title: [Evaluation of the efficacy of powered and manual toothbrushes in preventing oral diseases (Systematic review with meta-analysis)].
abstract: BACKGROUND
  The removal of dental plaque plays an essential role in the maintenance of oral health. Numerous powered and manual toothbrushes were manufactured to achieve this goal, but even up to this day different opinions and research results have been revealed to assess the priority of the mentioned devices.
  
  
  OBJECTIVE
  Comparison of powered and manual toothbrushes on the basis of periodontal parameters and safety.
  
  
  METHODS
  Electronic search of the databases of MEDLINE and EMBASE (until May 2014) was carried out with the help of keywords in order to find relevant trials. The inclusion criteria were as follows: randomised controlled clinical trials, adult population, the presence of at least 15 permanent teeth. Split-mouth trials and interventions carried out by dental professionals, were excluded. Primary outcomes were the changes of plaque and gingival indices, while secondary outcomes were probing pocket depth (PPD), safety and quality assessment. The effect-size of the interventions was expressed by the standardised mean difference (SMD) with 95% confidence interval (CI). Random-effects models were performed.
  
  
  RESULTS
  Electronic search resulted in 173 hits. 21 trials with the total number of 1500 subjects were then eligible for the meta-analysis. Both toothbrushes were safe, without considerable side effects on soft or hard tissues. Powered toothbrushes seemed to be generally more effective in removing plaque (-9%), reducing gingivitis (-6%) and preventing calculus formation. The SMDs for plaque and gingival indices were -0,40 (95% Cl: -0,95 to -0,16) and -0,29 (95% Cl: -0,56 to -0,03) respectively, in favour of the powered devices. There was no significant difference in changes of PPD. By further dividing the powered toothbrushes according to their mode of action, the plaque removal effect of the rotation oscillation (plus three dimensional), side to side sonic and ultrasonic toothbrushes seemed to be significantly better, than their manual ones, while the counter oscillation and the ionic toothbrushes did not perform better. Quality assessment and sensitivity analysis revealed various types of bias up to a certain extent. Consequently, no trial was found to be eligible for the highest quality criteria.
  
  
  CONCLUSIONS
  The investigated rotation oscillation and vibrating toothbrushes appeared to be statistically more effective than their manual counterparts, although there is little known about its clinical relevance. The advantage of the electric toothbrushes disappears in case of adequately instructed and motivated patients that highlights the importance of individualised oral hygiene education. The design of the trials shows high heterogeneity, therefore their clinical implications should be handled carefully.
authors.forename: Pál
authors.initials: P
authors.lastname: Nagy
authors.forename: Krisztián
authors.initials: K
authors.lastname: Kövér
authors.forename: István
authors.initials: I
authors.lastname: Gera
authors.forename: Attila
authors.initials: A
authors.lastname: Horváth
mesh_terms: D003728:Dental Calculus / Q000517:prevention & control; D003742:Dental Devices, Home Care; D003773:Dental Plaque / Q000517:prevention & control; D004560:Electricity; D004867:Equipment Design; D005891:Gingivitis / Q000517:prevention & control; D006801:Humans; D009910:Oral Hygiene / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic; D012399:Rotation; D014099:Toothbrushing / Q000295:instrumentation*; D014465:Ultrasonics