Clinical Oral Investigations

, Volume 22, Issue 3, pp 1147–1155 | Cite as

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

  • Gerhard Schmalz
  • Katharina Kiehl
  • Jan Schmickler
  • Sven Rinke
  • Jana Schmidt
  • Felix Krause
  • Rainer Haak
  • Dirk Ziebolz
Original Article



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.


Clinical trial Toothbrushing Dental plaque Sonic-active Oscillating-rotating Manual toothbrush Oral hygiene instruction 



We would like to thank Dr. Tanja Kottmann (Clinical Research Organization, Hamm) for the statistical analysis. Furthermore, the authors thank Philips GmbH (Hamburg, Germany), CP GABA (GmbH, Hamburg, Germany), and GlaxoSmithKline Oral Health Care GmbH (Brühl, Germany) for providing materials for the study. Moreover, we would like to thank Mrs. M. Mühle and A. Oehme for conducting the professional tooth cleaning of all study participants.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was reviewed and approved by the Ethics Committee of the University Medical Center in Leipzig, Germany (No. 217-15-01062015). This RCT was registered in the “WHO International Clinical Trials Registry Platform” in the German Clinical Trials Register (DRKS; No. DRKS00011422) and conducted in accordance with the CONSORT guidelines.

Informed consent

Patients were informed verbally and in writing about the study and gave written informed consent.

Supplementary material

784_2017_2200_MOESM1_ESM.doc (189 kb)
ESM 1 (DOC 189 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Cariology, Endodontology and PeriodontologyUniversity Medical Center LeipzigLeipzigGermany
  2. 2.Dental Practice Hanau & AlzenauHanauGermany
  3. 3.Department of ProsthodonticsUniversity Medical Centre GöttingenGöttingenGermany

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