Should clinicians recommend oscillating-rotating toothbrushes over sonic models for superior plaque and gingivitis control?

Abstract

A commentary on: Adam R, Grender J, Timm H, Qaqish J, Goyal C R. A randomized controlled trial evaluating a novel oscillating-rotating electric toothbrush versus a sonic toothbrush for plaque and gingivitis. Am J Dent 2025; 38: 3-8.

Data sources: The study was a rigorously designed, single-center, examiner-blinded, randomized controlled trial. It included adult participants presenting with clinical signs of gingivitis and visible plaque. Subjects were randomly assigned to use either an oscillating-rotating electric toothbrush or a high-end sonic electric toothbrush. Both groups brushed twice daily for four weeks using a standard sodium fluoride toothpaste. Gingival inflammation was evaluated using the Modified Gingival Index and the Gingival Bleeding Index. Plaque accumulation was assessed via the Rustogi Modification of the Navy Plaque Index. Data were collected at baseline, immediately after a single brushing session and after four weeks of consistent use.

Study selection: Participants were adults diagnosed with plaque-induced gingivitis. They were randomized into two arms: one group used the Oral-B iO2 toothbrush with the Ultimate Clean brush head in Daily Clean mode while the other group used the usmile Marble-Art toothbrush with the Advanced Whitening brush head in high-intensity clean mode. All participants followed a standardized brushing regimen. Examiner blinding was implemented to reduce observational bias and enhance objectivity.

Data extraction and synthesis: Gingival inflammation and plaque levels were assessed at three distinct intervals. The percentage of participants achieving gingival health defined as fewer than ten percent of bleeding sites was also measured. Comparisons were performed within and between groups. The threshold for statistical significance was set at a probability value less than 0.05.

Results: Both devices led to statistically significant reductions in plaque accumulation and gingival inflammation. However, the oscillating-rotating toothbrush demonstrated superior performance across all parameters. Participants using this toothbrush exhibited a significantly greater reduction in Modified Gingival Index scores and a marked decrease in the number of bleeding sites. A higher proportion of users in this group attained gingival health status. Plaque removal was more effective following a single brushing session with notable improvements observed throughout the entire mouth, interproximal surfaces and along the gingival margins. These benefits were maintained at the four-week follow-up.

Conclusion: The oscillating-rotating toothbrush achieved superior clinical outcomes in the reduction of plaque and gingival inflammation when compared to the sonic toothbrush. Its efficacy was observed both immediately and after consistent use over a four-week period.