Lack of proper oral hygiene practices can lead to treatment failure in patients with implant-retained restorations. Structural changes of toothbrush bristles were studied using scanning electron microscopy and correlated with cleaning efficiency which was assessed at baseline and after 3 months of use of various toothbrushes types in 146 patients with implant-retained restorations. Oral hygiene was valued according to several indices (Approximal Plaque-Index (API), the Turesky index (PI), a modified superstructure plaque index Silness-Loe (PLIsk). Ultrasound toothbrush provided the best and the most efficient cleaning outcome in patients with implant-retained restorations. Scanning electron microscopy proved ultrasonic toothbrush bristles to be more resistant to abrasion during the three-month use.