Purpose: Toothbrushes are manufactured in different designs but it is unclear whether these differences may lead to improvement in the removal of bacterial plaque or make the toothbrushes more appealing to users. The aim of this study is to compare the efficacy of 11 toothbrushes in terms of plaque removal and their acceptance by patients. Materials and methods: Eleven toothbrushes were randomly assigned to one of the 12 sectors of the mouth of 48 patients. Each patient underwent one plaque recording before and after toothbrushing. Eleven sectors of the mouth were brushed by 11 different toothbrushes, while one sector was used as a control (no toothbrushing). Two questionnaires were also administered to investigate the aesthetic and comfort preference by each participant. Results: All 11 toothbrushes resulted in effective plaque reduction with respect to the control sector (P 0.0001). No significant differences were found between them. Colgate Massager showed the highest score for aesthetic preference by the patients when compared with Butler 311 and Gum Super Tip 463 (P = 0.0148). Oral-B Indicator 35 exhibited the highest score in terms of comfort felt by the patients compared to Colgate Omni and Gum Technique 493 (P = 0.0095). Conclusions: All of the tested toothbrushes, even though different with respect to shape and scope of function, demonstrated efficacious plaque removal. Keywords: dental plaque, mechanical plaque removal, patient preference, randomised controlled trial, toothbrush