Planimetrical Assessment of Simulated Organic Plaque Removal by Different Flosssing

Objectives: Interdental plaque removal plays a pivotal role in preventing caries and periodontitis in susceptible subjects. Therefore, it was the aim to test ex-vivo the cleaning efficacy of (i) a flosser with crossing filaments and to compare to (ii) a conventional flosser and to (iii) a conventional rolled floss using organic plaque simulation (Flad et al., 2016) and computer-assisted planimetrical assessment of interdental risk fields.
Methods: Plaque removal efficacy at 20 interdental planimetrical coronal and root risk fields by prototype DenTek Cross Flosser, DenTek Triple Clean Flosser (Prestige Brands, Tarrytown, NY, USA) and by Oral-B Glide Floss (Procter & Gamble, Cincinnati, OH, USA) was assessed. Typodont teeth in anatomical position were covered with plaque simulation. Interdental spaces were flossed with two gliding strokes below contact point in up and down motion parallel to tooth axis. Tests were executed seven times. Percentage of plaque removal at risk fields at four sites per tooth was documented by optical planimetry. Cleaning efficacy at all teeth underwent statistical approval between the test devices (Bonferroni correction).
Results: Cross Flosser exhibited the best plaque control efficacy ranking from 26.0-27.5%, different (p≤0.05) from Triple Clean (19.0-20.4%) and from Glide Dental Floss (19.6-19.7%).

Analysis of single teeth showed different cleaning percentages depending from anatomical space in-between the teeth. Cross Flosser was most effective around canines, premolars and molars. Crossing design of two filaments in angulation of 12° is decisive for the significant differences. According to single tooth analysis cleaning range interdentally is from 52.2-4.0%.
Conclusions: The new ex-vivo test methodology of interdental cleaning with flossers compared to flossing is highly standardized. The planimetrical plaque control at four sites of teeth results in precise efficacy values. The innovative Cross Flosser removes more plaque compared to the conventional single filament flosser and to flossing. Therefore, X-floss filaments are superior in cleaning open interdental spaces.