Comparison of Short-Term Oral Impacts Experienced by Patients Treated with Invisalign or Conventional Fixed Orthodontic Appliances

Abstract

Objectives: Our objective was to test the hypothesis that thermoplastic clear aligners (Invisalign®; Align Technology, Santa Clara, CA, USA) are more pleasant for patients than conventional fixed orthodontic appliances. Subjects and Methods: This was an observational retrospective study in which subjects were matched for age, treatment modality, and the treating orthodontist. A total of 60 adult patients (30 in the Invisalign group and 30 in the conventional buccal fixed appliance group) who met the inclusion criteria completed a validated self-reporting questionnaire, rating their experience after appliance activation in regard to oral impact experience and satisfaction of both treatment modalities. Categorical variables were compared using the χ² test, Fisher’s exact test, and the Z test. Continuous variables such as pain level and age were analyzed using the 2-sample t test. Results: Patients on clear aligner therapy reported significantly more difficulty in speech (p = 0.035) necessitating change in speech delivery (p = 0.003). In addition, they reported better chewing ability (p < 0.001), no restrictions on amounts or types of food (p = 0.02), and less mucosal ulcerations (p = 0.01). Effects on daily routine, use of analgesics, and overall treatment satisfaction were not significantly different between the 2 groups. Conclusion: Clear aligner therapy is not necessarily more pleasant, but it is more tolerable as it satisfies patient needs over food consumption and absence of mucosal ulcerations. However, clear aligners affect pronunciation and speech delivery in the short term.

Effects of orthodontic treatment with aligners and fixed appliances on speech:

“…Accordingly, considering that the present study performed evaluations at different time points, the adaptation period observed may be considered acceptable, and the temporary alterations in speech production would not restrict the indication for treatment with OAs. 8,14 The semiobjective (perceptive/auditive) evaluation carried out in this study demonstrated a significant change in speech production for the phoneme /ch/ only in patients treated with OAs, immediately and 3 days after insertion. Immediately after insertion of the appliances, 50% of patients in the OA group produced a more intense and prolonged phoneme sound, while 35% exhibited prolonged pronunciation.…”

“…These results were in agreement with other studies in which researchers observed the need for a period of patient adaptation for speech production after insertion of fixed or removable orthodontic appliances. 6,8,13 For patients treated with FAs, the difficulty in speaking reported immediately after insertion of the appliance and at 3 days was probably due to the presence of a foreign body on the buccal surface of the teeth, which could have altered oral sensory perception and lip mobility. Regardless of the group, the sensory adaptation and adaptation of the mobility of the perioral musculature, in addition to the resolution of the signs and symptoms, may have contributed to the patients' adaptation, 6,14,15 so that the results at 30 and 180 days would be similar to those at baseline.…”

“…Pogal-Sussman-Gandia et al, 7 in a cross-sectional study, also evaluated patients treated exclusively with OAs and found modifications in the fricative consonants /z/ and /s/, with changes in the production of speech, which could affect the patient's adherence to treatment. In the observational, retrospective study conducted by Alajmi et al, 8 the patients who underwent treatment with aligners and fixed orthodontic appliances reported difficulty with speech, particularly those patients who used aligners; however, the degree of satisfaction was no different between the treatments. Still, the authors pointed to several limitations in the design and execution of the study, such as the lack of rigidity of inclusion criteria with regard to patient availability and willingness to participate, the significant disparity in age within the groups, stage of treatment, and type of tooth movement.…”

Oral Impacts Experienced by Orthodontic Patients Undergoing Fixed or Removable Appliances Therapy in Saudi Arabia: A Cross-Sectional Study

“…12,15,25 On the contrary, Alajmi et al found no significant differences in sleep difficulties between patients undergoing fixed and Invisalign orthodontic treatment. 19 While Wu et al did not find any difference in sleeping problems between lingual and buccal fixed orthodontic patients. 26 In our study, fixed orthodontic patients had a higher incidence of mucosal sores on the lips, tongue, and cheeks due to the use of metal brackets, wires, and bands, which increases the risk of mucosal irritation than the removable appliance therapy.…”

“…It consists of fourteen items that assess the effects of orthodontic appliances on daily activities, disturbances in eating, and oral symptoms. 19 According to Zamora-Martinez et al, the quality of life of orthodontic patients decreased significantly throughout therapy compared to their pre-treatment status but increased considerably at the end of treatment. 20 Orthodontic appliances are expected to negatively impact OHRQoL because of the position and design of removable and fixed appliances.…”