***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The purpose of the present study was to compare in untreated patients suffering from moderate to severe periodontitis the efficacy of dental floss ( DF ) and interdental brushes ( IDB ) in the reduction of plaque , gingival inflammation , and probing depth in a 6-week period prior to subgingival debridement . Twenty-six patients ( 12 female , 14 male ; mean age 37.4 years ; range 27 to 72 years ) were instructed to use DF for one side of the dentition and IDB for the other side as an adjunct to the daily toothbrushing for 6 weeks . Oral hygiene instructions for toothbrushing and the use of the two devices were given at baseline and at week 3 . Measurements were carried out at baseline and at 6 weeks including plaque scores , probing depth , and 2 bleeding scores ( periodontal pocket bleeding index and angulated bleeding index ) . With the IDB , the approximal plaque score at baseline of 3.09 reduced to 2.15 at 6 weeks and with DF from 3.10 to 2.47 , respectively . IDB proved to remove significantly more plaque than DF . Baseline probing depth of 5.84 mm for IDB sites and 5.59 mm for DF sites was reduced to 5.01 mm at 6 weeks for both regimens . Analysis showed that the use of IDB result ed in a greater pocket reduction . Both bleeding indices were slightly reduced with IDB and DF , but no differences between devices were found . In relation to patient acceptance , more problems were observed with DF , and IDB were felt to be more efficacious . In conclusion , the results of the present study indicate that in combination with a manual toothbrush , the use of interdental brushes is more effective in removal of plaque and results in a larger reduction of probing depth than the use of dental floss . Although the differences were small , they indicate , in combination with patient preferences , that interdental brushes are to be considered preferable to floss for interdental plaque removal in patients suffering from moderate to severe periodontitis OBJECTIVE The study was conducted to compare the performance of three interdental products to dental floss in the control and removal of plaque , and in the reduction of gingivitis . METHODOLOGY One-hundred and twenty subjects were screened for the presence of interproximal sites of a size suitable for a GUMO Go-Betweens cleaner , and for being in compliance with inclusion and exclusion criteria . They were then assessed with the Plaque , Gingivitis , and Eastman Interdental Bleeding Indices ( EIBI ) at baseline , given a prophylaxis , r and omly assigned to one of four products ( Glide dental floss , Butler flossers , GUM Go-Betweens cleaners , and GUM Soft-Picks cleaners ) , and given product use instructions . Subjects returned at three weeks for a compliance review and at six weeks for a final visit . Plaque was assessed at the final visit before and after using the assigned products . Plaque , gingivitis , and bleeding scores were evaluated by analysis of covariance using the baseline measurements as the covariate . RESULTS All four interdental products significantly reduced interdental plaque from baseline to before-use at the final visit ( after six weeks ) employing baseline plaque as a covariate . Reductions were 16 % to 24 % . Similarly , use of the products at the final visit result ed in 26 % to 31 % reductions in plaque with the before-use plaque as a covariate . Interdental gingivitis scores showed a reduction both lingually and buccally , with reductions ranging from 27 % to 36 % for the former and 34 % to 53 % for the latter ( baseline was the covariate ) . No statistical differences were found between the products on the lingual interdental sites . The Go-Betweens cleaners showed a statistically greater reduction in the Gingival Index score buccally than the other three products . No differences were noted among the products for the EIBI . CONCLUSION In this study , dental floss , the recognized " gold st and ard " for gingivitis reduction , was matched in performance by flossers and an interdental cleaner with small elastomeric fingers , and surpassed by an interdental brush . All products performed comparably for plaque reduction and removal The purpose of this study was to evaluate whether the home care of noncompliant adolescent orthodontic patients with " poor " oral hygiene could be improved through the use of a deception strategy design ed to intentionally induce the Hawthorne effect . This effect is often cited as being responsible for oral health improvements of control groups that receive placebo treatments . It is thought that participating in and fulfilling the requirements of a study alters subjects ' behavior , thereby contributing to the improvement . Forty patients with histories of poor oral hygiene were assigned , in a quasi-r and om fashion , to two groups . Experimental subjects ( n = 20 ) were presented with a situation that simulated participation in an experiment . These included the use of a consent form ; distribution of tubes of toothpaste labeled " experimental " ; instructions to brush twice a day for two minutes using a timer ; and a request to return unused toothpaste .  Control subjects ( n = 20 ) had no knowledge of study participation . Tooth surface area covered with plaque was used as a proxy measure of home care behavior . It was measured at baseline , three months , and six months . Mean percentages of tooth surface covered with plaque for the experimental and control groups were 71 ( + /- 11.52 ) and 74 ( + /- 11.46 ) at baseline ; 54 ( + /- 13.79 ) and 78 ( + /- 12.18 ) at three months ; and 52 ( + /- 13.04 ) and 79 ( + /- 10.76 ) at six months . No statistically significant difference ( p > .05 ) was obtained between groups at baseline . Statistically significant differences ( p < .05 ) were found between groups at three and six months . Significant differences ( p < .05 ) were also found only for the experimental subjects between baseline and each of the two subsequent observation periods . The efficiency and potential effectiveness of this strategy suggest that additional research be conducted to assess oral health improvements and possible applications to the private practice setting OBJECTIVE The aim of this study was to compare the effectiveness of the automated Interclean Interdental Plaque Remover with that of interdental brushes and Ultrafloss . METHOD AND MATERIAL S The interdental hygiene effectiveness of 35 healthy patients suffering from gingivitis was studied by an examiner daily over a period of 1 week . The sizes of the interdental spaces were classified and corresponding-sized interdental brushes or floss was selected . In a r and om , split-mouth design both interdental cleaning methods , mechanical and manual , were applied while the patients continued to use st and ard brushing techniques . Disclosed proximal plaque , the papillary bleeding index , and interdental bleeding tendency on stimulation were evaluated . RESULTS The papillary bleeding index was reduced from an average value of 40 % to 25 % . Only 5 % of interproximal plaque remained after manual interdental cleaning , whereas 40 % of plaque was still present after use of the Interclean device . Cleaning efficiency of manual and mechanical methods was comparable in only 1 interproximal space size . At the end of the study , the interdental bleeding on stimulation was significantly higher in the automatically cleaned interspaces than in the manually cleaned spaces . CONCLUSION Manual interproximal cleaning  was more effective than the automated device A single-blind , r and omized clinical study compared plaque removal efficacy of three  toothbrush design s under conditions simulating normal use . Ninety ( 90 ) subjects with substantially complete dentition used one of the three toothbrushes : Advanced Design Reach , Crest Complete and Oral-B 40 . Subjects were examined for plaque before and after a single brushing using the Global Plaque Index to estimate plaque on the entire tooth surface , and the  Proximal/Marginal Plaque Index ( PMI ) , a new index , was used to estimate plaque at proximal and marginal surfaces of the teeth . The Advanced Design Reach toothbrush reduced plaque scores significantly more than did the other toothbrushes tested ( p < 0.05 ) using either scoring method . At marginal and proximal sites , combined or separate , Advanced Design Reach toothbrush was significantly more effective than the other toothbrushes in plaque removal and produced significantly more plaque free sites than the other two toothbrushes . Evaluation of all anterior and posterior parts of the dentition with the Global Plaque Index indicated that Advanced Design Reach was superior in removing plaque in these regions . Both plaque indices were highly correlated ( correlation coefficient 0.91 ) indicating excellent consistency by the dental examiner The purpose of this study was to evaluate different methods of eliciting gingival bleeding as indicators of gingival inflammation in the experimental gingivitis model . Following a period of stringent oral hygiene , 103 dental students were scored for plaque and gingival bleeding assessed by 4 methods . From this group , 41 volunteers were r and omly allocated to 2 treatment groups . Dental students with clean teeth and healthy gingivae were asked to abolish all mechanical tooth cleaning in the lower jaw for a period of 3-weeks . During the 21-day experimental period , chlorhexidine ( Peridex ) or a placebo mouthrinse was applied to the lower jaw . Subjects brushed the upper jaw with a st and ard toothpaste . In principal , 2 different methods were employed to provoke bleeding : ( 1 ) at the marginal gingival tissue by running a probe along the soft tissue wall at the orifice of the pocket , and ( 2 ) by probing to the " bottom " of the pocket . Variations in the methods were based on angulation ( AngBI , ParBI ) of the probe in relation to the tooth surface and to the probing force ( PPBI.25N , PPBI.75N ) . 1 r and omly selected quadrant in the lower jaw was scored using the AngBI . The opposing quadrant was scored with a r and omly-allocated bleeding index , either ParBI , PPBI.25N or PPBI.75N . The results of this study confirm earlier findings that the angulation of the probe determines the number of sites with bleeding observed . It also indicates that bleeding as elicited by probing to the bottom of the pocket is a poor indicator of early gingivitis . It is recommended that gingivitis should be assessed by probing the marginal gingiva The plaque-removing efficacy when using waxed dental floss and three interdental brushes was compared in an intraindividual clinical trial . Nine adult patients treated for periodontal disease , with a reduced but healthy periodontium and large interdental spaces were subjects in the study . Each subject tested the four interdental cleaning aids in r and om sequence over a 2-wk period . The duration of the study was 8 wk . The results indicated that the use of interdental brushes is preferable to that of dental floss in cleaning interdental areas where the papilla is missing . No difference in achieved cleanliness was noted after use of the different interdental brushes tested . No gingival damage or damage to the hard tissue of the teeth was observed after use of interdental brushes or dental floss BACKGROUND Although interdental cleaning is an integral component of home plaque control for periodontally involved patients , limited data exist on the periodontal benefits of commonly used interdental cleaning methods before definitive root surface debridement is undertaken . Therefore , the aim of this study was to compare the effects of a customized interdental brushing technique and a customized flossing technique on clinical periodontal outcomes prior to root surface debridement in chronic periodontitis cases . METHODS This was a single-blind , r and omized controlled clinical trial . Seventy-seven patients with chronic periodontitis were measured for plaque , relative interdental papillae level , Eastman interdental bleeding index , probing depths , and bleeding on probing at interdental sites and underwent a 10-minute h and scaling to remove easily accessible calculus deposits . Before group allocation , patients were advised on toothbrushing and instructed in two customized methods of interdental cleaning involving dental floss and precurved interdental brushes . Material s were supplied after r and om allocation . Participants were recalled at 6 and 12 weeks for clinical measurements , reinforcement of instructions , and fresh material s. RESULTS There were significant reductions from baseline for all indices in both groups ( P < 0.01 ) . At 6 weeks , the interdental brush group improved more than the floss group in every parameter ( P < 0.05 ) . By 12 weeks , the changes in plaque , papillae level , and probing depths were significantly greater in the interdental brush group than the floss group ( P < 0.01 ) . CONCLUSION This trial demonstrated that patients were able to improve clinical periodontal outcomes by interdental cleaning , particularly with interdental brushes , even before thorough root surface debridement was undertaken The effectiveness of the Interspace brush , Inter-Dens , and waxed dental floss as proximal surface cleansing agents was compared in 35 subjects . Each subject used all three methods of cleansing in r and om order of selection . Statistical analysis of the results showed that there was no difference in the effectiveness of any one of these three agents . However , proximal surfaces of anterior teeth where cleaned more effectively than posterior teeth . The coronal half of the proximal surfaces was cleaned more effectively than the apical half and the facial half more effectively than the lingual half when Inter-Dens was used . Comparison of cleansing effectiveness between facial and lingual halves of proximal surfaces for the Interspace brush and waxed dental floss showed no significant difference . Mesial and distal proximal surfaces were cleaned with similar effectiveness . Plaque control was only satisfactory on approximately half of the proximal surfaces , though a wide variation occurred . Significantly lower plaque scores were found 1 week after the initial instruction session , irrespective of the agent used . The majority of subjects preferred  Inter-Dens  whilst waxed 
    Output:
    
As an adjunct to brushing , the IDB removes more dental plaque than brushing alone .
Studies showed a positive significant difference using IDB with respect to the plaque scores , bleeding scores and probing pocket depth .
The majority of the studies presented a positive significant difference in the plaque index when using the IDB compared with floss