Five years of evidence: a retrospective analysis of clinical trials comparing electric and manual toothbrush effectiveness in orthodontic patients

Abstract

Aim: To evaluate whether the use of an electric toothbrush represents a more effective option than a manual toothbrush in preventing dental plaque accumulation and managing daily oral hygiene in patients undergoing fixed orthodontic treatment, considering the increased cleaning challenges associated with the presence of orthodontic appliances. This study provides a comprehensive five-year literature update on the subject.

Materials and methods: A thorough literature search was conducted in PubMed for articles published from January 2020 to June 2025. This retrospective review was designed according to the guidelines of the Cochrane Handbook for Systematic Reviews and is reported in accordance with the PRISMA guidelines. To evaluate the methodological quality of the included randomized controlled trials, the Risk of Bias 2 (RoB 2) tool was employed.

Results: A total of 666 articles were analyzed. Based on the inclusion and exclusion criteria, four studies met the criteria for the final review. According to the RoB 2 assessment, three studies were judged to have 'some concerns' regarding the risk of bias, and only one article was at low risk of bias. Conclusion: The data from the studies analyzed indicate that, in the short term, the use of an electric toothbrush results in a significant improvement in plaque removal and a reduction in gingival conditions and bleeding on probing compared to a manual toothbrush; conversely, in the long term, the differences between the two types of toothbrush tend to decrease significantly. From this perspective, it becomes essential to consider the electric toothbrush as part of an integrated, personalized approach that includes continuous education, motivational strategies, and consistent follow-up to ensure adequate compliance throughout the entire orthodontic treatment period.