A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation

Kotsakis GA et al.
J Periodontol. 2018 Feb 19. doi: 10.1002/JPER.17-0368.

This study aims to compare the effect, measured as gingival inflammation, bleeding-on-probing, plaque, and pocket depth, between different interdental cleaning regimes. The regimes included are flossing, powered flossing, toothpicks, toothpicks and intensive oral hygiene instructions, water jet irrigation devices, interdental brushes, gum massaging devices, toothbrush only (controls), powered toothbrush (controls), powered toothbrush and waterjet.

Network meta-analysis is the method chosen to make both direct and indirect comparisons possible among included studies and to provide information which enables ranking of the included interventions based on the set outcomes. The results are based on the 22 studies that met the criteria to be included in the analysis.

Interdental brushes displayed the best result regarding gingival inflammation, plaque reduction, and pocket reduction. Concerning bleeding on probing, toothpicks in combination with intensive oral hygiene instruction presented the best outcome. Only one study used the intervention toothpicks in combination with intensive oral hygiene instruction, and in this case, it was not possible to determine whether the actual device or the instruction part was crucial for the result. However, the authors conclude that from an individual perspective the choice of devices needs to be based on individual and clinical conditions.

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