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Research Article
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A 4-week clinical comparison of an oscillating-rotating power brush

versus a marketed sonic brush in reducing dental plaque
BARBARA BÜCHEL, MARKUS REISE, DMD, MALGORZATA KLUKOWSKA, DDS, PHD, JULIE GRENDER, PHD, HANS TIMM, PHD,
RENZO ALBERTO CCAHUANA-VASQUEZ, DDS, PHD & BERND W. SIGUSCH, DMD, DDS

ABSTRACT: Purpose: To assess the plaque removal efficacy of an oscillating-rotating power brush relative to a newly-
introduced sonic power brush. Methods: This study used a randomized, examiner-blind, single-center, two-treatment,
parallel group 4-week design. Subjects with pre-existing plaque scores of at least 1.75 on the Turesky Modification of
the Quigley-Hein Plaque Index (TMQHPI) were evaluated for baseline whole mouth and approximal plaque scores.
They received either the oscillating-rotating brush (Oral-B Professional Care 1000, sold as Oral-B Professional Care
600 in some regions, with the Oral-B Precision Clean brush head, D16u/EB20) or the sonic brush (Colgate ProClinical
C200 with Colgate Triple Clean brush head) and brushed twice-daily with the assigned brush and a standard fluoride
dentifrice for 4 weeks before returning for plaque measurements. Prior to baseline and the Week 4 measurements, par-
ticipants abstained from oral hygiene for 12 hours and from eating, chewing gum and drinking for 4 hours. Results: A
total of 131 subjects were enrolled in the study at baseline, with all completing the study: 65 in the oscillating-rotating
group, and 66 in the sonic group. Both brushes significantly reduced plaque over the 4-week study period. The oscillat-
ing-rotating brush was statistically significantly more effective in reducing plaque (P< 0.001) than the sonic brush.
Compared to the sonic power brush, the adjusted mean plaque reduction scores for the oscillating-rotating power brush
were more than five times greater for whole mouth and approximal areas. (Am J Dent 2014;27:56-60).

CLINICAL SIGNIFICANCE: When recommending brushes to patients, the superior plaque reductions observed in this
study with an oscillating-rotating power brush are an important consideration for dental professionals.

: Dr. Malgorzata Klukowska, Procter & Gamble Health Care Research Center, 8700 Mason-Montgomery Road,
Mason, OH 45040, USA. E- : klukowska.m@pg.com

Introduction As such, the reduction of dental plaque and its thorough

Dental caries and periodontal disease are endemic
globally. Dental caries is the most common childhood disease
and has a high prevalence in all age groups. Globally, many
countries are estimated to have dental caries prevalence in the
general population (all ages) as high as 89%.1 In the United
States, untreated dental caries exists in more than 21% of the
US population.2 While the prevalence of dental caries has
declined in the overall population compared to 30 years ago,
it is still unacceptably high for a disease that is preventable.3
Dental caries may lead to irreversible tooth damage, with the
potential for tooth loss.
Periodontal disease, including reversible gingivitis, is also
highly prevalent. Globally, as much as 75% of the adult
population may experience gingivitis1 and up to 15% of the
adult population is estimated to experience advanced
periodontal disease (periodontal pockets at least 6 mm in
depth).4 Despite the high prevalence of periodontal disease,
the first stage of the disease, gingivitis, is preventable and
reversible. Gingivitis occurs as an inflammatory response to
the accumulation of dental plaque, and is evident 2 to 4 days
after plaque formation begins. By 2 to 3 weeks, an established
gingivitis is present. From the early phase of reversible
gingivitis, the disease process can gradually transform into one
of irreversible periodontal disease in susceptible hosts, with the
potential for significant attachment loss and tooth loss.5
Dental caries and periodontal disease are multifactorial,
and both are associated with the presence and build-up of
dental plaque containing cariogenic and periodontopathic
microorganisms that are causal for the respective diseases.6,7
twice-daily removal are key factors in preventing oral disease
and its progression. Reductions in plaque levels can be
achieved chemotherapeutically and mechanically by brushing.
It is, however, widely acknowledged that patients and con-
sumers do not brush as frequently or for as long as required
for oral health and may have difficulty brushing appropriately.
This highlights the need for oral hygiene aids that encourage
use and that are highly effective in removing plaque. Using a
brush that removes the most plaque in a given period of time
helps to counter the frequently less-than-optimal brushing
times observed in many studies, and promotes oral health.
Increasingly sophisticated designs have been introduced, in
particular for power brushes, in the last two decades. Studies
have shown that plaque removal with power brushes is more
effective than with various manual brush controls. The most
common power brushes are based on oscillating-rotating and
sonic technologies. Oscillating-rotating toothbrushes, introduced
by Oral-B,a move back and forth with alternating turns
clockwise and counterclockwise while sonic brushes move
side-to-side. In the most recent systematic review,8 evaluating
the plaque removal efficacy of power versus manual
toothbrushes, oscillating-rotating power brushes were found
to remove plaque and reduce gingivitis more than manual
brushes in the short and long term. No other power brush
designs were consistently superior to manual toothbrushes.
One of the latest designs for the Oral-B oscillating-
rotating power brush is the Precision Cleana brush head,
which has 29% more filaments than previous designs and a
trim profile for superior three-dimensional tooth wrapping. In
three separate trials,9-11 the brush head showed significantly
American Journal of Dentistry, Vol. 27, No. 1, February, 2014
Fig. 1. Colgate ProClinical C200 and Oral-B Professional Care 1000 (sold as
Oral-B Professional Care 600 in some regions, D16u/EB20).
greater plaque removal versus an ADA manual brush. One of
the trials11 also assessed gingivitis; significant reductions (by
almost 3 times) were demonstrated for the Precision Clean
brush head versus the ADA manual brush after 4 weeks of use.
Recently, a new sonic brush has been introduced as the
Colgate ProClinical C200.b This brush is manufactured by
Omron Healthcare Co. Ltd., in Japan and distributed by
Colgate. The ProClinical C200 is described as having a
unique sonic wave cleaning action that combines a pulsation-
like up-and-down motion with a side-to-side motion and up to
30,000 strokes/minute. It has a Triple Cleanb brush head, one
manual mode, a 2-minute timer and a 30-second pacer. The
ProClinical C200 is reported to result in five times greater
plaque removal at the gingival margin compared to a manual
flat trim brush after 12 weeks of use.12
This study compared the efficacy of an Oral-B oscillating-
rotating power brush with the Precision Clean brush head
versus the new Colgate sonic power toothbrush in reducing
plaque in a well-controlled randomized clinical trial in adults
with confirmed plaque levels (Fig. 1).
Materials and Methods
Study design - This clinical trial was a 4-week single-center,
randomized, examiner-blind, two treatment, parallel group
study. The study was first reviewed and approved by the Uni-
versity Hospital of Jena Institutional Review Board (N° 3673-
Power toothbrushes & plaque reduction 57
01/13), after which potential study participants were evaluated
to determine if they met the study inclusion criteria. In order to
qualify for the study, participants were required to be in good
health and be at least 18 years of age. They also had to have
refrained from any oral hygiene for 12 hours prior to baseline
measurements as well as refrained from chewing gum, eating or
drinking for 4 hours. In addition, potential participants were
excluded if they were found to have severe and active dental
caries, extensive restorations, fixed or removable appliances,
severe periodontitis, be pregnant/lactating or if they had used
antibiotics or oral chlorhexidine within the previous 2 weeks.
At Baseline, written informed consent was obtained from
potential participants and plaque measurements were obtained
using the Turesky Modification of the Quigley-Hein Plaque
Index (TMQHPI, 168 sites) to screen for participants. Partici-
pants were required to have a TMQHPI of  1.75 (on a scale of
0-5) to be included in the study and were stratified based on
age, gender, typical toothbrush used, and baseline whole mouth
mean TQHPI score and randomized to the oscillating-rotating
power brush (Oral-B Professional Care 1000a oscillating-
rotating power brush, sold as Oral-B Professional Care 600a in
some regions with the Oral-B Precision Clean brush head,
D16u/EB20) or to the sonic power brush group (Colgate Pro-
Clinical C200 sonic power toothbrush with Colgate Triple
Clean brush head). Participants were instructed to brush twice
daily for 4 weeks with the allocated brush and a standard
fluoride dentifrice (Blend-a-Med Classic,c 1,450 ppm F as
NaF), following the power brush manufacturer’s instructions,
and to refrain from using any other oral hygiene products.
At the end of Week 4, participants again refrained from
performing oral hygiene for 12 hours and from eating, drinking
or chewing gum as previously instructed, before returning to
the clinic. As at the baseline visit, plaque was scored using the
TMQHPI to assess plaque reduction efficacy of the brushes.
The same examiner, who was previously trained and calibrated
on the method, evaluated clinical measurements for each
subject at all time points.14
Turesky Modification of the Quigley-Hein Plaque Index
(TMQHPI)13 - Plaque was scored using the TMQHPI with a
scale of 0-5 as follows: ‘0’= no plaque/debris; ‘1’= separate
flecks of plaque at the cervical margins of a tooth; ‘2’= a thin
continuous band of plaque at the cervical margins of a tooth;
‘3’= a band of plaque with a width  1 mm and covering less
than one-third of the crown of a tooth; ‘4’= plaque covering at
least one-third and less than two-thirds of the crown of a tooth;
and ‘5’= plaque covering at least two-thirds of the crown of a
tooth. Measurements were taken at six sites/tooth: mesio-
buccal, buccal, disto-buccal, mesio-lingual, lingual and disto-
lingual. Sites that had extensive restorations or that were hypo-
plastic were excluded from grading. TMQHPI whole mouth
scores were calculated by summing the scores from all sites
graded and dividing this by the number of gradable sites. Ap-
proximal site scores were calculated by summing the scores of
all mesio-buccal, disto-buccal, mesio-lingual and disto-lingual
sites and then dividing this by the number of gradable mesial
and distal sites.
Statistical analyses - Pre-study sizing was achieved using
power analyses with =0.05, using a two-sided test and a
sample size of 65 and 66 subjects in the two groups respective-
ly (131 subjects total). This sample size was sufficient to pro-
 American Journal of Dentistry, Vol. 27, No. 1, February, 2014
58 Buchel et al

Table 1. Study participant demographics (randomized subjects). Table 2. Mean plaque reductions (TMQHPI) versus baseline.
____________________________________________________________________________________________________ ____________________________________________________________________________________________________

Demographic Oscillating-rotating Sonic Total Adjusted mean % change

characteristics (N=65) (N=66) (N=131) change from from
____________________________________________________________________________________________________
baseline (SE) baseline P value
Age (Years)a ____________________________________________________________________________________________________

Mean 34.8 35.5 35.2 Whole mouth

SD 11.9 12.6 12.2 Oscillating-rotating 0.390 (0.0315) 16.7% <0.001
Minimum 19 20 19 Sonic 0.075 (0.0307) 3.2% 0.016
Maximum 59 64 64 Approximal
Sexb,c Oscillating-rotating 0.347 (0.0288) 14.0% <0.001
Female 34 (52.3%) 38 (57.6%) 72 (55.0%) Sonic 0.068 (0.0280) 2.8% 0.016
____________________________________________________________________________________________________
Male 31 (47.7%) 28 (42.4%) 59 (45.0%)
Raceb
Caucasian 65 (100%) 66 (100%) 131 (100%) Table 3. Percentage of participants with improved plaque removal efficacy.
____________________________________________________________________________________________________
Brush Typeb,c
% participants % participants
Manual 41 (63.1%) 38 (57.6%) 79 (60.3%)
improved improved >0.5
Power 24 (36.9%) 28 (42.4%) 52 (39.7%) ____________________________________________________________________________________________________
____________________________________________________________________________________________________
a
Two sample t-test was used to compare mean age between the two treatment Oscillating-rotating 61 (96.8%) 17 (27.0%)
groups (P= 0.744). Sonic 42 (63.6%) 5 (7.6%)
b
Number and percent of subjects in each category. P-value <0.001 0.005
____________________________________________________________________________________________________
c
Chi-Square test was used to asses gender and brush type user balance
between the two groups (P= 0.600 and P= 0.593, respectively).

vide 90% power to detect differences in plaque reductions

measured using the TMQHPI. Between-group baseline subject
demographic data were assessed for balance using a two sample
t-test for age, and a chi-square test for gender and brush type.
Statistical analyses for plaque reduction efficacy were based on
whole mouth and approximal average TMQHPI from the
respective baseline and Week 4 scores. An ANCOVA was per-
formed to analyze whole mouth and approximal plaque differ-
ences by using the respective baseline plaque measurements as
the covariates. Additionally, confidence intervals were generated
on the treatment differences for the respective whole mouth and
approximal changes from baseline scores.
Results
* P< 0.001 in favor of O-R brush
A total of 131 subjects were enrolled in the study at
baseline, with all completing the study: 65 in the oscillating- Fig. 2. Whole mouth and approximal plaque reductions (TMQHPI) versus
baseline.
rotating group, and 66 in the sonic group. In accordance with
the inclusion criteria, all subjects had a whole mouth TMQHPI
Approximal plaque - The baseline approximal plaque scores for
score of at least 1.75 at the start of the study. More than half of
the oscillating-rotating and sonic power brush groups were
the participants in each group entered the trial as manual
2.426 and 2.519, respectively (P= 0.081). Both brushes resulted
toothbrush users (63.1% and 57.6%, respectively). Participant
in statistically significant approximal plaque reductions at
demographics can be found in Table 1.
Week 4 versus baseline (Table 2). The adjusted mean change
Whole mouth plaque - Baseline whole mouth plaque scores for from baseline for approximal plaque was 0.347 (P< 0.001) for
the oscillating-rotating and sonic power brush groups were the oscillating-rotating brush and 0.068 (P= 0.016) for the sonic
2.283 and 2.377, respectively (P= 0.09). Use of either power brush. This represents more than five times greater interproxi-
brush resulted in a statistically significant whole mouth plaque mal approximal plaque reduction for the oscillating-rotating
reduction at Week 4 versus baseline (Table 2). The adjusted brush versus the sonic brush (P< 0.001) (Fig. 2).
mean plaque reduction from baseline was 0.390 (P< 0.001) for
the oscillating-rotating brush group and 0.075 (P= 0.016) for
Discussion
the sonic brush group. This represents more than five times Poor oral hygiene is a known risk factor for dental caries
greater whole mouth plaque reduction for the oscillating- and periodontal disease. Since neither dental caries nor bac-
rotating brush versus the sonic brush (P< 0.001) (Fig. 2). terial periodontal disease can exist in the absence of the
Significantly more participants showed a reduction in whole respective causative microorganisms, preventing the build-up
mouth plaque at Week 4 with the oscillating-rotating brush than of plaque and reducing its presence are critically important for
with the sonic brush (96.8% vs. 63.6%, P< 0.001). The number maintenance of oral health. It is generally accepted that
of subjects showing an improvement of more than 0.5 on the brushing twice-daily for 2 minutes will control plaque on an
TMQHPI scale was also significantly greater in the oscillating- on-going basis, provided thorough brushing occurs. Nonethe-
rotating group versus the sonic group (27% vs. 7.6%, P= 0.005) less, barriers to achieving adequate plaque control include
(Table 3). infrequent brushing, brushing for an inadequate length of time
American Journal of Dentistry, Vol. 27, No. 1, February, 2014
(less than 2 minutes) and difficulty in performing oral hygiene.
Given all of these facts, there is considerable drive to design
efficient and user-friendly power brushes.
This trial is the first comparative report of the Oral-B
Professional Care 1000 oscillating-rotating power brush and the
novel Colgate ProClinical C200 sonic power brush for plaque
removal. Both brushes significantly reduced plaque over the 4-
week study period, but the oscillating-rotating brush removed
statistically significantly more plaque (P< 0.001) than the sonic
brush. Other studies15-23 have demonstrated the superiority of
oscillating-rotating power brushes compared to various sonic
brushes. A 2010 systematic review24 of 17 trials with over
1,300 participants compared power brush technologies, in-
cluding oscillating-rotating power brushes and sonic (side-to-
side) power brushes, over a period of at least 4 weeks. It was
concluded from a review of seven trials of up to 3 months dura-
tion that oscillating-rotating brushes were superior, resulting in
statistically significantly greater plaque reductions in the short
term (1-3 months) compared to side-to-side powered brushes.
Most recently, a 12-week randomized, controlled, parallel
group and examiner-blind clinical trial25 involving 127 subjects
was published that evaluated an Oral-B premium oscillating-
rotating power brush (Triumph,a D34) with the premium
Colgate ProClinical model (A1500b) for plaque and gingivitis
reductions. Plaque and gingivitis measurements were taken at
Baseline, Week 4 and Week 12 using the Modified Gingival
Index (MGI), Gingival Bleeding Index (GBI) and the Rustogi
Modified Navy Plaque Index (RMNPI). Similar to the results of
the 4-week clinical trial reported here, the oscillating-rotating
power brush showed significantly greater efficacy versus the
sonic brush. Statistically superior plaque and gingivitis reduc-
tions were found for all measures with the oscillating-rotating
power brush. At 12 weeks, a 24% greater mean adjusted reduc-
tion in whole mouth plaque was observed (P< 0.001), as well as
a 26% greater reduction in approximal plaque (P< 0.001). A
29% and 17% greater reduction in the mean adjusted MGI (P<
0.001) and GBI (P= 0.047), respectively, was also found, as
well as a 30% reduction in the total number of bleeding sites
(P= 0.002).
A review26 of six randomized, controlled, examiner-blind
clinical trials of 4 or 12 weeks duration comparing the efficacy
of plaque removal in hard-to-clean areas with oscillating-
rotating power brushes versus sonic power brushes or manual
brushes also supports the superiority of oscillating-rotating
power brushes. Depending on the study, either the TMQHPI or
the Rustogi Modification of the Navy Plaque Index (RMNPI)
was used to measure lingual, gingival, marginal and approximal
plaque. In comparison to sonic power brushes, the oscillating-
rotating power brushes resulted in 18% to 34% greater reduc-
tions in adjusted mean plaque on the lingual surfaces (P
0.044) and 32% to 49% on the lingual approximal surfaces (P<
0.001), as well as 31% and 32% greater plaque reductions in
the lingual mandibular anterior and lingual mandibular sites (P
0.005). Given the propensity for greater plaque build-up and
gingivitis at these hard-to-clean sites, the superior plaque re-
ductions observed with oscillating-rotating power brushes
demonstrated their benefits in reducing gingivitis and improv-
ing oral health.
Power toothbrushes & plaque reduction 59
In conclusion, the current study demonstrated superior
plaque reductions with an advanced oscillating-rotating power
brush compared to a novel sonic brush, corroborating previous
studies demonstrating the superiority of oscillating-rotating
power brushes relative to sonic brushes.
a. Procter & Gamble, Cincinnati, OH, USA.
b. Colgate-Palmolive, New York, NY, USA.
c. Procter & Gamble, Gross Gerau, Germany.
Disclosure statement: Drs. Klukowska, Grender, Ccahuana-Vasquez and Timm
are employees of Procter & Gamble. Prof. Dr. Dr. Sigusch, Ms. Büchel and Dr.
Reise reported no conflicts. The study was supported by Procter & Gamble.
Prof. Dr. Dr. Sigusch is a Professor, Ms. Büchel is a Dentist and Dr. Reise is a
Study Assistant at the University Hospital of Jena, Germany. Dr. Klukowska is
a Principal Scientist and Dr. Grender is a Research Fellow at the Procter &
Gamble Company, Mason, Ohio, USA. Dr. Timm is a Clinical Trial Manager
and Dr. Ccahuana-Vasquez is a Clinical Scientist at the Procter & Gamble
Company, Kronberg, Germany.
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