Non-Cochrane · intervention · PM42276584
Powered vs. manual toothbrushes in fixed orthodontic patients: a systematic review and meta-analysis.
Liu Yinli, Van der Weijden Fawn Nitanee, Jaquet Nadine, et al. · European journal of orthodontics · 2026 · PubMed · doi:10.1093/ejo/cjag026
Findings
Population Orthodontic patients with buccal fixed appliances
47 findings
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only low-risk-of-bias RCTs | SMD -0.60 [-1.66, 0.45] GRADE not reported 3 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only RCTs | SMD -0.44 [-0.83, -0.06] GRADE not reported 8 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only low-risk-of-bias studies | SMD -0.55 [-1.38, 0.27] GRADE not reported 4 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingivitis score (GS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only low-risk-of-bias RCTs | SMD -0.83 [-2.48, 0.83] GRADE not reported 3 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score, PI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: PI | MD -0.61 [-1.35, 0.12] GRADE not reported 3 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score, VPI (0-1) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: VPI (1 study, 2 comparisons) | MD 0.06 [0.00, 0.13] GRADE not reported 1 study |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingivitis score (GS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only studies without industry involvement | SMD -0.85 [-1.95, 0.26] GRADE not reported 5 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · All indices combined (BOP, MPBI, EIBI, BI, MGI-S; 10 comparisons) | SMD -0.51 [-0.88, -0.13] Low Downgraded: risk of bias, inconsistency 9 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score, QHPI/TMQH (0-5) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: QHPI, TMQH | MD -0.54 [-1.14, 0.06] GRADE not reported 2 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · All indices combined (QHPI, TMQH, OMPI, O'Leary PI, PI, JOPI; 14 comparisons) | SMD -0.77 [-1.33, -0.21] Low Downgraded: risk of bias, inconsistency 13 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingivitis score (GS) Longest follow-up · Orthodontic patients with fixed appliances · All indices combined (GI, RGI; 10 comparisons) | SMD -0.82 [-1.55, -0.09] Low Downgraded: risk of bias, inconsistency 10 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score, EIBI (0-1) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: EIBI | MD -0.06 [-0.14, 0.02] GRADE not reported 2 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingivitis score (GS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only low-risk-of-bias studies | SMD -0.67 [-1.96, 0.61] GRADE not reported 4 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingivitis score (GS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only RCTs | SMD -1.02 [-1.90, -0.14] GRADE not reported 8 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only RCTs | SMD -0.73 [-1.39, -0.06] GRADE not reported 10 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score, BOP (0-1) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: BOP | MD -0.18 [-0.46, 0.11] GRADE not reported 3 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingivitis score (GS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only RCTs without industry involvement | SMD -1.02 [-2.29, 0.25] GRADE not reported 4 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only studies without industry involvement | SMD -0.55 [-1.03, -0.07] GRADE not reported 3 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only RCTs without industry involvement | SMD -0.55 [-1.03, -0.07] GRADE not reported 4 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingivitis score, GI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: GI | MD -0.22 [-0.43, -0.02] GRADE not reported 9 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score, BI (0-1) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: BI (1 study, 2 comparisons) | MD 0.01 [-0.04, 0.05] GRADE not reported 1 study |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score, O'Leary PI (0-1) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: O'Leary PI | MD -0.17 [-0.48, 0.15] GRADE not reported 2 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only low-risk-of-bias RCTs | SMD -0.43 [-0.85, -0.02] GRADE not reported 3 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Gingival bleeding score, MPBI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: MPBI | MD -0.54 [-0.71, -0.36] GRADE not reported 2 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only RCTs without industry involvement | SMD -0.62 [-1.61, 0.38] GRADE not reported 4 studies |
| Powered toothbrush (any action mode) | Manual toothbrush (MTB) | Gingival bleeding scores (BS) After the longest follow-up · Orthodontic clinics (fixed appliances) · Sensitivity analysis: Only low-risk-of-bias studies | SMD -0.43 [-0.85, -0.02] GRADE not reported 3 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score, OMPI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · Same index only: OMPI | MD -0.03 [-0.11, 0.04] GRADE not reported 4 studies |
| Powered toothbrush (PTB), any action mode | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · Sensitivity analysis: Only studies without industry involvement | SMD -0.89 [-1.80, 0.03] GRADE not reported 5 studies |
| PTB with oscillating-rotating-pulsating or oscillating-rotating (ORP/OR) action | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -0.46 [-1.20, 0.28] Low Downgraded: risk of bias, inconsistency 6 studies |
| PTB with oscillating-rotating-pulsating or oscillating-rotating (ORP/OR) action | Manual toothbrush (MTB) | Gingivitis score (GS), GI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | MD 0.00 [-0.03, 0.04] Moderate Downgraded: risk of bias 4 studies |
| PTB with oscillating-rotating-pulsating or oscillating-rotating (ORP/OR) action | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -0.15 [-0.36, 0.07] Moderate Downgraded: risk of bias 5 studies |
| PTB with oscillating-rotating-pulsating or oscillating-rotating (ORP/OR) action | Manual toothbrush (MTB) | Plaque score, OMPI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · Same index and action mode | MD 0.00 [-0.04, 0.04] GRADE not reported 3 studies |
| PTB with oscillating-rotating-pulsating (ORP) action | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -1.13 [-2.74, 0.49] Very low Downgraded: risk of bias, imprecision, inconsistency 3 studies |
| Powered toothbrush, oscillating-rotating-pulsating (ORP) action | Manual toothbrush (MTB) | Plaque scores (PS) After the longest follow-up · Orthodontic clinics (fixed appliances) · Same action mode and index: ORP PTB, QHPI/TMQH (0-5) (2 studies) | MD -0.54 [-1.14, 0.06] GRADE not reported 2 studies |
| PTB with oscillating-rotating-pulsating (ORP) action | Manual toothbrush (MTB) | Gingivitis score (GS), GI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | MD 0.01 [-0.03, 0.05] Low Downgraded: risk of bias, imprecision 2 studies |
| PTB with oscillating-rotating-pulsating (ORP) action | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -0.11 [-0.46, 0.25] Low Downgraded: risk of bias, imprecision 2 studies |
| Powered toothbrush, oscillating-rotating (OR) action | Manual toothbrush (MTB) | Gingival bleeding scores (BS) After the longest follow-up · Orthodontic clinics (fixed appliances) · Same action mode and index: OR PTB, EIBI (0-1) (2 studies) | MD -0.06 [-0.14, 0.02] GRADE not reported 2 studies |
| PTB with oscillating-rotating (OR) action | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -0.17 [-0.43, 0.10] Moderate Downgraded: risk of bias 3 studies |
| PTB with oscillating-rotating (OR) action | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD 0.15 [-0.21, 0.51] Moderate Downgraded: risk of bias 3 studies |
| PTB with oscillating-rotating (OR) action | Manual toothbrush (MTB) | Plaque score, OMPI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · Same index and action mode | MD 0.00 [-0.11, 0.11] GRADE not reported 2 studies |
| PTB with oscillating-rotating (OR) action | Manual toothbrush (MTB) | Gingivitis score (GS), GI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | MD 0.00 [-0.05, 0.06] Low Downgraded: risk of bias, imprecision 2 studies |
| PTB with counter-rotational (CR) action | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -1.45 [-2.85, -0.05] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies |
| PTB with counter-rotational (CR) action | Manual toothbrush (MTB) | Gingivitis score (GS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -0.70 [-1.80, 0.39] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies |
| PTB with sonic action | Manual toothbrush (MTB) | Plaque score, PI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · Same index and action mode | MD -0.51 [-1.96, 0.94] GRADE not reported 2 studies |
| PTB with sonic action | Manual toothbrush (MTB) | Gingival bleeding score (BS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -1.65 [-3.53, 0.22] Low Downgraded: risk of bias, inconsistency 3 studies |
| PTB with sonic action | Manual toothbrush (MTB) | Gingivitis score (GS), GI (0-3) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | MD -0.30 [-0.75, 0.15] Very low Downgraded: risk of bias, imprecision, inconsistency 2 studies |
| PTB with sonic action | Manual toothbrush (MTB) | Plaque score (PS) Longest follow-up · Orthodontic patients with fixed appliances · By PTB action mode | SMD -1.20 [-2.67, 0.28] Low Downgraded: risk of bias, inconsistency 4 studies |
Included primary studies 44
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Costa 2007 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Costa 2007 Efficacy of ultrasonic, electric and manual toothbrushes in patients with fixed orthodontic appliances. PMID:17319775 | 2007 | 1 other review | not stated | not extracted yet |
| Kumar 2023 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Bilen 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bilen 2021 The short-term effects of manual and interactive powered toothbrushes on the periodontal status of orthodontic patients: A randomized… PMID:33384265 | 2021 | this review only | not stated | not extracted yet |
| Clerehugh 1998 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Clerehugh 1998 A practice-based randomised controlled trial of the efficacy of an electric and a manual toothbrush on gingival health in patients with… PMID:9793284 | 1998 | this review only | not stated | not extracted yet |
| Erbe 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Erbe 2019 Comparative assessment of plaque removal and motivation between a manual toothbrush and an interactive power toothbrush in adolescents… PMID:30935601 | 2019 | this review only | not stated | not extracted yet |
| Erden 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Erden 2024 Manual vs. interactive power toothbrush on plaque removal and salivary Streptococcus mutans and Lactobacillus casei levels :… PMID:37266910 | 2024 | this review only | not stated | not extracted yet |
| Farhadian 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Farhadian 2015 Comparison of Electric Toothbrush, Persica and Chlorhexidine Mouthwashes on Reduction of Gingival Enlargement in Orthodontic Patients: A… PMID:25610916 | 2015 | this review only | not stated | not extracted yet |
| Heasman 1998 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Heasman 1998 Comparative study of electric and manual toothbrushes in patients with fixed orthodontic appliances. PMID:9674679 | 1998 | this review only | not stated | not extracted yet |
| Hickman 2002 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hickman 2002 Powered vs manual tooth brushing in fixed appliance patients: a short term randomized clinical trial. PMID:11999936 | 2002 | this review only | not stated | not extracted yet |
| Ho 1997 The Mortality from Phthisis: A Statistical Investigation having bearing upon the Question of Personal Communicability. PMID:19978159 | 1914 | this review only | not stated | not extracted yet |
| Ho 1997 Effectiveness of the Sonicare sonic toothbrush on reduction of plaque, gingivitis, probing pocket depth and subgingival bacteria in… PMID:9487840 | 1997 | this review only | not stated | not extracted yet |
| Jackson 1991 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Jackson 1991 Comparison between electric toothbrushing and manual toothbrushing, with and without oral irrigation, for oral hygiene of orthodontic… PMID:1986517 | 1991 | this review only | not stated | not extracted yet |
| Kossack 2005 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kossack 2005 Plaque and gingivitis reduction in patients undergoing orthodontic treatment with fixed appliances-comparison of toothbrushes and… PMID:15711898 | 2005 | this review only | not stated | not extracted yet |
| Kumar 2023 The Efficacy of the Three Types of Plaque Control Methods During Fixed Orthodontic Treatment: A Randomized Controlled Trial. PMID:37261166 | 2023 | this review only | not stated | not extracted yet |
| Manphibool 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Manphibool 2023 Effects of blue-light LED toothbrush on reducing dental plaque and gingival inflammation in orthodontic patients with fixed appliances: a… PMID:37189136 | 2023 | this review only | not stated | not extracted yet |
| Mylonopoulou 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mylonopoulou 2021 A randomized, 3-month, parallel-group clinical trial to compare the efficacy of electric 3-dimensional toothbrushes vs manual toothbrushes… PMID:34752255 | 2021 | this review only | not stated | not extracted yet |
| Naqvi 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sadiq 2009 A comparison between two methods of brushing on clinical periodontal parameters in patients with fixed orthodontic appliance DOI:10.32828/mdj.v6i1.421 | 2018 | this review only | not stated | not extracted yet |
| Sadiq 2009 Methylation and acetylation of 15-hydroxyanandamide modulate its interaction with the endocannabinoid system. PMID:20096328 | 2010 | this review only | not stated | not extracted yet |
| Silvestrini 2010 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Silvestrini Biavati 2010 Manual orthodontic vs. oscillating-rotating electric toothbrush in orthodontic patients: a randomised clinical trial. PMID:21250772 | 2010 | this review only | not stated | not extracted yet |
| Thienpont 2001 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Thienpont 2001 Comparative study of 2 electric and 2 manual toothbrushes in patients with fixed orthodontic appliances. PMID:11606959 | 2001 | this review only | not stated | not extracted yet |
| Trimpeneers 1997 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Trimpeneers 1997 Effect of electric toothbrushes versus manual toothbrushes on removal of plaque and periodontal status during orthodontic treatment. PMID:9155807 | 1997 | this review only | not stated | not extracted yet |
| Trombeli 1995 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Trombeli 1995 Clinical evaluation of plaque removal by counterrotational electric toothbrush in orthodontic patients. PMID:7568736 | 1995 | this review only | not stated | not extracted yet |
| van Venrooy 1985 Plaque removal with a new powered instrument for orthodontic patients in fixed appliances. PMID:3867414 | 1985 | this review only | not stated | not extracted yet |
| White 1996 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| White 1996 Efficacy of a sonic toothbrush in reducing plaque and gingivitis in adolescent patients. PMID:9063177 | 1996 | this review only | not stated | not extracted yet |
| Wilcoxon 1991 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Wilcoxon 1991 The effectiveness of a counterrotational-action power toothbrush on plaque control in orthodontic patients. PMID:1986529 | 1991 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Orthodontic patients with buccal fixed appliances, in good general health, brushing performed by participants | Orthodontic patients with fixed appliances; 23 papers (39 comparisons); sample sizes 20 to 144; ages 10 to 53 years |
| Intervention | Powered toothbrushes (rechargeable, motor-driven bristle motion, single functional brush head) | PTBs: oscillating-rotating-pulsating (6 papers), oscillating-rotating (5), counter-rotational (5), rotary (1), sonic (6); action mode unspecified in 5 |
| Comparison | Manual toothbrushes | Manual toothbrushes (orthodontic MTBs in 10 papers; details not given in 3) |
| Outcomes | Plaque scores, gingivitis scores, gingival bleeding scores | Plaque scores (39 comparisons; 9 indices), gingivitis scores (21 comparisons; 4 indices), gingival bleeding scores (24 comparisons; 7 indices); meta-analysis of 14, 10 and 10 comparisons |
| Study designs | Randomized or non-randomized controlled clinical trials (parallel or crossover); split-mouth and single-brushing studies excluded | 19 RCTs and 4 CCTs; 13 parallel and 10 crossover designs |
| Timing | No minimum intervention duration; longest follow-up analyzed | Intervention duration 1 week to 4 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | Yes | Yes | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: Yes | NRSI: No · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | High | Low | no |