Surface-Specific and Time-Dependent Stain Removal Around Orthodontic Brackets: An In Vitro Comparison of Manual Toothbrush Designs.

OBJECTIVE

This study evaluated the efficacy of different manual toothbrush designs in removing extrinsic stains around orthodontic brackets using surface-specific and time-dependent assessments.

METHODS

Fifty extracted premolars bonded with brackets and archwires were stained and randomly allocated to five toothbrush groups: conventional (CTB), U-shaped (UTB), middle-groove (MTB), V-shaped (VTB) and triple-headed (THB) (n = 10/group). Simulated toothbrushing was performed for up to 10,000 cycles. Colour change (ΔE) was quantified using digital image analysis at four time points. Overall and surface-specific (mesiodistal, gingivo-occlusal) ΔE values were analysed using generalised estimating equations with Bonferroni correction.

RESULTS

Stain removal increased significantly over time across all groups (p < 0.001), although perceptible improvement was not consistently observed at early time points. THB demonstrated significantly higher overall ΔE values than other designs (p < 0.001), with differences becoming more pronounced from T2 onwards. Gingivo-occlusal surfaces showed greater stain removal than mesiodistal surfaces in four toothbrush groups (p < 0.05), whereas no surface difference was observed for THB. Differences between toothbrush designs were confined to mesiodistal surfaces, where THB achieved higher ΔE values than all other groups from T2 to T4 (p < 0.05); whereas no differences were detected at gingivo-occlusal surfaces.

CONCLUSION

Stain removal around orthodontic brackets is influenced by surface accessibility and brushing duration. Toothbrush design influenced stain removal most clearly under restricted-access conditions and after sufficient brushing time, with no significant differences observed at gingivo-occlusal surfaces. Triple-headed toothbrushes may offer an advantage in stain removal at anatomically restricted regions adjacent to brackets.