J Clin Exp Den . 2017;9(6):e756-61. Flossing loops and o al heal h
e756
Jou nal sec ion: Bioma e ials and Bioenginee ing in Den is y
Publica ion Types: Resea ch
E ec i eness o lossing loops in he con ol o he gingi al heal h
F ancisco Azca a e-Velázquez 1, Robe o Ga ido-Se ano 1, Gab iel Cas illo-Dalí 1, Ma ía-Angeles Se e a-
Figallo 1, Al onso Gañán-Cal o 2, Daniel To es-Laga es 1
1 Mas e in O al Su ge y. Depa men o Den is y. Facul y o Den is y. Uni e si y o Se ille, Spain
2 Depa men o Ae ospace Enginee ing and Fluid Mechanics. Uni e si y o Se ille, Spain
Co espondence:
Calle A icena s/n
41009
Se illa, Spain
[email p o ec ed]
Recei ed: 15/03/2017
Accep ed: 14/04/2017
Abs ac
Backg ound: One o he key ac o in he good condi ion o pe iodon al issues is hei daily hygiene. O al hygiene
echniques such b ushing and a good in e den al hygiene by co ec lossing a e e y impo an . The aim o his
s udy is o compa e he use o den al loss in a loop s adi ional loss in he con ol o Loe-Silness Gingi al In-
dex (IG), Tu esky´s Plaque Index (IPT), Gingi al Bleeding Index (IS) and he alues o in e leukin 6 (IL-6) and
in e leukin 8 (IL-8).
Ma e ial and Me hods: A compa a i e s udy o 40 pa ien s in which each pa ien was his own con ol, using du ing
45 days each one o he de ices (new loop loss and con en ional loss) o in e den al hygiene analysed. Da a o
Loe-Silness Gingi al Index (IG), Tu esky´s Plaque Index (IPT), Gingi al Bleeding Index (IS) and he alues o
in e leukin 6 (IL-6) and in e leukin 8 (IL-8)we e collec ed and measu ed in e e y isi o e e y ype o in e den al
hygiene de ice .
Resul s: Ou da a indica es ha he a e o Tu esky´s Plaque Index p esen ed s a is ically signi ican di e ences
be ween g oups (loop: 1.66 ± 0.8; adi ional: 1.12 ± 0.8; p <0.0001). The es o he indices s udied showed no
s a is ically signi ican di e ences.
Conclusions: The c ea ion o new den al loss designs y o make hei use easie and mo e sensi i e, and plaque
emo al mo e e ec i e. The loop design can acili a e in e den al hygiene, eaching simila e ec i eness han a-
di ional loss, imp o ing some indica o s, such as Tu esky´s Plaque Index.
Key wo ds: Den al loss, bac e ial plaque, loop loss, plaque index, pe iodon al diseases.
doi:10.4317/jced.53858
h p://dx.doi.o g/10.4317/jced.53858
In oduc ion
I is well known ha he p esence o bac e ial plaque is
associa ed wi h he de elopmen o gingi al and pe io-
don al disease (1). Good oo h b ushing (TB) p ocedu es
a e essen ial o achie e adequa e esul s in plaque con-
ol and emo al, and he use o den al loss in combina-
ion wi h TB has shown some e idences o imp o emen
o in e p oximal plaque emo al (2-5), in addi ion o he
A icle Numbe : 53858 h p://www.medicinao al.com/odo/indice.h m
© Medicina O al S. L. C.I.F. B 96689336 - eISSN: 1989-5488
eMail: [email p o ec ed]
Indexed in:
Pubmed
Pubmed Cen al® (PMC)
Scopus
DOI® Sys em
Azca a e-Velázquez F, Ga ido-Se ano R, Cas illo-Dalí G, Se e a-Figa-
llo MA, Gañán-Cal o A, To es-Laga es D. E ec i eness o lossing loops
in he con ol o he gingi al heal h. J Clin Exp Den . 2017;9(6):e756-61.
h p://www.medicinao al.com/odo/ olumenes/ 9i6/jced 9i6p756.pd
J Clin Exp Den . 2017;9(6):e756-61. Flossing loops and o al heal h
e757
ob ious help in in e den al deb is emo al. Howe e ,
cu en esea ches cas doub s on he bene i s o loss
on plaque and clinical pa ame e s o gingi i is (6), poin-
ing o a undamen al issue: he echnique-sensi i eness
o den al loss. In his ega d, some indings poin o a
de imen al e ec o he use o some kinds o loss unde
ce ain pe iodon al condi ions (7).
Cu en gene al public exposu e o in o ma ion on gene-
al heal h guidelines allows pa adigm shi s ha , combi-
ned wi h sel -ca e measu es, can p oduce e y signi ican
posi i e global heal h impac . In he case o pe iodon al
sel -ca e (8), pe sonal assessmen o compliance wi h
den al lossing owa ds plaque emo al can be c i ical.
To his end, nowadays he e is a g ea amoun o che-
mical me hods in he ma ke such as plaque e y h osine,
malachi e g een, basic uchsin, and o he ood dyes ha
a e used o iden i ied he p esence o den al plaque.
Too hb ushes could be conside ed one o he main ins-
umen s o he emo al o den al plaque. Those can be
manual o elec ic. Some o he mos well-known ma-
nual b ushing echniques a e he Bass echnique o mo-
di ied S illman echnique (9). In e ms o e ec i eness,
elec ic oo hb ushes wi h oscilla o y / o a y head ha e
a highe le el o scien i ic e idence han manual oo h-
b ushes, ega ding o bo h plaque emo al and gingi i is
con ol. This no only comes o be e plaque emo al,
bu because he elec ic oo hb ush makes b ushing mo e
com o able and longe las ing (9).
As basic ools o emo ing in e p oximal plaque, den-
al loss has gene ally been used in s ing o m, bu also
has been ma ke ed in di e en o ms, as a ached o U-
shaped suppo s, in o de o acili a e i s use. The e is a
wide ange in he ma ke : waxed o unwaxed, s iplike
o ound sec ion, igid o so and wi h di e en ac i e
ing edien s such as luo ide, chlo hexidine o la o ing
subs ances. I s inal aim is o acili a e i s mo emen o e
he p oximal su aces and cleaning o he small su ace
i egula i ies. A good quali y s ing should s e ch p o-
pe ly wi hou aying.
The use o in e p oximal b ushes o di e en sizes,
s aigh o angled, make he plaque emo al easie
(10,11), especially esidues in pos e io sec o s. Also o
in e p oximal cleaning a e used in e den al s imula o s
o cones (9).
O he ins umen s used a e wooden wedges o oo h-
picks. These can be made o wood o plas ic al hough i s
e ec i eness is much discussed since hei use, in some
cases as in heal hy pa ien s, can be mo e ha m ul han
bene icial (10).
De ices like o al i iga o s use he p essu e o he wa e
agains issues and hey a e use ul o emo e ood pa i-
cles bu no e ec i e o plaque emo al. They a e only
use ul i used oge he wi h oo hb ush and loss. Use
can be made o chemicals o con ol plaque, o exam-
ple, chlo hexidine (6,11,12).
Fo i s gene al accep ance, low p ice, simplici y and o-
bus ness, den al loss has been conside ed a majo de i-
ce ca ego y o inno a ion and imp o emen . Howe e ,
as no ed abo e, i s own simplici y, inhe en echnique-
sensi i eness and consequen use low compliance lea e
li le oom o inno a ion and pose ob ious clinical li-
mi a ions.
The only oom o ce ain inno a ion in den al loss o
make i clinically a ac i e, while keeping he ex eme
simplici y and low p ice o he o iginal de ice, would be
in he di ec ion o he imp o emen o use compliance.
A basic mechanical concep ual app oach in ha di ec-
ion would be es ic ing he la ge numbe o deg ees o
eedom allowed by he o iginal de ice. In his pape , he
mos ob ious, simple, obus , and ye ne e clinically
s udied inno a ion in his ega d is conside ed: ying up
he ends o a con en ional loss o o m a ci cle o closed
loop. Majo ad an ages o eseen o e he o iginal linea
loss a e: (i) d as ic imp o emen o use compliance,
(ii) easie handling, (iii) lowe aw ma e ial and s ing
was e, (i ) d as ic imp o emen o s ing leng h use, ( )
imp o ed s ing hygiene, and ( i) imp o ed plaque e-
mo al e icacy and pe iodon al condi ion.
Thus, he de ice s udied in his a icle o in e den al
cleaning echnique is a den al loss loop (Fig. 1). This
loop is aken wi h se e al inge s o make i ense. Den al
loss is passed h ough he in e p oximal spaces du ing
usage, while i is o a ed o allow he use a clean piece
o loss in each in e p oximal space (Fig. 2). In his way,
he e iciency o he use o loss ma e ial is maximum.
Fig. 1: Looped den al loss. Design.
The cu en use o adi ional den al loss demands a
ic ion o ce wi h he skin o he inge s o keep i me-
chanically esis i e o pe pendicula o ces associa ed
o in e p oximal space inse ion. No e ha e en i he
use employs a gene ous ex a loss leng h o make some
loose loops a ound each inge , ic ion o ce is always
p esen as he majo mechanical componen o he esis-
i e o ces. Such a esul is highly a iable depending
on he na u e o he skin, i s mois u e con en , e c. In
con as , he looped den al loss con igu a ion allows a
J Clin Exp Den . 2017;9(6):e756-61. Flossing loops and o al heal h
e758
Fig. 2: Biomechanics o looped den al loss.
ension in excess o he one o adi ional loss wi hou
eso ing o ic ion a all: e en i he inge s a e we ,
ac ing like mechanical pulleys, he wi e is kep unde a
ension o ce ha is en i ely imposed by he di ec o ce
ha he use pu s h ough his/he hands o a ms. This
es ic s e y signi ican ly he a iabili y el by he use
and p o ides a comple e con ol on he loop. In addi ion,
he loop p o ides he possibili y o using i s en i e leng h
in cleaning, only by u ning he used loss p og essi ely,
ensu ing a high alue o e ec i eness o he loss.
Besides, in e leukin-6 is a mul i unc ional cy okine wi h
biological ac i i ies such as B lymphocy e di e en ia-
ion, T cells p oli e a ion and s imula ing he sec e ion
o immunoglobulins (Ig) by B lymphocy es, s imula ion
o p o ein syn hesis in acu e phase and ac i a ion o he
complemen cascade (13). Pa icula impo ance is he
abili y o IL-6 o induce bone eso p ion, bo h by i sel
and in combina ion wi h o he agen s o bone eso p ion
(14). These e ec s a e de eloped especially in cases o
bac e ial in ec ion and a e he e o e also o c ucial im-
po ance in in lamma o y pe iodon al diseases (15). Au-
ho s like Mo elli e al. in 2014 concluded ha sali a y
le els o IL-1 a and IL-6 could be po en ial indica o s
o changes in p obing dep h and gingi al in lamma ion-
inducing (16).
IL-8 is a po en chemokine wi h unc ion in he e-
c ui men and ac i a ion o human g anulocy es and
media ion o in lamma o y p ocesses (17). I can be
eleased om a ious cells, including monocy es / ma-
c ophages, lymphocy es, ib oblas s, endo helial cells,
and epi helial cells (17,18). IL-8 plays an impo an ole
in he egula ion o neu ophil unc ion (19). Lü ioglu e
al. in 2015 linked he inc ease in IL-8 in he p esence o
pe iodon al disease, his being highe in ch onic agg es-
si e pe iodon i is and gingi i is (20).
In ou s udy, he bene i o using looped den al loss
was s udied in con olling den al plaque and gingi i is
h ough he analysis o a ious clinical indica o s and
measu ing he concen a ion o IL-6 and IL 8 in c e i-
cula luid.
Ma e ial and Me hods
Ou clinical s udy was conduc ed a he clinic o he Fa-
cul y o Den is y a he Uni e si y o Se ille a e being
app o ed by he E hics Commi ee Resea ch a Vi gen
del Rocio Teaching Hospi als in Se ille, Spain. Resea ch
has been conduc ed in ull acco dance wi h he Wo ld
Medical Associa ion Decla a ion o Helsinki. We ha e
ob ained w i ed consen om all pa icipan s in ol ed
in you s udy (consen p ocedu e was app o ed by he
e hics commi ee).
The s udy began wi h he s uc u ing o he s udy g oups
wi h a o al o 40 andomized pa ien s which should
mee he ollowing inclusion c i e ia: pa ien s aged be -
ween 18 and 30 yea s wi hou unde lying pa hology as-
socia ed (hype ension, diabe es, endoc ine pa hology,
among o he s), p esence in he mou h o mo e han 20
ee h (excluding hi d mola s) and absence o in ec ious
disease o den al decay. Simila ly, pa ien s should no
submi any o he exclusion c i e ia: inju y o inabili y
o pe o m b ushing / use o loop, lack o mou h opening
(<30 mm), p esence o o hodon ic appliances ixed,
p egnancy, smoking o ha ing pe iodon al disease.
All pa ien s s udied we e s uden s o he Deg ee in Den-
is y a he Uni e si y o Se ille. They we e andomized
in a g oup (n = 40) ha began wi h he use o con en-
ional loss. This g oup unde wen ou ine scaling and
polish a baseline (T0), a 15 (T15) and 45 days (T45)
days measu emen s and IL samples aken. A e aking
he samples T45 p oceeded o make a new ou ine sca-
ling all pa ien s, and began using he me hod o looped
den al loss. A 15 days (T60) and 45 (T90) he same
ope a ion akes da a (Fig. 3) we e epea ed.
Clinical gingi al index, Tu esky´s plaque index, blee-
ding on p obing index and he concen a ion o in lam-
ma o y ma ke s in e leukin 6 and 8, bo h p esen in he
c e icula luid we e eco ded and analyzed.
C e icula luid samples we e collec ed om he in-
e den al a eas in he lowe la e al inciso s wi h ou
wo-cen ime e s long pape poin s p e iously s e ilized.
The soaking ime o each pa ien was i e seconds and
immedia ely inse ed in o 0.5ml Eppendo mic o ubes
wi h 50 μl o saline a 4° C o p ese a ion.
T anspo a ion o samples o he biological labo a o y
was conduc ed in a co k e ige a o wi h he mal ice
shee s, and ozen a -80° C on a i al o lab. Then we
p oceeded o analyze he concen a ion o in e leukins
(IL-6 and IL-8) de ec ed in each sample by panels bio-
plex ma k Luminex, which a e based on binding be ween
he di ec immuno luo escence echnique (DIF) and low
cy ome y (FCM), h ough magne ized sphe es labeled
J Clin Exp Den . 2017;9(6):e756-61. Flossing loops and o al heal h
e759
Fig. 3: Ch onology o he esea ch.
enzyma ically wi h s ep a idin, (which upon addi ion
o i s subs a e subsequen ly gene a es a de ec able and
measu able colou ed p oduc ), and ma ked wi h wo
speci ic an ibodies (one o each In e leukin o s udy).
The labo a o y p o ocol began wi h a desc ip ion o he
de ec ion me hod Bio-Plex P o Assay. Reac i e subs an-
ces, calib a ion o “Luminex” eade and so wa e we e
se up o p oceed wi h he p ocedu e unning he assay
(poin s 1-16). A e his p ocedu e, he p o eins desig-
na ed we e analyzed o he p pa a ion o he s anda s
BioRAD - Bio-Plex Human Cance Bioma ke s Panel 2,
18 plex s anda s cu es. This cu e is used o in e pola e
he esul s o he cuan i ia i e measu emen .
Thus, he p esence o bo h hese wo in e leukins a e de-
ec ed only and speci ically o bo h hei quan i y and
hei concen a ion (pg / ml), simul aneously o bo h
analy es.
The da a we e included in a da a base SPP 15.0 o Win-
dows, compa ing da a om bo h es sys ems using he
U Mann-Whi ney, wi h a le el o s a is ical signi icance
o p <0.05, using he so wa e men ioned abo e.
Resul s
F om an ini ial sample o 40 indi iduals who me he in-
clusion c i e ia only 35 indi iduals comple ed he s udy.
These i e indi iduals who we e los du ing he s udy
we e disca ded due o wo causes: hey ook an i-in la-
mma o y ea men o 90 days ( wo o hem) o missed
any o he isi s ( h ee o hem). Among he 35 indi i-
duals who comple ed he s udy, he e we e i e men and
30 women.
In e e ence o he Gingi al Index (GI), he e is a dec ea-
se be ween Visi 2 (0.95 ± 0.3) and isi 3 (0.87 ± 0.4)
in con ol g oup as occu s be ween isi 2 g oup (1.00 ±
0.4) and isi 3 (0.98 ± 0.4) in he s udy g oup, he di e-
ence is no s a is ically signi ican (p = 0.69) (Table 1).
When we analyze Tu esky´s Plaque Index, we ind ha
he e is an inc ease in alues be ween isi 2 (1.49 ± 0.8)
and isi 3 (1.66 ± 0.8) in he con ol g oup, bu he s udy
g oup ound a dec ease be ween isi 2 (1.70 ± 0.7) and
isi 3 (1.12 ± 0.8), he di e ence is s a is ically signi i-
can (p <0.05) (Table 1).
Rega ding o he Gingi al Bleeding Index (ISG), he e
is a dec ease be ween Visi 2 (1.09 ± 0.4) and isi 3
(0.88 ± 0.6) in he con ol g oup as occu s be ween isi
2 (1.11 ± 0.6) and isi 3 (1.05 ± 0.5) in he s udy g oup,
he di e ence is no s a is ically signi ican (p = 0.089)
(Table 1).
Resul s o biochemical pa ame e s like In e leukin 6
(IL-6) showed ha he e is a le elling-o be ween di-
e en alues be ween isi 2 (0.32 ± 0.9) and Visi 3
(0.46 ± 1.5) in con ol g oup as occu s be ween isi 2
(1.35 ± 2.3) and isi 3 (1.55 ± 5.0) in he s udy g oup,
he di e ence is no s a is ically signi ican (p = 0.658)
(Table 1).
In espec o In e leukin 8 (IL-8), he e is a le elling-
o be ween di e en alues be ween isi 2 (139.9 ±
208.25) and Visi 3 (237.89 ± 268.2) in con ol g oup
as occu s be ween isi 2 (241.72 ± 177.0) and isi 3
(235.93 ± 225.2) in he s udy g oup, he di e ence is no
s a is ically signi ican (p = 0.984) (Table 1).
Discussion
Th oughou his o y, many me hods ha e been used o
he p e en ion and ea men o pe iodon al disease. Ty-
pically, den al loss is used as a con ol me hod o in e -
den al plaque. I s use equi es a lea ning pe iod which
depends on a ious ac o s such as pa ien ’s abili y o
pa ien ´s o al heal h mo i a ion.
In o de o ob ain he maximum le els in e den al plaque
emo al, den al loss should be combined wi h a good
b ushing echnique. Tha is why ou s udy combines he
use o b ushing wi h den al loss (21,22).
Two echniques lossing we e compa ed in his s udy,
con en ional loss and looped den al loss, analyzing
hei e ec i eness in emo ing plaque.
Sys ema ic e iew conduc ed by Chapple e al. in 2015
(23) suppo s he need o con ol den al plaque o main-
ain gingi al heal h h ough elec ic oo hb ushes. The
use o loss is only ecommended o hose loca ions
J Clin Exp Den . 2017;9(6):e756-61. Flossing loops and o al heal h
e760
NT adi ional Looped p
IG Visi 2 35 0,95 ± 0,3 1,00 ± 0,4 0,195
Visi 3 35 0,87 ± 0,4 0,89 ± 0,4 0,648
Di . Vis. 3 – Vis. 2 35 -0,08 ± 0,5 -0,11 ± 0,6 0,690
TPI Visi 2 35 1,49 ± 0,8 1,70 ± 0,7 0,008
Visi 3 35 1,66 ± 0,8 1,12 ± 0,8 0,0001
Di . Vis. 3 – Vis. 2 35 0,17 ± 1,18 -0,58 ± 1,0 0,0001
GBI Visi 2 35 1,09 ± 0,4 1,11 ± 0,6 0,658
Visi 3 35 0,88 ± 0,6 1,05 ± 0,5 0,006
Di . Vis. 3 – Vis. 2 35 -0,20 ± 0,7 -0,06 ± 0,8 0,089
IL6
(pg/ml)
Visi 2 35 0,32 ± 0,9 1,35 ± 2,3 0,02
Visi 3 35 0,46 ± 1,5 1,55 ± 5,0 0,104
Di . Vis. 3 – Vis. 2 35 -0,08 ± 1,2 0,24 ± 5,6 0,658
IL8
(pg/ml)
Visi 2 35 208,25 ± 139,9 241,72 ± 177,0 0,267
Visi 3 35 237,89 ± 268,2 235,93 ± 225,2 0,967
Di . Vis. 3 – Vis. 2 35 1,95 ± 211 3,00 ± 285 0,984

Table 1: Resul s o IL6, IL8 Tu esky´s Plaque Index, Gingi al Bleeding Index.
whe e you canno use in e den al oo hb ushes wi hou
auma. The e o e, acco ding o his au o , he in e poxi-
mal oo hb ushes would be he ins umen o choice o
main ain gingi al heal h.
Salze e al. in 2015 (24) e alua ed he e ec i eness
o di e en ins umen s o con ol in e den al plaque
h ough a sys ema ic e iew. They concluded ha in e -
p oximal b ushes we e he mos e ec i e me hod and
mos o he s udies did no demons a e ha he use o
loss was e ec i e. All de ices help o con ol gingi i is.
Ou s udy e alua es he echnique o using den al loss.
Mo e con empo a y s udies such as C onin e al. com-
pa ed elec ic in e den al cleaning de ices, losse ,
oo hpick, and adi ional den al loss wi h wax. They
cncluded ha he oo hpick g oup had a highe plaque
index compa ed o he o he s (25). These s udies show
ha den al loss gene ally educes he p esence o plaque
in a sa is ac o y manne wi hou encoun e ing di e ence
be ween he di e en ypes.
Va ious s udies show ha he addi ion o excipien s
such as e asodium py ophospha e podwe , due o i s
an i-plaque ac ion, only las s wo hou s a e applica ion
(26). In ou s udy we ha e e alua ed he echnique i sel
o he emo al o plaque.
Te ezhalmy e al. in 2008 compa ed he e ec i eness
in emo ing plaque om ou di e en ypes o den al
loss in hei mic os uc u e ( h ee con en ional silks:
unwaxed, in e wined and esis an o b eakage and loss
in s ick) concluding ha he e was no di e ence s a is-
ically signi ican be ween hem al hough loss in s ick
emo ed mo e plaque (27). I showed ha he e was
only s a is ically signi ican di e ence compa ed wi h
b ushing alone. In ou s udy he ype o loss ma e ial
was no e alua ed, only i s p esen a ion and minimal di-
e ences we e ound, hence bo h sys ems ha e a simila
e iciency.
Shibly e al. in 2001 compa ed di e en p esen a ions
o den al loss. In his case hey we e compa ed con en-
ional loss o “au oma ic powe losse ”. No di e ences
be ween he gingi al index and plaque index we e ound
(28).
Ciancio e al. compa ed wo ypes o den al loss (waxed
and expanded poly e a luo oe hylene) concluding ha
lossing gene ally imp o es plaque emo al, i does no
ma e i s p esen a ion (29).
Mizu ani e al. e alua ed he o al heal h acco ding
bleeding, a ques ionnai e o al hygiene habi s and sel -
e icacy scale hygiene. They concluded ha he e was
co ela ion be ween good hygiene, e ec i eness and co-
llege s uden s (30). Indi iduals used in ou s udy may be
hype mo i a ed in hei o al hygiene habi s.
Some s udies show ha he e is an inc ease in he con-
cen a ion o IL-6 when we a e aced wi h an episode o
ch onic (31) pe iodon i is o agg essi e. In ou s udy we
do no ha e any o hese case and o hem he alues o
IL-6 we e s able du ing he s udy. Mo elli e al. in 2014

J Clin Exp Den . 2017;9(6):e756-61. Flossing loops and o al heal h
e761
concluded ha sali a y le els o IL-1 and IL-6 could be
po en ial indica o s o changes in p obing dep h when
gingi al in lamma ion (16) is induced. Compa ed wi h
ou s udy, we ound no inc ease in p obing dep h o le-
els o IL-6. O he s udies show ha only he alues o
p os aglandin E2 and mac ophage in lamma o y p o ein
(MIP) -1a a e he only ones ha inc eases and allow us
o disce n be ween heal h and gingi i is (32).
Some s udies show signi ican changes in alues in c e-
icula luid when pe iodon al disease is in an ad an-
ced s age and / o agg essi e (20) and e en in cases o
pe i-implan pa hology as pe implan i is (33), showing
a posi i e co ela ion be ween p obing dep h and he
p esence o IL-8 (34).
In conclusion, he esul s o ou s udy indica e ha he use
o looped den al loss is use ul in emo ing den al plaque
and gingi i is con ol. While mos clinical indica o s and
IL6 and IL8 we e le elled o be ween he wo g oups, a
signi ican imp o emen in he a e o Tu esky´s Plaque
Index in he looped den al loss g oup was iden i ied.
Re e ences
1. B own LJ, Löe H. P e alence, ex en , se e i y and p og ession o
pe iodon al disease. Pe iodon ol 2000. 1993;2:57-71.
2. Biesb ock A, Co by PM a, Ba izek R, Co by AL, Coelho M, Cos a
S, e al. Assessmen o ea men esponses o den al lossing in wins.
J Pe iodon ol. 2006;77:1386-91.
3. Kige RD, Nylund K, Felle RP. A compa ison o p oximal pla-
que emo al using loss and in e den al b ushes. J Clin Pe iodon ol.
1991;18(9):681-4.
4. Loe H, Theilade E, Jensen SB. Expe imen al Gingi i is in Man. J
Pe iodon ol. 1966;36:177-87.
5. Biesb ock A, Co by PM, Ba izek R, Co by AL, Coelho M, Cos a S,
e al. Assessmen o ea men esponses o den al lossing in wins. J
Pe iodon ol. 2006;77:1386-91.
6. Wilde RS, B ay KS. Imp o ing pe iodon al ou comes: me ging cli-
nical and beha io al science. Pe iodon ol 2000. 2016;71:65-81.
7. Kelekis-Cholakis A, Pe y JB, P e e L, Mille e A. Success ul
ea men o gene alized e ac o y ch onic pe iodon i is h ough dis-
con inua ion o waxed o coa ed den al loss use: A epo o 4 cases. J
Am Den Assoc. 2016;147:974-8.
8. D isko CL. Pe iodon al sel -ca e: e idence-based suppo . Pe io-
don ol 2000. 2013;62:243-55.
9. Vibhu e A, Vandana KL. The e ec i eness o manual e sus powe-
ed oo hb ushes o plaque emo al and gingi al heal h: A me a-
analysis. J Indian Soc Pe iodon ol. 2012;16:156-60.
10. Jo dan RA, Hong HM, Lucaciu A, Zimme S. E icacy o s aigh
e sus angled in e den al b ushes on in e p oximal oo h cleaning: A
andomized con olled ial. In J Den Hyg. 2014;12:152-7.
11. Husseini A, Slo DE, Van de Weijden GA. The e icacy o o al
i iga ion in addi ion o a oo hb ush on plaque and he clinical pa a-
me e s o pe iodon al in lamma ion: a sys ema ic e iew. In J Den
Hyg. 2008;6:304-14.
12. Van de Weijden FA, Van de Sluijs E, Ciancio SG, Slo DE. Can
Chemical Mou hwash Agen s Achie e Plaque/Gingi i is Con ol?
Den Clin No h Am. 2015;59:799-829.
13. Hi ano T, Aki a S, Taga T, Kishimo o T. Biological and clinical
aspec s o in e leukin 6. Immunol Today. 1990;11:443-9.
14. Ishimi Y, Miyau a C, Jin CH, Aka su T, Abe E, Nakamu a Y, e al.
IL-6 is p oduced by os eoblas s and induces bone eso p ion. J Immu-
nol. 1990;145:3297-303.
15. Mengel R, Bache M, Flo es-De-Jacoby L. In e ac ions be ween
s ess, in e leukin-1be a, in e leukin-6 and co isol in pe iodon ally di-
seased pa ien s. J Clin Pe iodon ol. 2002;29:1012-22.
16. Mo elli T, S ella M, Ba os SP, Ma chesan JT, Moss KL, Kim SJ, e
al. Sali a y bioma ke s in a bio ilm o e g ow h model. J Pe iodon ol.
2014;85:1770-8.
17. Baggiolini M, Walz A, Kunkel SL. Neu ophil-ac i a ing pep i-
de-1/in e leukin 8, a no el cy okine ha ac i a es neu ophils. J Clin
In es . 1989;84:1045-9.
18. Lawlo F, Camp R, G ea es M. Epide mal in e leukin 1 alpha
unc ional ac i i y and in e leukin 8 immuno eac i i y a e inc ea-
sed in pa ien s wi h cu aneous T-cell lymphoma. J In es De ma ol.
1992;99:514-5.
19. Tone i MS. Molecula ac o s associa ed wi h compa men aliza-
ion o gingi al immune esponses and ansepi helial neu ophil mi-
g a ion. J Pe iodon al Res. 1997;32:104-9.
20. Lü ioğlu M, Aydoğdu A, Sakallioğlu EE, Alaçam H, Pamuk
F. Gingi al c e icula luid in e leukin-8 and lipoxin A4 le els o
smoke s and nonsmoke s wi h di e en pe iodon al s a us: a c oss-
sec ional s udy. J Pe iodon al Res. 2016;51:471-80.
21. Cuenca Sala E BGP. Odon ología P e en i a y Comuni a ia. P in-
cipios, mé odos y aplicaciones. 3 d ed. Masson SA; 2005.
22. Schmickle J, Wu bs S, Wu bs S, Lange K, Rinke S, Ho necke E,
e al. In luence o he u iliza ion ime o di e en manual oo hb ushes
on o al hygiene assessed du ing a 6-mon h obse a ion pe iod: a an-
domized clinical ial. J Pe iodon ol. 2014;85:1050-8.
23. Chapple ILC, Van de Weijden F, Doe e C, He e a D, Shapi a L,
Polak D, e al. P ima y p e en ion o pe iodon i is: managing gingi i-
is. J Clin Pe iodon ol. 2015;42:S71-6.
24. Sälze S, Slo DE, Van de Weijden FA, Dö e CE. E icacy o
in e den al mechanical plaque con ol in managing gingi i is -me a-
e iew. J Clin Pe iodon ol. 2015;42:S92-105.
25. C onin MJ, Dembling WZ, Cugini M, Thompson MC, Wa en PR.
A 30-day clinical compa ison o a no el in e den al cleaning de ice
and den al loss in he educ ion o plaque and gingi i is. J Clin Den .
2005;16:33-7.
26. Ped azzi V, Co si LP, Ped azzi H, Ne o EI, do Nascimen o C,
Ma degan Issa JP. Clinical e alua ion o esidual e asodium py o-
phospha e eleased om wo di e en an icalculus losses. B az Den
J. 2015;26:116-20.
27. Te ézhalmy GT, Ba izek RD, Biesb ock AR. Plaque- emo al e i-
cacy o ou ypes o den al loss. J Pe iodon ol. 2008;79:245-51.
28. Shibly O, Ciancio SG, Shos ad S, Ma he M, Boa dman TJ. Cli-
nical e alua ion o an au oma ic lossing de ice s. manual lossing. J
Clin Den . 2001;12:63-6.
29. Ciancio SG, Shibly O, Fa be GA. Clinical e alua ion o he e ec
o wo ypes o de nal loss on plaque and gingi al heal h. Clin P e
Den . 1992;14:14-8.
30. Mizu ani S, Ekuni D, Fu u a M, Tomo uji T, I ie K, Azuma T, e al.
E ec s o sel -e icacy on o al heal h beha iou s and gingi al heal h
in uni e si y s uden s aged 18- o 19-yea s-old. J Clin Pe iodon ol.
2012;39:844-9.
31. Scapoli L, Gi a di A, Palmie i A, Ca inci F, Tes o i T, Zu e i F,
e al. IL6 and IL10 a e gene ic suscep ibili y ac o s o pe iodon al
disease. Den Res J (Is ahan). 2012;9:197-202.
32. Synde gaa d B, Al-Sabbagh M, K yscio RJ, Xi J, Ding X, Ebe sole
JL, e al. Sali a y bioma ke s associa ed wi h gingi i is and esponse
o he apy. J Pe iodon ol. 2014;85:e295-303.
33. Schminke B, om O de F, G ube R, Schliephake H, Bu ge s R,
Miosge N. The Pa hology o Bone Tissue du ing Pe i-Implan i is. J
Den Res. 2014;94:354-61.
34. Recke EN, A ila-O iz G, Fische CL, Pagan-Ri e a K, B ogden
KA, Dawson D V, e al. A c oss-sec ional assessmen o bioma ke
le els a ound implan s e sus na u al ee h in pe iodon al main enance
pa ien s. J Pe iodon ol. 2015;86:264-72.
Acknowledgemen s
None.
Con lic o In e es
None.