Effectiveness of different mechanical bacterial plaque removal methods in patients with fixed orthodontic appliance: a systematic review/meta-analysis
the presence of a fixed orthodontic appliance and its accessories tends to affect bacterial plaque removal, resulting in inadequate cleaning being performed by the patient. Thus, the aim of this systematic review and meta-analysis was to answer the following focal question: are the mechanical methods of oral cleaning effective for the reduction of bacterial dental plaque in patients with a fixed orthodontic appliance? A systematic search of the literature was conducted in the following databases: Scopus, PubMed, Cochrane, Web of Science, Embase, and Medline, in addition to Controlled Trials and Grey Literature, without limitations of language and year of publication. Furthermore, searches were also conducted in the reference lists of the articles selected. Included in the present review were clinical studies with patients undergoing therapy with fixed orthodontic appliances, which would, by means of comparison, evaluate the effectiveness of different mechanical bacterial plaque removal methods. The methodological quality of the articles included was evaluated in accordance with the checklist prepared as methodological evaluation protocol, and was classified as high, moderate or low. In order to perform the meta-analysis, articles with high methodological quality were included. Analysis of sub-groups was performed according to the type of intervention. The plaque index was defined as the continuous outcome variable, using the fixed effect when there was homogeneity among the articles, and the random effect in cases of heterogeneity. 1815 articles were found, of which only 23 fulfilled the eligibility criteria, with 17 being of high methodological quality and 6 of moderate quality. Of these, 18 included an analysis of the effectiveness of the conventional manual brush, 4 of the manual orthodontic brush,15 of electric brushes, 3 of interdental brushes, 1 of dental floss and 4 or oral irrigation devices, and 1 of Siwak. In the qualitative evaluation of the studies, the use of these mechanical control methods was shown to be effective, with exception of the use of Siwak, which presented an increase in bacterial plaque. Moreover, the results of the meta-analysis indicated a significant reduction of -0.98 (IC 95%) in the plaque index for the use of conventional manual brushes in the period of one month (p<0.001). There is a body of evidence that proves the effectiveness of mechanical bacterial plaque removal in patients using orthodontic appliances and accessories. The findings of the meta-analysis proved the effectiveness of the conventional manual brush. Further studies with better standardization of samples are required to strengthen the evidences.
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