***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: INTRODUCTION The objective of this r and omized , single use , single blind , single center , 4-group parallel clinical study was to evaluate the plaque removal  efficacy of  three power toothbrushes and a manual toothbrush .  METHODS One hundred forty-four ( 144 ) subjects completed the study . Subjects were r and omly assigned to one of four toothbrush groups : Sonicare Elite , Oral-B Sonic Complete , Waterpik Sensonic or Oral-B Indicator ( manual ) . Subjects abstained from brushing 23 - 25 hours prior to the pre-brushing data collection . Pre-brushing scores were obtained using the Rustogi modified navy plaque index ( RMNPI ) . Post-brushing RMNPI scores were obtained after a supervised uninstructed two-minute brushing with the assigned toothbrush . Scores were recorded for whole mouth , marginal region , and approximal region for each subject . RESULTS Pre-brush comparability of whole mouth , marginal and approximal regions indicated no statistical differences among the four groups for any of the three measurement regions . All four toothbrushes showed statistically significant change from pre-brush to post-brush scores for whole mouth , marginal region , and approximal region . The Waterpik Sensonic provided significantly greater reduction in plaque as measured by the RMNPI compared to the other three brushes for whole mouth ( 89 % ) , marginal area ( 81 % ) and approximal area ( 97 % ) . The only exception was for adjusted p-values for the approximal area compared to the Oral-B Sonic Complete ( p = 0.12 ) . CONCLUSION All groups demonstrated a significant reduction in plaque . The single use plaque removal efficacy of the Waterpik Sensonic toothbrush compared favorably to the other two power toothbrushes , the Sonicare Elite and the Oral-B Sonic Complete , and compared favorably to the manual toothbrush , the Oral-B Indicator PURPOSE To test the plaque removing efficacy of three different toothbrushes  in relation to duration of toothbrushing . MATERIAL S AND METHODS The brushes studied were the Sonicare , the Braun Plak Remover ( D7 ) , and a modified Plak Control with increased speed ( D9 ) . Part 1 of the study was divided into four experiments which differed only in respect to the brushing time . The available times were 15 , 30 , 45 , 60 seconds per quadrant . After 48 hours plaque accumulation , all subjects ( n = 22 ) were brushed professionally using at r and om a brush in one quadrant ( without toothpaste ) . Part 2 was a 3-way cross-over design in which the same three brushes were tested . In total 49 , subjects participated . They were given a brief instruction on the use of each toothbrush and were allowed to get familiarized with each brush during a 2-week period . After 48 hours plaque accumulation , they brushed in a r and om order the four quadrants , each with a different brushing time ( 15 , 30 , 45 , 60 seconds ) . The amount of dental plaque was evaluated pre- and post-brushing by means of the Silness & Löe plaque index at six sites around each tooth investigated . RESULTS The results of Part 1 and 2 showed an increase in efficacy for all brushes varying from 1 minute per quadrant to 4 minutes per quadrant . In Part 1 , the D7 was more effective than the Sonicare brush at 15 , 20 , 45 seconds whereas the D9 was more effective at all four brushing times . In Part 2 , both the D7 and D9 were more effective than the Sonicare at the 2-minute brushing time . These differences were mainly caused by a greater plaque removal from the approximal areas BACKGROUND This study measured the ability of  three toothbrushes  to remove plaque following three single brushing episodes with each toothbrush . METHODS This was a r and omized , controlled , examiner-blind , nine-period crossover study conducted in 72 adult subjects over a 3-month period that examined plaque removal with a rechargeable power toothbrush and two manual toothbrushes .  During the course of this study , subjects brushed three times with each of the toothbrushes .  Plaque was scored before and after brushing using the Rustogi Modification of the Navy Plaque Index . RESULTS Average baseline plaque scores were between 0.373 and 0.376 for the three treatment groups . The power toothbrush delivered an adjusted ( via analysis of covariance ) mean difference between baseline and post-brushing plaque scores of 0.270 , whereas the manual toothbrushes delivered adjusted mean differences of 0.211 ( control ADA manual toothbrush ) and 0.190 ( experimental manual toothbrush ) . The power toothbrush demonstrated a statistically significantly greater reduction in plaque than the ADA reference manual toothbrush ( P < 0.001 ) , which in turn had a statistically significantly greater reduction in plaque than the experimental manual toothbrush ( P < 0.001 ) . The powered toothbrush group had , on average , 42.4 % and 28.2 % greater plaque removal scores than the experimental manual toothbrush and ADA reference manual toothbrush groups , respectively . Results for the interproximal and gingival regions also demonstrated statistically significantly ( P < 0.001 ) greater plaque removal for the powered toothbrush relative to the control manual toothbrushes . CONCLUSION The powered toothbrush was found to deliver greater plaque removal by 42.4 % and 28.2 % compared to the control manual toothbrushes BACKGROUND The Rustogi et al. Modified Navy ( RMNPI ) and Turesky et al Modification of the Quigley Hein ( TQHPI ) plaque indices are commonly used to measure plaque removal . This study evaluated the possible correlations of both indices using data relative to a single use assessment of plaque removal using commercially available toothbrushes . METHODS Single use crossover study design s have been previously reported . Disclosed plaque was scored pre- and post-brushing using both the RMNPI and the TQHPI .  Sixty subjects , with an initial mean RMNPI score of 0.6 or greater , were enrolled and completed the study . No minimum score was required for TQHPI . After the initial scoring , the order for each index was r and omized so that each subject was scored with either RMNPI followed by TQHPI or vice versa . Two manual toothbrushes [ Oral-B CrossAction ( CA ) and Colgate Navigator ( NA ) ] and one battery-powered brush ( Crest SpinBrush Pro ) ( SBP ) were evaluated in the trial . One examiner performed all clinical measurements . Pearson correlations were performed on whole mouth , buccal , and lingual plaque scores for the CA toothbrush . RESULTS Strong positive correlations were found between the two plaque indices for pre- and post-brushing scores for the whole mouth and on lingual and buccal surfaces , where Pearson correlation coefficients ranged between 0.963 and 0.995 . There was no correlation between the pre-brushing plaque score and the amount of plaque removed by brushing indicating that higher plaque levels before brushing do not necessarily predict that greater amounts of plaque will be removed during toothbrushing . Each toothbrush was found to be safe and significantly reduced plaque levels after a single brushing ( t-test , p=0.0001 ) . Significantly greater plaque reductions were found with the CA than the NA and SBP toothbrushes at whole mouth , lingual , and approximal surfaces for both indices ( analysis of variance ( ANOVA ) , p < or = 0.0002 for all comparisons ) . CONCLUSIONS Strong positive correlations were found between two plaque indices ( the RMNPI and TQHPI ) for pre- and post-brushing scores at whole mouth , lingual , and buccal surfaces as assessed using data from a single use assessment of plaque removal . Efficacy data from this study demonstrated the CA toothbrush provided superior cleaning when compared to the NA manual toothbrush and SBP battery toothbrush . CLINICAL IMPLICATION S Two commonly used indices for assessing plaque removal in clinical studies are RMNPI and TQHPI . However , each index differs in the way plaque is scored . This study used both indices to assess comparative  toothbrush efficacy  and showed a strong correlation between indices for both pre- and post- brushing plaque scores . The result suggests that both indices demonstrate sufficient sensitivity to differentiate toothbrush efficacy AIM Powered or manual toothbrushes are daily-used instrument in the Western area for the control and removal of bacterial biofilm . Among powered-toothbrushes , sonic technology has shown to produce fluid turbulent activity that might assist in plaque removal ; however , limited knowledge is available in-vivo . The objectives of this study were to compare the plaque removal efficacy of two different toothbrushes in a population not familiar with sonic technology , and to collect and analyse data regarding oral hygiene habits . The null-hypothesis was that a sonic toothbrush is able to remove a superior amount of plaque compared to the manual type . MATERIAL S AND METHODS Forty young adult patients were enrolled in the study . A single-cohort crossover clinical trial was design ed . For each patient , three appointments were scheduled : the first ( T0 ) was used for oral care education and explanations of toothbrushes techniques , for a preliminary professional hygiene session , and for delivery of a question naire ; at one week ( T1 ) , plaque evaluation was performed ( Turesky modification of the Quigley and Hein index ) at baseline and after asking patients to brush with the r and omly selected manual or sonic device . At the last appointment ( week 3 , T2 ) , the same plaque evaluations of T1 were repeated asking patients to brush with the other toothbrush . Entire mouth indexes were calculated and mean reductions in whole mouth plaque scores were obtained ( pre-brushing minus post-brushing values ) for the two tested toothbrushes . Multiple ANOVA tests ( p = 0.05 ) were used 1 ) to compare plaque levels between male and female subjects at baseline and post-brushing , regardless the type of toothbrush , and 2 ) to differentiate between mean reductions in whole mouth plaque scores according to the type of toothbrush ( manual versus sonic ) . The study population was subjected to descriptive statistical analysis ; potential relationships between socio-demographic variables and obtained plaque scores were evaluated ( Mann-Whitney and Kruskal-Wallis tests ) . RESULTS Full-mouth plaque levels were reduced at post-brushing sessions , regardless the device , by approximately 62 % ( p<0.0001 ) . Mean plaque index reductions  for manual and sonic toothbrush were of 1.05 ± 0.22 and 1.19 ± 0.37 , respectively . A statistically significant difference was found between the two devices ( p = 0.0342 ) . The powered sonic toothbrush removed about 10 % more plaque than the manual type . From the collected question naire financial data , willingness to pay ( WTP ) values expressing economic efforts of patients for the purchase of toothbrushes were of Euros 4.83 ± 3.86 and of Euros 54.75 ± 36 , for the manual and sonic devices , respectively . CONCLUSION Within the limitations of the study , in subjects without any previous experience of a similar technology , the single use of the sonic toothbrush showed a significantly greater plaque reduction compared to the manual traditional toothbrush ( null-hypothesis accepted ) OBJECTIVE To assess the plaque removal efficacy of an oscillating/rotating power toothbrush  with novel brush head ( Oral-B Precision Clean ) in comparison to an American Dental Association ( ADA ) reference manual toothbrush . METHODS This was a replicate-use , single-brushing , two-treatment , examiner-blind , r and omized , four-period ( visit ) study with a crossover design . At each visit , subjects disclosed their plaque with disclosing solution for one minute , and an examiner performed a baseline ( pre-brushing ) plaque examination ( Rustogi , et al. Modification of the Navy Plaque Index ) . Subjects were then instructed to brush for two minutes ( according to manufacturer 's instructions ) with their assigned power toothbrush or as they normally do with the ADA manual brush under supervision , after which they again disclosed their plaque and were given a post-brushing plaque examination . RESULTS Both the power brush and manual brush showed statistically significant plaque reductions from baseline for the whole mouth , along the gingival margin , and on approximal surfaces . The power brush showed statistically significant advantages ( p < 0.001 ) over the manual brush in plaque reduction for whole mouth ( 28.8 % ) , gingival margin ( 44.3 % ) , and approximal surfaces ( 20.7 % ) . CONCLUSION The oscillating/rotating power toothbrush with a novel brush head showed statistically significantly superior plaque reduction ( whole mouth , gingival margin , and approximal surfaces ) compared to a manual toothbrush PURPOSE To determine the effectiveness of a new multi-directional power toothbrush in reducing plaque when compared to a st and ard manual toothbrush control in a single brushing design . METHODS This was a r and omized , replicate use , single-brushing , two-treatment , four-period , examiner-blinded crossover clinical trial at a single center . Qualified subjects entered an acclimation phase , after which they were r and omly assigned to one of four treatment sequences specifying the order of use of the two test toothbrushes : a novel multi-directional power toothbrush with a 2-D drive ( Oral-B Vitality TriZone ) and an American Dental Association ( ADA ) reference soft manual brush .  Subjects used each brush twice over the course of the trial . At each of the four period visits 
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Results showed a significant effect in favour of the PTB .
Conclusion There is moderate certainty that the PTB was more effective than the MTB with respect to plaque removal following a single brushing exercise independent of the plaque index scale that was used