SANP (Sayem-Amit-Nilesh-Prajakta) Brushing Technique - Modified Sulcular Cleansing Technique for Orthodontic Cases

INTRODUCTION The World Health Organization ranks malocclusion as one of the most serious oral health issues, following caries and periodontal disease. Its prevalence is highly varied, with estimates ranging from 39% to 93% in children and adolescents.[1] When a child starts to transition into mixed dentition, malocclusion frequently occurs. Speech issues, feeding difficulties, facial structure alterations, and biting of the tongue and cheek are all consequences of malocclusion.[2] There are many treatment methods available for correcting the malocclusion. The majority of these include the use of some fixed, semi-fixed, or removable appliances to correct the deformed occlusion. At times, surgeries are indicated, such as skeletal malocclusions. Although necessary, these treatment options can often lead to some or the other complications, such as root resorption, calcifications, temporomandibular joint disorders (TMD), traumatic ulceration, pulpal death, and the most common being periodontal diseases.[3] The periodontal condition may be preserved, harmed, or improved by orthodontic therapy. Patients may be more susceptible to periodontal disease or other diseases while undergoing orthodontic therapy. Patients who have orthodontic devices and attachments may have a higher chance of acquiring or redeveloping periodontal illnesses because they are unable to adequately eliminate tooth plaque.[4-6] Thus, plaque control is an essential step in maintaining the periodontal health during orthodontic treatment. Short, circular, or back-and-forth motions are used in the Charter brushing technique to clean teeth. People who have exposed roots, gum recession, or braces are frequently advised to have it. The brush is held directed toward the chewing surface at a 45° angle to the gum line. The teeth are lightly pushed up against the bristles. For 15–20 repetitions, brief, circular, or back-and-forth motions are performed for every tooth. Braces, dentures, and surgical areas require extra caution. When gingival stimulation is taken into account, it is ineffective even though it is one of the finest ways to get rid of food particles, helps the area heal after periodontal surgery, and may be used to clean around orthodontic equipment. Lack of gingival sulcus cleaning leads to plaque accumulation and resultant gingivitis and periodontitis. Thus, to combat these drawbacks, we innovated and theorized a novel technique which combines the modified Bass method with the Charters method to efficiently clean the gingival sulcus while also stimulating it to prevent orthodontic treatment-associated gingivitis and subsequent periodontitis. SAYEM-AMIT-NILESH-PRAJAKTA (SANP) BRUSHING TECHNIQUE Registration of the technique The technique is registered in the Copyright Office, Government of India, under Literary/Dramatic Work with registration number “L-156157/2024.” Aim of the technique This technique aims to combat the drawbacks and shortcomings of the traditional Charters method. This technique is theorized to combine the modified Bass method with that of the Charters method. Procedure The first step in the brushing technique is to gently enter the bristle tips into the gingival sulcus while holding the toothbrush at a 45° angle to the gingival edge. The sulcular and marginal gingival regions, which are crucial locations for plaque buildup, may be efficiently accessed by the bristles because to this angulation. The modified Bass technique allows for the rupture of plaque biofilm beneath the gingival edge while limiting damage to the gingival tissues by applying brief, mild vibratory and circular motions without applying undue pressure. A sweeping motion typical of the roll method is added after the vibratory phase of the Bass technique. Plaque and debris are successfully swept away from the gingival border and toward the occlusal or incisal surfaces by this action, which guides the bristles coronally. In order to minimize damage to orthodontic equipment and to provide targeted cleaning around the gingival edge and bracket bases, this sweeping action is purposefully limited up to the level of the brackets in patients. To guarantee consistent plaque removal, the same procedure vibration followed by a controlled sweep is methodically repeated for every tooth. The classic Charters method’s horizontal strokes are used once the modified bass and roll motions are finished. To better reach regions around orthodontic brackets and interproximal gaps, the bristles are slanted at a 45° angle toward the tooth’s crown in this stage. In order to ensure thorough cleaning of the gingival and coronal areas, gentle horizontal strokes are used to assist in removing plaque that has been held on the tooth surfaces and around appliance components [Figure 1].Figure 1: Sayem-Amit-Nilesh-Prajakta (SANP) brushing techniqueAdvantages Intrasulcular cleaning is possible with this method Massage and stimulation of the entire gingiva is possible. Disadvantages High dexterity is needed Time-consuming Necessitates certain easily employable toothbrushes. Future prospects This brushing routine is essentially multidisciplinary, incorporating ideas from periodontology, orthodontics, preventive dentistry, and oral public health. In order to avoid gingivitis and periodontal deterioration, the modified Bass method is used to reduce plaque at the gingival edge and within the sulcus. Orthodontic issues are addressed by modifications such as limiting the sweeping action close to orthodontic brackets and using the Charters technique, which guarantees efficient plaque removal around fixed appliances without jeopardizing bracket integrity. The combined methods emphasize biofilm disruption, patient safety, and long-term oral health maintenance from the standpoint of preventive dentistry, and their structured and teachable nature supports public health objectives of enhancing oral hygiene practices through patient education and behavioral modification. This is a theorized concept and needs clinical trials to test its efficiency in routine practice. The technique needs to be tested in patients in comparison to the other techniques available. The technique should also be tested for its efficacy with various toothbrushes available. CONCLUSION Sulcular cleansing is an important part of maintaining oral hygiene, especially in orthodontic cases. The use of Sayem-Amit-Nilesh-Prajakta brushing technique combines the advantages of the modified Bass method along with the Charters method. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.