Journal of Dental Medicine

Background and Aims: Intrabony periodontal defects are one of the important problems in periodontal diseases. Treatment of intrabony periodontal defects with synthetic materials such as Cerasorb has been shown to enhance periodontal regeneration. The aim of this study was to compare the effect of Cerasorb with autogenous bone graft (A.B.G) as a gold standard in treatment of two to three wall periodontal defects.
Materials and Methods: In this interventional or randomized clinical trial study, 24 two to three wall intrabony defects were selected in a double blind manner. Defects were randomly (with tossing a coin) divided into two groups (test and control). Defects in test group were treated with flap surgery and Cerasorb. In control group, defects were treated with flap surgery and autogenous bone graft. At baseline and 3-month, 6-month and one-year follow up evaluations clinical and radiographic assessments were performed. Data were statistically analyzed using the paired t test, Wilcoxon and Mann-whiteny. The level of significance was set at P<0.05.
Result: At the 3-month, 6-month and one-year visits, the parameters of probing pocket depth (PPD), probing attachment level (PAL), bone level (distance between CEJ and alveolar crest), and bone density were not significantly difference in test and control groups (P>0.05). However, in each group there was significant difference in 4 parameters before and after surgery (P<0.05).
Conclusion: Treatment with Cerasorb compared to A.B.G produced the same results of improvement in two to three-wall intrabony defects. So the use of Cerasorb can be suggested for treatment of intrabony periodontal defects.

Background and Aims: Evaluation is a continuous process which is necessary for improvement of students learning and planning for required changes to obtain the educational objectives. The aim of the present study was to assess students' perspective on the achievement of the educational objectives of the Community Oral Health and Periodontology Departments using the CIPP model of evaluation.
Materials and Methods: A cross-sectional survey has been conducted using a questionnaire consists of four domains as introduced in the CIPP model of evaluation (Context, Input, Process and Product). Two groups of senior dental students of the dental school of Tehran University of Medical Sciences were approached. Data was collected anonymously and was analyzed with non-parametric Mann-Whitney test using the SPSS statistical package.
Results: The response rate was 67.7% for year 6 and 87.5% for the year 5 students. Respondents considered material presented in Periodontology Department more relevant and in need for their future career. However, teaching skills and motivation of the educators in Periodontology Department was considered inadequate. 67% of students reported having problem with material taught in Periodontology Department. Overall, significant difference in domains of Context and Process was observed between two departments (p<0.05). In the output domain students rated their clinical and theoretical ability "weak" in relation to splint, implant, management of acute gingivitis and electrosurgery compared with other topics which rated "good". Students considered their ability in using the principals of Evidence-Based Dentistry moderate.
Conclusion: The evaluation of the educational achievements of the two departments (COH and Periodontics) using CIPP model of evaluation showed that there is significant difference in two domains (Context and Process). In those topics which achievement was reported weak the revision of teaching methods is recommended.
Key Words: Education dental Program evaluation Self-evaluation

Background and Aims: The aim of this study was to evaluate the effect of application of two types of primers over bracket bases on the shear bond strength (SBS) and mode of bond failure.
Materials and Methods: In this study, 75 human premolar teeth were divided into three equal groups. In group 1 (control), after surface preparation of enamel by conventional method (acid etching+primer) brackets were bonded with Transbond XT composite. In group 2 (TX), brackets were bonded to enamel same as the first group but Transbond XT primer were used on bracket bases before placement of composite. In group 3 (PL), Transbond plus primer was applied on bracket bases before placement of composite. After 24 h, the SBS test was performed by universal testing machine at crosshead speed of 0.5 mm/min. Then, adhesive remnant index (ARI) scores and percentage of cohesive fracture were determined using stereomicroscopy. SBS data were analyzed by one-way ANOVA and Duncan tests. Kruskal-Wallis and Mann-Whitney tests were used to analyze ARI and cohesive fracture results.
Results: There was significant difference in SBS values among the groups (P<0.001). The highest SBS was shown in TX group and the lowest was seen in PL group. There was no significant difference between control and TX groups in ARI scores (P=0.199). No significant difference was found in cohesive fracture values between the groups (P=0.093). Both the control and TX groups showed significant difference in ARI scores and cohesive fracture compared with the PL group in all of the comparisons (P<0.001).
Conclusion: Application of Transbond XT primer over bracket base affects the bond strength and failure mode. Transbond XT primer increased the bond strength but Transbond plus primer decreased it.

Background and Aims: Since a large marginal opening allows more plaque accumulation, gingival sulcular fluid flow and bone loss, microleakage, recurrent caries and periodontal disease, marginal fit is of great importance in fixed restorations. The aim of this study was to compare the marginal fit of zirconium-based all ceramic (Cercon) frameworks, made by two different approaches (Direct and Wax-up scanning).

Materials and Methods: An abutment analog, with 5.5 mm width and height, was selected as an experimental model. Twenty all ceramic cores were made for this model (10 specimens per each group). In the first group (Direct), experimental models were scanned directly using Computer Aided Design/Computer Aided Manufacturing (CAD/CAM). The core was then designed with the aid of a computer and machined. In the second group (Wax-up or CAM) a wax-up pattern was made on the experimental model and then scanned and milled from Cercon blocks. The marginal discrepancy of each specimen was recorded using a stereomicroscope (SZX9, Olympus, Japan) and digital camera (Mode TK, C1380E, JVC, Japan) and then measured by Adobe Photoshop CS software. The data were analyzed using T-test.

Results: Mean marginal discrepancy of Direct group (85.2±3.95 µm) was significantly less than that of Wax-up group (120.2±6.91 µm).

Conclusion: Improved marginal fit of zirconia ceramics was found with the direct model scanning compared with that of Wax-up scanning using CAD/CAM.

Background and Aims: The oral impact on daily performance (OIDP) is one of the oral health-related quality of life indices to measure physical, social and mental consequences of the oral health status. This study aimed to evaluate the OIDP index in patients referring to Tehran dental school.

Materials and Methods: Four hundred and ninety nine patients referring to patients' clinic in Dental School of Tehran University of Medical Sciences in spring 2011 participated in this study. They were interviewed for demographic factors including age, gender and level of education, and OIDP index questionnaire before receiving any treatment. Statistical analysis was carried out by means of linear regression modeling.

Results: 85.6% of patients confirmed that they had at least one oral impact on daily performance during the last 6 months. The most prevalent performances affected were eating (50.1%) and smiling and showing teeth without shame (12.8%). The mean OIDP score for the population was 5.6 ranging from 0 to 36. Linear regression modeling controlling for age, gender and years of education revealed that older patients and those with lower education had significantly higher OIDP scores.

Conclusion: The effect of oral health on daily performance was clear. The association among age, education and oral impact on daily performance indicates the need for more comprehensive preventive oral health care for adults with lower educational level.

Background and Aims: There is concern that leached components from dental composites may cause adverse changes in the reproductive health. This study aimed to assess the effects of leached components from a hybrid resin composite on the reproductive system of male mice.
Materials and Methods: In the present animal study, twenty adult Syrian male mice were divided into two groups of 10 mice each. In the test group, components which leached from samples made from Filtek Z250 resin composite into 75% ethanol were daily administered to the mice for 28 days. In the control group, the procedure was repeated in the same way as the test group but without placing composite samples in the solution. Then, the body weight, weights of paired testes, Gonado Somatic Index, sperm viability, sperm motility, epididymal sperm reserve and daily sperm production were recorded. Four male mice in each group were mated with untreated female mice for 10 days. After that, the number of pregnant females and number of infants were recorded. The data were analyzed using repeated measures ANOVA, Chi-square test and t-test.
Results: There was a significant reduction in the sperm viability and sperm motility of male mice in the test group compared to the control group (P=0.001). There was no any significant differences in other parameters between two groups (P>0.05).
Conclusion: This study showed that the leached components from resin composites cannot cause infertility but they could potentially cause some adverse effects on the reproductive system of male mice.

Background and Aims: The aim of this study was to investigate the prevalence of diabetes and other risk factors in patients with dental infections.

Materials and Methods: A cross-sectional study was conducted among 50 patients who preferred in maxillofacial word of shariaty hospital with acute dental infections in 9 months. A self-administered questionnaire was administered during a dental appointment in order to gather demographic information and recorded past history of systemic disease, OPG radiography, gingival examination, and the result of lab tests such as CBC , FBS , PT, Bilirubin , Creat, T3, T4, TSH, HIVAb and HBSAg.

Results: 28% of the subjects and diabetes, 28% Anemia, 4% Hepatitis and 4% suffered from thyroid deficiency. 28% were smokers and 18% declared using alcohol. 6% of this population was addicted to narcotic substances. There was a significant correlation between age, education, diabetes and dental infections (P<0.05). DMFT for people with dental infections without any systemic disease were 8, for diabetic patients, smokers and alcohol users were respectively 17.16, 17 and 14.

Conclusion: Diabetes found highly prevalent in patients with dental infection and high DMFT.It indicates a need to establish a comprehensive oral health promotion program based on whole examination and blood glucose control in diabetic patients who have acute dental infection by collaboration between dental and general health care professionals. Moreover, it is recommended that all patients should be educated in dental and oral health for prevention of dental infections.

Background and Aims: To evaluate the effect of polishing on surface roughness of silorane-based composite using profilometery and Scanning Election Microscopy (SEM) and compare it with that of a methylmethacrylate-based composite and a glass ionomer.

Materials and Methods: In this study, 3 groups (n=28) were tested: specimens of two composites (Filtek P90 and Filtek P60) and a glass ionomer (Fuji IX) which were prepared in polyethylene molds (4 mm diameter×10 mm height). Half of the specimens in each group were finished with 180-grit silicon carbide paper and the remaining were finished with 180-grit, and subsequently polished with 250, 400, 800, 1000, 2000, and 2500-grit silicon carbide papers. The surface roughness was evaluated using a contact profilometer and then mean (R_a) and maximum (R_max) of surface roughness were recorded. Then, the surface of 4 specimens of each subgroup was observed under SEM. Statistical analysis was performed with T-test, ANOVA and Dunnett T3 tests.

Results: In all materials, Ra was different between polishing with 180 and 2500-grit silicon carbide papers. In 180-grit group, only R_a of Filtek P60 and Fuji IX showed significant difference (P=0.01). In 2500-grit group, there was no significant difference between the Ra of Filtek P60 and Filtek P90 (P=0.56).

Conclusion: Polishing is recommended for the glass ionomer and posterior composite restorations.

Background and Aims: Polymerization shrinkage in Methacrylate-based composite is one of the most important factors in composite restorations failure. Silorane-based composite is introduced to compensate this drawback and claimed to have low shrinkage. The aim of this study was to evaluate the polymerization shrinkage of these two composites.

Materials and Methods: In this experimental study, 5 disk shape samples for each resin composites were placed in the centre of metallic ring bonded to microscopic glass slab. Top surface of ring was covered by a glass cover slip. Glass slab and sample were placed on a special LVDT holder in order to light cure from bottom surface and to measure the polymerization shrinkage. In this study, Deflecting Disk method and LVDT (linear variable differential transducer) was used for dimensional change measurement of resin composites. In this study, two LED curing units were used for composite polymerization.

Results: The mean of polymerization shrinkage in Z250 cured with LED and High Power LED was 11.15±0.08µm and 11.51±0.17µm, respectively (P=0.094), and in P90 cured with LED and High Power LED was 1.08±0.06µm and 1.16±0.12µm, respectively (P=0.019).

Conclusion: Silorane-based composite (P90) showed significantly less polymerization shrinkage than that of methacrylate-based composite (Z250). For the two types of composite, there was no significant difference between the two curing units in polymerization shrinkage.

Background and Aims: The purpose of this in vitro study was to assess the effect of two different surface treatments on the contrast ratio of IPS e.max press ceramic submitted to accelerated aging.

Materials and Methods: Ten ceramic (IPS e.max Press) disks (10-mm diameter and 1.5-mm thick) were fabricated according to the manufacturer's recommendations. The samples were randomly divided into 2 groups (n=5): polishing and glazing. Contrast ratio ware obtained with a spectrophotometer before and after accelerated aging. The contrast ratio (CR=Yb/Yw), was defined as the ratio of illuminance (Y) of the test material when it is placed on the black background (Yb) to the illuminance of the same material when it is placed over a white background (Yw), was determined. The data were statistically analyzed by two-way analysis of variance (P<0.05).

Results: All specimens of IPS e.max press ceramic showed significant increase in CR after 300-hour accelerated aging time (P=0.005). Polished samples showed significantly higher opacity compared with that of the glazed ones (P=0.018).

Conclusion: Within the limitations of this study, it may be concluded that the glazed specimens showed higher stability in their translucency than the polished specimens.

Background and Aims: Skeletal class III malocclusions are considered as one of the most complex and difficult orthodontic problems to diagnose and treat. Facial appearance and occlusion problems make the patients to seek treatment as soon as possible. The purpose of this study was to evaluate the outcomes of early treatment with facemask compared to the patients who had no treatment.

Materials and Methods: For this retrospective study, 38 growing patients (mean age, 8.5 years old) with class III dentoskeletal malocclusion were divided into 2 groups. 23 patients were treated with facemask and 15 patients who did not receive any treatment were assigned as control group. Lateral cephalograms were taken before and after treatment and dentoskeletal changes were estimated. Data were analyzed using Wilcoxon signed ranks test.

Results: The results revealed statistically significant forward displacement of maxillary bone and upper incisors (P<0.001), and downward-backward rotation of mandible in facemask group (P<0.001). Increased lower facial height was seen in both treatment and untreated groups. However, in untreated group some measurements revealed forward displacement of maxillary complex as well.

Conclusion: It seems that in class III patients treating with facemask is a better choice than ChinCap and decision making for early treatment in class III patients should be considered seriously. Moreover, specific attention to the type of patient’s skeletal discrepancy is necessary. In class III patients, facemask might be a better option than other appliances.

  Background and Aims: Along with the advances in dental materials and invention of new techniques for ceramic producion, the demand for the beauty and matching restoration’s color with patient’s natural teeth is growing. Nowadays, zirconia systems are the focus of attention. Despite their strength, one of the problems with such systems is the high opacity and failing to provide the favored color. Considering few studies about the influence of shading on Zirconia, the purpose of this in vitro study was to evaluate the effect of different shading of zirconia-based ceramics on the biaxial flexural strength .

  Materials and Methods: In this in vitro experimental study, Rainbow (Dentium, Korea) zirconia-based ceramics (the diameter of 15mm and 1mm in thick) were divided into four groups of 10 specimens. According to Vita shade guide system and manufacturer’s time recommendations (3 seconds), three groups of disc specimens were shaded to A3, B3 and D3 colors and other ten specimens remained uncolored as control group. The biaxial flexural strength test of discs was evaluated and the elements’ composition of colors was detected by Energy Dispersiue X-ray Microanalysisd (EDX). Finally, data were analyzed using one-way ANOVA and Post-hoc tests.

  Results: The biaxial flexural strength in non colored specimens, A3 shaded discs, B3 shaded, and D3 shaded specimens were determined 1061.93, 819.16, 1100.10, and 825.48 MPa respectively which was statistically significant among groups (P<0.001). The statistical analysis revealed that the highest strength in B3 and non colored groups which were significantly higher than A3 and D3. EDX analysis showed significant differences among different colored compositions.

  Conclusion: The biaxial flexural strength of zirconia cores are affected by shading and the specific selected color.

  Background and Aims: Metallic nano-particles show exclusive biological, chemical and physical characteristic. The purpose of this research was to evaluate the effect of various amounts of nanosilver incorporation (0 (as control), 20, 40, 80, 120, 200 ppm) on the mechanical Properties ( compressive and flexural strength) of resin modified Glass ionomer Cement.

  Materials and Methods: Based on ISO 4049 and ISO 9971 for polyalkenoid cements, 90 cases in each group were prepared for the flexural and compressive strength. Specimens in 6 groups with different amounts of nanosilver (20, 40, 80, 120 and 200 ppm) and control (Fuji II LC improved), stored in distilled water at 37 ° C for 1 day and 30 days. Flexural strength, using a three-point bending method, Modulus of elasticity and the compressive strength were measured by universal testing machine (Zwick) with crosshead speed of 0.5 mm/min. Data were analyzed using two-way ANOVA and Tukey post HOC test.

  Results: The flexural strength and modulus of various amounts of nanosilver incorporation of resin modified glass-ionomer cement were not significantly different (P>0.05). The compressive strength of incorporating of
20 ppm compared with control (P=0.01), 40 ppm (P=0.02) and 80 ppm compared with control (P<0.001) were increased. The flexural strength and compressive strength of Fuji II LC, containing nanosilver particles were increased after 1 day and 1 month significantly (P<0.001).

  Conclusion: Incorporation of 20 to 80 ppm nanosilver into Fuji II LC had increased mechanical properties compared to the original cement.

  Background and Aims: The increase in the number of complex implant cases has drawn the attention of researchers toward materials having bone regeneration promoting ability. Socket preservation and bone graft are recommended to minimize bone resorption. The aim of this study was to evaluate a kind of xenograft collagenic bone (osteo biol gen_oss) in socket regeneration.

  Materials and Methods: This randomized clinical trial was performed in 12 cases (6 in test and 6 in control groups) with two hopeless teeth. After tooth extraction, in test group, graft material was put in sockets but in the control group the socket was healed naturally. Three months later, during implant placement the specimens from both sites were sent to a pathologist for histologic and histomorphometric evaluations. Data were analyzed using Mc Nemar and Wilcoxan sigh rank test (α=0.05).

  Results: There were no significant differences between two groups in foreign body reaction, inflammation, bone vitality and percentage of bone gain. Average percentage of residual graft in test site was 6.73±1.43.

  Conclusion: Osteobiol gen_oss xenograft is an appropriate biocompatible osteoconductive material that promotes bone regeneration at 3 months following socket preservation in human extraction sockets.

  Background and Aims : Antibiotics are commonly used for controlling the growth of porphyromons gingivalis (P.g) which is one of the most important etiologic factors in the periodontal diseases. Different side effects of synthetics and chemical drugs such as increasing the drug resistancy in the human pathogens have led to study on the herbal antibacterial effect. The aim of this study was to evaluate the antibacterial effect of cinnamon on the growth of porphyromons gingivalis in chronic periodontitis patients with deep pockets.

  Materials and Methods: In this experimental study, samples were provided from patients having pockets. After culturing the microorganism and diagnosis of P.g by gram staining and biochemical tests, cinnamon in different concentrations (10, 50, 100, 250, 500, 750 and 1500 mg/ml ) with oil solvent were prepared and placed by disks in the cultures medium. Positive controls were amoxicillin, metronidazole, ciprofloxacin, amikacin and gentamycin . Oil was negative control. Then the plates were incubated for 24 hours in 37 ⁰ C and then non-growth halos by disk diffusion method, MIC (Minimum Inhibitory Concentration) and MBC (Minimum Bactericidal Concentration) were determined. Data were analyzed using One-way ANOVA test.

  Results: The results showed that the cinnamon at the concentration of MIC=750 mg/ml had the inhibitory effects of bacteria and at the concentration of MIC=1500 mg/ml had killing effect. However, this antibacterial effect compared with commonly used antibiotics (amoxicillin, metronidazole), was much weaker (P<0.001).

  Conclusion: Cinnamon showed an antimicrobial effect on porphyromonas gingivalis in chronic periodontitis patients with deep pockets.

  Background and Aims: Since recurrent caries are one of the major causes of failure in resin restorations, the production of antibacterial resin composites was always under investigation. The aim of this study was to evaluate the efficacy of fissure sealants containing nanosilver particles against the Streptococcus mutans.

  Materials and Methods: In this experimental study, the antibacterial properties of two sealants (with fluoride (Clinpro 3M) and without fluoride (Concise 3M) was investigated with 0, 0.01, 0.02, 0.03, 0.04, 0.05% w/w after adding nano-silver using direct contact test. Sealants formed on the walls of 500ml micro tube and after curing, they left in contact with bacterial suspension. In periods of 3, 24, 48h, a 10 µl volume of liquid medium was placed in blood agar culture and after 24 h incubation at 37ºC, the number of S.mutans colony was counted by colony counter. Data were analyzed using ANOVA and
T-test.

  Results: Results reported sealants with fluoride comparing to non fluoride ones had significant effect on inhibition of S.mutans growth (P<0.001). The direct contact test demonstrated that by increasing the amount of nano particles, the bacterial growth was significantly diminished (P<0.001).

  Conclusion: While sealants with fluoride demonstrated antibacterial effect, sealants with incorporation of higher weight percentage of nanosilver particles, had stronger and more significant antibacterial effect in direct contact test.

  Background and Aims : Dentists have usually a critical role in diagnosing oral cancer lesions in their early stages. In this study we aimed to assess the senior dental student’ and dentists’ knowledge, attitude and behaviors regarding oral cancer in Isfahan.

  Materials and Methods: A valid and reliable self-administered questionnaire was designed to assess the current practice, knowledge and attitude of general dentists working in Isfahan-Iran and senior dental students regarding oral cancer lesions. The questionnaire was consisted of questions to assess the knowledge and attitude regarding diagnosis, risk factors and prognosis of oropharyngeal cancerous lesions. The frequencies of answers to questions in sections of practice and attitude (just for dentists) and sum score of questions in knowledge section were calculated and compared using statistical analysis regarding age, sex, duration of experience and practice setting ) p ublic/private) of participants. Data were analyzed using ANOVA, chi-square, linear regression and logistic regression.

  Results: 139 questionnaires from dentists and 57 questionnaires from students were returned. The mean score of dentists’ knowledge was 5.41 out of 13 (CI95%=5.03-7.79 ). Significant differences were observed among dentists regarding their experience (P=0.001). Only one fifth of the dentists in our survey reported to perform oral cancer examination for all of their patients in age of 40 and above and just about 34% of dentists gained acceptable level of knowledge. Among senior dental students, the status of knowledge was better as about 58% of them gained the level of acceptance (P=0.01).

  Conclusion: Although dentists were willing to follow the diagnostic protocol for oral cancer, they were mostly unsatisfied with the level of their knowledge. Therefore, this study highlights the need for educational planning and training activities in general dentists with regard to the risk factors and early detection of oral cancers.

  Background and Aims: The aim of this review article was to present the information have been published, regarding the functional properties of Zirconia until today.

  Materials and Methods: A review of the literature was carried out in MEDLINE database using key words (Dental ceramic, Zirconia, 3Y-TZP, Clinical performance, Machining and Transformation toughening). These searches were limited to the articles published after the year 2000.

  Conclusion: Despite excellent clinical results in short-term studies, there is still a major need to have more clinical and laboratory long-term information about zirconia restorations.

  Background and Aims: The purpose of the present study was to review the studies regarding serological and salivary oxidant / antioxidant status in patients with recurrent aphthous stomatitis (RAS).

  Materials and Methods: The literature was searched using key words RAS, Antioxidants, Saliva, Hematinic (s) and Hematinic Acid in the last 10 years, particularly the recent 3 years (2010-2013). At total of 37 clinical trials, 18 case-control articles were selected and evaluated fulfilling the requirements as the RAS patients having at least 3 oral aphthous attack per year. The exclusion criteria included systemic as well as periodontal diseases, iron deficiency associated anemia, medication usage and smoking.

  Conclusion: Almost all lipid-peroxidation studies in serum and saliva were manifested by an increase of malondialdehyde (MDA) concentration in RAS patients compared with controls. This would indicate the role of reactive oxygen species (ROS) in the etiology of the disease. Serum trace elements (Zn, Se) were reduced and Cu was increased in RAS patients in comparison with control individuals. A decreased serum superoxide dismutase (SOD) and an increased salivary SOD were observed in all RAS patients. Catalase (CAT) and uric acid (UA) analyses were non-inclusive. Levels of paraoxonase and arylesterase as well as antioxidant vitamins (A, E, C) were lower in RAS patients than that of controls.

  Background and Aims: The routine mechanical plaque control is done by toothbrush. With regard to different designs of tooth head brushes in order to better plaque removal, the aim of this study was to evaluate the effect of between teeth and cross-action tooth brush on the plaque and gingival status among dental students of dental branch-Islamic Azad University during 2012-13 academic years.

  Materials and Methods: This single-blind, cross over, clinical trial was conducted on 30 subjects with mean age (23±0.9) in two groups of 15 persons . They had at least 20 teeth and had gingivitis with no history of antibiotic use in the last 3 months. Those who were undergoing orthodontic treatment, using drugs affecting the gums and having crown and bridge were excluded from the study. The first group used the cross action toothbrush and the second group used between teeth toothbrush and the subjects were asked to brush their teeth for two minutes twice a day in modified bass method and not to floss during the execution of this study. After 14 days plaque index (Turesky, Approximal plaque index) and gingival bleeding index were recorded on all teeth except third molars. After a week wash out period, second stage of the study was conducted the same as the first stage with the other kind of brush for each group. Data were analyzed using Generalized Linear Model (GLM) test.

  Results: There was no statistical significant difference between two toothbrushes based on plaque index, gingival bleeding index and approximal plaque index, respectively (P = 0.29, P = 0.47, P = 0.33). In all measured indices, the treatment sequence showed no significant difference (P = 0.23).

  Conclusion: There was no statistical difference between cross-action and between teeth toothbrush in reducing plaque and gingival bleeding.