Effectiveness of orthodontic toothbrush versus conventional toothbrush on plaque and gingival index reduction: a systematic review and meta-analysis.

Abstract

OBJECTIVE\nIn orthodontic patients submitted to oral hygiene instruction, what is the efficacy of orthodontic toothbrush (O-TB) versus conventional toothbrush (C-TB) on plaque and gingival index reduction in randomized and nonrandomized controlled clinical trials?\n\n\nMETHODS\nElectronic database search was performed on: PubMed, ClinicalTrials.gov, Cochrane Library, and Google Scholar. Database research, study selection, data extraction and ROBINS-I and Risk of Bias Tool 2.0 analysis were conducted by two independently examiners in duplicate. Two different meta-analyses were performed for plaque index and gingival index, followed by the analysis of overall quality of the evidence using GRADE.\n\n\nRESULTS\nA total of 158 studies were identified for screening, 6 articles were included in qualitative synthesis, and of those, three were subjected to a quantitative synthesis (meta-analysis). Three non-randomized studies presented an overall low , moderate and high risk of bias for each one of the articles, and the 3 randomized clinical trials presented low risk for two articles and some concerns quality for the other one. The overall strength of evidence was ranked very low quality for plaque index and gingival index subgroups.\n\n\nCONCLUSIONS\nGingival bleeding is not modified by orthodontic design toothbrush, but there is circumstantial scientific evidence for recommending the use of an O-TB instead a C-TB based on the analysis of plaque index control. Although major plaque removal of the O-TB was validated by meta-analysis, this improvement is not completely clarified which calls for further clinical studies to assess the effects of using an O-TB compared to a C-TB.