Title Clear Aligner Therapy provides lower caries risk compared to Fixed Orthodontic Treatment
Clinical Question Do clear aligners increase patient’s risk for dental caries when compared to traditional attached braces?
Clinical Bottom Line The removable nature of clear aligners reduces plaque accumulation when compared to fixed orthodontic appliances. Clear aligners may be preferential for patients with a high caries risk.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
29921415Jiang/20189 studies which included 427 patients. 190 patients used clear aligners, and 237 patients used fixed appliances.Meta Analysis
Key resultsA decreased periodontal status is observed in patients with fixed appliance therapy when compared to those using removable aligners. A significantly greater (P<0.001) plaque index was observed in fixed appliance groups in all studies that were analyzed.
Evidence Search plaque AND clear aligners
Comments on
The Evidence
Validity: This was a meta-analysis in which the investigators searched for qualifying papers using PubMed, Web of Science, Cochrane Library, and Embase. They included RCT and cohort studies of healthy human subjects that used clear aligners and fixed appliances as intervention and control. Any studies that contained patients with history of systemic disease or prolonged antibiotic treatment were excluded. Unpublished studies or non-English papers were also not used in the meta-analysis. In total, the authors evaluated 57 full-text articles for relevant source material and narrowed the pool to nine after assessment by three independent investigators. In all of the literature they reviewed, the biggest risk of bias was the lack of blinding of study participants; a common finding in orthodontic trials. The researchers also scrutinized their own pooled results with trial sequential analysis to ensure there were no false-positives and overestimation of treatment effects. Perspective: Since plaque accumulation and biofilm production are large risk factors for caries formation, any treatment modality that increases the clinical presence of these risk factors will leave patients at increased chance of developing lesions. Plaque index is a major consideration when preforming a patient caries risk assessment. There are very few studies that analyze caries risk specifically. Because many different sequelae are concurrent with periodontal disease, the results of this analysis can safely be extended to caries.
Applicability Evidence pertains to patients with mild to moderate malocclusion within any orthodontic practice treated through clear aligner therapy or fixed orthodontic appliances. Patients with notable caries history may benefit from choosing clear aligners over a fixed option because it facilitates unimpeded oral hygiene and limits plaque retention. When clear aligners are not an option for patients, best practice should include patient education, treatment planning and recall protocol which takes into account the increase caries risk.
Specialty (General Dentistry) (Orthodontics) (Pediatric Dentistry) (Periodontics)
Keywords Clear aligners, Invisalign, caries, plaque index, orthodontics
ID# 3365
Date of submission 12/13/2018
E-mail marshs@uthscsa.edu
Author Spencer Marsh
Co-author(s) e-mail
Faculty mentor Dr. Ravikumar Anthony
Faculty mentor e-mail AnthonyR@uthscsa.edu
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