Comparison of Plaque Removal Efficacy of Different Toothbrushes in Clear Aligner Patients

Dental plaque is a complex biofilm and a primary etiological factor in the development of dental caries and periodontal diseases. Orthodontic treatments may increase plaque accumulation due to the presence of attachments bonded to the tooth surface.

Clear aligner therapy has become increasingly popular due to its esthetic and removable nature. However, attachments used during treatment may compromise oral hygiene by promoting plaque retention, particularly in the gingival region.

This study is designed to evaluate and compare the plaque removal effectiveness of manual and powered toothbrushes in patients undergoing clear aligner orthodontic treatment.

A total of 14 patients receiving clear aligner therapy will be randomly assigned to either a manual toothbrush group or a powered toothbrush group. Dental plaque accumulation around attachments will be assessed before brushing (T0) and after a standardized two-minute brushing period (T1) using the Modified Plaque Index adapted for orthodontic patients.

Plaque scores will be evaluated at multiple tooth surfaces (mesial, distal, occlusal, and gingival) and analyzed both on a patient-based and tooth-based level. Attachments will also be categorized as conventional or optimized, and plaque reduction will be compared between attachment types.

The findings of this study are expected to provide evidence regarding the effectiveness of different toothbrush types in maintaining oral hygiene in patients treated with clear aligners.

Inclusion criteria

• Age ≥ 18 years
• Undergoing orthodontic treatment with clear aligners
• Presence of bonded attachments on teeth
• No known systemic diseases
• Not using any regular systemic medications
• Right-handed individuals (actively using the right hand)

Exclusion criteria

• Age < 18 years
• Absence of attachments on teeth
• Presence of any systemic disease
• Regular use of systemic medications
• Left-handed or ambidextrous individuals