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Title Electric toothbrushes are not more effective than manual toothbrushes in the removal of dental biofilms around implants.
Clinical Question In systemically healthy adult patients with peri-implant mucositis, is an electric toothbrush more effective at removing plaque than a manual toothbrush?
Clinical Bottom Line Electric toothbrushes are not more effective than manual toothbrushes in the removal of dental biofilms around implants. This is supported by a systematic review of 20 prospective studies and a prospective clinical trial involving 31 patients with dental implants. These studies indicate that although electric toothbrushes are safe and effective oral hygiene aids for use by patients with dental implants, there is no statistically significant difference in the amount of plaque removal when compared to manual toothbrushes. These results are applicable to both rotating-oscillating and sonic electric toothbrushes.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26711217Bidra, AS/201620 studies involving 1088 adult patients with dental implantsSystematic review of randomized trials
Key resultsKey Results: The use of an electric toothbrush, as part of homecare maintenance, is as safe and effective in removing plaque around a dental implant as a manual toothbrush. No damage to the dental implant or soft tissue was seen in the 20 included studies. Out of the 20 included studies, only 11 of these studies reported on the mechanical removal of plaque with electric versus manual toothbrushes around implants. Although comparable results have been seen and patient compliance is improved with electric toothbrushes, in terms of plaque removal, they are not superior to manual toothbrushes. The authors conclude that interproximal brushes are the most effective oral hygiene aid for plaque removal around dental implants.
#2) 25495416Savli/201511 RCT’s involving 484 patients with peri-implant mucositisSystematic Review
Key resultsOut of these 11 studies, only 4 of the studies commented on the outcomes of plaque control with regards to the type of toothbrush used (electric versus manual) around dental implants. Two of these studies reported the electric toothbrushes were more effective at removing peri-implant plaque whereas two of the studies suggested they were no more effective. After 2 years, there was a strong association made between better long-term implant survival rates in patients who used an electric toothbrush compared manual.
Evidence Search ("Implant"[Mesh] AND "Electric toothbrush"[Mesh] AND “Manual toothbrush”[Mesh]) AND "Plaque"[Mesh]
Comments on
The Evidence
Bidra et al, used PRISMA and performed extensive searches of several databases. This SR did not include meta-analysis due to low quantitative data availability and heterogeneous participants. Researchers outline their method to focus on qualitative outcomes, separating data into like measures. Salvi et al, also used PRISMA and pulled retrospective evidence up through publication year 2012. However, of the 4 studies that commented on peri-implant health in regard to type of toothbrush used, three lacked a clear definition for peri-implant mucositis from start. No included studies provided data or outcomes related to toothbrush methodology. Meta-analysis was not performed due to the limited number of available studies. Quality control was ensured via the Cochrane Collaboration's tool for the assessment of risk bias. Further, more robust clinical trials with data collection over time would provide quantitative data to support more inclusive systematic review and meta analysis. Perspective: Current evidence indicates that the use of an electric toothbrush is equally effective as manual toothbrushes in the removal of dental plaque around implants.No matter a patients choice for tooth brush,personalized and consistent patient education regarding plaque removal is best practice for all patients with dental implants.
Applicability There are many reasons why natural teeth are replaced with alternatives, such as implants. However, a large percentile of natural tooth replacement is in patients with a history of periodontitis in response to poor oral home care. Therefore, meticulous oral hygiene is critical for the prevention of both further tooth loss and maintaining implant health. This literature review highlighted two additional considerations: manual toothbrush use requires dexterity and, if used improperly, could lead to hard or soft tissue defects around dental implants; while electric toothbrushes improve patient motivation, they are significantly more expensive than manual toothbrushes. Clinicians must make recommendations and provide oral care education with all of these factors in mind.
Specialty/Discipline (General Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Electric toothbrush, manual toothbrush, implant, plaque
ID# 3334
Date of submission: 10/22/2018spacer
E-mail voigtr@livemail.uthscsa.edu
Author Rachael L. Voigt, DMD
Co-author(s) e-mail
Faculty mentor/Co-author Angela Coomes
Faculty mentor/Co-author e-mail angela.m.coomes.mil@mail.mil
Basic Science Rationale
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