Dental implants became one of the most accepted treatments for the rehabilitation of partial or complete edentulism [1]. However, inflammatory processes may still occur due to the presence of the implant itself [2]. It is well known that peri-mucositis and peri-implantitis are strictly related to the presence of plaque on the surface of the implant-prosthetic complex, which lead respectively to the inflammation of peri-implant soft tissues and the bone loss around the implant neck area [3, 4]. The problem of implant maintenance must be taken in serious consideration even before the dental implant placement. Many risk factors have been associated to peri-implantitis such as smoke, diabetes, and a history of periodontal disease [5,6,7,8]. Furthermore, the prevalence of this pathology is rising. It has been estimated, in fact, that a range from 10 to 43% of all implants placed today will have some form of peri-implantitis in about 10 years [9, 10]. Many authors associated the microbiological flora responsible of peri-implantitis to the one associated to periodontal disease, while others confuted this hypothesis [11].

Many techniques and protocols have been introduced for the treatment of peri-implantitis; however, the topic is still debated and the different rates of success of various treatments still suggest that a good prevention must still be preferred [12]. The presence of bacterial microfilm on the implant surface has been individuated as the primary cause of the pathologic mechanism. As well as in the teeth, mechanical removal represents the only treatment able to remove the microfilm and toothbrush and dental floss are the only effective domiciliary devices able to remove plaque from the teeth and dental implant. Mouth rinses or other methods may enhance periodontal indices but only when associated to an effective primary mechanic removal device. It has also been proved how both manual and electric toothbrushes are effective in the plaque removal [13]. Several authors comparing the two devices were not able to find any differences in term of clinical results, while others found advantages for one technique with respect to the other [14,15,16,17]. Patients with motor problems and elderly may found benefit in using the electric toothbrush, which does not require the same level of manual skills as the manual one [18, 19]. Recently, there has been introduced a new type of electric toothbrush, with a visual-sound system, showing the correct pressure to apply when brushing and the exact amount of time necessary to complete one or half dental arch. Special designed toothbrush heads for different areas of the mouth and different surfaces, like dental implants, have recently been introduced for electric toothbrushes without a clear scientific support. The present study aims to investigate the efficacy of an oscillating-rotating toothbrush using a dedicated designed head, in patients with dental implants.