***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: OBJECTIVES The purpose of the present study was to evaluate the effect of an electrically active toothbrush on established plaque and gingivitis in a 7-month clinical trial . MATERIAL AND METHODS For this study , 66 volunteers ( non-dental University students ) were selected on the basis of having moderate gingival inflammation . At baseline , plaque ( Quigley & Hein ) , bleeding upon marginal probing and the Modified Gingival index were assessed on the vestibular , mesio-vestibular , disto-vestibular and lingual surfaces at four sites per tooth . Subjects were r and omly divided among two groups ; one group brushed with a control brush ( Butler GUM 309 ) while the other used the electrically active test brush . After 2 weeks , 4 weeks , 4 months and 7 months the clinical indices were again recorded . At each assessment the participants received a new brush head for the electrically active brush ( test group ) or a new manual control toothbrush ( control group ) . RESULTS All baseline indices appeared to be well balanced . A mean Quigley & Hein plaque score of 1.98 and 2.13 was found in the control and test group , respectively . Little change was observed from baseline to 7 months . The mean bleeding upon marginal probing score at baseline was 0.62 for the control group and 0.59 for the test group . Little to no improvement was observed for the manual brush , whereas an increase in bleeding was observed in the test group in the course of this study . The mean percent reduction in plaque after 1 min of brushing varied throughout the study between 36 % and 46 % . No difference between the brushes was observed at any time point during the 7-month test period . CONCLUSION No beneficial effect could be shown for the ' electrically active design feature ' compared to a regular manual toothbrush control This single-blind , 8-week study compared the efficacy of a sonic toothbrush and a manual brush in 40 patients with adult periodontitis . Qualitative clinical indices and quantitative laboratory methods were used to monitor the periodontal status of 3 pockets 5 to 7 mm deep in each subject . Patients were r and omly assigned either a sonic or manual toothbrush . The two groups were comparable with respect to age , gender , and anatomical location of the test sites . Data were collected from all sites at baseline and at 2 , 4 , and 8 weeks . Over the 8-week period , both groups showed significant improvements in the clinical indices used . Descriptive statistics indicated the sonic brush group had greater improvement than the manual group in the clinical parameters ( gingival index , bleeding index , probing depth , and clinical attachment level ) . Gingival crevicular fluid ( GCF ) flow was significantly lower in the sonic brush group ( P = 0.018 ) . Considerable variation was present in the levels detected for both inflammatory cytokines tested , however , concentration of interleukin-1 beta was significantly lower in the GCF of sonic group patients ( P = 0.05 ) , while concentration of interleukin-6 was significantly reduced in both groups ( P < or = 0.05 ) ( t tests ) . Under these conditions , there is some evidence to suggest that the sonic toothbrush is more beneficial in resolving inflammation in patients with moderate periodontal disease Twenty-five subjects were assessed for plaque and soft tissue safety monitored by gingival irritation the first thing in the morning of day one following no toothbrushing for 12 - 14 hours . Subjects then brushed with either the Dentrust ( manual toothbrush ) , Crest Complete ( manual toothbrush ) or Interplak ( mechanical toothbrush ) for a timed three minutes under supervision . The toothbrush assignments were by a table of r and om numbers . Following brushing , the subjects were assessed immediately for levels of plaque and gingival irritation . The subjects were then recalled three hours later for another assessment of plaque levels and residual gingival irritation from the morning toothbrushing . After three or four days the subjects were recalled to test an alternate toothbrush . Three or four days later the subjects were recalled to test the final toothbrush . Levels of irritation severity were evaluated using st and ard soft tissue examination procedures , and after rinsing with disclosing solution and photography , with subsequent blind judging of stain intensity and area on the gingiva by a panel of three experienced investigators . In the first morning assessment there was no significant difference among plaque or gingival appearance or stain uptake levels of the three groups before using the three toothbrushes . Immediately following toothbrushing , the three groups exhibited similar levels of plaque removal and clinical or stain-related gingival irritation . There was no significant statistical difference among the plaque or safety evaluations , although the Interplak toothbrush demonstrated higher irritation levels judged by stain uptake than the manual toothbrushes . ( ABSTRACT TRUNCATED AT 250 WORDS The purpose of the present study was to test the plaque-removing efficacy of 4 different toothbrushes in relation to duration of toothbrushing . The brushes studied were a manual toothbrush ( M ) , a conventional electric toothbrush -- the Blend-a-Dent ( BL ) , the Interplak ( IP ) and the Braun Plak Control ( BPC ) . For this study , 20 subjects were selected . The study was divided into 5 experiments which differed only in respect to the brushing time . The available time in experiment 1 through 5 was 7.5 , 15 , 30 , 45 , 90 s per quadrant respectively . Prior to each experiment , all subjects were asked to abstain from oral hygiene procedures for at least 24 h. The efficacy of toothbrushing in each experiment was studied while one investigator ( MAL ) brushed the teeth of the subjects . In each subject , all 4 brushes were tested . Each brush was assigned to a quadrant in a r and om order . No toothpaste was used throughout this study . The amount of dental plaque was evaluated before and after brushing by means of the Silness & Löe plaque index at 6 sites around each tooth investigated . The results show an increase in efficacy for all brushes varying from 7.5 s per quadrant to 90 s per quadrant ( mean plaque reduction in terms of percentage 7.5 s-90 s : M = 40%-75 % , BL = 45%-82 % , BPC = 51%-94 % , IP = 64%-92 % ) . The IP removed significantly more plaque than the other 3 after 7.5 s of brushing . From 15 s through 90 s , the IP and BPC were equally effective . ( ABSTRACT TRUNCATED AT 250 WORDS Forty-seven adult orthodontic patients with fixed orthodontic appliances were divided into three study groups : ( 1 ) oral irrigation with automatic toothbrush , ( n = 16 ) ; ( 2 ) oral irrigation with manual toothbrushing , ( n = 16 ) ; ( 3 ) control group with continued normal toothbrushing only , ( n = 15 ) . Gingival and plaque indices , bleeding after probing , and gingival sulcus depths were assessed at baseline , 1-month , and 2-month periods . Marked and significant gingival and plaque improvements from baseline were measured in all three study groups . After 1 to 2 months use of the automatic toothbrush and /or the oral irrigation device , there was a significant reduction in plaque when compared with the control group who used only the manual toothbrush ( p = 0.026 ) . Also , there was a significant reduction in gingival inflammation ( p = 0.045 ) and evidence for reducing bleeding after probing ( p = 0.037 ) . No significant differences were found in probe depths among the three study groups , however , use of both devices reduced the pocket depth significantly from baseline by 0.5 mm ( p < 0.0002 ) . For this population of orthodontic patients , significant reductions in plaque , gingival inflammation , and a tendency for reduced bleeding after probing occurred in both groups with the power device . These improvements were most attributable to the effect of the oral irrigation device Twelve dentulous patients , age 65 or older , with no medical or pharmacologic predisposition to gingival hyperplasia were enrolled in a controlled clinical trial to evaluate the effect of the unaided use of an ultrasonic toothbrush on supragingival plaque and gingival bleeding . Subjects used the ultrasonic toothbrush in lieu of their conventional toothbrushes for a 30-day period . Clinical measurements of the plaque index and bleeding index were made at baseline and at 15 and 30 days . At the end of the 30-day test period , the use of the ultrasonic toothbrush result ed in significant reductions in plaque score , proportion of high plaque surfaces , and bleeding index . The reduction of the bleeding index indicates significant improvement in oral health . In this study , the use of an ultrasonic toothbrush effectively improved oral hygiene and health in a population that often exhibits decreased manual dexterity . Strategies for oral health care assessment and education for guidance of effective interventions are included in checklist form ; level of care classification , cost in both time involved and equipment , and purchase instructions also are discussed . Further study is warranted to evaluate this instrument for cognitively impaired elders , who often rely on caregivers for oral hygiene procedures BACKGROUND The purpose of this 30-day blinded , parallel- design study was to compare the effect of 2 powered toothbrushes , the Rowenta MH700 and the Braun Plak Control Ultra , on reducing plaque accumulation , gingivitis , and gingival bleeding in a cohort of 60 healthy adults . METHODS After baseline evaluation of plaque , gingivitis , and gingival bleeding , subjects were r and omly assigned to one of the experimental groups , provided written and verbal toothbrushing instructions , and had their teeth polished . At 2 weeks ( follow-up 1 ) and 4 weeks ( follow-up 2 ) all clinical parameters were again evaluated . RESULTS The Braun group demonstrated a nearly significant reduction in gingival index ( Gl ) and a significant reduction in GI at follow-up 2 . The Rowenta group demonstrated significant reductions in GI , plaque index ( PI ) , and bleeding index ( GBI ) at both follow-up 1 and 2 examinations . At follow-up 1 , the Braun group demonstrated a nearly significant reduction in GI , a significant reduction in PI , and a non-significant reduction in GBI . At follow-up 2 , the Braun group demonstrated a significant reduction in GBI , but not a significant reduction in PI . The reduction in GI for the Rowenta group was significantly greater ( P values of 0.0001 and 0.0001 , respectively ) than that demonstrated in the Braun group . However , the Rowenta group did not demonstrate a significantly greater reduction in PI ( P values of 0.7135 and 0.3184 for follow-up 1 and follow-up 2 , respectively ) or GBI than the Braun group at either examination ( P values of 0.0663 and 0.3397 for followup 1 and 2 , respectively ) . CONCLUSIONS The results of this study support the findings of numerous other studies that powered toothbrushes have great potential to remove plaque and improve gingival health and that the improvement can be demonstrated in a relatively short period of time . J Periodontol 1999;70:840 - 847 PURPOSE To compare the safety and efficacy of two oscillating-rotating power toothbrushes , the rechargeable Braun Oral-B D8 and the battery-powered Colgate Actibrush . MATERIAL S AND METHODS This was a r and omized , examiner-blind , parallel-group study , carried out over 3 months of product use , involving a total of 113 healthy subjects with a plaque score of > or = 1.5 and a gingivitis score of > or = 1.1 . Subjects were given written and verbal instructions in the use of their respective power brushes and were told to brush twice per day . At baseline , hard and soft tissues were examined , and plaque scores and gingival scores were recorded after 12 - 18 hrs of no oral hygiene . Subjects returned after 3 months , at which time soft and hard tissues were re-examined and plaque and gingivitis scores were recorded . RESULTS No evidence was found of soft or hard tissue trauma and both brushes were considered to be safe when used according to the manufacturers ' instructions . After 3 months , whole mouth plaque scores had decreased by 7 % in the D8 group but had increased by 4.3 % in the Actibrush group . The decrease from baseline in the D8 group was statistically significant , but the increase in the Actibrush group was not . The difference between the two groups was statistically significant both for the whole mouth and all individual sites . Whole mouth gingivitis scores were also reduced significantly from baseline in both groups , by 22.5 % in the D8 group and by 17.5 % in the Actibrush group . For whole mouth scores and all individual sites ( interproximal , buccal and lingual ) , the D8 was significantly more effective than the Actibrush BACKGROUND Reports suggest powered toothbrushing may provide some clinical benefit over manual tooth-brushing , but most studies have been of short duration with subjects trained in toothbrush use . The aim was to determine if the oscillating-rotating powered brush ( PB ) could safely provide clinical benefits over and above a manual brush ( M ) in subjects with no formal instruction or experience in powered brush use . METHODS This 6-month , single-masked , parallel design , r and omized clinical trial compared the PB with an American Dental Association (ADA)-accepted soft-bristle manual brush in a non-flossing gingivitis population ( n = 157 ) . Subjects were given written instructions but no demonstration on toothbrush use at baseline . Efficacy was ass 
    Output:
    
Brushes that worked with a rotation oscillation action removed more plaque and reduced gingivitis more effectively than manual brushes in the short and long term .
There was no evidence of any publication bias .
No other powered brush design s were consistently superior to manual toothbrushes .
REVIEW ER 'S CONCLUSIONS Powered toothbrushes with a rotation oscillation action achieve a modest reduction in plaque and gingivitis compared to manual toothbrushing .