Comparison of Interproximal Biofilm Removal with Sonicare Elite and Ultreo

Objective: The purpose of this study was to compare Sonicare Elite 9000 and an ultrasonic power toothbrush (Ultreo) in removing interproximal plaque biofilm beyond the reach of the bristles without direct bristle contact. Methods: An in vitro typodont model containing multispecies oral biofilms grown on hydroxyapatite discs was used to comparatively evaluate biofilm removal ability between the two toothbrushes. Discs with biofilms were located on interproximal sites of molar teeth at a distance of 2-4 mm from the bristles, and exposed to the fluid dynamic activity generated by the activated brushes. To evaluate the effect of ultrasonic activity over bristle motion alone, a modified Ultreo was included of which the ultrasonic activity was disabled while the bristle motion was maintained. Plaque removal efficacy was determined by enumeration of the percentage of viable bacteria removed from the interproximal discs as a result of brushing treatment. Results: The active Sonicare Elite removed significantly more interproximal biofilm compared to Ultreo (p<0.0001), with no significant difference between the Ultreo and Elite-Off (p=0.40). When compared to the Ultreo with ultrasonic activity (off) disabled, only Elite removed significantly more interproximal biofilm (p<0.001). No significant differences were observed between the disabled Ultreo and either the active Ultreo (on) (p=0.91) or Ultreo simply set in the off mode (p=0.98). Conclusion: Sonicare Elite removed significantly more dental plaque biofilm beyond the bristles than the active Ultreo and the Ultreo with the ultrasonic component disabled, suggesting that neither bristle activity nor ultrasonic activity generated appreciable fluid dynamic activity in this in vitro model.