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. 2018 May;89(5):558-570.
doi: 10.1002/JPER.17-0368.

A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation

Georgios A Kotsakis  1 , Qinshu Lian  2 , Andreas L Ioannou  3 , Bryan S Michalowicz  4 , Mike T John  5 , Haitao Chu  2
Affiliations

A network meta-analysis of interproximal oral hygiene methods in the reduction of clinical indices of inflammation

Georgios A Kotsakis et al. J Periodontol. 2018 May.

Abstract

Background: A wide selection of Interdental Oral Hygiene (IOH) aids is available to consumers. Recommendations for selection are, however, limited by the lack of direct comparisons in available studies. We aimed to assess the comparative efficacy of IOH aids using Bayesian Network Meta-Analysis (BNMA).

Methods: Two independent reviewers performed a systematic literature review of randomized clinical trials assessing IOH aids, based on a focused question. Gingival inflammation (Gingival Index (GI), Bleeding-on-probing (BOP)) was the primary outcome and plaque and probing depth were secondary outcomes A random-effects arm-based BNMA model was run for each outcome; posterior medians and 95% credible-intervals (CIs) summarized marginal distributions of parameters.

Results: A two-phase selection process identified 22 trials assessing 10 IOH aids as brushing adjuncts. Interdental brushes (IB) yielded the largest reduction in GI (0.23 [95% CI: 0.09, 0.37]) as toothbrushing adjuncts, followed by water-jet (WJ) (0.19 [95% CI: 0.14, 0.24]). Rankings based on posterior probabilities revealed that IB and WJ had the highest probability of being "best" (64.7% and 27.4%, respectively) for GI reduction, whereas the probability for toothpick and floss being the "best" IOH aids was near zero. Notably, except for toothpicks, all IOH aids were better at reducing GI as compared with control.

Conclusions: BNMA enabled us to quantitatively evaluate IOH aids and provide a global ranking of their efficacy. Interdental brushes and water-jets ranked high for reducing gingival bleeding, whereas toothpicks and floss ranked last. The patient-perceived benefit of IOH aids is not clear because gingival inflammation measures are physical indicators of periodontal health.

Keywords: dental hygiene; gingivitis; meta-analysis; oral hygiene; systematic reviews and evidence-based medicine.

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Figures

Figure 1
Figure 1
Network plots of the studies assessing gingival inflammation (primary outcome) with either of two measures: either as Bleeding on probing (BOP) or Gingival Index (GI). The nodes represent the interventions, and edges connecting two nodes indicate that the direct evidences of the corresponding intervention comparisons. The node size is proportional to the number of studies that include the corresponding intervention. The thickness of the edge is proportional to the number of studies that directly compare the corresponding pair of interventions.
Figure 2
Figure 2
Bar-plot of ranks for (a) BOP reduction, (b) GI reduction, (c) PCR reduction and (d) PD reduction
Figure 2
Figure 2
Bar-plot of ranks for (a) BOP reduction, (b) GI reduction, (c) PCR reduction and (d) PD reduction
Figure 2
Figure 2
Bar-plot of ranks for (a) BOP reduction, (b) GI reduction, (c) PCR reduction and (d) PD reduction
Figure 2
Figure 2
Bar-plot of ranks for (a) BOP reduction, (b) GI reduction, (c) PCR reduction and (d) PD reduction
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