Comparative Evaluation of Oral Health Status in Patients Undergoing Orthodontic Treatment With Clear Aligner Therapy Versus Conventional Fixed Appliance Therapy: An Umbrella Review

TL;DR

This umbrella review compares oral health outcomes between clear aligner therapy and conventional fixed appliances, finding better short-term hygiene with aligners but limited long-term data.

Contribution

A comprehensive synthesis of existing systematic reviews and meta-analyses comparing oral health outcomes of clear aligners versus conventional orthodontic appliances.

Findings

Clear aligner therapy is associated with lower plaque and gingival indices compared to conventional fixed appliances.

Current evidence on long-term periodontal effects and enamel demineralization remains limited and inconsistent.

Most included reviews showed moderate methodological quality and called for standardized metrics and longer follow-ups.

Abstract

Orthodontic treatment serves an essential function in correcting malocclusion and improving both function and esthetics, but different appliance systems can influence oral health outcomes due to variations in plaque accumulation, gingival response, and enamel demineralization. Clear aligner therapy (CAT) has gained recognition as a substitute for traditional fixed appliance therapy (CFAT), asserting advantages such as improved oral hygiene and fewer periodontal issues. This overview assesses and integrates results from current systematic reviews and meta-analyses that compare the oral health conditions of patients receiving CAT with those treated with CFAT. An extensive examination of peer-reviewed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines-compliant meta-analyses and systematic reviews was carried out, making use of databases like PubMed, Scopus, and the Cochrane Library. Studies assessing oral hygiene parameters, including periodontal, gingival, and plaque indices, and enamel demineralization, were included. The reviews chosen were assessed based on their methodological rigor, founded on the AMSTAR-2 criteria. After eliminating 327 duplicates, there were 916 records left for title and abstract screening. Out of these, 742 records were discarded for failing to fulfill the inclusion requirements. The entire texts of 174 articles were evaluated for inclusion, with 166 being excluded because there were insufficient data, irrelevant outcomes, or poor study design. In the end, the inclusion criteria were fulfilled by eight meta-analyses and systematic reviews, which were incorporated into this overview. Across the included reviews, findings consistently showed superior oral hygiene results in individuals receiving treatment with clear aligners. Individuals using CAT exhibited significantly lower plaque and gingival indices in contrast to individuals who received fixed appliances, largely due to the removability of aligners, which enables more efficient oral hygiene practices. However, evidence regarding long-term periodontal effects and enamel demineralization remains limited and heterogeneous. Most reviews demonstrated moderate methodological quality and highlighted the necessity for uniform outcome metrics and extended follow-up durations. Typically, current research indicates that clear aligner therapy provides better short-term oral health outcomes than conventional fixed appliances. Despite these promising findings, variations in study design and a lack of long-term data underscore the necessity for further high-quality research to draw definitive conclusions about long-term oral health relating to periodontal conditions and the risk of cavities.

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