title: Interproximal biofilm removal by intervallic use of a sonic toothbrush compared to an oral irrigation system.
abstract: BACKGROUND
  The purpose of this in-vitro study was to investigate the potential of biofilm removal in interproximal tooth regions using intervallic cleaning with an oral irrigator or a sonic toothbrush.
  
  
  METHODS
  Three-species biofilms (Streptococcus mutans (OMZ 918), Streptococcus oralis SK 248 (OMZ 60), Actinomyces naeslundii (OMZ 745)) were grown on hydroxyapatite discs for 3 days in culture media. Every 24 h, specimens were incubated for 15 min in resazurin solution (i.e., culture medium and 10 % v/v alamarBlue®) to measure the metabolic activity with a fluorescence spectrophotometer in relative fluorescence units (rfu) at baseline. Then, specimens were fixed in interproximal holding devices and underwent treatment with an oral irrigator (WF; Waterpik® Sensonic WP-100E), an active sonic toothbrush (WPa), or an inactive sonic toothbrush (WPi; Waterpik® Sensonic SR-3000E) for 10 s (n = 18/group). Untreated biofilms served as controls (CO). After treatment, bacterial activity was re-measured, and specimens were re-grown in fresh medium for 24 h until next cleaning procedure. Altogether, cleaning was repeated in intervals of three treatment days (d1, d2, d3). After d3, SEM images were taken (n = 8) and CFU was measured (n = 3). Metabolic activity was analyzed for each disc separately, rfu values were averaged for d1 to compare initial biofilm stability, and ratios of baseline and post-treatment values were compared. Results were analyzed using ANOVA with the post-hoc Scheffé test, or Kruskal-Wallis with post-hoc Mann-Whitney test.
  
  
  RESULTS
  Median baseline rfu-values of d1 resulted in 7821.8 rfu (interquartile range = 5114.5). Highest reduction in metabolic activity was recorded significantly for the oral irrigator used for 10 s (residual activity per day d1: WF 17.9 %, WPa 58.8 %, WPi 82.5 %, CO 89.6 %; d2: WF 36.8 %, WPa 85.2 %, WPi 82.5 %, CO 90.0 %; d3: WF 17.2.%, WPa 79.6 %, WPi 96.3 %, CO 116.3 %). SEM images of untreated specimens (CO) and specimens treated with the sonic toothbrush (WPa and WPi) showed huge amounts of biofilm, while oral irrigator-treated specimens (WF) revealed barely any bacteria. CFU data confirmed the graduations between the groups.
  
  
  CONCLUSIONS
  Cleaning of interproximal regions achieved better success with an oral irrigator as compared to the use of a sonic toothbrush. (350/350 words).
authors.affiliation: Clinic of Preventive Dentistry, Periodontology and Cariology, University of Zurich, Center of Dental Medicine, 8032, Zurich, Switzerland. nina.tawakoli@zzm.uzh.ch.
authors.forename: Pune N
authors.initials: PN
authors.lastname: Tawakoli
authors.affiliation: Clinic of Preventive Dentistry, Periodontology and Cariology, University of Zurich, Center of Dental Medicine, 8032, Zurich, Switzerland. baerbel.sauer@zzm.uzh.ch.
authors.forename: Bärbel
authors.initials: B
authors.lastname: Sauer
authors.affiliation: Clinic of Preventive Dentistry, Periodontology and Cariology, University of Zurich, Center of Dental Medicine, 8032, Zurich, Switzerland. klaus.becker@zzm.uzh.ch.
authors.forename: Klaus
authors.initials: K
authors.lastname: Becker
authors.affiliation: Department for Conservative Dentistry and Periodontology, University Medical Center, University of Regensburg, Regensburg, Germany. wolfgang.buchalla@ukr.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Buchalla
authors.affiliation: Clinic of Preventive Dentistry, Periodontology and Cariology, University of Zurich, Center of Dental Medicine, 8032, Zurich, Switzerland. thomas.attin@zzm.uzh.ch.
authors.forename: Thomas
authors.initials: T
authors.lastname: Attin
mesh_terms: D000190:Actinomyces / Q000302:isolation & purification / Q000378:metabolism; D058491:Bacterial Load; D001431:Bacteriological Techniques; D018441:Biofilms; D003742:Dental Devices, Home Care; D017886:Durapatite / Q000737:chemistry; D004867:Equipment Design; D006801:Humans; D007202:Indicators and Reagents; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D010078:Oxazines; D013010:Sonication / Q000295:instrumentation; D013050:Spectrometry, Fluorescence; D013295:Streptococcus mutans / Q000302:isolation & purification / Q000378:metabolism; D019533:Streptococcus oralis / Q000302:isolation & purification / Q000378:metabolism; D013499:Surface Properties; D007507:Therapeutic Irrigation / Q000295:instrumentation*; D013997:Time Factors; D014070:Tooth / Q000382:microbiology*; D014099:Toothbrushing / Q000295:instrumentation*; D014966:Xanthenes
chemical_list: D007202:Indicators and Reagents; D010078:Oxazines; D014966:Xanthenes; C005843:resazurin; D017886:Durapatite