Effect of Individually Trained Oral Prophylaxis (iTOP) on Gingival Health in Orthodontic Patients

Effect of Individually Trained Oral Prophylaxis (iTOP) Versus Conventional Oral Hygiene Instruction on Gingival Health in Orthodontic Patients Using Calibrated Interdental Brushes: A Randomized Controlled Clinical Trial

This randomized controlled clinical trial aims to evaluate the effectiveness of individualized oral hygiene education using the Individually Trained Oral Prophylaxis (iTOP) method compared with conventional oral hygiene instruction using model demonstration and video-based education in orthodontic patients diagnosed with gingivitis.

Sixty orthodontic patients underwent professional mechanical plaque removal and received oral hygiene instruction using calibrated interdental brushes. Participants were randomly assigned to either the iTOP training group or the conventional education group.

Clinical outcomes including Approximal Plaque Index (API), Gingival Index (GI), and Full Mouth Bleeding Score (FMBS) were assessed at baseline and after three months to determine the effectiveness of the educational interventions on plaque control and gingival health.

Orthodontic patients with fixed appliances are at increased risk for plaque accumulation and gingival inflammation due to the presence of plaque-retentive surfaces created by orthodontic brackets and wires. Effective oral hygiene education is therefore essential to maintain periodontal health during orthodontic treatment.

Traditional oral hygiene education methods, such as model demonstration and video instruction, provide general guidance but often lack individualized feedback and psychomotor skill training.

The Individually Trained Oral Prophylaxis (iTOP) method introduces a personalized hands-on approach using the "Touch-to-Teach" concept, where clinicians guide the patient's hand to demonstrate correct interdental cleaning techniques using calibrated interdental brushes.

This study compares the effectiveness of the iTOP method with conventional oral hygiene instruction in orthodontic patients diagnosed with gingivitis. The primary outcome measure is the change in the Approximal Plaque Index (API), while secondary outcomes include the Gingival Index (GI) and Full Mouth Bleeding Score (FMBS). These parameters are assessed at baseline and after a three-month follow-up period to determine improvements in plaque control and gingival health.

Inclusion Criteria:

• Systemically healthy adult patients aged 18 years or older
• Currently undergoing fixed orthodontic treatment
• Clinical diagnosis of generalized biofilm-induced gingivitis
• Adequate manual dexterity to use calibrated interdental brushes
• Willingness and ability to comply with assigned oral hygiene protocols and complete all 3-month follow-up visits

Exclusion Criteria:

• History of systemic diseases that influence gingival health or tissue response (e.g., uncontrolled diabetes)
• Use of medications known to affect gingival tissues (e.g., phenytoin, cyclosporine, calcium channel blockers)
• History of chemotherapy or radiotherapy in the head and neck region
• Current tobacco smokers or users of smokeless tobacco
• Pregnant or lactating women
• Presence of clinical attachment loss (periodontal pockets or gingival recession)
• Presence of open proximal carious lesions or defective restorations causing plaque retention
• Physical or cognitive conditions impeding independent oral hygiene performance