Effects of Multibracket Orthodontic Treatment versus Clear Aligners on Periodontal Health: An Integrative Review

Abstract

Objective: This integrative review aimed to identify studies comparing the periodontal health in patients wearing multibracket orthodontic appliances and clear aligners. Materials and methods: An integrative literature search was performed through different databases, PubMed/Medline, PMC, and the Cochrane Library. This work was submitted to a search strategy following the PICO method and included the focus question: “Could the chosen orthodontic appliance change significantly the oral hygiene of the patient, impairing the periodontal health?” This work included analytical and controlled studies on humans published between 2005 and 2020, in the English language, establishing a comparison of the periodontal status in patients undergoing orthodontic multibracket and clear aligners therapies. The main periodontal indexes assessed were plaque index (PI), pocket depth (PD), gingival index (GI), and bleeding on probing (BoP). Results: The electronic research displayed 386 articles on PMC, 106 on PubMed, and 40 on the Cochrane Library. After removal, just 25 articles were selected for full-text screening, but just eight studies were eligible for this integrative review. It was enumerated that 204 patients were treated with aligners and 294 with multibracket orthodontic appliances, mainly elastomeric ligated brackets. Only the plaque index displayed a significant difference between the two groups and general data obtained showed a better control for periodontal health in the clear aligners. Limitations such as age, malocclusion severity, therapeutic choice, and different time measure was observed. In addition, the oral hygiene instruction and follow-up by a professional were different, and the role of malocclusion was not present in the studies. Conclusions: Within the limitations of this study, better results for periodontal health were found in the clear aligners. Therefore, more studies are necessary to affirm that aligners are synonymous with better gingival conditions in comparison with multibracket appliances. Other variables such as oral hygiene instructions, motivation, and supportive treatment tend to be more prevalent than the type of appliance itself in the periodontal evaluation.

Digital orthodontic setup and clear aligners system for treating adult patients with periodontitis: a descriptive case report

“…In this regard, we opted for a slower movement stage (0,15 mm/1°) along with specific design features (see below) to obtain good periodontal results (26,30). Clear aligners are claimed as a better solution for maintaining periodontal health conditions compared to fixed appliances, due to better management of daily oral hygiene maneuvers (31). The patient found it beneficial to be able to remove the aligners and maintain her oral hygiene routine without the encumbrance of fixed components of the conventional orthodontic appliance.…”

Occlusal Changes with Clear Aligners and the Case Complexity Influence: A Longitudinal Cohort Clinical Study

“…The growing number of orthodontic treatments performed with CA, [28] in which the occlusal coverage prevents the obtention of natural contacts, has become a crucial research topic in Dentistry, [29] more specifically in the orthodontic community. The presence of the CA material in the interocclusal space may lead to anatomical changes and difficulties that are inherent to the obtention of those contacts and therefore compete against the final goal of CAT [1,7,8,13].…”

Periodontal health status, oral microbiome, white-spot lesions and oral health related to quality of life-clear aligners versus fixed appliances: A systematic review, meta-analysis and meta-regression

“…These findings are consistent with what Jiang et al 11 and Oikonomou et al 14 previously reported, highlighting significantly lower plaque index scores in CA patients. An integrative review performed by Partouche et al 13 concluded that CA patients were less subject to plaque accumulation than FA patients. However, among all the indexes evaluated, only PI differed significantly.…”

“…10,11 Recent evidence from systematic reviews suggests that patients in treatment with CAs show better periodontal health indicators than those wearing traditional braces. [11][12][13] However, the level of evidence of the articles included in the qualitative or quantitative synthesis was low due to the risk of bias and heterogeneity in the selected studies. 11 White spot lesions (WSLs) are a major concern when dealing with orthodontic patients.…”