Effect of Novel Oral Hygiene Regimen on Non-surgical Treatment of Stage II and III Periodontitis

Dental plaque is causally linked to gingival inflammation and essential for the onset of periodontitis. The main goal of periodontal treatment is the establishment of adequate infection control to reduce the bacterial load below individual threshold levels of inflammation. Achievement of adequate oral hygiene standards is critical to effective periodontal therapy. Classical studies have shown that professional tooth cleaning during healing of subgingival debridement provides superior outcomes. Regrettably, costs do not allow routine implementation of these regimens. By far, patient-centred homecare is the most cost-effective approach to maintaining good oral hygiene. Therefore, improving the adherence with self-performed oral hygiene is a priority in periodontal practice.

Conventionally, clinicians provide oral hygiene instructions to the patients based on the results of their clinical examinations, sometimes supplemented with written information in brochure and disclosing agents to show the location of the biofilm. However, patients' adherence to a proper daily oral hygiene regimen generally remains poor. New technology based on an internet of things network of intelligent toothbrushes (i-Brush) has shown excellent adherence of use in a pilot study in a maintenance population. Other studies have shown that electronic messaging and mobile health (mHealth) supported by smartphones and applications improve oral hygiene performance, particularly in younger individuals undergoing orthodontic treatment. New electric artificial intelligence powered toothbrushes are able to precisely sense the location of the brushing being performed by the patient and transmit information to the clinician who is able to analyze the data and provide targeted instructions, if needed. Remote sensing of oral hygiene practices through the connected intelligent powered toothbrush allows more specific and targeted messages, thereby promoting personalized oral health care and eventually improving the healing outcomes of periodontal therapy through a two-way communication between patients and clinicians. This study aims to investigate the clinical efficacy of a novel regimen consisting of a new generation of power-driven internet connected i-Brush and targeted m-Health messages in improving periodontal treatment outcomes in comparison with routine oral hygiene instructions.

Inclusion criteria

• Aged 18 and above
• Generalized Stage II and Stage III periodontitis
• Subjects willing to receive NSPT necessary for the management of periodontitis and to comply with research appointments/schedule
• Use of a compatible Android cell phone with Oral-B 8.5.1 Application

Exclusion criteria

• Edentulism
• Presence of any systemic disease that can alter the manifestation/outcome of periodontal treatment
• Pregnancy or intention to become pregnant at any point during the study duration
• Having received antibiotics within the previous 3 months
• Need for antibiotic prophylaxis in the context of dental treatment
• Having received professional periodontal treatment (other than supragingival cleaning) within the previous 12 months
• Presence of xerostomia interfering with saliva sampling
• Participation in another intervention trial
• Inability or unwillingness of individual to give written informed consent.