Plaque removal efficacy of manual versus powered toothbrushes in patients with clear aligners: a single-brushing randomized controlled trial

This study aimed to compare the plaque removal efficacy of manual and powered toothbrushes around attachments in patients undergoing clear aligner therapy under standardized, single-brushing conditions. This single-center, single-blind randomized controlled trial included 14 adults undergoing clear aligner therapy for more than 6 months. Participants were randomly assigned to either a manual (n = 7) or powered (n = 7) toothbrush group. To standardize plaque accumulation, toothbrushing was discontinued for at least 12 h prior to assessment. Plaque was disclosed and scored at baseline (T0) and after brushing (T1) using a Modified Plaque Index (MPI) on four surfaces around each attachment (mesial, distal, occlusal, and gingival). Following standardized oral hygiene instructions, participants brushed for 2 min with their assigned toothbrush. Patient- and tooth-level analyses were conducted to evaluate plaque reduction (ΔMPI), surface-specific differences, regional distribution, attachment type effects, and clinical response rates. Fourteen patients and 244 teeth with attachments were evaluated. Significant reductions in plaque scores were observed from T0 to T1 in both groups across all regions (p < 0.05). No statistically significant differences were found between manual and powered toothbrushes in plaque reduction across any region or surface (all p > 0.05). Surface-based analyses showed non-uniform plaque distribution, with higher plaque levels on distal and gingival surfaces and lower levels on occlusal surfaces (p < 0.001). Plaque reduction was not significantly influenced by attachment type. Clinical response rates were comparable between groups. Under standardized single-brushing conditions, no statistically significant difference was observed between manual and powered toothbrushes in plaque removal around attachments in patients with clear aligners. These findings suggest that plaque removal may depend more on brushing technique and surface accessibility than on toothbrush type.