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Comparaison des brosses à dents électriques et manuelles pour la santé bucco‐dentaire

Appendices

Appendix 1. Cochrane Oral Health Group's Trials Register search strategy

From January 2014, searches of the Cochrane Oral Health Group's Trials Register for this review were undertaken using the Cochrane Register of Studies and the search strategy below:

1 ((toothbrush* or tooth‐brush* or "tooth brush*"):ti,ab) AND (INREGISTER)
2 ((manual or conventional or handbrush):ti,ab) AND (INREGISTER)
3 ((power* or mechanical* or electric* or electronic or ultrasonic* or sonic* or "motor driven" or "battery operated" or "battery power*" or automatic*):ti,ab) AND (INREGISTER)
4 (#1 and #2 and #3) AND (INREGISTER)

Previous searches of the Cochrane Oral Health Group's Trials Register were undertaken using the Procite software and the search strategy below:

(toothbrush* AND (manual or conventional or handbrush) AND (power* or mechanical* or electri* or electronic* or "motor driven" or ultrasonic* or automatic* or oscillat* or *sonic* or "counter rota*" or "battery operat" or battery‐powered))

Appendix 2. Cochrane Central Register of Controlled Trials (CENTRAL) search strategy

#1 MeSH descriptor toothbrushing this term only
#2 toothbrush* in All Text
#3 ((tooth in All Text near/6 clean* in All Text) or (teeth in All Text near/6 clean* in All Text))
#4 (#1 or #2 or #3)
#5 (manual in All Text or conventional* in All Text or handbrush* in AllText)
#6 (power* in All Text or mechanical* in All Text or electric* in All Text or electronic in All Text or ultrasonic* in All Text or sonic* in All Text or "motor driven" in All Text or "battery operated" in All Text or "battery power*" in All Text or automatic* in All Text)
#7 (#4 and #5 and #6)

Appendix 3. MEDLINE (OVID) search strategy

1. exp Toothbrushing/
2. toothbrush$.mp.
3. ((tooth or teeth) adj3 clean$).mp.
4. or/1‐3
5. manual$.mp.
6. conventional$.mp.
7. handbrush$.mp.
8. 5 or 6 or 7
9. power$.mp.
10. mechanical$.mp.
11. electronic$.mp.
12. electric$.mp.
13. ultrasonic$.mp.
14. sonic$.mp.
15. "motor driven".mp.
16. "battery operated".mp.
17. automatic$.mp.
18. or/9‐17
19. 4 and 8 and 18

The above subject search was linked to the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomised trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of theCochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 (updated March 2011) (Higgins 2011).

1. randomized controlled trial.pt.
2. controlled clinical trial.pt.
3. randomized.ab.
4. placebo.ab.
5. drug therapy.fs.
6. randomly.ab.
7. trial.ab.
8. groups.ab.
9. or/1‐8
10. exp animals/ not humans.sh.
11. 9 not 10

Appendix 4. EMBASE (OVID) search strategy

1. Tooth brushing/
2. (toothbrush$ or (tooth adj brush$))
3. ((tooth or teeth) adj3 clean$)
4. 1 or 2 or 3
5. manual$
6. conventional$
7. handbrush$
8. 5 or 6 or 7
9. power$
10. mechanical$
11. electric$
12. electronic$
13. ultrasonic$
14. sonic$
15. "motor driven"
16. "battery operated"
17. automatic$
18. 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17
19. 4 and 8 and 18

The above subject search was linked to the Cochrane Oral Health Group filter for EMBASE via OVID:

1. random$.ti,ab.
2. factorial$.ti,ab.
3. (crossover$ or cross over$ or cross‐over$).ti,ab.
4. placebo$.ti,ab.
5. (doubl$ adj blind$).ti,ab.
6. (singl$ adj blind$).ti,ab.
7. assign$.ti,ab.
8. allocat$.ti,ab.
9. volunteer$.ti,ab.
10. CROSSOVER PROCEDURE.sh.
11. DOUBLE‐BLIND PROCEDURE.sh.
12. RANDOMIZED CONTROLLED TRIAL.sh.
13. SINGLE BLIND PROCEDURE.sh.
14. or/1‐13
15. ANIMAL/ or NONHUMAN/ or ANIMAL EXPERIMENT/
16. HUMAN/
17. 16 and 15
18. 15 not 17
19. 14 not 18

Appendix 5. CINAHL (EBSCO) search strategy

S1 MH "Toothbrushing+"  
S2 toothbrush*  
S3 (tooth N3 clean*) or (teeth N3 clean*)  
S4 S1 or S2 or S3  
S5 manual*  
S6 conventional*  
S7 handbrush*  
S8 S5 or S6 or S7  
S9 power*  
S10 mechanical*  
S11 electric*  
S12 electronic*  
S13 ultrasonic*   
S14 sonic*  
S15 "motor driven"  
S16 "battery operated"  
S17 automatic*  
S18 S9 or S10 or S11 or S12 or S13 or S14 or S15 or S16 or S17  
S19 S4 and S8 and S18  

The above subject search was linked to the Cochrane Oral Health Group filter for CINAHL via EBSCO

S1 MH Random Assignment or MH Single‐blind Studies or MH Double‐blind Studies or MH Triple‐blind Studies or MH Crossover design or MH Factorial Design  
S2 TI ("multicentre study" or "multicenter study" or "multi‐centre study" or "multi‐center study") or AB ("multicentre study" or "multicenter study" or "multi‐centre study" or "multi‐center study") or SU ("multicentre study" or "multicenter study" or "multi‐centre study" or "multi‐center study")   
S3 TI random* or AB random*  
S4 AB "latin square" or TI "latin square" 
S5 TI (crossover or cross‐over) or AB (crossover or cross‐over) or SU (crossover or cross‐over)  
S6 MH Placebos  
S7 AB (singl* or doubl* or trebl* or tripl*) or TI (singl* or doubl* or trebl* or tripl*)
S8 TI blind* or AB mask* or AB blind* or TI mask*  
S9 S7 and S8
S10 TI Placebo* or AB Placebo* or SU Placebo*  
S11 MH Clinical Trials 
S12 TI (Clinical AND Trial) or AB (Clinical AND Trial) or SU (Clinical AND Trial) 
S13 S1 or S2 or S3 or S4 or S5 or S6 or S9 or S10 or S11 or S12  

In a previous version of this review, the following search strategy was used for CINAHL via OVID:

1. exp toothbrushes/
2. toothbrush$
3. ((tooth or teeth) adj3 clean$)
4. 1 or 2 or 3
5. manual$
6. conventional$
7. handbrush$
8. 5 or 6 or 7
9. power$
10. mechanical$
11. electric$
12. electronic$
13. ultrasonic$
14. sonic$
15. "motor driven"
16. "battery operated"
17. automatic$
18. 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17
19. 4 and 8 and 18

Appendix 6. US National Institutes of Health Trials Register (ClinicalTrials.gov) and WHO International Trials Register Platform search strategy

toothbrush* AND electric*
toothbrush* AND power*

Flow chart of study selection in this update.
Figuras y tablas -
Figure 1

Flow chart of study selection in this update.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot of Comparison 1: All powered toothbrushes versus manual toothbrushes, Outcome 1.1: Plaque scores at 1 to 3 months at all sites.
Figuras y tablas -
Figure 4

Funnel plot of Comparison 1: All powered toothbrushes versus manual toothbrushes, Outcome 1.1: Plaque scores at 1 to 3 months at all sites.

Funnel plot of Comparison 1: All powered toothbrushes versus manual toothbrushes, Outcome 1.2: Gingival scores at 1 to 3 months at all sites.
Figuras y tablas -
Figure 5

Funnel plot of Comparison 1: All powered toothbrushes versus manual toothbrushes, Outcome 1.2: Gingival scores at 1 to 3 months at all sites.

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.
Figuras y tablas -
Analysis 1.1

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 1.2

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.
Figuras y tablas -
Analysis 1.3

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.
Figuras y tablas -
Analysis 1.4

Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.
Figuras y tablas -
Analysis 2.1

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 2.2

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.
Figuras y tablas -
Analysis 2.3

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.
Figuras y tablas -
Analysis 2.4

Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.
Figuras y tablas -
Analysis 3.1

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 2 Gingivitis scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 3.2

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 2 Gingivitis scores at 1 to 3 months at all sites.

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.
Figuras y tablas -
Analysis 3.3

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.
Figuras y tablas -
Analysis 3.4

Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.
Figuras y tablas -
Analysis 4.1

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 4.2

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.
Figuras y tablas -
Analysis 4.3

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months.

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.
Figuras y tablas -
Analysis 4.4

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.

Study

Plaque

Gingivitis

Costa 2007

No statistically significant pre‐post differences shown

No statistically significant pre‐post differences shown

Gugerli 2007

"Subjects using a power toothbrush during initial treatment reduced supragingival plaque to lower levels...than subjects using a manual brush"

"Subjects using a power toothbrush ...showed significantly less bleeding on probing than subjects using a manual brush"

Zimmer 2005

Median change in Quigely‐Hein at 4 weeks:

Powered (Cybersonic): 0.23

Powered (Braun 3D Excel): 0.07

Manual: 0.22

Median change in Quigely‐Hein at 8 weeks:

Powered (Cybersonic): 0.41

Powered (Braun 3D Excel): 0.08

Manual: 0.35

All indices showed statistically significant reductions for both power
toothbrushes which were superior to the manual brush

Median change in papillary bleeding index at 4 weeks:

Powered (Cybersonic): 0.25

Powered (Braun 3D Excel): 0.02

Manual: 0.39

Median change in papillary bleeding index at 8 weeks:

Powered (Cybersonic): 0.36

Powered (Braun 3D Excel): 0.10

Manual: 0.61

Figuras y tablas -
Analysis 4.5

Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 5 Rotation oscillation versus manual: data not suitable for meta‐analysis.

Comparison 5 Circular powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.
Figuras y tablas -
Analysis 5.1

Comparison 5 Circular powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.

Comparison 5 Circular powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 5.2

Comparison 5 Circular powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 months.
Figuras y tablas -
Analysis 6.1

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 months.

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 2 Plaque scores at >3 months at all sites.
Figuras y tablas -
Analysis 6.2

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 2 Plaque scores at >3 months at all sites.

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 3 Gingivitis at 1 to 3 months.
Figuras y tablas -
Analysis 6.3

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 3 Gingivitis at 1 to 3 months.

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months at all sites.
Figuras y tablas -
Analysis 6.4

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months at all sites.

Study

Plaque

Gingivitis

Galgut 1996

The electrically active toothbrushes better plaque removal than the inactive toothbrushes (6.5% more plaque removal at final visit)

Not reported

Moreira 2007

Frequency distribution for plaque zero at baseline and 28 days was 9.27+/‐ 10.14/17.75+/‐9.60 and 8.42+/‐10.43/16.79+/‐8.93 for ionic and conventional toothbrushes respectively

Not reported

Figuras y tablas -
Analysis 6.5

Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 5 Ionic versus manual: data not suitable for meta‐analysis.

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.
Figuras y tablas -
Analysis 7.1

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites.

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 7.2

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months at all sites.
Figuras y tablas -
Analysis 7.3

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months at all sites.

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.
Figuras y tablas -
Analysis 7.4

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months.

Study

Plaque

Gingivitis

Costa 2007

"There was a significant difference for the ultrasonic/buccal group indicating that the ultrasonic brush improved plaque reduction on the buccal surfaces (p=0.007, Wilcoxon test)"

Marginal bleeding: "No significant differences were noted in the nine subgroups (p>0.05, Wilcoxon test)"

Zimmer 2005

"Improvements of the indices after 4 and 8 weeks were calculated for comparison between groups. After 4 and 8 weeks, with respect to all indices, the use of the power toothbrushes resulted in improvements which were statistically significant superior to what was found for the manual brush (p<0.001)." Results were presented as box‐plots with medians and 25, 75 percentiles. Non‐parametric tests have been used for the data analysis

"Improvements of the indices after 4 and 8 weeks were calculated for comparison between groups. After 4 and 8 weeks, with respect to all indices, the use of the power toothbrushes resulted in improvements which were statistically significant superior to what was found for the manual brush (p<0.001)." Results were presented as box‐plots with medians and 25, 75 percentiles. Non‐parametric tests have been used for the data analysis

Figuras y tablas -
Analysis 7.5

Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 5 Ultrasonic versus manual: data not suitable for meta‐analysis.

Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 8.1

Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 months at all sites.

Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.
Figuras y tablas -
Analysis 8.2

Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites.

Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 3 Gingival scores >3 months at all sites.
Figuras y tablas -
Analysis 8.3

Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 3 Gingival scores >3 months at all sites.

Powered toothbrushes compared with manual toothbrushes for oral health

Patient or population: Individuals of any age with no reported disability that might affect toothbrushing

Intervention: Powered toothbrushes with any mode of action

Comparison: Manual toothbrushes

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Manual toothbrush

Powered toothbrush

Plaque scores at 1 to 3 months

Scale from: 0 to 5

The mean plaque score in the control group was 2.16 points1

The mean plaque score in the intervention groups was
0.23 lower (0.32 lower to 0.14 lower)

2871 (40 studies)

⊕⊕⊕⊝
moderate3,4

This effect represents an 11% reduction in plaque at 1 to 3 months

Long‐term data (>3 months) also showed a statistically significant reduction in plaque for powered toothbrushes compared to manual toothbrushes

Gingival scores at 1 to 3 months

Scale from: 0 to 3

The mean gingivitis score in the control group was 1.1 points2

The mean gingivitis score in the intervention groups was
0.07 lower (0.10 lower to 0.04 lower)

3345
(44 studies)

⊕⊕⊕⊝
moderate3,4

This effect represents a 6% reduction in gingivitis at 1 to 3 months

Long‐term data (>3 months) also showed a statistically significant reduction in gingivitis for powered toothbrushes compared to manual toothbrushes

Adverse events

There was no apparent relationship between the use of powered toothbrushes and soft tissue trauma. In part this finding was due to the very small number of adverse events reported in the trials

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

1. Based on median of control means for all trials presenting data using Quigley Hein index at 1 to 3 months

2. Based on median of control means for all trials presenting data using Löe and Silness index at 1 to 3 months

3. Downgraded due to statistically significant heterogeneity (I2 = 83% for plaque; I2 = 82% for gingivitis)

4. No downgrading was undertaken for risk of bias although 46/56 included trials were assessed as being at unclear risk of bias. Given that many of the studies were conducted over 10 years ago, it was felt much of the uncertainty may be due to poor reporting

Figuras y tablas -
Table 1. Summary of inclusion criteria categories within included studies

Inclusion criteria

Number (n = 56)

Adults

43

Minimum number of teeth

31

Minimum periodontal baseline measures

28

Participants recruited from dental clinics

9

Concurrent fixed orthodontic treatment

8

Some participants aged less than 16 years

11

Volunteer university students

3

Dental students

2

School children

3

Figuras y tablas -
Table 1. Summary of inclusion criteria categories within included studies
Table 2. Summary of exclusion criteria categories within included studies

Exclusion criteria1

Number (n = 56)

Exclusion criteria related to medical history

31

Pregnancy or lactation

5

Previous use of powered toothbrushes

6

Patients undergoing orthodontic treatment

9

Previous periodontal treatment

3

Dental students

2

Cervical restorations

1

Smoking

3

Maximum periodontal measure

8

Wearing partial denture

2

1 Not all trials explicitly stated exclusion criteria

Figuras y tablas -
Table 2. Summary of exclusion criteria categories within included studies
Table 3. Summary of toothbrush modes of action, number of trials and participants

Mode of action

Trial ID

Number of trials

Number in trials

Side to side

Glass 1965, Ho 1997, Johnson 1994, Lobene 1964, McCracken 2009, Moritis 2008, O'Beirne 1996, Tritten 1996, Walsh 1989, Yankell 1997

10

988

Counter oscillation

Baab 1989, Khocht 1992, Stabholz 1996, Wilson 1993, Yukna 1993

5

267

Rotation oscillation

Ainamo 1997, Barnes 1993, Biavati Silvestrini 2010, Biesbrock 2007, Clerehugh 1998, Costa 2007, Cronin 1998, Dentino 2002, Dorfer 2009, Garcia‐Godoy 2001, Gugerli 2007, Haffajee 2001a, Heasman 1999, Hickman 2002, Lapiere unpublished, Lazarescu unpublished, McCracken 2004, Rosema 2008, Sharma 2000, Silverman 2004, Soparkar 2000, Sowinski 2000, Stoltze 1994, van der Weijden 1994, Warren 2001, Yankell 1997, Zimmer 2005

27

2159

Circular

Khocht 1992, Yankell 1996

2

162

Ultrasonic

Costa 2007, Forgas‐B 1998, Goyal 2007, Sharma 2010, Terezhalmy 1995, Zimmer 2002, Zimmer 2005

7

506

Unknown

Emling 1991, Kallar 2011, Singh unpublished, Soparkar 1964, Toto 1966

5

1130

Ionic

Galgut 1996, Moreira 2007, Pucher 1999, van Swol 1996

4

221

Four trials evaluated two powered toothbrushes

Figuras y tablas -
Table 3. Summary of toothbrush modes of action, number of trials and participants
Table 4. Sensitivity analyses of all trials for all indices

Index

Group selected

Number of trials

SMD

Effect P value

Het. P value

I2

Plaque

1‐3 months

All trials

40

‐0.50 (‐0.70 to ‐0.31)

<0.0001

<0.0001

88

Full mouth

34

‐0.58 (‐0.80 to ‐0.36)

<0.0001

<0.0001

85

Low risk of bias

3

‐0.83 (‐2.02 to 0.36)

0.17

<0.0001

94

Manufacturer funded

26

‐0.56 (‐0.82 to ‐0.29)

<0.0001

<0.0001

88

Trials excluding ortho patients

36

‐0.46 (‐0.66 to ‐0.27)

<0.0001

<0.0001

83

Plaque

>3 months

All trials

14

‐0.37 (‐0.50 to ‐0.24)

<0.0001

<0.0001

86

Full mouth

13

‐0.39 (‐0.53 to ‐0.26)

<0.0001

<0.0001

87

Low risk of bias

2

0.12 (‐0.27 to 0.52)

0.53

0.51

0

Manufacturer funded

9

‐0.41 (‐0.56 to ‐0.25)

<0.0001

<0.0001

91

Trials excluding ortho patients

14 (all)

‐0.37 (‐0.50 to ‐0.24)

<0.0001

<0.0001

86

Gingivitis

1‐3 months

All trials

44

‐0.43 (‐0.60 to ‐0.25)

<0.0001

<0.0001

82

Full mouth

35

‐0.47 (‐0.68 to ‐0.25)

<0.0001

<0.0001

85

Low risk of bias

3

‐0.96 (‐1.95 to 0.03)

0.06

<0.0001

93

Manufacturer funded

32

‐0.47 (‐0.68 to ‐0.26)

<0.0001

<0.0001

84

Trials excluding ortho patients

38

‐0.42 (‐0.61 to ‐0.23)

<0.0001

<0.0001

83

 

Gingivitis >3 months

All trials

16

‐0.21 (‐0.31 to ‐0.12)

<0.0001

<0.0001

51

Full mouth

14

‐0.25 (‐0.37 to ‐0.13)

<0.0001

0.006

56

Low risk of bias

2

‐0.12 (‐0.52 to 0.27)

0.54

0.52

0

Manufacturer funded

10

‐0.21 (‐0.35 to ‐0.07)

0.003

0.003

68

Trials excluding ortho patients

16 (all)

‐0.21 (‐0.31 to ‐0.12)

<0.0001

<0.0001

51

SMD = standardised mean difference

Figuras y tablas -
Table 4. Sensitivity analyses of all trials for all indices
Comparison 1. All powered toothbrushes versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 month at all sites Show forest plot

40

2871

Std. Mean Difference (IV, Random, 95% CI)

‐0.50 [‐0.70, ‐0.31]

1.1 Quigley Hein (Turesky)

28

2000

Std. Mean Difference (IV, Random, 95% CI)

‐0.39 [‐0.56, ‐0.22]

1.2 Silness and Löe

6

431

Std. Mean Difference (IV, Random, 95% CI)

‐0.94 [‐1.83, ‐0.05]

1.3 Visible plaque index Ainamo Bay

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.26 [‐0.63, 0.12]

1.4 Ortho modification of Silness and Löe

1

60

Std. Mean Difference (IV, Random, 95% CI)

0.0 [‐0.51, 0.51]

1.5 Navy plaque index mod Rustogi

3

249

Std. Mean Difference (IV, Random, 95% CI)

‐1.13 [‐1.94, ‐0.31]

1.6 O'Leary index

1

20

Std. Mean Difference (IV, Random, 95% CI)

‐1.81 [‐2.88, ‐0.73]

2 Gingival scores at 1 to 3 months at all sites Show forest plot

44

3345

Std. Mean Difference (IV, Random, 95% CI)

‐0.43 [‐0.60, ‐0.25]

2.1 Löe and Silness

30

2109

Std. Mean Difference (IV, Random, 95% CI)

‐0.46 [‐0.66, ‐0.25]

2.2 Lobene gingival index

8

907

Std. Mean Difference (IV, Random, 95% CI)

‐0.43 [‐0.88, 0.03]

2.3 BOP

3

159

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐0.50, 0.12]

2.4 Papillary bleeding index 0‐4 scale

2

95

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐1.55, 1.33]

2.5 BOMP 0‐2 scale

1

75

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐1.04, ‐0.12]

3 Plaque scores at >3 months Show forest plot

14

978

Std. Mean Difference (IV, Random, 95% CI)

‐0.47 [‐0.82, ‐0.11]

3.1 Quigley Hein (Turesky)

11

736

Std. Mean Difference (IV, Random, 95% CI)

‐0.51 [‐0.97, ‐0.04]

3.2 Silness and Löe

2

131

Std. Mean Difference (IV, Random, 95% CI)

‐0.38 [‐1.09, 0.34]

3.3 Visible plaque index Ainamo Bay

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.66, 0.09]

4 Gingival scores at >3 months Show forest plot

16

1645

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.21 [‐0.31, ‐0.12]

4.1 Löe and Silness

5

318

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.27 [‐0.49, ‐0.05]

4.2 Lobene gingival index

4

440

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐0.33, 0.04]

4.3 BOP

4

270

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.46 [‐0.70, ‐0.22]

4.4 Papillary bleeding index 0‐4 scale

1

32

Std. Mean Difference (IV, Fixed, 95% CI)

0.65 [‐0.07, 1.36]

4.5 BOMP 0‐2 scale

1

75

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.24 [‐0.69, 0.22]

4.6 PMA

1

510

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.16 [‐0.34, 0.02]

Figuras y tablas -
Comparison 1. All powered toothbrushes versus manual toothbrushes
Comparison 2. Side to side powered toothbrushes versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 month at all sites Show forest plot

7

570

Std. Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.77, 0.23]

1.1 Quigley Hein (Turesky)

4

324

Std. Mean Difference (IV, Random, 95% CI)

‐0.14 [‐0.36, 0.08]

1.2 Silness and Löe

3

246

Std. Mean Difference (IV, Random, 95% CI)

‐0.78 [‐2.25, 0.68]

2 Gingival scores at 1 to 3 months at all sites Show forest plot

9

795

Std. Mean Difference (IV, Random, 95% CI)

‐0.32 [‐0.81, 0.17]

2.1 Löe and Silness

6

385

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.88, 0.32]

2.2 Lobene gingival index

3

410

Std. Mean Difference (IV, Random, 95% CI)

‐0.39 [‐1.24, 0.46]

3 Plaque scores at >3 months Show forest plot

3

272

Std. Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.21, 0.26]

3.1 Quigley Hein (Turesky)

2

218

Std. Mean Difference (IV, Fixed, 95% CI)

0.03 [‐0.24, 0.30]

3.2 Silness and Löe

1

54

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.53, 0.53]

4 Gingival scores at >3 months Show forest plot

3

272

Std. Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.14, 0.34]

4.1 Löe and Silness

1

54

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.53, 0.53]

4.2 Lobene gingival index

1

166

Std. Mean Difference (IV, Fixed, 95% CI)

0.16 [‐0.14, 0.47]

4.3 BOP

1

52

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.54, 0.54]

Figuras y tablas -
Comparison 2. Side to side powered toothbrushes versus manual toothbrushes
Comparison 3. Counter oscillation powered toothbrushes versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 month at all sites Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Quigley Hein (Turesky)

4

184

Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.15, 0.10]

2 Gingivitis scores at 1 to 3 months at all sites Show forest plot

4

172

Std. Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.30, 0.31]

2.1 Löe and Silness

2

103

Std. Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.39, 0.40]

2.2 Lobene gingival index

1

40

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.65, 0.59]

2.3 BOP

1

29

Std. Mean Difference (IV, Fixed, 95% CI)

0.06 [‐0.68, 0.79]

3 Plaque scores at >3 months Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 Quigley Hein (Turesky)

2

69

Mean Difference (IV, Fixed, 95% CI)

‐0.27 [‐0.48, ‐0.07]

4 Gingival scores at >3 months Show forest plot

2

69

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.19 [‐0.66, 0.29]

4.1 Lobene gingival index

1

40

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.18 [‐0.80, 0.44]

4.2 BOP

1

29

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.19 [‐0.93, 0.54]

Figuras y tablas -
Comparison 3. Counter oscillation powered toothbrushes versus manual toothbrushes
Comparison 4. Rotation oscillation powered toothbrushes versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 month at all sites Show forest plot

20

1404

Std. Mean Difference (IV, Random, 95% CI)

‐0.53 [‐0.74, ‐0.31]

1.1 Quigley Hein (Turesky)

13

979

Std. Mean Difference (IV, Random, 95% CI)

‐0.44 [‐0.69, ‐0.20]

1.2 Silness and Löe

2

115

Std. Mean Difference (IV, Random, 95% CI)

‐1.17 [‐2.74, 0.40]

1.3 Visible plaque index Ainamo Bay

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.26 [‐0.63, 0.12]

1.4 Ortho modification of Silness and Löe

1

60

Std. Mean Difference (IV, Random, 95% CI)

0.0 [‐0.51, 0.51]

1.5 Navy plaque index mod Rustogi

2

119

Std. Mean Difference (IV, Random, 95% CI)

‐0.72 [‐1.09, ‐0.35]

1.6 O'Leary index

1

20

Std. Mean Difference (IV, Random, 95% CI)

‐1.81 [‐2.88, ‐0.73]

2 Gingival scores at 1 to 3 months at all sites Show forest plot

21

1479

Std. Mean Difference (IV, Random, 95% CI)

‐0.49 [‐0.73, ‐0.26]

2.1 Löe and Silness

14

952

Std. Mean Difference (IV, Random, 95% CI)

‐0.68 [‐0.99, ‐0.38]

2.2 Lobene gingival index

3

290

Std. Mean Difference (IV, Random, 95% CI)

‐0.11 [‐0.46, 0.24]

2.3 BOP

2

130

Std. Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.59, 0.10]

2.4 Papillary bleeding index

1

32

Std. Mean Difference (IV, Random, 95% CI)

0.65 [‐0.07, 1.36]

2.5 BOMP 0‐2 scale

1

75

Std. Mean Difference (IV, Random, 95% CI)

‐0.58 [‐1.04, ‐0.12]

3 Plaque scores at >3 months Show forest plot

7

527

Std. Mean Difference (IV, Random, 95% CI)

‐0.66 [‐1.28, ‐0.03]

3.1 Quigley Hein (Turesky)

5

339

Std. Mean Difference (IV, Random, 95% CI)

‐0.73 [‐1.69, 0.24]

3.2 Silness and Löe

1

77

Std. Mean Difference (IV, Random, 95% CI)

‐0.73 [‐1.19, ‐0.26]

3.3 Visible plaque index Ainamo Bay

1

111

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.66, 0.09]

4 Gingival scores at >3 months Show forest plot

8

684

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.35 [‐0.50, ‐0.20]

4.1 Lobene gingival index

2

234

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.36 [‐0.62, ‐0.10]

4.2 BOP

2

189

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.64 [‐0.93, ‐0.34]

4.3 Löe and Silness

2

154

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.25 [‐0.57, 0.07]

4.4 Papillary bleeding index 0‐4 scale

1

32

Std. Mean Difference (IV, Fixed, 95% CI)

0.65 [‐0.07, 1.36]

4.5 BOMP 0‐2 scale

1

75

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.24 [‐0.69, 0.22]

5 Rotation oscillation versus manual: data not suitable for meta‐analysis Show forest plot

Other data

No numeric data

Figuras y tablas -
Comparison 4. Rotation oscillation powered toothbrushes versus manual toothbrushes
Comparison 5. Circular powered toothbrushes versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 month at all sites Show forest plot

2

128

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.37, 0.33]

1.1 Quigley Hein (Turesky)

2

128

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.02 [‐0.37, 0.33]

1.2 Silness and Löe

0

0

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Gingival scores at 1 to 3 months at all sites Show forest plot

2

128

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.18 [‐0.53, 0.17]

2.1 Löe and Silness

1

63

Std. Mean Difference (IV, Fixed, 95% CI)

0.13 [‐0.36, 0.63]

2.2 Lobene gingival index

1

65

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.50 [‐0.99, ‐0.00]

Figuras y tablas -
Comparison 5. Circular powered toothbrushes versus manual toothbrushes
Comparison 6. Ionic toothbrushes versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 months Show forest plot

3

186

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.57 [‐0.87, ‐0.27]

1.1 Quigley Hein (Turesky)

2

116

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.67, 0.06]

1.2 Silness and Löe

1

70

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.07 [‐1.57, ‐0.57]

2 Plaque scores at >3 months at all sites Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Quigley Hein (Turesky)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Gingivitis at 1 to 3 months Show forest plot

2

116

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.04, 0.02]

3.1 Löe and Silness

2

116

Mean Difference (IV, Fixed, 95% CI)

‐0.01 [‐0.04, 0.02]

4 Gingival scores at >3 months at all sites Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Löe and Silness

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Ionic versus manual: data not suitable for meta‐analysis Show forest plot

Other data

No numeric data

Figuras y tablas -
Comparison 6. Ionic toothbrushes versus manual toothbrushes
Comparison 7. Ultrasonic powered toothbrushes versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 month at all sites Show forest plot

4

301

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.33 [‐1.59, ‐1.07]

1.1 Quigley Hein (Turesky)

3

171

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.97 [‐1.30, ‐0.63]

1.2 Navy plaque index mod Rustogi

1

130

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.89 [‐2.30, ‐1.47]

2 Gingival scores at 1 to 3 months at all sites Show forest plot

5

354

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.99 [‐1.21, ‐0.76]

2.1 Löe and Silness

3

161

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.56 [‐0.88, ‐0.25]

2.2 Lobene gingival index

1

130

Std. Mean Difference (IV, Fixed, 95% CI)

‐1.80 [‐2.21, ‐1.39]

2.3 Papillary bleeding index 0‐4 scale

1

63

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.82 [‐1.34, ‐0.31]

3 Plaque scores at >3 months at all sites Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Quigley Hein

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Gingival scores at >3 months Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Löe and Silness

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Ultrasonic versus manual: data not suitable for meta‐analysis Show forest plot

Other data

No numeric data

Figuras y tablas -
Comparison 7. Ultrasonic powered toothbrushes versus manual toothbrushes
Comparison 8. Unknown or other action versus manual toothbrushes

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Plaque scores at 1 to 3 months at all sites Show forest plot

2

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Quigley Hein (Turesky)

2

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Gingival scores at 1 to 3 months at all sites Show forest plot

3

Std. Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 Löe and Sillness

3

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Gingival scores >3 months at all sites Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 PMA

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 8. Unknown or other action versus manual toothbrushes