title: Bristle splaying and its effect on pre-existing gingival recession-a 12-month randomized controlled trial.
abstract: OBJECTIVE
  The link between bristle splaying and gingival recession is unclear.
  
  
  METHODS
  In a 12-month, parallel group, randomized, controlled clinical trial, 110 systemically healthy participants with pre-existing gingival recessions (pre-GR) were assigned to brush their teeth with either a manual (MT) or a powered toothbrush (PT). Every 3 months, toothbrushes and brush heads were replaced. Wear was measured using the Bristle-Splaying-Index (BSI), matched between groups and correlated to the change of pre-GR.
  
  
  RESULTS
  Data from 109 subjects (PT, 55; MT, 54) were analyzed. The overall mean BSI was found to be significantly lower (p < 0.001) in the PT group (median 5.5; second and third quartile 1.9-10.0) as compared to the MT group (21.5; 15.0-30.5). After 12 months, pre-GR decreased significantly in the PT group (∆0.2 ± 0.1 mm; p < 0.001) and remained stable in the MT group (∆0.1 ± 0.1 mm; p > 0.05). In the MT group, higher BSI values were associated with a higher risk for increasing or stable recession over 12 months: odds ratio (95 % CI) = 27.9 (1.7; 452.9); p = 0.019.
  
  
  CONCLUSIONS
  After a mean using time of 3 months, the PT group demonstrated a lower BSI than the MT group, and the greater bristle splaying was associated with a higher risk of increased (or stable) GR in subjects using a MT but not a PT.
  
  
  CONCLUSIONS
  Compared to a manual toothbrush, powered toothbrushes seem to be utilized with less force and can be considered safe to use in patients with pre-existing gingival recession.
authors: Clinic for Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany.
authors: C
authors: C
authors: Graetz
authors: Clinic for Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany. plaumann@konspar.uni-kiel.de.
authors: A
authors: http://orcid.org/0000-0002-6735-0457
authors: A
authors: Plaumann
authors: Clinic for Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany.
authors: N
authors: N
authors: Heinevetter
authors: Clinic for Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany.
authors: S
authors: S
authors: Sälzer
authors: Clinic for Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany.
authors: J
authors: J
authors: Bielfeldt
authors: Clinic for Conservative Dentistry and Periodontology, University of Kiel, Arnold-Heller-Str. 3, Haus 26, 24105, Kiel, Germany.
authors: C E
authors: CE
authors: Dörfer
mesh_terms: D000328:Adult; D000368:Aged; D003742:Dental Devices, Home Care; D004867:Equipment Design; D005260:Female; D005889:Gingival Recession / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014099:Toothbrushing / Q000009:adverse effects / Q000295:instrumentation*
keywords: Bristle splaying; Gingival recession; Powered tooth brushing; Randomized clinical trial; Toothbrush wear