Sizing The Gap A new tool on the tray

Sizing The Gap A new tool on the tray

Interdental cleaning just got a whole lot easier thanks to the colorimetric IAP probe

By Dr Tihana Divnic-Resnik BDS, MSc, PhD

REGULAR REMOVAL AND disruption of oral biofilm is the goal of oral selfcare and an important component of primary prevention of dental caries, periodontal, as well as peri-implant diseases. Although tooth brushing is the primary and widely used mechanical method for controlling oral biofilms, the focus of modern prevention has been shifted towards shaping and improving mechanical devices used for cleaning of interproximal areas. Various anatomic characteristics make natural (between two teeth) or artificially created (between two restored teeth or implants) interdental space, unique and susceptible to disease. Its position renders it “hidden” and less accessible to natural-cleaning mechanisms such as saliva, tongue/lips, thus making it a good ground for undisturbed biofilm accumulation and dysbiosis conductive to caries or periodontal diseases.

Regular use of toothbrush is proven to be optimal for cleaning of flat tooth surfaces (1,2) . However, the benefits of regular use of interdental cleaning devices as an adjunct to tooth brushing, have been confirmed with data from the National Health and Nutrition Examination Survey (NHANES 2011- 2012 & 2013-2014) (3) . Individuals who were using interdental cleaning devices on a regular basis, showed higher standards of oral health, with less prevalence of periodontal diseases, reduced coronal and interproximal caries, and fewer missing teeth (3) .

About the author Dr Tihana Divnic-Resnik BDS, MSc, PhD is a clinical lecturer and Doctor of Dental Medicine (DMD) course coordinator in the Discipline of Periodontics at The University of Sydney. She was a lecturer in Periodontics and Oral Medicine at University of Belgrade (Serbia) for 10 years, where she also practiced as a specialist of Periodontology and Oral Medicine. She has published her work in several international journals and presented it at numerous professional conferences. She is a member of European Federation of Periodontology (EFP), Australian Society of Periodontics (ASP) and fellow of the International College of Dentists (ICD).

Dental floss has been routinely recommended by majority of dental professionals for cleaning of closed interdental spaces that may be seen in individuals with healthy periodontium, while interdental brushes are mainly recommended in periodontal patients or in those with open embrasures. There is still concern regarding their use in primary prevention at healthy sites, due to potential discomfort and trauma to interdental papilla (4) . Existing clinical studies, however, did not find any associated papilla or hard-tissue damage after the use of interdental brushes 5 . In addition, it has been observed that in a group of 99 young individuals with healthy periodontium, 92.3% of interdental sites were accessible to interdental brushing 6 . As compared to dental floss, interdental brushes are easier to use and readily accepted by patients. They are more effective in cleaning of interproximal surfaces, especially in region of posterior teeth that feature mesial and distal concavities, inaccessible by dental floss (7) . Proven to be superior than dental floss, interdental brushes are becoming the first choice for mechanical interdental hygiene. However, while recommending devices for mechanical biofilm control, including interdental brushes, we must

Image 1-1 Efficacy of dental floss and interdental brushes

Image 1-2 Efficacy of dental floss and interdental brushes

Image 1-3 Efficacy of dental floss and interdental brushes

keep in mind the following criteria: – the recommended device must be simple to use and should be easily accepted by the patients – it must be effective – it should not cause trauma to soft or hard tissue All the criteria may be affected by the size of interdental brush, hence the important step in selection process is the determination of dimensions of interdental spaces and matching them to the interdental brushes of appropriate sizes. As there is no established scientific method for the choice of interdental brushes, the empirical so-called reference technique is used in everyday practice (6) . Interdental brushes of various sizes are used in increasing order of diameters until the one, that fits the interdental space best without causing friction or discomfort, is identified. This technique of selection may be time consuming and difficult for the clinician, especially in posterior sites, and at the same time unpleasant for the patient. A measuring tool in the shape of a probe has been designed to match the size of the interdental space with the best-fitting interdental brush. A color-coded interproximal access probe (IAP) designed by Curaden AG, Kriens, Switzerland, is a conical instrument with a rounded tip. Its working part contains coloured bands corresponding to dimensions of interdental brushes. Starting from the base, interdental diameters taper off, and are coded as green, yellow, pink, red and blue.

An access diameter of interdental brush is defined by the gauge of wire core and may affect accessibility, while an effective cleaning diameter is determined by the length of the bristles and controls efficacy. The widest part of each coloured band on the probe is designed to match with the effective cleaning diameter of the corresponding interdental brush from CPS Prime range of Curaprox © . The IAP probe is mounted on the handle via click fastening joint that secures it in the desired position, straight or angled, for easy interdental insertion. The technique consists of inserting a probe under light constant pressure of approximately 50 N/cm2 (0.20-gram force) horizontally from vestibular or oral aspect, until it achieves tight contact with interproximal surfaces of adjacent teeth. The coloured band that is emerging from the interdental space on the vestibular or oral aspect, depending on the direction of insertion, indicates the best fitting interdental brush.

How to use the IAP probe

The IAP interdental brush in action

The accompanying colour chart

The IAP probe is designed to be used exclusively with interdental brushes from CPS Prime range of Curaprox © and can’t be used with other brands. Its crucial role lies in precise determination of the brush that best matches the designated interdental space and is valuable in calibration of type I embrasures. The probe is autoclavable and reusable. It is complemented by the interdental access card which allows the clinician to allocate the correct brush size for each interdental space. Patients may use the card as a map that will guide them through the process of cleaning. The IAP probe has been tested in several studies and proven to be useful in clinical practice. I have been using the probe for clinical training and assessments of Doctor of Dental Medicine (DMD) students for several years now, and I can say that it simplifies the process of interdental brush selection, eliminates guesswork, and increases students’ confidence in the choice of the right brush for their patients.

So far, interdental brushes selected using IAP probe, are confirmed to be efficient in biofilm removal and prevention of inflammation 8 . From a clinical point of view, screening of interdental spaces with IAP probe minimises risk of bias, reduces potential discomfort and may increase patient compliance with individually tailored oral self-care. •

The IAP Probe interdental access card

References: 1. De la Rosa M, Zacarias Guerra J, Johnston DA, Radike AW. Plaque growth and removal with daily tooth brushing. J Periodontol 1979;50:661-64. 2.Slot DE, Wiggelinkhuizen L, Rosema NA, Van der Weijden GA. The efficacy of manual toothbrushes following a brushing exercise. A systematic review. Int J Dent Hyg 2012;10:187-197. 3.Marchesan JT, Morelli T, Moss K, Preisser JS Zandona AF, Offenbacher S, Beck J. Interdental cleaning is associated with decreased oral disease prevalence. J Dent Res 2018;97:773-78. 4.Chapple IL, Van der Weijden F, Doerfer C, et al. Primary prevention of periodontitis. Managing gingivitis. J Clin Periodontol 2015;42 (suppl 16):S71-S76. 5.Bergenholtz A, Olsson AA. Efficacy of plaque-removal using interdental brush and waxed dental floss. Scand J Dent Res 1984;92:198-203. 6.Carrouel F, Llodra JC, Viennot S, Santamaria J, Bravo M, Bourgeois D (2016) Access to interdental brushing in periodontlay healthy young adults: a cross-sectional study. PLoS ONE 11(5):e0155467. doi:10.1371/journal. pone.0155467 7. Imai PH, Hatzimanolakis PC. Interdental brush in type I embrasures: examiner blinded randomised clinical trial on bleeding and plaque efficacy. Can J Dent Hyg 2011;45:13-20. 8.Bourgeois D, Saliasi I, Llodr JC, Bravo M, Viennot S, Carrouel F. Efficacy of interdental calibrated brushes on bleeding reduction in adults: A threemonth randomized controlled clinical trial. Eur J Oral Sci 2016;124:566-571.

Dr Tihana Divnic-Resnik BDS, MSc, PhD

About the author

Dr Tihana Divnic-Resnik BDS, MSc, PhD is a clinical lecturer and Doctor of Dental Medicine (DMD) course coordinator in the Discipline of Periodontics at The University of Sydney. She was a lecturer in Periodontics and Oral Medicine at University of Belgrade (Serbia) for 10 years, where she also practiced as a specialist of Periodontology and Oral Medicine. She has published her work in several international journals and presented it at numerous professional conferences. She is a member of European Federation of Periodontology (EFP), Australian Society of Periodontics (ASP) and fellow of the International College of Dentists (ICD).