Touch-to-Teach Interdental Brush Instruction Versus Conventional Guidance on Gingival Health in Patients With Fixed Dental Prostheses

NCT07636954 | Completed

• 1 other identifier: MDSPerio2023 - 1
• Study Type: interventional
• Target: 32
• Locations: 1 country
• Sites: 1

Brief Summary

Why is this study being done? People with dental crowns often develop inflamed gums because bacteria accumulate in the tight spaces between teeth that a regular toothbrush cannot reach. Interdental brushes can clean these spaces, but patients frequently use them incorrectly. This study tested whether a personalised, hands-on instructional method called Touch-to-Teach produces healthier gums compared with standard dental hygiene advice. Who participated? 40 adults with at least one porcelain-fused-to-metal crown in the molar region with supragingival margins took part at Thumbay University Hospital, Ajman, UAE. Four participants withdrew; 36 completed the three-month study. What did participants do? All participants received full-mouth scaling and standardised toothbrushing instruction. Group 1 (Touch-to-Teach) additionally received probe-guided, site-specific interdental brush selection and guided in-mouth training, with correctly sized brushes provided for home use. Group 2 (Conventional Instruction) received verbal advice, educational videos, and a model-based demonstration, with brush size selected empirically and no brushes provided for home use. Follow-up visits were conducted at one, two, and three months. What was measured? A blinded examiner recorded gum inflammation, plaque levels, gum pocket depth, and bleeding at each visit. Both groups completed a questionnaire on brush comfort, perceived efficacy, and satisfaction at one and three months. What were the key results? The Touch-to-Teach group showed significantly greater reductions in plaque accumulation, gingival inflammation, and probing depth compared with the control group. Both groups showed meaningful reductions in gingival bleeding over time, with no statistically significant difference between groups at three months. Patient-reported outcomes consistently favoured the Touch-to-Teach group. These findings suggest that calibrated, personalised interdental brush instruction may offer advantages for patients with fixed dental prostheses.

Conditions

Gingivitis; Periodontal Disease; Fixed Dental Prosthesis; Dental Plaque

Keywords

Touch-to-Teach; interdental brush; fixed prosthesis; gingival health; plaque control; patient education; oral hygiene instruction; periodontal maintenance

Outcome Measures

Primary Outcomes (1)

• Gingival Index (GI)

  Description: Full-mouth Gingival Index (Löe \& Silness, 1963) assessed at crown-adjacent interproximal sites on a 0-3 ordinal scale: 0 = normal gingiva; 1 = mild inflammation, no bleeding on probing; 2 = moderate inflammation with bleeding on probing; 3 = severe inflammation with spontaneous bleeding tendency.

  Baseline, 1, 2, and 3 months (primary endpoint: 3 months)

Secondary Outcomes (5)

• Bleeding on Probing (BOP%)

  Baseline, 1 month, 2 months, and 3 months

• Patient-reported acceptability (PROM)

  3 months

• Plaque Index (PI)

  Baseline, 1 month, 2 months, and 3 months

• Probing Pocket Depth (PD)

  Baseline, 1 month, 2 months, and 3 months

• Patient-Reported Outcome Measures (PROMs)

  1 month and 3 months

Study Arms (2)

Touch-to-Teach Instruction

EXPERIMENTAL

Participants received standardized oral hygiene instruction (Modified Bass technique) and full-mouth scaling and root surface debridement, plus individualized Touch-to-Teach interdental brush instruction using the Curaprox Chairside System. A color-coded CPS colorimetric probe measured each interproximal space precisely (blue 0.6mm, red 0.7mm, pink 0.8mm, yellow 0.9mm, green 1.1mm). Matching color-coded brushes were prescribed per site. The clinician demonstrated correct technique on a dental model then guided each patient through the procedure in their own mouth until correct insertion, manipulation, and removal were demonstrated at each designated space. Prescribed size-calibrated interdental brushes were provided for home use throughout the 3-month study period

Behavioral: Touch-to-Teach interdental brush instruction

Conventional Instruction (Active Comparator)

ACTIVE COMPARATOR

Participants received standardized oral hygiene instruction (Modified Bass technique) and full-mouth scaling and root surface debridement. Conventional guidance comprised verbal instruction, access to European Federation of Periodontology animated patient education videos on interdental cleaning, and chairside hands-on demonstration of interdental brush insertion and manipulation using dental models with error correction. Brush size was selected empirically by the clinician without a calibrated sizing system. No personalized brush prescription, no CPS probe measurement, and no in-mouth guided insertion were provided.

Behavioral: Conventional oral hygiene instruction

Interventions

Touch-to-Teach interdental brush instruction BEHAVIORAL

Individualized interdental brush care delivered using the Curaprox Chairside System (Curaprox AG) through three structured phases: Diagnostic Phase: CPS colorimetric probe with five autoclavable color-coded tips (blue 0.6mm, red 0.7mm, pink 0.8mm, yellow 0.9mm, green 1.1mm) used to measure precise accessibility diameter of each interproximal space. Prescription Phase: Matching color-coded interdental brush selected per space. Brush correctly sized when fitting snugly without wire bending or forceful insertion required. Training Phase: Clinician demonstrated technique on dental model then guided patient through procedure in their own mouth until proficiency in correct insertion angle, gentle manipulation, and removal was achieved at each space. Prescribed brushes provided for daily home use for 3 months.

Touch-to-Teach Instruction

Conventional oral hygiene instruction BEHAVIORAL

Standardized oral hygiene guidance comprising: verbal instruction in Modified Bass toothbrushing technique; access to European Federation of Periodontology patient portal animated education videos demonstrating interdental cleaning techniques; and chairside hands-on demonstration of interdental brush insertion and manipulation using dental models with corrections provided as necessary. Brush size selected empirically without calibrated probe system. No personalized brush prescription, no CPS probe measurement, and no in-mouth guided insertion performed.

Conventional Instruction (Active Comparator)

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged 18 years and older
• Presence of at least one porcelain-fused-to-metal (PFM) crown in the molar region with supragingival margins, in occlusal function for a minimum of 3 months prior to enrollment
• Prosthesis does not interfere with the supracrestal attachment apparatus (biologic width preserved)
• Clinically healthy periodontium confirmed at screening, with no signs of periodontal disease as per the 2017 World Workshop classification criteria
• Systemically healthy with no conditions known to affect periodontal healing or gingival response
• Ability and willingness to attend all scheduled study visits at baseline, 1 month, 2 months, and 3 months
• Willing and able to provide written informed consent

You may not qualify if:

• Uncontrolled diabetes mellitus
• Use of interdental brushes within the previous 6 months
• Current smoker or any tobacco user
• Use of systemic antibiotics or anti-inflammatory medications within the previous 3 months
• Regular use of anti-plaque or antimicrobial mouth rinses within the previous 3 months
• Currently pregnant or breastfeeding
• Fractured or defective fixed prosthesis requiring repair or replacement prior to enrollment
• Inability to attend scheduled follow-up visits

Sponsors & Collaborators

• Gulf Medical University: lead

Study Sites (1)

ostgraduate Dental Center, Thumbay University Hospital, Gulf Medical University

Ajman, Ajman Emirate, United Arab Emirates

Location

Related Publications (13)

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  PMID: 28503739 BACKGROUND

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  PMID: 27192409 BACKGROUND

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  PMID: 22672101 BACKGROUND

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  PMID: 18715352 BACKGROUND

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  PMID: 4500182 BACKGROUND

• Bourgeois D, Saliasi I, Llodra JC, Bravo M, Viennot S, Carrouel F. Efficacy of interdental calibrated brushes on bleeding reduction in adults: a 3-month randomized controlled clinical trial. Eur J Oral Sci. 2016 Dec;124(6):566-571. doi: 10.1111/eos.12302. Epub 2016 Sep 29.

  PMID: 27681016 BACKGROUND

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  PMID: 19138177 BACKGROUND

• Worthington HV, MacDonald L, Poklepovic Pericic T, Sambunjak D, Johnson TM, Imai P, Clarkson JE. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev. 2019 Apr 10;4(4):CD012018. doi: 10.1002/14651858.CD012018.pub2.

  PMID: 30968949 BACKGROUND

• Ng E, Lim LP. An Overview of Different Interdental Cleaning Aids and Their Effectiveness. Dent J (Basel). 2019 Jun 1;7(2):56. doi: 10.3390/dj7020056.

  PMID: 31159354 BACKGROUND

• Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018 Jun;89 Suppl 1:S159-S172. doi: 10.1002/JPER.18-0006.

  PMID: 29926952 BACKGROUND

• Salzer S, Slot DE, Van der Weijden FA, Dorfer CE. Efficacy of inter-dental mechanical plaque control in managing gingivitis--a meta-review. J Clin Periodontol. 2015 Apr;42 Suppl 16:S92-105. doi: 10.1111/jcpe.12363.

  PMID: 25581718 BACKGROUND

• Subramanya AP, Prabhuji MLV. Comparative evaluation of efficacy and patient-reported outcome measures of oral hygiene instruction methods for calibrated interdental brush. Int J Dent Hyg. 2021 Aug;19(3):287-294. doi: 10.1111/idh.12530. Epub 2021 Jun 18.

  PMID: 34101341 RESULT

Related Links

• European Federation of Periodontology patient education portal. Videos from this site were used as the educational resource for control group participants on interdental cleaning technique.

MeSH Terms

Conditions

Gingivitis; Periodontal Diseases; Dental Plaque

Condition Hierarchy (Ancestors)

Infections; Gingival Diseases; Mouth Diseases; Stomatognathic Diseases; Dental Deposits; Tooth Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Single-blind study design. The clinical examiner performing periodontal measurements (PI, GI, PD, BOP) at baseline and follow-up visits was blinded to group allocation. Participants could not be blinded due to the distinct nature of Touch-to-Teach hands-on instruction versus conventional verbal guidance. The treating clinician delivering interventions was not blinded. Allocation concealment maintained using sequentially-numbered opaque envelopes.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Two-arm parallel randomized controlled trial comparing Touch-to-Teach interdental brush instruction using the Curaprox Colorimetric Probe System (experimental arm) versus conventional oral hygiene instruction (active control arm) in patients with fixed dental prostheses. Both arms received baseline full-mouth scaling and standardized oral hygiene instruction. The experimental arm received additional individualized hands-on Touch-to-Teach interdental brush training with size-calibrated brush provision for 3 months.

Study Record Dates

• First Submitted: May 20, 2026
• First Posted: June 9, 2026
• Study Start: March 15, 2024
• Primary Completion: June 15, 2025
• Study Completion: June 15, 2025
• Last Updated: June 9, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

AE (1)