In-vitro simulation methods for mechanical plaque removal: a systematic scoping review of current techniques and future directions.

BACKGROUND AND OBJECTIVES

Different methods to simulate plaque in order to test the efficacy of oral cleaning methods have been published. This scoping review aims to provide an overview of the existing models and to highlight their respective benefits and limitations.

MATERIAL AND METHODS

Following the recommended scoping review methodology the scientific literature was systematically searched electronically (PubMed and Scopus) and by hand search up to July 2024, using combinations of search items related to oral plaque simulation, periodontitis or peri-implantitis. Retrieved study titles and abstracts were screened for possible inclusion. Finally, data from included fulltexts was extracted by two independent reviewers. Nine different characteristics for proper plaque simulation method were defined and each existing method evaluated and rated accordingly, and an overall rating was calculated for each method.

RESULTS

Initially, 1787 records were identified. After abstract and title screening and fulltext revision, 25 fulltexts describing 7 different simulation methods, were included. The assessed methods of simulation were ink (12), varnish (5), calcium phosphate (1), calcium carbonate (1), occlusal spray (3), aluminum (1), commercially distributed and prepared artificial plaque (2). Even though some materials achieved good results in the assessment for individual criteria like water solubility, big differences could be found concerning practicability and production time, no simulation method was rated "very good" or even "good" in the overall evaluation. While ink and varnish were considered simulation materials of moderate quality for oral plaque simulation, all other techniques were assessed as weak simulation materials.

CONCLUSION

Among the different published methods for the simulation of mechanical plaque removal, none seems to sufficiently simulate the essential characteristics of oral plaque, while some simulation methods may be useful to feature single properties of plaque in in-vitro studies sufficiently. Nevertheless, advanced models reflecting the diverse features of dental plaque more comprehensively are needed.