Comparative efficacy of electric toothbrush technologies in plaque and gingivitis reduction: a network meta-analysis

The comparative efficacy of different types of electric toothbrushes relative to each other and to manual toothbrushes remains a subject of clinical investigation. This network meta-analysis (NMA) aims to rank the efficacy of various electric toothbrush technologies for plaque and gingivitis reduction.

A systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was conducted from inception to June 2025. Randomized controlled trials (RCTs) comparing electric (oscillating-rotating, sonic, ultrasonic, other) and manual toothbrushes were included. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. A frequentist NMA was performed, and treatments were ranked using Surface Under the Cumulative Ranking (SUCRA) values. Consistency between direct and indirect evidence was evaluated.

Nineteen RCTs were included. In terms of plaque reduction, oscillating-rotating brushes were ranked first (SUCRA = 89.2%), followed by sonic (SUCRA = 72.4%), ultrasonic (SUCRA = 54.1%), other electric (SUCRA = 45.3%), and manual toothbrushes (SUCRA = 18.3%). A similar ranking was observed for gingivitis reduction. Subgroup analyses indicated superior benefits for orthodontic patients and children. The overall risk of bias was low, and no significant inconsistency was detected.

Oscillating-rotating electric toothbrushes demonstrated the highest probability of being among the most effective interventions for reducing plaque and gingivitis among the compared technologies. This evidence suggests that they may be considered a preferred choice for improved oral hygiene in clinical practice, particularly in high-risk groups such as orthodontic patients and children.