Title Clear Aligners May Reduce Impact on Periodontal Health Compared to Fixed Orthodontic Appliances
Clinical Question In orthodontic patients, do clear aligners compared to fixed appliances result in better periodontal health?
Clinical Bottom Line Clear aligners may have advantages over fixed orthodontic appliances for oral hygiene and periodontal health, based on a systematic review and meta-analysis. This may be beneficial for high risk gingivitis patients requiring orthodontic treatment.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
29921415Jiang/2018464 total subjects undergoing orthodontic treatment (207 clear aligners/257 fixed appliances) Meta-Analysis
Key resultsClear aligner subjects had significantly lower plaque scores (-0.53, 95% CI -0.85 to -0.2, P=0.001) and gingival index scores (-0.27 95%CI -0.37 to -0.17, P<0.001). Initially, there was a significant difference in probing depth, but trial sequential analysis found this to be a false-positive result due to insufficient sample size.
Evidence Search ("Orthodontic Appliances"[Mesh]) AND "Gingivitis"[Mesh] AND "Clear aligner"
Comments on
The Evidence
This was a systematic review of 3 randomized clinical trials and 7 cohort studies. One cohort study was not included in the meta-analysis due to reporting only median results. These studies were selected from a detailed systematic literature search of multiple databases, unpublished literature, and clinical trial registries. The authors confirmed meta-analysis findings with a trial sequential analysis to overcome false-positive results from systematic bias and random errors. All studies were evaluated for methodological quality, and the most common risk of bias reported was a lack of blinding of participants, personnel, and outcome assessments. The authors rated the evidence as medium, and additional studies are needed.
Applicability These results apply to a specific population of patients undergoing orthodontic treatment who are eligible for either clear aligner or fixed appliance therapy options. Dentists who provide orthodontic treatment can include this information in the informed consent for patients deciding on orthodontic treatment options. Clear aligners may be a better option for those at a high risk of gingivitis but requiring orthodontic treatment. It is also beneficial for providers concurrently treating patients in active orthodontic therapy to be aware of the effect of different treatment modalities on oral hygiene and periodontal health. Regardless of type of orthodontic treatment, adequate patient oral hygiene is necessary for periodontal health.
Specialty (General Dentistry) (Orthodontics) (Pediatric Dentistry) (Periodontics)
Keywords clear aligners, orthodontics, gingivitis, oral hygiene, Invisalign
ID# 3333
Date of submission 10/16/2018
E-mail kennedyk4@livemail.uthscsa.edu
Author Kristi NJ Kennedy, DDS, MPH
Co-author(s) e-mail
Faculty mentor Angela M. Coomes, DDS, MS
Faculty mentor e-mail angela.m.coomes.mil@mail.mil
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available