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The Science Behind Sonicare
oothbrush
Notes from Dr. Joerg Strate
Vice President, Philips Oral Healthcare,
Clinical & Scientific Affairs
Philips Sonicare has redefined personal oral hygiene once again
When we decide to launch a new edition of the clinical proof brochure, the document in your
hands, you know we must have a significant reason to do so. Launching two new products and
introducing breakthrough technology that’s likely to change our perspective on interdental
cleaning are indeed significant accomplishments.
The clinical and scientific research por tfolio summarized in this document provides objective
and relevant information about our products, and insights into the way we work. Our
clinical credibility and commitment to providing patients and dental professionals with the
most advanced solutions for home oral healthcare have resulted in global recognition and
professional recommendation of Philips Sonicare products. True innovation at Philips Sonicare
follows a simple paradigm that integrates the latest scientific knowledge with an in-depth
understanding of today’s oral healthcare needs. Adhering to these principles frequently results
in solutions and technologies that are ahead of their time, and subsequently lead the industry.
The original Sonicare technology was exactly that type of industry-leading innovation — it
defined a new standard for power toothbrushes. Recently, Sonicare For Kids established a
unique solution for the specific oral healthcare needs of children. Now the new Sonicare
DiamondClean takes our ambition to the next level with the best clinical performance of any
Sonicare to date, thanks to its unique brush head and ergonomic handle design.
The requirements for our latest innovation, the entirely new Philips Sonicare AirFloss, could
not be matched by existing concepts — we had to invent them. The result is a unique device
that impresses equally with its convenience of use and its clinical efficacy, which could not
exist without the unprecedented AirFloss microburst technology invented by Philips engineers.
When you read the following pages, I hope you will agree with me that Sonicare
DiamondClean and AirFloss represent a significant next step toward even better, more
intuitive solutions for daily oral hygiene — exactly what Philips Sonicare is all about.
Sonicare AirFloss
Plaque Biofilm Disruption
in vitro study*
In vitro evaluation of interproximal biofilm
removal with Philips Sonicare AirFloss
de Jager M, Hix J, Aspiras M, Schmitt P. Data on file, 2010
Objective
To evaluate, in vitro, the additional removal of interproximal plaque
biofilm of Philips Sonicare AirFloss when used in combination with
Philips Sonicare FlexCare.
Methodology
This study evaluated interproximal biofilm removal of Sonicare FlexCare
with or without subsequent use of Sonicare AirFloss. An in vitro tooth
model was used to assess the efficacy in removing dental plaque biofilm
from the interproximal spaces of molar teeth. The dental plaque model was
a multispecies oral biofilm grown on hydroxyapatite discs. In a typodont, the
discs with biofilm were located on interproximal sites of molar teeth at a
distance of 2-4 mm from the tip of the bristles or the nozzle. The typodont
was exposed to the dynamic fluid activity generated by the high-frequency
bristle movement from the activated Sonicare FlexCare (15 seconds) and
by the high-velocity droplet air spray from Sonicare AirFloss (single shot).
An inactivated Sonicare FlexCare was used as a control. Plaque removal
efficacy was determined by enumeration of the percentage of viable bacteria
removed from the discs as a result of these exposures.
Results
Sonicare AirFloss in conjunction with Sonicare FlexCare removed 66%
(p<0.0001) more interproximal biofilm than the active Sonicare FlexCare
alone. Sonicare FlexCare active removed significantly more biofilm than
Sonicare FlexCare inactive (p<0.0001).
Conclusion
Sonicare AirFloss removed 66% more interproximal plaque biofilm than
Sonicare FlexCare alone.
Comparison of In Vitro Interproximal Plaque Removal
60
% of Plaque
Biofilm Removed
51.6%
40
31.0%
20
0
Sonicare FlexCare active
plus Sonicare AirFloss
Sonicare FlexCare
active
*Results will var y with actual use
1
Sonicare FlexCare /
FlexCare+
Plaque Biofilm Disruption
in vitro study*
In vitro evaluation of interproximal biofilm
removal with power toothbrushes
Aspiras M, Elliott N, Nelson R, Hix J, Johnson M, de Jager M. In vitro evaluation of interproximal biofilm
removal with power toothbrushes. Compend Contin Educ Dent. 2007; 28 (suppl 1):10-14)
Objective
To compare the removal of interproximal biofilm beyond the reach of the bristles
of the Sonicare FlexCare and a rotating-oscillating power toothbrush, using an in
vitro model.
Methodology
The ability of the Sonicare FlexCare and Oral-B Triumph® to remove biofilm without
direct bristle contact was evaluated using a dental plaque model of a multispecies
oral biofilm grown on hydroxyapatite discs. In a typodont model, the discs with
plaque biofilm 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. An inactivated Sonicare FlexCare was used as a control.
Plaque removal efficacy was determined by enumeration of the percentage of viable
bacteria removed from the discs as a result of brushing.
Results
The active Sonicare FlexCare toothbrush removed a significantly higher percentage
of biofilm bacteria when compared to both the inactive state (p<0.0001) and the
active Oral-B Triumph toothbrush (p=0.0001). Moreover, with 73% plaque biofilm
removal, the Sonicare FlexCare removed three times the amount of plaque biofilm
when compared to the Oral-B Triumph, with 23% removal.
Conclusion
Sonicare FlexCare removed significantly more biofilm 2-4 mm beyond the reach of
the bristles than the Oral-B Triumph.
Removal of biofilm bacteria from HA discs
in an interproximal site model
80%
73.3%
Sonicare FlexCare
Oral-B Triumph®
60%
mean % biofilm
removed
40%
22.8%
20%
0%
Sonicare
FlexCare
Oral-B
Triumph
(p=0.0001)
*Results will var y with actual use
2
Sonicare FlexCare /
FlexCare+
Plaque Biofilm Disruption
in vitro study*
Interproximal plaque biofilm removal of Sonicare
FlexCare, National® Doltz and GC Prinia Slim
sonic toothbrushes
Hix J, Aspiras M, Wei J, de Jager M. Interproximal Biofilm Removal Sonicare, Doltz and Prinia Sonic
Toothbrushes. J Dent Res 87 (spec Iss B): 2044, 2008
Objective
To compare the ability of three sonic toothbrushes in removing interproximal plaque
biofilm beyond the reach of the bristles in vitro.
Methodology
Using an in vitro typodont model containing saliva-based multispecies oral biofilms
grown on hydroxyapatite discs, two studies were executed, comparing Sonicare
FlexCare (with ProResults brush head) against either National Doltz EW1045 (with
brush head EW0901) and GC Prinia Slim (handle MI-0002, brush head MI-1013).
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. As control, an inactivated FlexCare "off" was used. 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 activated Sonicare FlexCare toothbrush removed significantly more interproximal
biofilm compared to either Doltz (73.1% vs 37.3%, p=0.0001), Prinia (73.1% vs 18.3%,
p<0.0001) or the inactivated FlexCare "off" (p<0.0001).
Conclusion
Of the three sonic toothbrushes tested in vitro, the Sonicare FlexCare removed
significantly more dental plaque biofilm up to 4 mm beyond the bristles than the
National Doltz EW1045 and the GC Prinia Slim.
*Results will var y with actual use
3
Sonicare FlexCare /
FlexCare+
Removal of plaque biofilm bacteria from
HA discs in an interproximal site model
80%
Mean % of Plaque
Biofilm Removed
73.1%
Sonicare FlexCare
60%
37.3%
40%
National® Doltz
20%
0%
Treatment
Removal of plaque biofilm bacteria from
HA discs in an interproximal site model
80%
Mean % of Plaque
Biofilm Removed
73.1%
Sonicare FlexCare
60%
GC Prinia Slim
40%
18.3%
20%
0%
Treatment
4
Sonicare FlexCare /
FlexCare+
Plaque Biofilm Disruption
in vitro study*
Effect of the Sonicare FlexCare power
toothbrush on fluoride delivery through
Streptococcus mutans biofilms
Stoodley P, Nguyen D, Longwell M, Nistico L, von Ohle Ch, Milanovich N, de Jager M. Effect of the
Sonicare FlexCare power toothbrush on fluoride delivery through Streptococcus mutans biofilms.
Compend Contin Educ Dent. 2007;28 (suppl 1):15-22)
Objective
Evaluate the ability of two power toothbrushes, the Sonicare FlexCare and the
Oral-B Triumph®, to enhance the diffusion of fluoride through a biofilm by fluid
dynamic action in vitro.
Methodology
Fluoride diffusion was established by an experimental system that measured the rate
of fluoride diffusion through a membrane colonized with a Streptococcus mutans
biofilm. In a fluid-filled container, the biofilm colonized membrane was contained in a
water tight partition that separated the “brushing” chamber from the “measurement”
chamber. Brushes were positioned perpendicular to the biofilm at 10 mm distance,
then fluoride (1100 ppm NaF) was added to the brushing chamber and the brush
activated to enhance fluoride penetration to the measurement chamber through
fluid dynamic activity. Penetration of fluoride through the biofilm and membrane was
measured with a fluoride electrode over a four minute period, and expressed as the
“mass transfer coefficient.”
Results
The mass transfer coefficient (a measure of the rate of delivery of fluoride through
the biofilm-colonized membrane)of fluoride generated by powered brushing was
significantly greater (p<0.05) than that from passive diffusion alone (no brushing):
Sonicare FlexCare increased diffusion by 129% over no brushing. Sonicare FlexCare
resulted in a significantly greater (p<0.05) mass transfer coefficient than the Oral-B
Triumph by 29%.
Conclusion
This study demonstrated that the fluid dynamic action of Sonicare FlexCare
enhances the penetration of fluoride through biofilm which may, in turn, help
increase the bioavailability of fluoride in residual dental plaque.
*Results will var y with actual use
5
Sonicare FlexCare /
FlexCare+
.9
.8
.7
Fluoride
.6
concentration (mg/l)
.9
.5
.8
.4
.7
.3
Fluoride
.6
concentration (mg/l)
0
50
100
150
200
250
Time (s)
.5
.4
Sonicare FlexCare
Oral-B Triumph®
No brush
.3
0
50
100
150
200
250
Time5x10
(s)
-5
Sonicare FlexCare
Mass transfer
coefficient (cm/s)
Sonicare FlexCare
Oral-B
4x10Triumph®
-5
Oral-B Triumph®
No brush
3x10-5
Mass transfer
coefficient
(cm/s)
5x10-5
2x10-5
-5
4x10
1x10-5
3x10-5
0%
Sonicare FlexCare
Oral-B Triumph®
No brush
Sonicare
FlexCare
2x10-5
1x10-5
0%
Sonicare
FlexCare
6
No brush
Oral-B
Triumph
No brush
Oral-B
Triumph
No brush
Sonicare FlexCare /
FlexCare+
Plaque Biofilm Disruption
in vitro study*
In vitro tooth-cleaning efficacy of
electric toothbrushes around brackets
Schätzle M, Sener B, Schmidlin P, Imfeld T, Attin T. In vitro tooth-cleaning efficacy of electric
toothbrushes around brackets. Eur J Orthod, Advance Access published on June 15, 2010;
doi:10.1093/ejo/cjp166
Objective
To evaluate the cleaning efficacy of twelve different brush heads of two
electric toothbrush actions (side-to-side and oscillating/rotating) around
upper incisor brackets mounted on a custom model in a laboratory setting.
Test Devices
Oscillating / rotating toothbrushes
Oral-B Professional Care 9500
• MicroPulse EB 25
• Precision Clean
• Ortho Care
• Dual Clean
Side-to-side (sonic) toothbrushes
Oral-B Sonic Complete
• Sonic CrissCross
• Sonic Sensitive
WaterPik SenSonic
• Advanced Brush 2SRB-2WI
• Small Brush SRSB-2
Philips Sonicare
• Standard ProResults brush head
• Compact ProResults brush head
WaterPik SenSonic SR 800E
• Standard Brush SRBL-2I
• Small Brush SR1B-2I
Methodology
Standard and Mini DiamondTM brackets were fixed on black-stained
model teeth. The model teeth were then coated with white titanium
oxide to simulate plaque accumulation and were brushed by a fixed,
automated mechanism under constant conditions of load and equivalent
duration of exposure. Twelve different brush heads with either side-to-side
or oscillating-rotating action were tested. After brushing, the teeth were
scanned, the images digitized and the surfaces re-appearing black were
assessed utilizing custom software capable to detect gray-scale intensity.
The quantification of the reduction of simulated plaque is expressed as a
percentage of the total tooth area. ANOVA test was used for individual
comparison of the brush types. Bonferroni/Dunn adjustment was applied
for multiple testing.
Results
The Sonicare power toothbrush with compact ProResults brush head and
standard ProResults brush head were statistically significantly better than
other brush heads in the test at removing simulated plaque, with 81.7%
and 80.8% observed reduction overall, respectively.
*Results will var y with actual use
7
Sonicare FlexCare /
FlexCare+
Conclusion
In this in vitro experiment, the Sonicare power toothbrush with the compact
ProResults brush head and the standard ProResults brush head provided superior
cleaning efficacy of teeth with fixed orthodontic attachments.
Percentage of Touched (Cleaned) Tooth Surfaces
for the Respective Toothbrushes
Brush Heads:
1
Oral-B®
MicroPulse EB 25
2
Oral-B®
Precision Clean
100%
3
90%
Oral-B®
Ortho Care
4
Oral-B®
Dual Clean
5
Oral-B® Sonic
CrissCross
6
Oral-B® Sonic
Sensitive
1
Sonicare Standard
ProResults
2
Sonicare Compact
ProResults
1
WaterPik® Advanced
Brush 2SRB-2W1
10%
2
WaterPik® Small
Brush SRSB-2
0%
3
WaterPik® Standard
Brush SRBL-2I
4
WaterPik® Small
Brush SRIB-2I
% of Cleaned Area
80%
70%
50%
1
1
2
5
4
40%
30%
3
2
60%
1
2
6
3
20%
Horizontal bars: Medians; Boxes: Inter-quartile areas;
Error bars: 10th and 90th percentile; Dots: Extreme values
8
4
Sonicare Elite
Plaque Biofilm Disruption
in vitro study*
Comparison of interproximal plaque
removal efficacy of two power
toothbrushes using in vitro oral biofilms
Hope CK,Wilson M. Am J Dent 2002;15:7B-11B
Objective
To compare, in vitro, the interproximal plaque removal beyond the bristles of two
power toothbrushes.
Methodology
A dental plaque model in which a multispecies biofilm was grown on hydroxyapatite
discs was used to evaluate the ability of Sonicare Elite and Oral-B 3D® to remove
biofilm without bristle contact.The dental plaque model was located interproximally
at a distance of approximately 2 mm from the bristles and exposed to the fluid
dynamic activity generated by the brushes with the motors either activated or
inactivated for 5 seconds.
Results
In the activated state, both brushes removed a significantly higher percentage of
plaque biofilm compared to the inactive brushes.The percentage of plaque bacteria
removed by Sonicare Elite (32.2%) beyond the bristles was significantly greater than
that removed by Oral-B 3D (9.5%), (p<0.05).
Conclusion
Sonicare Elite removed significantly more dental plaque biofilm 2–3 mm beyond the
reach of the bristles than Oral-B 3D.
40%
Sonicare Elite
32.2%
Oral-B 3D®
30%
% Plaque
Bacteria
Removal
20%
9.5%
10%
0%
Sonicare Elite
Oral-B 3D
(p<0.05)
*Results will var y with actual use
9