Berus gigi letrik berbanding berus gigi manual untuk kesihatan gigi dan mulut
Referencias
References to studies included in this review
References to studies excluded from this review
References to studies awaiting assessment
Additional references
References to other published versions of this review
Characteristics of studies
Characteristics of included studies [ordered by study ID]
| Methods | RCT, parallel, single blind, 12 months, n = 112 with 1 drop‐out. | |
| Participants | Finland, adults, 20 to 63 years, 64 M 47 F, bleeding on probing >30% sites, no medical problems. | |
| Interventions | Braun Oral B Plak Control versus Jordan soft, 2 min twice daily. Use of timer not stated. | |
| Outcomes | Ainamo and Bay Visible plaque index and modified gingival bleeding index. 3, 6 and 12 months. Whole mouth recording PI and GI. | |
| Notes | No pre‐examination instructions reported. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "The study was randomised..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "... parallel group, single blind (to examiner), with a duration of 12 months." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 1/112. 1 withdrew from the electric toothbrush group for personal (non‐clinical) reasons before the 3‐month assessment. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 1 month, n = 41, with 2 drop‐outs. | |
| Participants | USA, adults, 18 to 59 years, 24 M:16 F, >20 teeth with moderate gingivitis, no medical problems. | |
| Interventions | Interplak versus Butler 411, 3 min twice daily. Use of timer not stated. | |
| Outcomes | O'Leary plaque index, Löe and Silness gingival index, Ainamo and Bay gingival bleeding index. Ramfjord teeth for GI, whole mouth for PI. Gingival abrasion reported to be not significant. Plaque scores awaiting assessment. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned.." Insufficient information. |
| Allocation concealment (selection bias) | Low risk | Quote: "....The manufacturer provided 20 Interplak electric toothbrushes and 20 Butler 411 toothbrushes... arranged randomly in consecutively‐numbered boxes." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "...One investigator (DAB) served as the blind examiner and made all clinical..." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 2/41. 1 participant did not comply (manual) and 1 other withdrew from study (electric). Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 3 months, n = 70 with 1 drop‐out. | |
| Participants | USA, adults, 18 to 65 years, >20 teeth, gingival index >1.5, plaque index >2. | |
| Interventions | Braun Oral B Plaque Remover versus Johnson & Johnson Reach, as per normal use. | |
| Outcomes | Quigley Hein (Turesky) plaque index, Löe and Silness (Lobene) gingival index at full mouth sites. Soft tissue trauma, no difference between brushes. Whole mouth recording PI and GI. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned.." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "All clinical examinations were performed by the same evaluator. This study was conducted in a single‐blind manner." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 1/70. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, 8 weeks, n = 20, no drop‐outs, F 12:M 8. | |
| Participants | Italy, orthodontic patients, 10 to 14 years with permanent dentition, scheduled to receive multibracket. | |
| Interventions | Oral B 35 versus Oral B Pro Care 8500, 2 min twice daily. | |
| Outcomes | O'Leary plaque index, Ainamo and Bay index, unsure full mouth sites or partial mouth score, not monitored compliance and adverse event. | |
| Notes | Source of funding unclear, no pre‐examination instruction reported, low number of subjects. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly divided..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information. |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adeqaute reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 8 weeks, n = 179 with 5 drop‐outs in full trial (n = 59 for powered versus manual comparison). | |
| Participants | United States, adults, 18 to 69 years, ≥15 sites with bleeding on probing. | |
| Interventions | Oral B Pro Care series versus Oral B Cross Action, 2 min twice daily, use of timer not stated. | |
| Outcomes | Rustogi Mod of the Navy plaque index, Löe & Sillness gingival index at 0 and 8 weeks. Whole mouth recording of plaque and gingivitis. Adverse event reported; no different between groups. | |
| Notes | Manufacturer funded. This is a trial of 2 manual groups with different toothpaste. 3 other groups with numerous combinations ‐ 2 powered toothbrushes and mouthwash were also assessed. We used the comparison of manual and powered using the same toothpaste. Pre‐intervention prophylaxis done. Pre‐examination instruction given; no brushing for 12 hours and no drinking, no eating or tobacco for 4 hours. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Eligible subjects were stratified based on gender and the number of baseline sites (≤40 or ≥41), and randomly assigned to ....." Insufficient information. |
| Allocation concealment (selection bias) | Low risk | Quote: "... all test products were distributed in blinded kit boxes...." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "... all clinical assessment (efficacy and safety) were conducted by examiners who were blinded as to treatment assignment." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 1/59. None due to product‐related adverse events. Unlikely influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 8 weeks, n = 84 with 5 drop‐outs. | |
| Participants | UK, children and adolescents, 10 to 20 years, orthodontic patients in practice, fixed appliances, gingival bleeding at 30% sites, no medical conditions. | |
| Interventions | Braun Plaque Remover with OD 5 head versus Reach medium compact head, 2 min twice daily. Timer used. | |
| Outcomes | Orthodontic modification of Silness and Löe plaque index, Eastman bleeding index at all buccal sites at 4, 8 weeks. No evidence of trauma. 1 mechanical brush failed. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "...subjects were randomly allocated to groups using the minimisation methods..." |
| Allocation concealment (selection bias) | Low risk | Quote: "..and the clinical trial investigator remained blind to the toothbrush group allocation." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: " ..and the clinical trial investigator remained blind to the toothbrush group allocation." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 5/84 completed. Reason for drop‐outs: electric toothbrush group (37/41) ‐ 1 failed to attend final examination, 1 failed to follow brushing instruction, 1 failed to use the product for 7 days prior to the week 4 examination, 1 was put on tetracycline; manual group (42/43) ‐ 1 developed chicken pox and could not attend for examination. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, single blind, cross‐over, n = 21 with no drop‐outs, 30 days (15 days wash‐out period). | |
| Participants | Brazil, orthodontics patients, aged 12 to 18 years, at least 20 teeth assessable, orthodontic treatment a minimum of 1 year, non‐smokers with no history of periodontal disease. | |
| Interventions | Ultrasonex Ultima versus Oral B 3D versus Oral B Model 30, 2 min 3 times daily, use of timer not stated. | |
| Outcomes | Sillness and Löe plaque indices, Löe and sillness gingival indices, microbiological parameters assessed, no difference in clinical and microbiological parameters. No adverse effect reported. | |
| Notes | Funding unclear, pre‐intervention prophylaxis done. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly divided into three groups ...." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information. |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 3 months, n = 114, 9 drop‐outs. | |
| Participants | USA, adults, >18 teeth, no medical problems, 18 to 65 years. | |
| Interventions | Braun Oral B 3D Plaque Remover versus standard ADA reference manual, 2 min twice daily. Timer used. | |
| Outcomes | Quigley Hein (Turesky) plaque index, Löe and Silness gingivitis and bleeding index, at 14, 35 and 90 days, at all sites. Gingival recession recorded, no change seen. No other adverse effects. Whole mouth recording PI and GI. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Randomly assigned to 2 groups by Zelen's method of permuted blocks of size 4. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..all subject were evaluated by the same examiner who was unaware of the type of toothbrush used by the subject." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 9/114 completed. Reasons for drop‐outs: powered group ‐ 8 with reasons unrelated to treatment; manual group ‐ 1 failed to return for final examination. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 6 months, n = 172 with 15 drop‐outs. | |
| Participants | USA, adults, mild to moderate gingivitis with >20 teeth, no previous powered brush experience. Excluded if pregnant/lactating. | |
| Interventions | Braun Oral B D9 versus ADA accepted standard soft bristle manual, 2 min twice daily. Use of timer not stated. | |
| Outcomes | Quigley Hein (Turesky) plaque index and Lobene gingival index at 3 and 6 months. Powered brush removed more calculus. No difference in stain removal reported. PI and GI whole mouth. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Based on the screening visits, patients were stratified by gender, MGI, plaque index (PI), and smoking using a computer program, and were randomly assigned..." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "This 6‐month, single‐masked, parallel design.." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 15/172 but unclear as to which group these were from. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 6 months, n = 109 with 3 drop‐outs. | |
| Participants | Germany, adult with recession, 18 to 70 years, ≥18 teeth present, ≥2 sites with at least 2 mm recession. | |
| Interventions | Oral B 7000 (D17) versus ADA toothbrush, 2 min twice daily, use of timer not stated. | |
| Outcomes | Turesky modified Quigley Hein plaque indices and gingivitis indices at 0, 6 months. Whole mouth recording of plaque and gingivitis. Main outcome measured was gingival recession; reduced pre‐existing gingival recession in both groups. Other outcomes: PPD, PAL. Adverse event reported; no different between both groups. All patients reported to be compliant. | |
| Notes | Manufacturer funded. Pre‐intervention instruction on use of each toothbrushes done. Matched or stratified groups. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "prospective randomized, controlled ..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "...examiner blind.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 3/109. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 30 days, n = 60 with 3 drop‐outs. | |
| Participants | USA, adults, no medical problems, no current ortho, not pregnant, >17 teeth, 18 to 60 years. | |
| Interventions | Plak Trac versus Colgate ADA approved, twice daily. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque index. Yankell, interproximal plaque index, Löe and Sillness gingival index. Ramfjord teeth for both PI and GI. | |
| Notes | Pre‐brushing measurements used. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned ...." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The study was thus conducted in a single‐blind manner." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 3/60. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 30 days, n = 62 with 6 drop‐outs. | |
| Participants | USA, adults, mean age 37 years +/‐ 10 years, >16 teeth, plaque index >2, no medical problems, 21 M:35 F. | |
| Interventions | Ultrasonex versus manual Oral B, twice daily. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque index, Eastman gingival bleeding index at 30 days. Ramfjord teeth for PI and GI. Soft tissue trauma reported, no difference between groups. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned ...." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "Examiners were blind to group assignment." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 6/62 (5 from manual group; 1 from powered group). Uneven drop‐outs across groups; reasons not stated. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 28 days, n = 70 with 7 drop‐outs. | |
| Participants | UK, Caucasians, male, 19 to 36 years. | |
| Interventions | Sangi Co Electronic (Active) versus Sangi Co Electronic (non‐active), 3 minutes when brushing. No frequency stated. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque index, Löe and Silness gingival index at 2, 4 weeks. Whole mouth recording for indices. No adverse events recorded. | |
| Notes | Manufacturer funded. Assessment after 24 hours of no brushing. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The company supplied 75 toothbrushes, numbered 1 to 75. Some ...were electrically active, and others...inactive" "Subjects received a trial toothbrush in numerical order.." Not explicit but probably appropriate method. |
| Allocation concealment (selection bias) | Low risk | Quote: "Subjects received a trial toothbrush in numerical order..." "After completion of the clinical trial, coding ...was revealed to the primary investigator." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..toothbrushes were indistinguishable by anyone concerned with the clinical trial...." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 7/70. Unclear as to drop‐outs by group. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 30 days, n = 70 with 4 drop‐outs. | |
| Participants | USA, children, 6 to 11 years, able to understand procedure. | |
| Interventions | Braun Oral B D10 per manufacturers instructions versus ADA approved manual brush as normal. | |
| Outcomes | Quigley Hein (Turesky) plaque index. Whole mouth. No adverse events recorded. | |
| Notes | Manufacturer funded. Assessment after 12 to 18 hours from last brushing. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomized to..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "...conducted by the same examiner who was blinded to the treatment group." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 4/70. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 11 months, n = 250 with 84 drop‐outs. | |
| Participants | USA, dental students, male, 20 to 29 years. | |
| Interventions | GEC powered versus Pycopay brand manual twice daily. Use of timer not stated. | |
| Outcomes | Glass debris and gingival indices at 6 weeks, 7 and 11 months at all sites. Stain and calculus reported to be no different between brush types. Whole mouth recording PI and GI. No soft tissue trauma reported. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "A random, binary digit was punched by a computer into each name card to provide identification of two groups" "A coin was tossed to determine the assignment of brushes." |
| Allocation concealment (selection bias) | Low risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..the examiner was unaware of the brush type used by the subject." |
| Incomplete outcome data (attrition bias) | High risk | Drop‐outs: 84/250 drop‐outs. Unclear of drop‐outs by group; could influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 30 days, n = 53 with no drop‐outs. | |
| Participants | Canada, adults, 18 to 65 years, Löe and Sillness gingival index ≥ 1.5. | |
| Interventions | Ultreo Versus Oral B 35, twice daily, period of brushing not stated, use of timer not stated. | |
| Outcomes | Löe and Silness gingival indices at 0, 30 days at all sites. Whole mouth. Adverse event reported; no different between groups. Subjective experience of cleanliness assessed revealed higher score in Ultreo group. No adverse event reported. | |
| Notes | Manufacturer funded. No pre‐intervention treatment and pre‐examination instruction given. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned ...." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: " ..was a randomised, examiner blind, parallel..." |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 28 days, n = 70 with no drop‐outs. | |
| Participants | Switzerland, adults, 18 to 70 years, M 46 F 46, minimun of 12 score able teeth, chronic periodontitis, Class II, good general health. | |
| Interventions | Oral B Pro Care 8000 versus ADA, twice daily, period of brushing not stated, use of timer not stated. | |
| Outcomes | Sillness and Löe plaque indices and Löe and Sillness gingival indices at 0, 28 days at all sites. Whole mouth recording of plaque and gingival indices. Compliance recorded in diaries. Abrasion reported in 3 patients of each groups. | |
| Notes | Manufacturer funded. Pre‐intervention prophylaxis done, pre‐intervention instructions on oral hygiene given for 15 min. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Subjects were assigned randomly by a computer‐generated table..." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "This was an examiner‐masked..." |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 6 months, n = 52 with 4 drop‐outs. | |
| Participants | USA, systemically healthy participants with adult periodontitis, 20 to 64 years, minimum of 20 teeth. | |
| Interventions | Crest Complete versus Braun Oral B D15 Plaque Remover. Frequency unclear. Use of timer not stated. | |
| Outcomes | Turesky plaque index , Löe and Silness gingival index, bleeding on probing and probing attachment level at baseline, 3 and 6 months. Measurements taken for 6 sites per tooth for up to 28 teeth. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: " ..toothbrushing group using a pre‐determined randomisation schedule." |
| Allocation concealment (selection bias) | Low risk | Quote: " A copy of randomization schedule and study codes were kept by the principal investigator." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "In this 6 months, single‐blind study,..." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 4/52. Reasons for drop‐outs: moving away from the area, did not want to use toothpaste provided and reasons unrelated to study. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 6 weeks, n = 75 with 1 drop‐out. | |
| Participants | UK, adults, >permanent 20 teeth, 18 to 25 years, no medical problems. | |
| Interventions | Braun Oral B D7 versus Philips Jordan HP 735 versus Oral B Advantage B35, >90 seconds twice daily. Use of timer not stated. | |
| Outcomes | Quigley Hein (Turesky) plaque index at 24 hours and 6 weeks, Löe and Silness gingival index at 6 weeks, all sites. | |
| Notes | Assessment done within 3 to 4 hours of last brushing. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...allocated ranomly..." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..single‐blind clinical trial was undertaken.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 1/75. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, blinding unclear, 8 weeks, n = 63 with 3 drop‐outs. | |
| Participants | UK, orthodontic patients, 10 to 20 years, medically fit. | |
| Interventions | Braun Plaque Remover 3D with orthodontic head versus Reach compact head manual, 2 min twice daily. Timer supplied. | |
| Outcomes | Silness and Löe plaque index (orthodontic modification) and Löe and Silness gingival index, full mouth at 4 and 8 weeks. | |
| Notes | Manufacturer funded. Brush as normal post‐breakfast. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "...randomly assigned...", "...prepared by the trial statistician..." Sequence generation not explicit, but assumed low risk of bias. |
| Allocation concealment (selection bias) | Unclear risk | Quote: "The trial coordinator who opened a sealed envelopes, prepared by the trial statistician, containing the group allocation, undertook randomization." Unclear if sealed envelopes were sequentially numbered. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The trial researcher was blinded to the group allocation.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 3/63. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 4 weeks, n = 24, drop‐outs unclear. | |
| Participants | USA, orthodontic patients, with fixed appliances, 11 to 18 years, gingival index >2, no medical conditions. | |
| Interventions | Sonicare Ultrasonic versus Oral B P35, 2 min twice daily. Timer supplied. | |
| Outcomes | Silness and Löe gingival and plaque indices on 6 sites per bonded tooth and bleeding on probing all at 4 weeks. Whole mouth recording PI and GI. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "..subjects to the two groups was done through use of two tables of random numbers." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "A single investigator (HH), who was blinded as to which toothbrush was being used.." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs unclear. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 4 weeks, n = 53 with 10 drop‐outs. | |
| Participants | USA, adults, >20 teeth, gingival index >1.5 on Ramjford teeth, no medical conditions, 20 to 54 years. | |
| Interventions | Philips Sonicare versus Oral B 30, 2 min twice daily. Timer supplied. | |
| Outcomes | Quigley Hein (Turesky) on all sites, Ainamo and Bay gingival index and sulcular bleeding indices on Ramfjord at 1, 2, 4 weeks. Soft tissue trauma "abnormalities" 7 sites in 6 subjects for manual and 10 sites in 7 subjects for powered. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned...." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..randomised, single‐blind, controlled clinical study." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 10/53. Even drop‐outs, due to missed visits. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, 12 weeks, n = 200 and unsure of drop‐outs (assume no drop‐outs). | |
| Participants | India, school children aged 6 to 13 years. | |
| Interventions | Unknown powered versus unknown manual toothbrush, no information on methods, time and duration of brushing. | |
| Outcomes | Turesky Quigley Hein plaque index on all sites, full mouth at 3, 6, 9 and 12 weeks. | |
| Notes | Funding source not stated. Mix of supervised and unsupervised brushing. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "Children were randomly divided into two groups." Insufficient information |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information. |
| Incomplete outcome data (attrition bias) | Unclear risk | Unclear but assumed no drop‐outs. |
| Selective reporting (reporting bias) | High risk | Gingivitis not reported. |
| Other bias | Unclear risk | Unclear as little text in the report. |
| Methods | RCT, parallel, single blind, 4 weeks, n = 96 with 1 drop‐out. | |
| Participants | USA, adults, >15 teeth with no restorations affecting cervical region plaque score >1.8 and gingival score >0.9, no medical conditions. | |
| Interventions | Epident and Interplak versus Oral B 40, twice daily. Use of timer not stated. | |
| Outcomes | Quigley Hein (Turesky) plaque index and Löe and Silness gingivitis index at all sites at 28 days. Whole mouth recording for PI and GI. No reported soft tissue abrasion. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned...." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "This single (examiner) blind.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 1/96. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 12 weeks, n = 48 with no drop‐outs stated. | |
| Participants | Belgium, periodontal patients, 18 to 65 years, 20 natural teeth, no removable dentures, probing pocket depth >2 mm but <5 mm, free from subgingival calculus. | |
| Interventions | Philips HP 550 versus P Oral B 35 versus Braun Oral B D5, 2 min 3 times a day. Use of timer not stated. | |
| Outcomes | Quigley Hein (Turesky) plaque index and Löe and Silness gingivitis index, whole mouth at 12 weeks. | |
| Notes | Funding unclear. No pre‐examination instructions reported. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Only mentions randomised. Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "Everything was done to keep the whole procedure as blinded as possible." |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 18 weeks, n = 80 with 2 drop‐outs. | |
| Participants | Romania, adults, >20 teeth, medically fit and no previous powered brush experience. | |
| Interventions | Philips/Jordan HP 735 versus Oral B 40 manual with normal brushing pattern. Use of timer not stated. | |
| Outcomes | Quigley Hein (Turesky) plaque index at 6 sites per tooth and gingival bleeding index at proximal smooth surfaces at 18 weeks. Whole mouth recording PI and GI. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote: "..subjects were divided into two groups by an independent examiner not taking part in the further clinical assessment." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The investigator were blinded to the toothbrush used by the subjects." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 2/80. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, n = 185, 3 months, drop‐outs unclear. | |
| Participants | USA, female college students, aged 17 to 21 years. | |
| Interventions | General electric reciprocating action versus Oral B 40 manual with no instruction. Use of timer not stated. | |
| Outcomes | Lobene gingivitis index at 3 months. Whole mouth recording PI and GI. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Only mentions randomised. Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..the examiner was unaware of the group to which any subject was assigned." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs unclear. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 16 months, n = 40 with 8 drop‐outs. | |
| Participants | UK, patients who attended periodontal clinic, 25 to 70 years, periodontal disease identified clinically by minimum of 10 sites with PPD ≥5 mm confirmed by radiograph, full mouth plaque score at least 2.0, minimum of 20 permanent teeth. Excluded: previous use of powered toothbrush. | |
| Interventions | Philip Sensiflex 2000 brand versus Oral B Advantage. 2 min twice daily, use of timer not stated. | |
| Outcomes | Turesky modified Quigley Hein plaque indices and Papilla bleeding indices at 0, 3, 10, 16 months, whole mouth recordings. Other outcomes: pocket depth reported: no different between both groups. Soft tissue lesion (abrasion and ulcer) reported; 8 in manual and 5 in powered. | |
| Notes | Manufacturer funded. Pre‐intervention prophylaxis at baseline. No prophylaxis done at different visit. Use of interdental cleaning was recommended for at least once a day. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "A numerically balanced, stratified (for gender,age,smoking status) and randomised allocation of patients produced two groups..", "A 75% weighted randomisation was used to balance the distribution of the stratification characteristics between the groups." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "A two group, parallel, single blind...." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 8/40. Even distribution of drop‐outs and reasons not linked to interventions. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 12 months, n = 60 with 8 drop‐outs. | |
| Participants | UK, periodontal patients from dental hospital, 18 to 45 years, localised areas of buccal/labial gingival recession with at least 1 mm attachment loss with Miller classification I and II recession defects. Excluded: moderate to severe chronic and agressive periodontitis and routinely using powered toothbrushes. | |
| Interventions | Philips Sonicare Elite versus Oral B 35. 2 min twice daily, use of timer not stated. | |
| Outcomes | Turesky modified Quigley Hein plaque indices and bleeding on probing (dichotomous) at 0, 3, 6, 9 and 12 months. Whole mouth. Other outcomes on CAL, PD, recession, wear of the brushes reported; no differences between both groups. Adverse events reported not related to studies; 18 in manual and 16 in powered groups. | |
| Notes | Manufacturer funded. Pre‐intervention prophylaxis and instruction done. Reinforced oral hygiene at each visits. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The randomization sequence was generated using SPSS (version 14) using a block methodology..." |
| Allocation concealment (selection bias) | Low risk | Quote: "This remained concealed until the time of brush allocation..." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "two clinical examiners remained blinded to group allocation.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 8/60. Even distribution of drop‐outs and reasons not linked to interventions. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, cross‐over, single blind, 28 days, n = 20 with no drop‐outs, 14 days wash‐out period. | |
| Participants | Brazil, first year dental students, 18‐29 years old, 15 F 5 M, at least 20 teeth present, right handed subjects, 15% plaque visible at buccal and lingual surfaces. Excluded: subjects with orthodontics appliances, taking any medication would interfere plaque formation and antibiotics treatment during the 3/12 prior to study. | |
| Interventions | HyG ionic versus Close‐up Essential, 2 min twice daily. Use of timer not stated. | |
| Outcomes | Turesky modified Quigley Hein plaque indices and gingival bleeding indices (Ainamo and Bay dichotomomization of the Löe gingival index) at 0 and 28 days. Full mouth score. No difference between groups. Adverse event reported in later study (Moreira 2008); no differences between groups. | |
| Notes | No external funding for initial study. Scholarship by CAPES acknowledged in Moreira 2008. Pre‐intervention prophylaxis at baseline and between wash‐out period. Refrained oral hygiene 10‐12 hours prior to examination. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "..after the examination and by means of the flip of a coin, individuals were assigned to either one of the two toothbrushes..." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "...blinded calibrated examiner..." |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 4 weeks, n = 180 with 12 drop‐outs. | |
| Participants | UK, adults, 18 to 65 years, 142 F 27 M, non‐smokers with at least 20 natural teeth, gingival index of ≥2.0 on at least 20 sites and plaque index of ≥0.8, excluded: severe gingivitis and periodontitis. | |
| Interventions | Sonicare Elite versus manual. 2 min twice daily. Use of timer not stated. | |
| Outcomes | Sillness and Löe plaque indices and Löe and Sillness gingival indices at 0, 2, 4 weeks. Whole mouth. Abrasion reported: 1 in manual and 1 in powered. Compliance monitored at average subjects brushed 2 min twice daily. Adversed events not reported. | |
| Notes | Manufacturer funded. No pre‐intervention treatment. Refrained from oral hygiene for 2 to 6 hours before baseline examination. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned...." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "...examiner calibrated and blinded to product assignment." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 12/180. 4 lost to follow‐up, 5 drop‐outs due to adverse event not related to study, 3 scheduling conflicts. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 8 weeks, n = 40, drop‐outs unclear. | |
| Participants | USA, adults with inflammatory periodontal disease, >20 teeth and received periodontal treatment, 22 M: 18 F, 18 to 65 years. | |
| Interventions | Sonicare Ultrasonex versus Oral B manual 2 min twice daily. Timer supplied. | |
| Outcomes | Löe and Silness gingival index, Barnett papillary bleeding index at 2, 4 and 8 weeks, at all sites. Whole mouth recording PI and GI. Minor gingival trauma seen in 1 participant in each group. | |
| Notes | Part funded by manufacturer. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: " devices were packaged in kits, arranged in random order and numbered in sequence by the sponsoring company, independednt of the investigators." |
| Allocation concealment (selection bias) | Low risk | Quote: " devices were packaged in kits, arranged in random order and numbered in sequence by the sponsoring company, independednt of the investigators." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: " ..single‐blinded, randomised clinical investigation.." |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, double blind, 6 weeks, n = 60 with 8 drop‐outs. | |
| Participants | USA, orthodontic patients, >20 teeth, >12 years, 23 M: 29 F after drop‐outs. | |
| Interventions | Hukuba ionic (active) versus Hukuba ionic (non‐active) with usual technique twice daily. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque index, Löe and Silness gingival index, whole mouth at 6 weeks. No adverse events/effects recorded. | |
| Notes | Funding not stated. No brushing for 12 hours and pre‐brushing data used. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "..randomly assigned.." Insufficient information. |
| Allocation concealment (selection bias) | Low risk | Quote: "The patients were given a prepackaged, coded toothbrush." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "...both participants and the examiner were unaware of which toothbrush the participants were using during..." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 8/60. Unclear as to which group drop‐outs came from. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 9 months, n = 118 with 4 drop‐outs. | |
| Participants | Nertherlands, general population (with intensive pre‐intervention oral hygiene care), aged ≥18 years, minimun of 5 evaluable teeth per quadrant, gingival bleeding ≥40%, absence of oral lesion. No pocket depth >5 mm, no wearing partial denture, orthodontic wires. | |
| Interventions | Oral B D25 Pro Care 9000 versus ADA toothbrush, 2 min twice daily. Use of timer. | |
| Outcomes | Modified Quigley and Hein plaque indices, partial mouth score, bleeding on marginal probing index (BOMP 0‐2 scale) at 0, 10 weeks, 6 and 9 months. Powered toothbrush maintained lower plaque levels for 9 months better than manual toothbrush. No adverse events reported. | |
| Notes | Manufacturer funded. Pre‐intervention: very intensive oral home care for 3 weeks. Pre‐intervention prophylaxis at baseline, reinforced oral hygiene intervention at 6 and 10 months. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Randomization was performed using true random numbers generated by ..." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "... examiner masked..." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 4/118. Even distribution of drop‐outs and reasons not linked to interventions. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | The subjects who smoked were not balanced between the groups; 5 for manual group and 2 only for powered group but unlikely to influence results. |
| Methods | RCT, parallel, single blind, 30 days, n = 62 with 1 drop‐out. | |
| Participants | Canada, adults, 18 to 62 years, good general and oral health, 26 M: 36 F. | |
| Interventions | Colgate Actibrush versus Colgate diamond headed manual for 1 min twice daily. Use of timer not stated. | |
| Outcomes | Navy (Rustogi) plaque index, Löe and Silness (Chilton) gingival index, full mouth at 30 days, no adverse effects. | |
| Notes | Manufacturer funded. No pre‐examination brushing for 8 hours. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "randomly assigned..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information. |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 1/62. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 4 weeks, n = 132 with 3 drop‐outs. | |
| Participants | USA, adults, aged 18 to 56 years, ≥18 years old, good general health. Gingivitis 1.75‐2.3. | |
| Interventions | Oral B Pulsonic versus ADA manual toothbrush, 2 min and twice daily. | |
| Outcomes | Rustogi modified Navy plaque index, modified gingival index, full mouth at 0, 4 weeks. No reported adverse events from both groups. | |
| Notes | Manufacturer funded. Pre‐examination instruction: abstain from oral hygiene procedure 12 hours prior to investigation. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "...randomly allocated via a computer‐generated balance and assignment program to one of the two toothbrush test groups...." |
| Allocation concealment (selection bias) | Low risk | Quote: "... test product distribution processes were conducted in a separate area not accessible to the clinical examiner and data recorders." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "examiner blind, parallel group design." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 3/132. Unlikely to influence resutls. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 6 weeks, n = 59 with 2 drop‐outs. | |
| Participants | USA, children, 4 to 5 years, excluded: history of periodontal disease. | |
| Interventions | Oralgiene 60 second time machine versus Oral B Mickey Mouse versus Oral B Rugrats 20; (2 powered and 1 manual), 60 seconds twice daily for Oralgiene, others 2 min twice daily. Own toothpaste used. Timer used. | |
| Outcomes | Turesky modified Quigley and Hein plaque indices and Löe and Sillness gingival indices at 0, 6 weeks. Whole mouth. No adverse effects reported. Mechanical reliability checked on compressive load needed to activate the powered toothbrush, revealed higher compressive load needed for Oralgiene 60 seconds. | |
| Notes | Manufacturer funded. Use own toothpaste. Less parents involvement. All examination done at school. Baseline, pre‐brushing and post‐brushing data available but decided to use the baseline data. The Oral B Rugrats 20 (manual) and Oral B MIckey mouse (powered) are considered for analysis. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "Using random numbers table..." |
| Allocation concealment (selection bias) | Low risk | Quote: "..the assignment of toothbrushes and brushing were performed without the presence of examining investigator.." |
| Blinding of outcome assessment (detection bias) | Low risk | Reported as blind. |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 2/59. Reasons unclear, but unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. Age of children? |
| Methods | RCT, parallel, single blind, 60 days, n = 73 with 8 drop‐outs. | |
| Participants | USA, orthodontic patients, 11 to 19 years, >19 teeth, good health, no prophylaxis within last month. | |
| Interventions | Pulse Plaque Remover versus Oral B 35, 2 min. Frequency not stated. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque index, papillary bleeding score (Loesche) for gingivitis. | |
| Notes | Manufacturer funded. No pre‐examination brushing for 12 to 24 hours. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Quote: "The examiner were blinded with respects to the methods used for brushing.." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 8/73. Unclear as to which group drop‐outs came from. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 11 weeks, n = 270 with 32 drop‐outs. | |
| Participants | USA, college students non‐dental. | |
| Interventions | Unknown action powered versus old manual with normal regimen. Use of timer not stated. | |
| Outcomes | Gingival index (assumed Löe and Silness) on 0‐3 scale at 11 weeks. Anterior teeth only. | |
| Notes | No pre‐examination instructions reported. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...divided at random..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Quote: "..the examiner was not aware of either the previous gingival score of the subject being examined or the type of toothbrush...." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 32/270. Reasons for drop‐outs not discussed; unclear as to which group drop‐outs came from. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 30 days, n = 66 with 3 drop‐outs. | |
| Participants | USA, healthy adults, 18 to 70 years, 25 M: 38 F (data on drop‐outs not presented). | |
| Interventions | Colgate Actibrush versus ADA approved manual brush, 1 min twice daily. Use of timer not stated. | |
| Outcomes | Rustogi modification of Navy plaque index and Mandel‐Chilton modification of Löe Silness gingival index, all surfaces. | |
| Notes | Manufacturer funded. No pre‐examination brushing for 8 hours. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "It was a parallel, examiner‐blind, randomised, balanced, two‐group design..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "It was a parallel, examiner‐blind, randomised, balanced, two‐group design..." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 3/66 completed. 3 from ADA group failed to complete. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 30 days, n = 110 with no drop‐outs. | |
| Participants | USA, adults, 18 to 70 years, >15 teeth, no orthodontic appliances, no oral disease, 22 M: 88 F. | |
| Interventions | Colgate Actibrush versus Colgate diamond head manual, 1 min twice daily. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) and Löe and Silness gingival index, full mouth at 30 days. No adverse events. | |
| Notes | Manufacturer funded. No pre‐examination brushing for 24 hours. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | ADA guidelines followed but no word random. Only mentions that "Qualifying participants were stratified into two balanced treatment groups according to their baseline plaque index and gingivitis index scores." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "This independent clinical study, employed an examiner‐blind, two‐treatment...." |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blinded, n = 56 with 4 drop‐outs, 60 days. | |
| Participants | Israel, general population, no medical conditions. | |
| Interventions | Plaq and White A to Z technology versus Oral B 35 as per normal regimen. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) and Löe and Silness gingival and Eastman bleeding on probing indices on Ramfjord teeth at 15 and 30 days. No difference in soft tissue trauma between brush types. | |
| Notes | Participants asked to refrain from brushing for 12 hours prior to each assessment. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Quote: "An independent person was responsible for distributing the different toothbrushing and was the only..." Insufficient information given lack of detail regarding randomisation. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "Each examiner recorded 28 participants of both groups without knowing their brush assignment.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 4/56. 2 participants from each group did not complete for reasons not related to the protocol. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, unclear blinding method used, n = 40 with 2 drop‐outs, 6 weeks. | |
| Participants | Denmark, young adults 18 to 30 years, with plaque and gingival scores >1, >20 teeth, no medical problems. | |
| Interventions | Braun Oral B Plak Control D5 versus Tandex 40 manual, 2 min twice daily. Use of timer not stated. | |
| Outcomes | Silness and Löe plaque index, Löe and Silness gingival index at all sites, 1, 2 and 6 weeks. Whole mouth recording PI and GI. No gingival abrasion reported. | |
| Notes | No pre‐examination instructions reported. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...participants were at random allocated to a group..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information. |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 2/40. Reasons not stated. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 6 months, n = 54 with 4 drop‐outs. | |
| Participants | USA, adults, good health and free of oral pathology. | |
| Interventions | Ultra‐sonex ultrasonic versus Oral B manual 3 min twice daily. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque index and Löe and Silness gingival index at all sites and Eastman bleeding on probing index on contralateral Ramjford teeth. Assessed at 15 and 30 days and 6 months. No soft tissue trauma. | |
| Notes | Participants asked to refrain from brushing 12 to 14 hours prior to assessment. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information. |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 4/54. Reasons for drop‐outs was breach of compliance. Unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, blinding unclear, 120 days, n = 527 with 17 drop‐outs. | |
| Participants | USA, boarding school children, 6 to 18 years. | |
| Interventions | Sunbeam cordless versus unspecified manual. Frequency not stated. Use of timer not stated. | |
| Outcomes | PMA index, whole mouth. | |
| Notes | Funding not clear. No pre‐examination instructions. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...distributed at random..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Unclear risk | Insufficient information. |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 17/527. Reasons not discussed but unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 12 weeks, n = 60 with 4 drop‐outs. | |
| Participants | USA, adults 18 to 65 years, dental hospital patients, no professional cleaning previous 3 months, minimum 20 teeth, no previous periodontal treatment and unaware of active pregnancy. | |
| Interventions | Sonicare versus Butler 311, 2 min twice daily. Timer supplied. | |
| Outcomes | Quigley and Hein (Turesky) plaque index all teeth, Löe and Silness gingival index Ramfjord teeth. Gingival abrasion seen in 5 manual and 1 powered brush subjects. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "..patients were randomised by having them draw their group assignment from a box containing a mixture of 30 labels marked 'manual group' and 30 labels marked ..." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "One investigator (CT), who was blinded to the brush assignments of each group.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 4/60. Excluded from analysis; either received antibiotics therapy (2) or failed to appear for 1 of the scheduled study visit (2). Drop‐outs unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 8 months, n = 87 with 10 drop‐outs. | |
| Participants | Netherlands, non‐dental students, bleeding on probing at least 35% of sites and modified gingival index of at least 1, no previous experience of electric toothbrush. Healthy. No ortho. No pockets >5 mm. | |
| Interventions | Braun Plak control versus Butler Gum 311 for 2 min. Timer supplied. | |
| Outcomes | Silness and Löe plaque index, Lobene gingival index at all sites at 1, 2, 5, 8 months. Whole mouth recording PI and GI. 12 manual brush subjects and 5 powered brush subjects with gingival abrasion. Calculus scored no difference in change between groups. | |
| Notes | Participants asked to brush thoroughly, but not within 1 hour of assessment. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly divided..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "Therefore in the course of the experiment, the examiner was unaware of the brush types used by the subject.." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 10/87. 8 particpants (control group) and 2 particpants (powered brush) left the study because of scheduling conflicts with clinical examination. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, double blind, 6 months, n = 71 with 7 drop‐outs. | |
| Participants | USA, adults, >20 teeth, not using mouthrinse, 9 M: 55 F. | |
| Interventions | HyG ionic brush (active) versus HyG ionic brush (non‐active), usual time twice daily. Use of timer not stated. | |
| Outcomes | Quigley and Hein plaque index and Löe and Silness gingival index, whole mouth at 3 and 6 months. Adverse events not reported despite being collected. | |
| Notes | Manufacturer funded. No pre‐examination instructions. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "The subject were given prepackaged and coded hyG ionic action toothbrush. The toothbrushes were received evenly divided (36 of each) between those that had active batteries .." |
| Allocation concealment (selection bias) | Low risk | Quote: "Each packet had a code number that was recorded for the subject at the time of delivery neither the researchers nor the subjects knew whether their toothbrush contained an active or inactive battery." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "Neither the researcher nor the subject knew wether their toothbrush contained an active or inactive battery." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 7/71. Reasons were "four did not use their assigned toothbrush exclusively during the test period, and three took physician prescribed antibiotics." Number of drop‐outs by group unlcear but unlikely to influence results. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, n = 108, 6 months, drop‐outs unclear. | |
| Participants | USA, adults from university and dental clinics, 18 to 65 years, >20 teeth, no dental/medical problems, gingival index >1 on 6+ sites of 18 sites probed on Ramfjord teeth. | |
| Interventions | LPA/Broxo powered versus Oral B 40 manual, twice daily. Use of timer not stated. | |
| Outcomes | Silness and Löe plaque index on Ramfjord teeth, bleeding on probing on Ramfjord teeth at 3, 6 months. No soft tissue changes reported. Stain reported as no difference between brush types. | |
| Notes | No pre‐examination instructions reported. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Quote: "...subjects were randomly allocated to groups in consecutive order by time and date of entry into study." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "examiners did not known to which groups the patients belonged....." |
| Incomplete outcome data (attrition bias) | Unclear risk | Insufficient information to determine drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 12 weeks, n = 110 with 9 drop‐outs. | |
| Participants | USA, adult volunteers, 18 to 65 years, >18 teeth, plaque index >1.8, non‐smokers, with no medical problems. | |
| Interventions | Braun Oral B D 17 versus ADA standard manual, 2 min twice daily. Timer supplied. | |
| Outcomes | Quigley and Hein (Turesky) plaque index, Löe and Silness gingival index and modified Löe and Silness bleeding index, on all sites at 1, 3 months. Whole mouth recording PI and GI. No soft tissue changes reported. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Quote: "...were randomly assigned to one of two treatment groups, according to the method of Zelen." |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..all subjects were evaluated by the same examiner who was unaware of the types of toothbrush..." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 9/110. Reasons unrelated to intervention and drop‐outs evenly balanced. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 12 months, n = 32 with 3 drop‐outs. | |
| Participants | USA, adults, 18+ years, minimum 20 teeth, at least 50% tooth surface plaque coverage (O'Leary), bleeding score >0.75. Barnett‐Muhleman bleeding index, no medical problems, no orthodontics, no untreated perio or pockets >6 mm. | |
| Interventions | Interplak, Bausch and Lomb versus Butler 311, 3 min. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque index, Barnett Muhleman gingival index on all sites at 1, 2, 6, 9 and 12 months. Whole mouth recording PI and GI. No difference in gingival abrasion found between brush types. | |
| Notes | Participants asked to brush 1 hour prior to assessment. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..a single‐blind, ....." |
| Incomplete outcome data (attrition bias) | High risk | Drop‐outs: 3/32. All drop‐outs from control group. Reasons were: 1 generalised periodontal diseases progression; 2 non‐compliance/withdrawn from study. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 4 weeks, n = 66 with 1 drop‐out. | |
| Participants | USA, children with 4 of 6 Ramfjord teeth present, no medical problems. | |
| Interventions | Rowenta Dentiphant versus Oral B 20, 1 min twice daily. Use of timer not stated. | |
| Outcomes | Quigley and Hein (Turesky) plaque and Löe and Silness (Lobene) gingival indices on Ramjford teeth at 2 and 4 weeks. No soft tissue changes reported. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned.." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "The same clinical investigators saw and assessed the same subjects at each examination period and were unaware of the toothbrush product being used by the subjects." |
| Incomplete outcome data (attrition bias) | Unclear risk | Quote: "...attrition not related to product use.." Insufficient information. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 30 days, n = 128 with 13 drop‐outs. | |
| Participants | USA, adults, 18 to 50 years, >18 teeth, no current orthodontic bands, no medical problems. | |
| Interventions | Rowenta Plaque Dentacontrol Plus versus Sonicare versus Braun Oral B Ultra versus Oral B P35, 2 min twice daily. Timer specified for powered. | |
| Outcomes | Quigley and Hein (Turesky) plaque and Eastman bleeding indices on Ramfjord teeth and also Löe and Silness (Lobene) gingival index on whole mouth at 4 weeks. No soft tissue changes reported. | |
| Notes | Rowenta data excluded due to extended brushing period. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned..." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "..single‐blind.." |
| Incomplete outcome data (attrition bias) | Unclear risk | Drop‐outs: 13/128. Quote: "..attrition not related to product use.." |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 6 months, n = 42 with 2 drop‐outs. | |
| Participants | USA, adults with past periodontal surgical treatment. Excluded if on antibiotics/NSAIDS or orthodontic appliances. | |
| Interventions | Interplak, Bausch and Lomb versus unspecified manual brush. Use of timer not stated. | |
| Outcomes | Quigley and Hein and O'Leary plaque indices, Lobene gingival index and bleeding on probing. Whole mouth recording PI and GI. 4 of 20 powered brushes had mechanical failure. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned.." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Quote: "All the instruction and device distribution were performed by auxiliary personal without examiner being present." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "All intraoral examinations for a given patient were performed by one of the two examiners, who were blinded to the grouping of the subjects." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 2/42. Reasons for drop‐outs were non‐compliance with appointments (manual brush) and restorative dentistry resulted in too few scorable teeth (powered brush). |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Unclear risk | Comparibility of groups at baseline unclear. |
| Methods | RCT, parallel, single blind, 8 weeks, n = 64 with 1 drop‐out. | |
| Participants | Germany, adults, 18 to 56 years good general health, no periodontal disease, 32 M: 32 F. | |
| Interventions | Ultra Sonex Ultima versus Aronal compact manual, 3 min twice daily. Timer supplied. | |
| Outcomes | Quigley and Hein (Turesky) and papillary bleeding index, full mouth at 4 and 8 weeks. | |
| Notes | Manufacturer funded. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned.." Insufficient information. |
| Allocation concealment (selection bias) | Low risk | Quote: "..each participant received the assigned toothbrush and instructions for use by a person not involved in the study." |
| Blinding of outcome assessment (detection bias) | Low risk | Quote: "All examinations were treatment blind and performed by one examiner." |
| Incomplete outcome data (attrition bias) | Low risk | Drop‐outs: 1/64. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
| Methods | RCT, parallel, single blind, 8 weeks, n = 120, no drop‐outs. | |
| Participants | Germany, adults, 18 to 65 years, exclusion: orthodontic fixed appliance patient, severe periodontal disease, long‐term use of NSAIDs, wear removable partial denture, less than 20 teeth, regular use of electric toothbrush, dental professionals. | |
| Interventions | 2 electric toothbrushes: Cybersonic and Oral B 3D excel versus Elmex Super 29 manual, 2 min twice daily. Digital timer supplied. | |
| Outcomes | Quigley and Hein (Turesky) and papillary bleeding index, full mouth at 4 and 8 weeks. Nor report on adverse events. | |
| Notes | Peer review grant and other source of funding. Pre‐intervention scaling ad prophylaxis. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Quote: "...randomly assigned.." Insufficient information. |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information. |
| Blinding of outcome assessment (detection bias) | Low risk | Quote "All examination were treatment blind.." |
| Incomplete outcome data (attrition bias) | Low risk | No drop‐outs. |
| Selective reporting (reporting bias) | Low risk | Adequate reporting of important outcomes. |
| Other bias | Low risk | No other apparent biases. |
ADA = American Dental Association; BOMP = bleeding on marginal probing; CAL= clinical attachment level; F = female; GI = gingival index; M = male; PAL = probing attachment level; PD = pocket depth; PI = plaque index; PMA = papillary marginal attachment; PPD = periodontal pocket depth; RCT = randomised controlled trial.
Characteristics of excluded studies [ordered by study ID]
| Study | Reason for exclusion |
| Less than 28 days. | |
| Contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Less than 28 days. | |
| No movement of powered head. | |
| Less than 28 days. | |
| Contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Outcome not under consideration. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Brush used by another person. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Split‐mouth study. | |
| Less than 28 days. | |
| Contacted authors for more information, no reply after 3 months. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Combined intervention. | |
| Less than 28 days. | |
| Data on number of participants in each group not presented. The study will be included once these data are determined. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Split‐mouth design. | |
| Abstract only. | |
| Outcomes not under consideration. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Split‐mouth design. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Split‐mouth design. | |
| Split‐mouth design. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Combined intervention. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Single used study design. | |
| Less than 28 days. | |
| Abstract with insufficient information. | |
| Less than 28 days. | |
| Previously author was contacted for information but no reply after 3 months. | |
| Contacted authors for more information, no reply after 3 months. | |
| Contacted authors for more information, no reply after 3 months. | |
| No mechanical action of brush head. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Contacted authors for more information, no reply after 3 months. | |
| Split‐mouth design. | |
| Contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Split‐mouth design. | |
| Not true randomisation; alternate allocation. | |
| Less than 28 days. | |
| Contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Contacted authors for more information, after reply still not adequate to be included. | |
| Outcomes not under consideration. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Split‐mouth design. | |
| Less than 28 days. | |
| Participants selected from population at random, but not allocated to groups at random. | |
| Cross‐over study, contacted authors for more information, no reply after 3 months. | |
| Contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Split‐mouth design. | |
| Single used study design. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Split‐mouth design. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Split‐mouth design. | |
| Abstract only. | |
| Split‐mouth design. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Contacted authors for more information, no reply after 3 months. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Cross‐over study, contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Cross‐over study, contacted authors for more information, no reply after 3 months. | |
| Cross‐over study, contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Combined interventions. | |
| Less than 28 days. | |
| Split‐mouth study. | |
| Split‐mouth study. | |
| Less than 28 days. | |
| Potential for compromised self toothbrushing efficacy. | |
| Teeth brushed by other person. | |
| Split‐mouth design. | |
| Less than 28 days. | |
| Less than 28 days. | |
| Potential high for compromised self toothbrushing efficacy. | |
| Split‐mouth design. | |
| Cross‐over study, contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Less than 28 days. | |
| No movement of brush head. | |
| Contacted authors for more information, no reply after 3 months. | |
| Less than 28 days. | |
| Combined intervention. | |
| Less than 28 days. |
Characteristics of studies awaiting assessment [ordered by study ID]
| Methods | |
| Participants | |
| Interventions | |
| Outcomes | |
| Notes | Unable to locate a copy to date. |
| Methods | |
| Participants | |
| Interventions | |
| Outcomes | |
| Notes | Unable to locate a copy to date. |
| Methods | |
| Participants | |
| Interventions | |
| Outcomes | |
| Notes | Unable to locate a copy to date. |
| Methods | 6‐week, parallel arm RCT. |
| Participants | Adults (aged 18‐28) with moderate gingivitis (at least 25% of test sites showing bleeding on probing). Excludes orthodontic patients. |
| Interventions | Group 1 – Oral B Classic Ultraclean medium manual toothbrush. Group 2 – Oral B Vitality Dual Clean powered toothbrush (rotation oscillation). Both groups' intervention was combined with commercially available fluoridated toothpaste (Pepsodent Regular). |
| Outcomes | Gingivitis (Löe and Silness gingival index, 1963) recorded at 1, 2, and 6 weeks. Oral hygiene (Green and Vemillion Oral Hygiene Index Simplified (OHI‐S), 1964) recorded at 1, 2, and 6 weeks. |
| Notes |
| Methods | 20‐week, 4‐parallel arm RCT. |
| Participants | Adolescent fixed‐orthodontic treatment patients. |
| Interventions | Group 1 – Oral B Triumph 5000 powered toothbrush (rotation oscillation), combined with oral hygiene instruction and motivation at baseline and at 4, 8, 12, 16, and 20 weeks. Group 2 – Oral B Triumph 5000 powered toothbrush (rotation oscillation), combined with oral hygiene instruction and motivation at baseline. Group 3 – Oral B Ortho P35, combined with oral hygiene instruction and motivation at baseline and at 4, 8, 12, 16, and 20 weeks. Group 4 – Oral B Ortho P35, combined with oral hygiene instruction and motivation at baseline. All groups' intervention was combined with commercially available fluoridated toothpaste (Colgate Total, 1450 ppm fluoride). All groups also received an interdental brush (Plakkontrol, 7 mm) at baseline and at 8 and 16 weeks. Replacement brushes (both manual and powered groups) were also issued at 8 and 16 weeks. |
| Outcomes | Plaque index (Quigley Hein plaque index, 1962) recorded at baseline and at 4, 8, 12, 16, and 20 weeks. |
| Notes |
| Methods | 16‐week, parallel arm RCT. |
| Participants | Adults (aged 20‐30) with poor oral hygiene (scoring between 76‐90 on approximal area plaque index). |
| Interventions | Group 1 – Oral B Plus 30 manual toothbrush. Group 2 – Braun dental timer D31 electric toothbrush. Both groups' intervention was combined with commercially available toothpaste (Oral‐B Zendium). |
| Outcomes | Plaque (Lange approximal area plaque index, 1987), recorded at 1, 2, 3, 4, 9, 10, and 11 weeks. |
| Notes |
| Methods | 12‐week, parallel arm RCT. |
| Participants | Adults (aged 18‐70) with mild gingivitis (at least scoring 1 on Löe and Silness gingival index) and mild plaque (at least scoring 0.6 on Rustogi modification of the modified Navy plaque index). Excludes orthodontic patients. |
| Interventions | Group 1 – Colgate ProClinical A1500 powered toothbrush with Triple Clean Brush Head (auto mode). Group 2 – Oral B Indicator manual flat‐trim toothbrush. Both groups' intervention was combined with commercially available fluoridated toothpaste (Colgate Cavity Protection). |
| Outcomes | Gingivitis (Löe and Silness gingival index, 1963), recorded at baseline and at 4 and 12 weeks. Gingival bleeding (gingivitis severity index, 1990), recorded at baseline and at 4 and 12 weeks. Plaque (Rustogi modification of the modified Navy plaque index, 1992), recorded at baseline and at 4 and 12 weeks. |
| Notes | Study supported by Colgate‐Palmolive. |
| Methods | 30‐day, parallel arm RCT. |
| Participants | Healthy adults. |
| Interventions | Group 1 – Colgate Actibrush battery‐powered toothbrush. Group 2 – Colgate Plus Diamond Head, full‐head soft‐bristled manual toothbrush. Both groups' intervention was combined with commercially available toothpaste (type not mentioned). |
| Outcomes | Plaque (index not mentioned), reported at baseline and 30 days. Ginigivitis (index not mentioned), reported at baseline and 30 days. |
| Notes | Abstract only. |
| Methods | 4‐week, parallel arm RCT. |
| Participants | Adults with mild‐moderate gingivitis. Excludes orthodontic patients. |
| Interventions | Group 1 – Oral B Professional Deep Clean TRICLEAN 1000 multi‐directional power toothbrush (D16u/EB30) (AKA Oral‐B TriZone). Group 2 – ADA reference standard soft manual control toothbrush. Both groups' intervention was combined with commercially available fluoridated toothpaste (Crest Cavity Protection, 0.243% sodium fluoride). |
| Outcomes | Gingivitis (Lobene modified gingival index), reported at baseline and 4 weeks. Gingival bleeding (gingival bleeding index), reported at baseline and 4 weeks. Plaque (Rustogi modified Navy plaque index), reported at baseline, and 1 and 4 weeks. |
| Notes |
| Methods | 52‐week, parallel arm RCT. |
| Participants | Partially edentulous adults (aged 45‐78), with at least 1 posterior implant. |
| Interventions | Group 1 – Philips Sonicare FlexCare sonic toothbrush. Group 2 – Oral B P40 manual toothbrush. Both groups' intervention was combined with commercially available fluoridated toothpaste (Colgate Total). |
| Outcomes | Gingivitis (Löe and Silness gingival index, 1963; bleeding on probing scale), recorded at baseline and at 3, 6, 9 and 12 months (for both tooth and implant). Plaque (Silness and Löe plaque index, 1964), recorded at baseline and at 3, 6, 9 and 12 months (for both tooth and implant). |
| Notes | Study supported by Philips Healthcare Systems. |
ADA = American Dental Association; ppm = parts per million; RCT = randomised controlled trial.
Data and analyses
| 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] |
| Analysis 1.1  Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites. | ||||
| 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] |
| Analysis 1.2  Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites. | ||||
| 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] |
| Analysis 1.3  Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months. | ||||
| 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] |
| Analysis 1.4  Comparison 1 All powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months. | ||||
| 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] |
| 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] |
| 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. | ||||
| 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] |
| 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. | ||||
| 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] |
| Analysis 2.3  Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months. | ||||
| 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] |
| Analysis 2.4  Comparison 2 Side to side powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months. | ||||
| 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] |
| 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 | |
| Analysis 3.1  Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites. | ||||
| 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] |
| Analysis 3.2  Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 2 Gingivitis scores at 1 to 3 months at all sites. | ||||
| 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 | |
| Analysis 3.3  Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months. | ||||
| 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] |
| Analysis 3.4  Comparison 3 Counter oscillation powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months. | ||||
| 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] |
| 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] | |||||||||||||||
| Analysis 4.1  Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites. | |||||||||||||||||||
| 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] | |||||||||||||||
| Analysis 4.2  Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites. | |||||||||||||||||||
| 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] | |||||||||||||||
| Analysis 4.3  Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months. | |||||||||||||||||||
| 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] | |||||||||||||||
| Analysis 4.4  Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months. | |||||||||||||||||||
| 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 | |||||||||||||||||
| Analysis 4.5
Comparison 4 Rotation oscillation powered toothbrushes versus manual toothbrushes, Outcome 5 Rotation oscillation versus manual: data not suitable for meta‐analysis. | |||||||||||||||||||
| 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] |
| Analysis 5.1  Comparison 5 Circular powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites. | ||||
| 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] |
| Analysis 5.2  Comparison 5 Circular powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites. | ||||
| 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] |
| 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] | ||||||||||||
| Analysis 6.1  Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 months. | ||||||||||||||||
| 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 | |||||||||||||
| Analysis 6.2  Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 2 Plaque scores at >3 months at all sites. | ||||||||||||||||
| 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] | ||||||||||||
| Analysis 6.3  Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 3 Gingivitis at 1 to 3 months. | ||||||||||||||||
| 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 | |||||||||||||
| Analysis 6.4  Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months at all sites. | ||||||||||||||||
| 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 | ||||||||||||||
| Analysis 6.5
Comparison 6 Ionic toothbrushes versus manual toothbrushes, Outcome 5 Ionic versus manual: data not suitable for meta‐analysis. | ||||||||||||||||
| 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] | ||||||||||||
| Analysis 7.1  Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 month at all sites. | ||||||||||||||||
| 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] | ||||||||||||
| Analysis 7.2  Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites. | ||||||||||||||||
| 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 | |||||||||||||
| Analysis 7.3  Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 3 Plaque scores at >3 months at all sites. | ||||||||||||||||
| 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 | |||||||||||||
| Analysis 7.4  Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 4 Gingival scores at >3 months. | ||||||||||||||||
| 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 | ||||||||||||||
| Analysis 7.5
Comparison 7 Ultrasonic powered toothbrushes versus manual toothbrushes, Outcome 5 Ultrasonic versus manual: data not suitable for meta‐analysis. | ||||||||||||||||
| 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 | |
| Analysis 8.1  Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 1 Plaque scores at 1 to 3 months at all sites. | ||||
| 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 | |
| Analysis 8.2  Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 2 Gingival scores at 1 to 3 months at all sites. | ||||
| 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 | |
| Analysis 8.3  Comparison 8 Unknown or other action versus manual toothbrushes, Outcome 3 Gingival scores >3 months at all sites. | ||||
| 3.1 PMA | 1 | Mean Difference (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 | 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 |
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.
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.
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.
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 |
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.
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.
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 |
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.
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.
| 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 | No of participants | Quality of the evidence | 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 | 2871 (40 studies) | ⊕⊕⊕⊝ | 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 | 3345 | ⊕⊕⊕⊝ | 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) | ||||||
| GRADE Working Group grades of evidence | ||||||
| 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 | ||||||
| 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 |
| 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 | |
| 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 | |||
| 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 | ||||||
| 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] |
| 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] |
| 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] |
| 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 | ||
| 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] |
| 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 | ||
| 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 | ||
| 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] | |
