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Table of Contents
Year : 2023  |  Volume : 13  |  Issue : 1  |  Page : 2-8

Comparison between subjective and colorimetric probe technique in grading interdental embrasure spaces in esthetic zone

Department of Periodontics, Kamineni Institute of Dental Sciences, Nalgonda, Telangana, India

Date of Submission28-Oct-2021
Date of Acceptance18-Jan-2023
Date of Web Publication28-Apr-2023

Correspondence Address:
Dr. Jagadish Reddy Gooty
Kamineni Institute Dental Sciences, Sreepuram, Narketpally, Nalgonda, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jid.jid_42_21

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Background: An effective nonsurgical and surgical periodontal treatment cannot be accomplished by brushing alone as it does not detach the plaque interdentally. Interdental cleaning aids can remove this interdental plaque. This optimizes the plaque control. Selecting the right size of interdental brush fills the entire interdental space thereby cleaning all the areas of the embrasure. Aim: The aim of the study was to assess the grading of gingival embrasure by periodontists with subjective technique and calibrated interdental probe. Subjects and Methods: Ten healthy patients were selected for the study. Gingival embrasures of patients were assessed with discretion by six periodontists. Later, every periodontist was educated about the use of calibrated probes. After a specific time-lapse, all the periodontists have examined the same patients again with the calibrated interdental probe. The embrasures in the patients were examined from left to right in maxillary and mandibular single-rooted and bicuspid teeth. Statistical Analysis: The assessment of scores between calibrated and arbitrary techniques by a single doctor for each gingival embrasure in all the patients was calculated by the Wilcoxon matched pair test. Comparison between doctors with the mean error was calculated by the Kruskal–Wallis ANOVA. Results: Significant results were observed in grading gingival embrasures by individual periodontists for every tooth between calibrated and arbitrary techniques. Conclusions: Based on morphology and location of teeth the gingival embrasure space differs. Choosing an interdental aid subjectively, probably will not give an appropriate cleaning viability. To accomplish a legitimate cleaning viability, an appropriate size interdental brush ought to be chosen for a specific embrasure. Utilizing a calibrated interdental probe helps the clinician choose an appropriate interdental brush for a specific embrasure space.

Keywords: Bicuspid, dentists, gingiva, humans, mandible, maxilla, tooth brushing

How to cite this article:
Alampur V, Gooty JR, Guntakandla VR, Rajababu P. Comparison between subjective and colorimetric probe technique in grading interdental embrasure spaces in esthetic zone. J Interdiscip Dentistry 2023;13:2-8

How to cite this URL:
Alampur V, Gooty JR, Guntakandla VR, Rajababu P. Comparison between subjective and colorimetric probe technique in grading interdental embrasure spaces in esthetic zone. J Interdiscip Dentistry [serial online] 2023 [cited 2023 Jun 2];13:2-8. Available from: https://www.jidonline.com/text.asp?2023/13/1/2/375288

   Clinical Relevance to Interdisciplinary Dentistry Top

A new calibrated technique is used to prescribe interdental brush to fill the entire interdental space.

   Introduction Top

Tooth brushing combined with interdental aid is the ideal home-use plaque removal technique once every 24 h.[1] The benefits of an optimal home-use plaque control measures include the opportunity to maintain a functional dentition throughout life, a reduction in the risk of loss of the periodontal attachment, and the optimization of esthetic values such as the appearance, prevent halitosis and also reduced the risk of a complex, uncomfortable, and expensive dental care.[2]

The embrasure is a sheltered area, which is difficult to access when the teeth are in their normal position.[3] For such regions, a special device called interdental aids is utilized. The interdental space is the actual space present between two adjoining teeth, its shape and volume are dictated by the morphology of the teeth.[4] However, the interdental brush was found to have an excellent effect both on the central part of the healthy interdental space and on the embrasures and may remove plaque as far as 2–2.5 mm below the gingival margin.[5] Good interdental oral hygiene requires a device that can penetrate between adjacent teeth and thereby touching as much of the exposed surface as possible.[6] Studies have demonstrated that approximately 10% of the population only is regularly applying interdental devices.[7] Professional flossing was shown to be effective in reducing interproximal caries risk; however, this beneficial effect was lost when flossing was self-performed.[8]

The access and size of the interdental aid have an impact on the acceptability, efficacy, and gingival trauma. The anatomy of the embrasure varies from different individuals and spaces between teeth of the same individual. Every gingival embrasure changes its shape due to age, periodontal health, and dental treatment.

Because of this shift in embrasure sizes, the colorimetric probe was designed based on the WHO community periodontal index of treatment needs probe model. This will help the clinician to prescribe the correct size of the interdental brush. There are two types of colorimetric probes:

Figure 1: IAP probe prime

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These probes are autoclavable to insert in interdental spaces. IAP probe prime has been developed for healthy and slightly injured papilla. IAP probe perio has been developed for periodontal patients with open interdental spaces. When the probe is fixed, based on the color that is visible the corresponding colored interdental brush is given to the patient. Different interdental brushes are designed based on color coding. The rationale for performing this study is that when the gingival embrasure classification is used, the interdental brushes prescribed may not fill the interdental space. Therefore, for an interdental brush to fill the entire interdental space and clean the concavities of the tooth, a calibrated probe is necessary.

Hence, this study aimed to assess the grading of gingival embrasure space by subjective technique and calibrated probe by trained periodontists.

   Subjects and Methods Top

Patient Selection

Study subjects

The study was performed in the Department of Periodontics, Kamineni Institute of Dental Sciences, Narketpally, Telangana, India. Based on the width of the patient's smile, it has been reported that a smile displays 10 maxillary teeth (up to and including second premolars).[9] The study of 10 healthy controls, with a total of 180 gingival embrasure sites (from central incisor to second premolars in each quadrant) of both sexes in the age group of 18–25 years were selected. The calibrated probe used in this study is designed for healthy controls.

Inclusion criteria

  • No periodontal pockets
  • No alveolar bone loss
  • No periodontal therapy was performed in the past 6 months.

Exclusion criteria

  • Medications which cause gingival changes
  • Smokers
  • Alcohol abusers
  • Patients under orthodontic treatment.

All the patients were educated about the nature of the study. The study was performed under the triple blinding technique. Under subjective technique, each periodontist was given diagnostic instruments to examine and visualize the interdental space. The gingival embrasures were assessed subjectively from left to right of maxillary and mandibular single-rooted teeth and first premolars (up to mesial sides of second premolars) by six periodontists. This is recorded in a particular planned case design with numbers dispensed to various embrasures spaces based on gingival embrasure classification [Table 1].[10]
Table 1: Subjective method of grading gingival embrasure

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Later in the colorimetric probe technique, every periodontist was educated about the IAP probe prime calibrated interdental probe. The IAP probe prime has various colour coding that addresses the increase in diameter from the tip to the base of the probe. This was recorded in a specifically designed case format with numbers allotted to different color coding [Table 2].
Table 2: Colorimetric grading gingival embrasure

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Statistical analysis

The readings of subjective and calibrated interdental probes were compiled for analysis. The assessment of scores between the calibrated and subjective techniques by each periodontist for each gingival embrasure in all the patients was calculated by the Wilcoxon matched pair test. Comparison between periodontists with the mean error was calculated by Kruskal–Wallis ANOVA [Table 3] and [Graph 1] and [Graph 2].
Table 3: Comparison of six doctors with mean error(after-before) of assessment in each tooth by Kruskal-Wallis ANOVA

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   Results Top

A statistically significant difference was observed between calibrated and subjective techniques by each periodontist but when compared among periodontists it was not statistically significant. Therefore, calibrated probe technique has proven to show better results than the subjective technique (P < 0.05).

   Discussion Top

An interdental aid is effective only when it fits the entire space, i.e., neither too loose fit nor too tight fit. This is applicable for both healthy interdental embrasures and wide-open embrasure spaces. Despite the fact that the self-assertive method is the most well-known procedure yet it does not give an exact size of interdental aid. Each clinician sees the size of the embrasure space in an arbitrary way. Accordingly, a scale ought to be planned which has to be simple, speedy, and high unwavering quality. One method of approach is to make use of color-coded interdental brushes which allows a health educator to help the patient to identify each area, allocate a color-coded brush according to the size of the space and instruct an appropriate technique for use.[2] Usually, a specialist examines clinically the embrasure space and prescribes an interdental aid. One of the consensus findings from the European Federation of Periodontology 2015, workshop states that “cleaning with interdental brushes is the most effective method for interproximal plaque removal, and consistently associated with more plaque removal than flossing or wood sticks.”[11] A colorimetric probe was designed to satisfy these features.

A colorimetric probe based on its color coding explains about the size of the interdental embrasure space. The diameter of the probe is increased from the tip to the base. For every color coding on the probe, a specific interdental brush was designed.

In 2011, Imai et al. conducted a study which used a measuring tool to determine the best-fitting interdental brush for proximal sites. A color-coded probe was inserted horizontally from the buccal aspect until snug, with the resulting color on the probe corresponding to the matching color of the interdental brush. The reduced number of bleeding sites noted in this study was attributed to the use of an appropriate size of the interdental brush, which resulted in “effective disruption of proximal biofilm compared to one size for all proximal spaces.”[12] Bourgeois et al. also used a color-coded probe to determine the appropriate size of the interdental brush. They found that calibrated interdental brushes reduce interdental bleeding by 46% at 1 week and 72% at 3 months.[13]

This study was performed to analyze between the subjective and colorimetric methods thereby to show which method has extreme outcomes for each specific embrasure among periodontists. A colorimetric interdental probe was designed to give a suitable diameter of the interdental brush for specific embrasure. For this technique to work the periodontist needs training before establishing into the study evaluators. Clinicians based on the force applied can either penetrate the probe deep or superficial that might cause the error. The error can also be the color of the probe that the clinician observes close to the embrasure. Every embrasure space has different grading. Prescribing multiple color-coded brushes for the individual are cumbersome and difficult in compliance.

   Conclusion Top

In phase I therapy, along with the tooth brushing technique, interdental cleaning should also be explained to the patient. Along with tooth brushing in each individual's day-to-day life, interdental cleaning should be a part to maintain a good gingival health. A proper training and using the interdental probe is necessary for prescribing the interdental aid to the patient which is time-consuming, since every embrasure in the oral cavity is of different sizes. However, to efficiently clean the interdental aid has to fill the entire interdental embrasure space. Therefore, a calibrated interdental probe technique is effective in measuring the embrasure and recommending the correct size interdental aid.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Lang NP, Cumming BR, Löe H. Toothbrushing frequency as it relates to plaque development and gingival health. J Periodontol 1973;44:396-405.  Back to cited text no. 1
Claydon NC. Current concepts in toothbrushing and interdental cleaning. Periodontol 2000 2008;48:10-22.  Back to cited text no. 2
Sälzer S, Slot DE, Van der Weijden FA, Dörfer CE. Efficacy of inter-dental mechanical plaque control in managing gingivitis – A meta-review. J Clin Periodontol 2015;42 Suppl 16:S92-105.  Back to cited text no. 3
Abdullah A, Pavithra S, Ahmed N. Interdental aids – A literature review. J Dent Sci 2018;3:2-7.  Back to cited text no. 4
Waerhaug J. The interdental brush and its place in operative and crown and bridge dentistry. J Oral Rehabil 1976;3:107-13.  Back to cited text no. 5
Rosema NA, Hennequin-Hoenderdos NL, Berchier CE, Slot DE, Lyle DM, van der Weijden GA. The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol 2011;13:2-10.  Back to cited text no. 6
Bakdash B. Current patterns of oral hygiene product use and practices. Periodontol 2000 1995;8:11-4.  Back to cited text no. 7
Hujoel PP, Cunha-Cruz J, Banting DW, Loesche WJ. Dental flossing and interproximal caries: A systematic review. J Dent Res 2006;85:298-305.  Back to cited text no. 8
Banerji S, Mehta SB. Practical Procedures in Aesthetic Dentistry. Hoboken (NJ): John Wiley and Sons Ltd; 2017.  Back to cited text no. 9
Peter S. Essentials of Public Health Dentistry: Community Dentistry. New Delhi (IN): Arya Medi Publishing House; 2006.  Back to cited text no. 10
Slot DE, Dörfer CE, Van der Weijden GA. The efficacy of interdental brushes on plaque and parameters of periodontal inflammation: A systematic review. Int J Dent Hyg 2008;6:253-64.  Back to cited text no. 11
Imai PH, Hatzimanolakis PC. Interdental brush in type I embrasures: Examiner blinded randomised clinical trial of bleeding and plaque efficacy. Can J Dent Hyg 2011;45:13-20.  Back to cited text no. 12
Bourgeois D, Saliasi I, Llodra JC, Bravo M, Viennot S, Carrouel F. Efficacy of interdental calibrated brushes on bleeding reduction in adults: A 3-month randomized controlled clinical trial. Eur J Oral Sci 2016;124:566-71.  Back to cited text no. 13


  [Figure 1]

  [Table 1], [Table 2], [Table 3]


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