Efficacy, Safety and Patient Preference of Knotted Floss Technique in Type I Gingival Embrasures.

The purpose of this study was to evaluate the efficacy and safety of the knotted floss (KF) technique with respect to plaque biofilm accumulation, gingival inflammation, bleeding, trauma, and patient preference when used in Type I gingival embrasures, in a crossover-comparison with a conventional flossing (CF) technique. Thirty healthy, non-flossing adults with at least one Type I gingival embrasure participated in this two-treatment-phase, crossover study. Each subject was randomly assigned to perform either KF or CF technique in the first 6-weeks, and the comparative technique in the second 6-weeks, with a 2-week washout phase in-between. Test-sites were scored at baseline, 2-weeks, 4-weeks, and 6-weeks using the Rustogi Modification of Navy Plaque Index (RMNPI), Modified Gingival Index (MGI), Modified Papillary Bleeding Index (MPBI), and the Carter-Hanson et al., scoring method for gingival trauma. A 3-factor analysis of variance was performed on the data to rule out treatment sequencing as a significant factor. Data was analyzed for differences between groups at respective time points using the student t-test and the paired t-test was used for changes within groups over time ( ≤ 0.05). Analysis of data showed a statistically significant improvement in RMNPI, MGl and MPBI scores within both flossing groups over the period of 6-weeks from baseline. The RMNPI scores were significantly less in the KF group at 2, 4, and 6 weeks when compared to the scores between the KF and CF treatment groups. No significant gingival trauma was recorded in either treatment group. Seventy-five percent of the subjects completing the study, chose KF when asked about their preferred flossing technique with respect to its ability to clean interdentally, while 71% chose KF as the flossing technique that they were willing to continue to use. KF is as effective and safe as an inter-dental oral hygiene technique for reducing plaque biofilm and gingival inflammation and bleeding, as compared to CF in Type I gingival embrasures, when both were used in conjunction with regular tooth-brushing. KF was shown to be better than CF in in terms of improved plaque biofilm scores.