Abstract
Data sources
Studies were sourced using Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Institute for Scientific Information proceedings, Cambridge Scientific Abstracts, UMI Proquest, Trials Central (www.trialscentral.org) and the metaregister of controlled trials (www.controlled-trials.coms), along with the references of identified articles. No restrictions were placed on year of publication, publication status or language of the retrieved trials.
Study selection
Randomised controlled trials were selected that compared powered and manual toothbrushes and involved participants of any age who wore fixed appliances, and which reported outcome measures quantifying gingival inflammation. Cross-over studies with a washout period of at least 1 month between experimental periods were also included. Split-mouth studies and trials involving interventions that combined toothbrushing with the use of antimicrobial mouthrinses, irrigation devices, or interdental cleansing and those of less than 4 weeks duration were excluded.
Data extraction and synthesis
Initial assessment and data abstraction was carried out by two reviewers independently. The quality of the trials was evaluated by assessing randomisation, allocation concealment, blinding of the examiner, description of losses, and the use of intention to treat analyses. Trials were divided into categories depending on the mode of action of the powered toothbrush. The weighted mean difference with 95% confidence intervals was used to express the comparative treatment effect. The random-effects method for meta-analysis was used to combine treatment effects across studies in each category. Heterogeneity was investigated visually, using the I2 test and the Cochran test.
Results
Only five trials were considered appropriate for inclusion in the meta-analysis, and these could be grouped into four categories according to mode of action. None of the studies was of more than 60 days duration. Based on quality assessment and the short experimental period of these trials, there is currently not sufficient evidence to suggest particular efficacy of powered toothbrushes in reducing gingivitis in people who are undergoing fixed orthodontic appliance therapy.
Conclusions
No conclusions can be drawn on the comparative effectiveness of powered toothbrushes in reducing gingivitis in clinical orthodontic practice. Greater standardisation of the methods used is desirable in future trials.
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References
Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF . Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 1999; 354:1896–1900.
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Address for correspondence: Eleftherios G Kaklamanos, Mitropolitou Gennadiou 10 Street, Neoi Epivates GR-57019, Thessaloniki, Greece. E-mail: ekaklam@dent.auth.gr
Kaklamanos EG, Kalfas S. Meta-analysis on the effectiveness of powered toothbrushes for orthodontic patients. Am J Orthod Dentofacial Orthop 2008; 133:18&,e1–14
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Chia, M. Evidence not strong enough to advocate powered toothbrushes over manual for orthodontic patients. Evid Based Dent 9, 78 (2008). https://doi.org/10.1038/sj.ebd.6400597
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DOI: https://doi.org/10.1038/sj.ebd.6400597