Computer-based intraoral image analysis of the clinical plaque removing capacity of 3 manual toothbrushes

Background: (I) Introducing an intraoral camera system with a special posit ioner to allow computer-based analysis of reproducible images on lingual to oth surfaces and (II) comparing plaque removal by three manual toothbrushes with different brushhead designs (convex, multilevel and flat trimmed) on lingual mandibular tooth surfaces. Method: In a clinical single-blind, crossover, 24-h plaque-regrowth study o n 25 subjects, a computer-based index (PPI) was used to evaluate pre- and p ostbrushing plaque on lingual surfaces of mandibular premolars and molars. Subjects brushed their teeth under standardized conditions at three visits, each time with a different, randomly assigned toothbrush. Results: The intraoral camera system allowed a reproducible and relatively convenient access to the lingual surfaces of the mandibular teeth and provi ded an increase in objectivity. Overall, each brush achieved statistically significant plaque removal, however, none reached clinical relevance. The m ultilevel brush was superior at specific sites, but failed to show statisti cally significant superiority in terms of overall plaque reduction. Without regard of the toothbrush used, the right handed subjects were less efficie nt in removing plaque from the right side compared to the left. Conclusions: The method is able to detect even small differences in plaque reduction. None of the different brushhead designs was able to compensate a n insufficient brushing techniques.