The study was conducted between September 2015 and June 2017 at Implantology Department of Policlinic Hospital, University of Milan, Milan. It was designed as a monocentric randomized clinical study according to the STROBE criteria. Eighty patients who underwent dental implant rehabilitation were selected for this study. At the screening visit, subjects were asked to read and sign a written informed consent and personal medical history and demographic information was obtained. Dental implants must have been placed at least 1 year before the recruitment; other inclusion criteria were age between 18 and 90 and a good general health. Patients with orthodontic therapy or removable prosthesis, including overdenture type, were not included in the study as well as non-controlled diabetic or heavy smoker (> 10 cigarettes) patients. The patients were already following a maintenance program after the implant placement; however, all of them were using the manual toothbrush for domiciliary oral hygiene. After being included in the study, each patient underwent periodontal (North Carolina) and peri-implant (perio probe) charting and recording of bleeding and plaque indexes (gingival bleeding index and plaque control record). Gingival bleeding index and plaque control record were recoded as the presence/absence of bleeding or plaque on four sites per tooth/implant. In order to detect the plaque, a disclosing agent was used. Sequentially, dental hygienist performed professional prophylaxis to establish a plaque free dentition. A software program randomly assigned 40 patients for both test and control groups. The electric toothbrush (Oral-B® ProfessionalCare 6000 with Bluetooth; Oral-B®, Procter & Gamble, Cincinnati, OH, United States) was introduced to patients of the test group, and instructions were given. According to the producer instruction, the procedure must have lasted not less than 2 min, using a timer set on 30 s for quadrant, twice/day. Furthermore, all the patients received a special toothbrush head designed for dental implants (Interspace; Oral-B®) together with another one for the natural teeth (Precision clean; Oral-B®) (Fig. 1). The patients of the control group did not change the manual toothbrush as a domiciliary oral hygiene device and received instructions of the modified Bass technique. The recommended time for toothbrushing was at least 90 s, twice a day. Patients of both groups received all the information in a paper copy. Once verified that the patients understood the instructions, new appointments were scheduled after 1 and 3 months. Bleeding on probing, plaque index, and probing depth were recorded at each visit on both dental implants and natural teeth. The entire sample had to use the same toothpaste to reduce the variability of the results.