Influence of Manual and Powered Toothbrushes on Gingival Lesions: A Systematic Review and Meta‐Analysis

AIM: The aim of the present systematic review is to compare the effects of manual vs. powered toothbrushes on gingival lesions. METHODS: Comprehensive literature searches of PubMed, Embase, Scopus, and the Cochrane Library were conducted up to May 6, 2024, to identify randomized clinical trials examining the impact of manual and powered toothbrushes on gingival lesions. Two independent reviewers selected studies according to predefined criteria and extracted relevant data. Risk of bias was assessed using the RoB 2 tool, and certainty of evidence was evaluated using the GRADE approach. Sensitivity analyses were also performed to explore the influence of statistical model choice and study design on the pooled findings. This review was registered in PROSPERO (CRD42022368852). RESULTS: A total of 2978 records were identified, of which 10 studies met the inclusion criteria. The included studies comprised five parallel-group randomized clinical trials and five crossover randomized clinical trials. Analysis of gingival recession showed no statistically significant difference between manual and powered toothbrushes at either 6- or 12-month follow-up (mean difference MD: -0.03; 95% confidence interval 95% CI: -0.07 to 0.02). Studies evaluating gingival abrasion suggested a trend toward fewer abrasions with powered toothbrushes; however, the evidence was inconsistent and mostly based on qualitative findings. The certainty of evidence for both gingival recession and gingival abrasion was very low. CONCLUSIONS: The available evidence does not demonstrate a clear difference between manual and powered toothbrushes regarding gingival recession progression. Although some studies suggested fewer gingival abrasions with powered toothbrushes, this finding should be interpreted with caution due to the very low certainty of evidence and the included studies presented important methodological limitations.