Concurrent Image Analysis Assessment of Gingivitis and Plaque Treatment Response

Objective: A randomized controlled trial evaluated concurrent image analysis methods to assess gingivitis and plaque after oral hygiene. Methods: After institutional review and consent, 59 healthy adults were enrolled in an experimental gingivitis clinical trial. Oral health was promoted via prophylaxes and daily supervised brushing over 14-days, hygiene was suspended to induce gingivitis over 21 days, and subjects were randomly assigned (1:1) to 7-days with an oral hygiene combination ± a therapeutic rinse. Combination therapy used a 0.454% stannous fluoride dentifrice (Crest® ProHealth™ Clinical Gum Protection), rotating-oscillating powered brush (Oral-B® ProfessionalCare® SmartSeries 5000 with SmartGuide), and expanded polytetrafluoroethylene floss (Oral-B Glide® Pro-Health Professional Clinical Protection), while the combination + rinse group also used a 0.07% cetylpyridinium chloride rinse (Crest ProHealth Multi-Protection). Use was supervised following label instructions. Gingivitis and plaque were measured using gingivitis image analysis (GIA) to assess ΔG, and fluorescein-disclosed digital plaque image analysis (DPIA) to assess area% coverage before/after brushing. Results: Mean (SD) age was 24.3 (6.5), and 58/59 completed the study. Both GIA and DPIA showed significant (p<0.01) changes consistent with the natural history. After induction, mean (SD) prebrush plaque area% was 54.3 (15.8). During the treatment phase, plaque levels declined quickly in both groups at Day 1, with adjusted mean pre & postbrush area% of 4.7 & 1.6 for the combination versus 2.6 & 1.3 for the combination + rinse. DPIA scores differed significantly from baseline throughout treatment period reaching 0.7% at Day 7 postbrushing. GIA results were similar, though delayed, as ΔG continued to decline the first treatment day. By Days 4 & 7, both groups showed significant (p<0.001) improvements in ranging from 9.0-10.9 ΔG. Conclusion: In an induced gingivitis study, concurrent instrumental gingivitis and plaque digital image analysis methods showed the natural history response including treatment, progression, and resolution of established disease.