Effectiveness of orthodontic toothbrush versus conventional toothbrush on plaque and gingival index reduction: A systematic review and meta-analysis.

OBJECTIVE: In orthodontic patients submitted to oral hygiene instruction, what is the efficacy of orthodontic toothbrush (O-TB) versus conventional toothbrush (C-TB) on plaque and gingival index reduction in randomized and non-randomized controlled clinical trials? METHODS: Electronic database search was performed on PubMed, ClinicalTrials.gov, Cochrane Library and Google Scholar. Database research, study selection, data extraction and ROBINS-I and Risk of Bias Tool 2.0 analysis were conducted by two independently examiners in duplicate. Two different meta-analyses were performed for plaque index and gingival index, followed by the analysis of overall quality of the evidence using GRADE. RESULTS: A total of 158 studies were identified for screening; six articles were included in qualitative synthesis, and of those, three were subjected to a quantitative synthesis (meta-analysis). Three non-randomized studies presented an overall 'low', 'moderate' and 'high' risk of bias for each one of the articles, and the three randomized clinical trials presented 'low risk' for two articles and 'some concerns' quality for the other one. The overall strength of evidence was ranked 'very low' quality for plaque index and gingival index subgroups. CONCLUSIONS: Gingival bleeding is not modified by orthodontic design toothbrush, but there is circumstantial scientific evidence for recommending the use of an O-TB instead a C-TB based on the analysis of plaque index control. Although major plaque removal of the O-TB was validated by meta-analysis, this improvement is not completely clarified which calls for further clinical studies to assess the effects of using an O-TB compared with a C-TB.

Combined Orthodontic-Orthognathic Approach for Dentofacial Deformities as a Risk Factor for Gingival Recession: A Systematic Review.

PURPOSE: The objective of this systematic review was to evaluate the risk of development of gingival recession (GR) as a result of the combined orthodontic-orthognathic approach. MATERIALS AND METHODS: The PubMed, Google Scholar, ClinicalTrials.gov, and Cochrane Library databases were searched. Included articles mentioned gingival parameters in their materials and methods sections; specifically, they evaluated GR, which was measured before and after the surgical procedure. Study parameters such as methodology, evaluation period, sample characteristics, and follow-up were extracted by 2 authors independently. RESULTS: In total, 133 relevant articles were identified from the databases; after screening and full-text analysis, 9 studies were included in this systematic review. Meta-analysis could not be conducted because of considerable heterogeneity in methods. The incidence of GR in the range of 0.5 to 3.0 mm as a significant clinical finding after orthognathic surgery showed statistically significant differences in all included articles. Among patients with GR, the mean age was 23.0 to 29.5 years and the mandibular incisors were the most common site. However, no case of recession greater than 3.0 mm was associated with surgery. CONCLUSIONS: On the basis of the findings of this review, GR of approximately 0.5 to 3.0 mm is a common finding after the combined orthodontic-orthognathic approach. Although periodontal damage up to 3 mm can be observed as an isolated finding in mainly the incisors, true recession is not associated with orthognathic surgery in general.