Effectiveness of Different Toothbrushing Methods on Plaque Accumulation and Gingival Health in Patients With Fixed Orthodontic Appliances

Introduction: Maintaining adequate oral hygiene during fixed orthodontic treatment is challenging because brackets, archwires, and ligatures promote plaque retention and increase the risk of gingival inflammation. Various toothbrush designs have been introduced to improve plaque removal; however, their comparative effectiveness in orthodontic patients remains unclear. We aimed to compare the effectiveness of different toothbrushing methods in maintaining plaque control and gingival health among patients undergoing fixed orthodontic treatment. Materials and methods: This prospective study included 90 participants undergoing fixed orthodontic treatment who were divided into five equal groups (n = 18 each) according to the prescribed toothbrushing method: conventional manual toothbrush, orthodontic manual toothbrush, powered electric toothbrush, conventional manual toothbrush with an interdental brush, and orthodontic manual toothbrush with an interdental brush. Plaque accumulation and gingival health were assessed at baseline and monthly intervals for six months using orthodontic plaque and gingival indices. Data were analyzed using two-way repeated-measures analysis of variance with appropriate post hoc tests, and statistical significance was established at p < 0.05. Results: All toothbrushing methods demonstrated progressive improvements in plaque and gingival scores during the six-month follow-up. Mean plaque index decreased from 1.16 ± 0.51 to 0.35 ± 0.12 in the conventional manual toothbrush group and from 1.07 ± 0.54 to 0.22 ± 0.12 in the powered electric toothbrush group. The gingival index decreased from 1.66 ± 0.48 to 0.39 ± 0.19 in the conventional manual toothbrush group and from 1.46 ± 0.61 to 0.28 ± 0.18 in the orthodontic manual toothbrush with interdental brush group. There was a significant main effect of time on both the plaque and gingival indices (p < 0.001). The group effect was significant for gingival index (p < 0.001) but not for plaque index (p = 0.178). No significant group × time interactions were observed. Post hoc analysis showed a significantly lower plaque index in the powered electric toothbrush group than in the conventional manual toothbrush group (p = 0.032). Conclusions: All evaluated toothbrushing methods improved oral hygiene and gingival health during fixed orthodontic treatment. The powered electric toothbrush showed the greatest plaque reduction and a statistically significant advantage over conventional manual toothbrushes in a post hoc comparison. In contrast, the orthodontic manual toothbrush combined with an interdental brush demonstrated the most favorable gingival health outcomes. Regular reinforcement of oral hygiene practices, together with appropriate toothbrush selection tailored to individual patient needs, may help minimize plaque-related complications during orthodontic treatment.