Skip to main content

Effect of interdental brush design on plaque during nonsurgical periodontal therapy



The aim of this randomized controlled trial was to evaluate the interproximal cleaning efficacy of waist-shaped compared with straight soft interdental brushes in patients undergoing nonsurgical periodontal therapy.

Materials and methods

Ten patients diagnosed with periodontitis stage II or III were scheduled for nonsurgical periodontal therapy. Baseline plaque control record (PCR), modified approximal plaque index (API), papillary bleeding index (PBI), probing pocket depth (PPD), and bleeding on probing (BOP) were evaluated. Four interdental spaces of equal sizes were determined, and baseline plaque indices (PI) were assessed on eight surfaces of the respective adjacent teeth, resulting in 640 measuring positions. Interdental brushes with a straight or waist-shaped design were randomly allocated to the right or left side, and patients received oral hygiene instructions. Follow-up measurements including PCR, API, PBI, and site-specific PI were performed during initial nonsurgical periodontal therapy sessions and reevaluation which was undertaken 8 weeks afterwards.


PCR, API, and PBI decreased significantly compared with baseline at each time point (p < 0.001).

PPD (waist-shaped, baseline 4 mm (range, 2–9 mm) vs. reevaluation 3 mm (range, 1–6 mm); p < 0.001; straight, baseline 4 mm (range, 2–10) vs. reevaluation 3 mm (range, 1–6) mm; p < 0.001) and BOP (p = 0.008) showed significant reduction in both groups. Sub-analysis of site-specific areas including line angles and interproximal areas revealed no significant reduction of plaque during the observation period between both brush designs. No difference between straight and waist-shaped brushes regarding PPD or BOP decrease was found.


The efficacy of both interdental brush designs concerning plaque control in patients undergoing nonsurgical periodontal therapy was similar.

Clinical relevance

The use of interdental brushes is essential for biofilm removal in patients during initial periodontal therapy, regardless of brush design.

Clinical trial registration

ISRCTNregistry (#ISRCTN24498365),

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. Chapple IL, Van der Weijden F, Doerfer C et al (2015) Primary prevention of periodontitis: managing gingivitis. J Clin Periodontol 42(Suppl 16):S71–S76

    Article  Google Scholar 

  2. Valen H, Scheie AA (2018) Biofilms and their properties. Eur J Oral Sci 126(Suppl 1):13–18

    Article  Google Scholar 

  3. Hajishengallis G (2014) The inflammophilic character of the periodontitis-associated microbiota. Mol Oral Microbiol 29:248–257

    Article  Google Scholar 

  4. Ji S, Choi YS, Choi Y (2015) Bacterial invasion and persistence: critical events in the pathogenesis of periodontitis? J Periodontal Res 50:570–585

    Article  Google Scholar 

  5. Lang NP, Cumming BR, Löe H (1973) Toothbrushing frequency as it relates to plaque development and gingival health. J Periodontol 44:396–405

    Article  Google Scholar 

  6. Axelsson PA (2014) Commentary: periodontitis is preventable. J Periodontol 85:1303–1307

    Article  Google Scholar 

  7. Costa FO, Costa AA, Cota LOM (2020) The use of interdental brushes or oral irrigators as adjuvants to conventional oral hygiene associated with recurrence of periodontitis in periodontal maintenance therapy: a 6-year prospective study. J Periodontol 91:26–36

  8. Murakami S, Mealey BL, Mariotti A, Chapple ILC (2018) Dental plaque-induced gingival conditions. J Periodontol 89(Suppl 1):S17–S27

    PubMed  Google Scholar 

  9. Magnusson I, Lindhe J, Yoneyama T, Liljenberg B (1984) Recolonization of a subgingival microbiota following scaling in deep pockets. J Clin Periodontol 11:193–207

    Article  Google Scholar 

  10. Lang NP, Cumming BR, Löe HA (1977) Oral hygiene and gingival health in Danish dental students and faculty. Community Dent Oral Epidemiol 5:237–242

    Article  Google Scholar 

  11. Caton JG, Blieden TM, Lowenguth RA, Frantz BJ, Wagener CJ, Doblin JM, Stein SH, Proskin HM (1993) Comparison between mechanical cleaning and an antimicrobial rinse for the treatment and prevention of interdental gingivitis. J Clin Periodontol 20:172–178

    Article  Google Scholar 

  12. Poklepovic T, Worthington HV, Johnson TM et al (2013) Interdental brushing for the prevention and control of periodontal diseases and dental caries in adults. Cochrane Database Syst Rev 18(12):CD009857

  13. Sälzer S, Slot DE, Van der Weijden FA, Dörfer CE (2015) Efficacy of inter-dental mechanical plaque control in managing gingivitis--a meta-review. J Clin Periodontol 42(Suppl 16):S92–S105

    Article  Google Scholar 

  14. Jordan RA, Hong HM, Lucaciu A, Zimmer S (2014) Efficacy of straight versus angled interdental brushes on interproximal tooth cleaning: a randomized controlled trial. Int J Dent Hyg 12:152–157

    Article  Google Scholar 

  15. Larsen HC, Slot DE, Van Zoelen C, Barendregt DS, Van der Weijden GA (2017) The effectiveness of conically shaped compared with cylindrically shaped interdental brushes - a randomized controlled clinical trial. Int J Dent Hyg 15:211–218

    Article  Google Scholar 

  16. Chongcharoen N, Lulic M, Lang NP (2012) Effectiveness of different interdental brushes on cleaning the interproximal surfaces of teeth and implants: a randomized controlled, double-blind cross-over study. Clin Oral Implants Res 23:635–640

    Article  Google Scholar 

  17. Schnabl D, Goebel G, Kadletz A et al (2019) Cleansing efficacy of waist-shaped interdental brushes. A randomized-controlled crossover study. J Clin Periodontol 47(1):30–35

  18. Rösing CK, Daudt FA, Festugatto FE, Oppermann RV (2006) Efficacy of interdental plaque control aids in periodontal maintenance patients: a comparative study. Oral Health Prev Dent 4:99–103

    PubMed  Google Scholar 

  19. Caton JG, Armitage G, Berglundh T, Chapple ILC, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS (2018) A new classification scheme for periodontal and peri-implant diseases and conditions - introduction and key changes from the 1999 classification. J Periodontol 89(Suppl 1):S1–S8

    PubMed  Google Scholar 

  20. O'Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43:38

    Article  Google Scholar 

  21. Silness J, Loe H (1964) Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand 22:121–135

    Article  Google Scholar 

  22. Research Randomizer. Available at:

  23. Bakdash B (1994) Oral hygiene and compliance as risk factors in periodontitis. J Periodontol 65(Suppl 5S):539–544

    Article  Google Scholar 

  24. Christou V, Timmerman MF, Van der Velden U, Van der Weijden FA (1998) Comparison of different approaches of interdental oral hygiene: interdental brushes versus dental floss. J Periodontol 69:759–764

    Article  Google Scholar 

  25. Worthington HV, MacDonald L, Poklepovic Pericic T et al (2019) Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev 4:CD012018

    PubMed  Google Scholar 

  26. Serino G, Rosling B, Ramberg P, Socransky SS, Lindhe J (2001) Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease. J Clin Periodontol 28:910–916

    Article  Google Scholar 

  27. Rosling B, Serino G, Hellström MK, Socransky SS, Lindhe J (2001) Longitudinal periodontal tissue alterations during supportive therapy. Findings from subjects with normal and high susceptibility to periodontal disease. J Clin Periodontol 28:241–249

    Article  Google Scholar 

  28. Turesky S, Gilmore ND, Glickman I (1970) Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol 41:41–43

    Article  Google Scholar 

  29. Wolff D, Joerss D, Dörfer CE (2006) In vitro-cleaning efficacy of interdental brushes with different stiffness and different diameter. Oral Health Prev Dent 4:279–285

    PubMed  Google Scholar 

  30. Baumgartner G, Wiedemeier DB, Hofer D, Sener B, Attin T, Schmidlin PR (2019) In vitro cleaning potential of waist-shaped interdental brushes. Swiss Dent J 129:360–367

    PubMed  Google Scholar 

  31. Parodontale Therapie – das Würzburger Konzept. Available at:

Download references


This study was supported by Topcaredent®, Zurich, Switzerland (provision of waist-shaped interdental brushes).


This study was supported by the Medical University of Vienna.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Hady Haririan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were approved by the Ethics Committee of the Medical University of Vienna (Nr. 1670/2016) and in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Prior to inclusion, informed consent was obtained from all individual participants.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(PDF 154 kb).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wehner, C., Husejnagic, S., Laky, B. et al. Effect of interdental brush design on plaque during nonsurgical periodontal therapy. Clin Oral Invest 25, 87–94 (2021).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Oral hygiene
  • Dental plaque
  • Periodontitis
  • Periodontal debridement
  • Dental plaque index