
with implant-supported fixed prostheses. J Dent Res
1998;77:710 (abstract 631).
18. Muhlemann HR, Son S. Gingival sulcus bleeding – a leading
sign in initial gingivitis. Helv Odont Acta 1971;15:107-113.
19. Twisk JWR. Applied longitudinal data analysis for epidemi-
ology. A practical guide. Cambridge, Cambridge University
Press, 2003.
20. Robinson PG, Deacon SA, Deery C, Heanue M, Walmsley
AD, Worthington HV, et al. Manual versus power tooth-
brushing for oral health. Cochrane Database of Systematic
Reviews 2005;Issue 2, Art. No. CD002281.pub2.
21. Sicilia A, Arregui I, Gallego M, Cabezas B, Cuesta SA.
Systematic review of powered vs manual toothbrushes in
periodontal cause-related therapy. J Clin Periodontol
2002;29:39-54; discussion 90-91.
22. Grusovin MG, Coulthard P, Worthington HV, Esposito M.
Maintaining and recovering soft tissue health around den-
tal implants: a Cochrane Systematic Review of Random-
ised Controlled Clinical Trials. Eur J Oral Implantol 2008;1
(1):11-22.
