{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:15:21Z","timestamp":1779257721342,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100004357","name":"Procter and Gamble","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004357","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dental Hygiene"],"abstract":"ABSTRACT<\/jats:title>\n \n Objective<\/jats:title>\n Bristle splaying may be associated with reduced cleaning efficacy; however, the relationship between the bristle splaying index (BSI) and contact pressure (CP) during brushing with a powered toothbrush (PT) with real\u2010time CP control for oscillating brush head movement (range: 0.8\u20132.5\u2009N) remains unknown.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This subgroup analysis of a randomised controlled trial (RCT), which included 47 subjects with gingival recession (GR), included digitally recorded data from 42 PT users: total brushing time (Btime; in minutes), brush head usage time (BHtime; in days), mean CP (in N), time duration with CP >\u20092.5\u2009N (CPhigh; in minutes) and CP <\u20090.8\u2009N (CPlow; in minutes) over 1\u2009year with quarterly brush head replacement (Q1\u2013Q4). The extent of bristle splaying was measured using a standardised set\u2010up to calculate the BSI. In addition to multivariate statistical tests, a linear regression model was employed (\n p<\/jats:italic>\n \u2009\u2264\u20090.05).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The highest BSI (mean (standard deviation)) occurred in Q1 with 7.9 (4.8) (\n p<\/jats:italic>\n \u2009\u2264\u20090.001) (BSI in Q2\/Q3\/Q4: 5.5 (4.9)\/4.4 (4.0)\/3.5 (2.8);\n p<\/jats:italic>\n \u2009>\u20090.05), with Btime, BHtime, CP, CPlow and CPhigh remaining constant (\n p<\/jats:italic>\n \u2009>\u20090.05). The BSI was significantly correlated with the CP (\n r<\/jats:italic>\n \u2009=\u20090.252;\n p<\/jats:italic>\n \u2009=\u20090.001) and study quarter (r\u2009=\u2009\u22120.363;\n p<\/jats:italic>\n \u2009<\u20090.001), but not with subject gender (\n r<\/jats:italic>\n \u2009=\u20090.088;\n p<\/jats:italic>\n \u2009=\u20090.254) and age (r\u2009=\u2009\u22120.025;\n p<\/jats:italic>\n \u2009=\u20090.745), nor with Btime (\n r<\/jats:italic>\n \u2009=\u20090.009;\n p<\/jats:italic>\n \u2009=\u20090.905), BHtime (\n r<\/jats:italic>\n \u2009=\u20090.109;\n p<\/jats:italic>\n \u2009=\u20090.158), CPlow (r\u2009=\u2009\u22120.104;\n p<\/jats:italic>\n \u2009=\u20090.181) and CPhigh (\n r<\/jats:italic>\n \u2009=\u20090.145;\n p<\/jats:italic>\n \u2009=\u20090.061). The regression model showed a significant effect on the BSI for the CP (B\u2009=\u20092.912;\n p<\/jats:italic>\n \u2009<\u20090.001) and study quarter (B\u2009=\u20091.678;\n p<\/jats:italic>\n \u2009<\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Cleaning periods with a CP >\u20092.5\u2009N were short and did not result in higher BSI.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance<\/jats:title>\n CP with PT may be important for cleaning efficacy, safety of the marginal gingiva and reduced brushing head wear.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/idh.70101","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:52:26Z","timestamp":1779256346000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Twelve\u2010Month Observation Analysis of Real\u2010Time Contact Pressure\u2010Controlled Powered Tooth Brushing as a Subgroup Analysis of a 36\u2010Month\n RCT<\/scp>"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8316-0565","authenticated-orcid":false,"given":"C.","family":"Graetz","sequence":"first","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"L\u00f6we","sequence":"additional","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"\u00dcbermuth","sequence":"additional","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Sutor","sequence":"additional","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Cyris","sequence":"additional","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Geiken","sequence":"additional","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"S\u00e4lzer","sequence":"additional","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"},{"name":"Private Practice Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. E.","family":"D\u00f6rfer","sequence":"additional","affiliation":[{"name":"Clinic of Conservative Dentistry and Periodontology University of Kiel Kiel Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"issue":"7","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1034\/j.1600-051X.2002.290709.x","article-title":"Comparison of New and 3\u2010Month\u2010Old Toothbrushes in Plaque Removal","volume":"29","author":"Tan E.","year":"2002","journal-title":"Journal of Clinical Periodontology"},{"issue":"1","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/idh.12370","article-title":"Toothbrush Wear in Relation to Toothbrushing Effectiveness","volume":"17","author":"Leeuwen M. P. 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Study of 2410 18\u201022\u2010Year\u2010Old Patients (1)","volume":"41","author":"Mierau H. D.","year":"1986","journal-title":"Deutsche Zahnarztliche Zeitschrift"},{"issue":"9","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1902\/jop.1994.65.9.864","article-title":"Gingival Recession: Intra\u2010Oral Distribution and Associated Factors","volume":"65","author":"Joshipura K. J.","year":"1994","journal-title":"Journal of Periodontology"},{"key":"e_1_2_14_8_1","first-page":"153","article-title":"Effect of Toothbrush Bristle Stiffness and Brushing Force on Cleaning Efficacy","volume":"21","author":"Tanner M.","year":"2023","journal-title":"Oral Health & Preventive Dentistry"},{"issue":"2","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/idh.12427","article-title":"Measurement of Bristle Splaying of Toothbrushes Using Digital Imaging and Evaluation of Plaque Removal Efficacy Over 3 Months: A Randomized Controlled Trial (RCT)","volume":"18","author":"Kaneyasu Y.","year":"2020","journal-title":"International Journal of Dental Hygiene"},{"issue":"4","key":"e_1_2_14_10_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/idh.12021","article-title":"Plaque\u2010Removing Efficacy of New and Used Manual Toothbrushes\u2010A Professional Brushing Study","volume":"11","author":"Rosema N. A.","year":"2013","journal-title":"International Journal of Dental Hygiene"},{"issue":"2","key":"e_1_2_14_11_1","first-page":"29","article-title":"An Investigation Into the Effect of Three Months' Clinical Wear on Toothbrush Efficacy: Results From Two Independent Studies","volume":"14","author":"Conforti N. J.","year":"2003","journal-title":"Journal of Clinical Dentistry"},{"issue":"1","key":"e_1_2_14_12_1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/idh.12834","article-title":"Effect of a Powered and a Manual Toothbrush in Subjects Susceptible to Gingival Recession: A 36\u2010Month Randomized Controlled Clinical Study","volume":"23","author":"Sutor S.","year":"2025","journal-title":"International Journal of Dental Hygiene"},{"issue":"5","key":"e_1_2_14_13_1","first-page":"219","article-title":"Gingival Health Effects With an Oscillating\u2010Rotating Electric Toothbrush With Micro\u2010Vibrations and a Novel Brush Head Designed for Stain Control: Results From a 12\u2010Week Randomized Controlled Trial","volume":"35","author":"Grender J.","year":"2022","journal-title":"American Journal of Dentistry"},{"issue":"3","key":"e_1_2_14_14_1","first-page":"f20","article-title":"A 12\u2010Week Randomized Controlled Trial Comparing a Novel Electric Toothbrush With an Extra Gentle Brush Head to a Manual Toothbrush for Plaque and Gingivitis Reduction","volume":"43","author":"Grender J.","year":"2022","journal-title":"Compendium of Continuing Education in Dentistry"},{"issue":"1","key":"e_1_2_14_15_1","doi-asserted-by":"crossref","first-page":"S16","DOI":"10.1111\/idj.12569","article-title":"Evaluation of an Oscillating\u2010Rotating Toothbrush With Micro\u2010Vibrations Versus a Sonic Toothbrush for the Reduction of Plaque and Gingivitis: Results From a Randomized Controlled Trial","volume":"70","author":"Adam R.","year":"2020","journal-title":"International Dental Journal"},{"issue":"1","key":"e_1_2_14_16_1","first-page":"54","article-title":"A 6\u2010Month Randomized Controlled Trial Evaluating a Novel Smart\u2010Connected Oscillating\u2010Rotating Toothbrush Versus a Smart\u2010Connected Sonic Toothbrush for the Reduction of Plaque and Gingivitis","volume":"34","author":"Goyal C. 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J.","year":"2021","journal-title":"Journal of Evidence\u2010Based Dental Practice"},{"issue":"1","key":"e_1_2_14_22_1","first-page":"14","article-title":"Condition of Toothbrushes in Use: Correlation With Behavioral and Socio\u2010Economic Factors","volume":"14","author":"Dean D. H.","year":"1992","journal-title":"Clinical Preventive Dentistry"},{"issue":"12","key":"e_1_2_14_23_1","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.1177\/00220345800590120401","article-title":"A Systematic Study of the Plaque Removal Efficiency of Worn Toothbrushes","volume":"59","author":"Kreifeldt J. G.","year":"1980","journal-title":"Journal of Dental Research"},{"issue":"2","key":"e_1_2_14_24_1","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1038\/sj.bdj.4802628","article-title":"Toothbrush Age and Wear","volume":"130","author":"McKendrick A. J.","year":"1971","journal-title":"An Analysis. Br Dent J"},{"issue":"1","key":"e_1_2_14_25_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1902\/jop.2010.100393","article-title":"Safety of Oscillating\u2010Rotating Powered Brushes Compared to Manual Toothbrushes: A Systematic Review","volume":"82","author":"Van der Weijden F. A.","year":"2011","journal-title":"Journal of Periodontology"},{"issue":"7","key":"e_1_2_14_26_1","first-page":"1","article-title":"Impact of a Novel Power Toothbrush With SmartGuide Technology on Brushing Pressure and Thoroughness","volume":"9","author":"Janusz K.","year":"2008","journal-title":"Journal of Contemporary Dental Practice"},{"issue":"6","key":"e_1_2_14_27_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0235194","article-title":"Effectiveness of a Digital Device Providing Real\u2010Time Visualized Tooth Brushing Instructions: A Randomized Controlled Trial","volume":"15","author":"Shida H.","year":"2020","journal-title":"PLoS One"},{"key":"e_1_2_14_28_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jdent.2020.103307","article-title":"Long\u2010Term Tooth Retention in Periodontitis Patients in Four German University Centres","volume":"94","author":"Graetz C.","year":"2020","journal-title":"Journal of Dentistry"},{"issue":"1396560","key":"e_1_2_14_29_1","first-page":"1","article-title":"Phage Communities in Household\u2010Related Biofilms Correlate With Bacterial Hosts","volume":"3","author":"Huttelmaier S.","year":"2024","journal-title":"Frontiers in Microbiomes"}],"container-title":["International Journal of Dental Hygiene"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/idh.70101","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/idh.70101","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/idh.70101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:52:31Z","timestamp":1779256351000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/idh.70101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,19]]},"references-count":28,"alternative-id":["10.1111\/idh.70101"],"URL":"https:\/\/doi.org\/10.1111\/idh.70101","archive":["Portico"],"relation":{},"ISSN":["1601-5029","1601-5037"],"issn-type":[{"value":"1601-5029","type":"print"},{"value":"1601-5037","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,19]]},"assertion":[{"value":"2024-10-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"idh.70101"}}