Department of Dentistry, Centro Universitário Christus, Fortaleza, Ceará, Brazil.
Int J Dent Hyg. 2022 Feb;20(1):87-99. doi: 10.1111/idh.12511. Epub 2021 May 29.
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?
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.
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.
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.
在接受口腔卫生指导的正畸患者中，正畸牙刷（O-TB）与传统牙刷（C-TB）相比，在随机和非随机对照临床试验中对菌斑和牙龈指数降低的效果如何？
在 PubMed、ClinicalTrials.gov、Cochrane 图书馆和 Google Scholar 上进行电子数据库检索。由两名独立的审查员重复进行数据库研究、研究选择、数据提取以及 ROBINS-I 和风险偏倚工具 2.0 分析。对菌斑指数和牙龈指数分别进行了两次不同的荟萃分析，然后使用 GRADE 对总体证据质量进行分析。
共筛选出 158 项研究；6 篇文章纳入定性综合分析，其中 3 篇进行了定量综合（荟萃分析）。3 项非随机研究对每篇文章的总体“低”、“中”和“高”风险偏倚进行了评估，3 项随机临床试验对其中 2 项评估为“低风险”，对另一项评估为“存在一些关注”。菌斑指数和牙龈指数亚组的总体证据强度被评为“极低”质量。
正畸设计牙刷不会改变牙龈出血情况，但基于对菌斑指数控制的分析，有间接的科学证据推荐使用 O-TB 而不是 C-TB。虽然荟萃分析验证了 O-TB 可以更有效地去除牙菌斑，但这种改善尚不完全清楚，需要进一步的临床研究来评估使用 O-TB 与 C-TB 的效果。
