Ultrasonic vs. Manual Toothbrushing in

Orthodontic Patients with Manifest Gingivitis

Executive Summary

Witten 2018


ORMED Institute for Oral Medicine at the University of Witten/Herdecke 

Principal investigators: Prof. Dr. Dr. h.c. P. Gängler
Dr. Tomas Lang, S. Saket, K. W. Weich

Sponsored by: EMAG AG, 64546 Mörfelden-Walldorf


Plaque retention around orthodontic brackets increases the short term gingivitis risk and the long term
caries risk in susceptible patients. It was, therefore, the aim of a randomized clinically-controlled study
to compare the improvement (i) of plaque control and (ii) gingivitis control by ultrasonic vs. manual


80 adolescents wearing fixed orthodontic appliances 6 month before removal and exhibiting ≥4
gingivitis teeth were randomly divided in 2 groups. The test group US (n=42) used the Emmi-dental
ultrasonic toothbrush (EMAG, Mörfelden-Waldorf, Germany). The control group CT (n=38) used the
manual toothbrush with oral hygiene tablets (Denttabs, Berlin, Germany). The Gingiva-Index was used
at 6 points/tooth at baseline, after 3-day-plaque-regrowth at start of study, after 2 and 12 weeks. The
modified Navy-Plaque-Index (Lang et al., 2011) was used at index teeth. Intra-oral photography
documented all teeth at baseline, at start and end of study with blinded pre-brushing and post-brushing
assessment of 6 planimetrical fields around the brackets buccally and 6 fields lingually and palatinally.


Highly significant reduction of gingivitis was documented for both groups,number of Gingivitis Teeth
from 13 to 4 in US and from 12 to 3 in CT. There was highly significant reduction of plaque index
(Ultrasonic 9.59 BL to 0.45 End around brackets, Manual 9.64 BL to 0.64 End). Hard and soft tissue
trauma have not been identified.


The study confirms earlier results of plaque reduction and contribution to gingival health (Denda, 2011
and May, 2013). The Emmi-dental Professional ultrasonic toothbrush used in a high risk cohort of
subjects unter orthodontic treatment and exhibiting chronic gingivitis is clinically effective in significant
plaque reduction and highly significantly decreasing the number of gingivitis teeth. The improvement of
oral hygiene is matching that of the control group. The advantage of ultrasonic brushing is the wearfree


Original-PDF of the study        Here you will find the scientific study

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