In recent years due to the widespread popularity of clear aligner systems, more and more adults are seeking orthodontic treatment for their long-standing malocclusions. Today, clear aligners are inarguably valid alternatives for traditional fixed appliances for their marvellous aesthetics and incomparable comfort.
Literature in orthodontics has attested for clear aligners possess various potential advantages over conventional braces. These include a reduction in the amount and incidence of root resorption following orthodontic therapy, improvement of TMD-related pain and headache, and most importantly, better maintenance of oral hygiene and periodontal health. While much is known about the benefits of clear aligners in comparison to traditional fixed appliances, not much research has been perpetuated linking the direct or indirect effects of orthodontic treatment on periodontal status and oral health.
Periodontal disease is a family of inflammatory conditions that affect the periodontium. It is no surprise that fixed brackets and wires of braces can create multiple plaque retention sites for food debris and biofilm. These biofilms make perfect breeding grounds for oral bacteria, ultimately risking the patient’s oral health and hygiene by starting the snowballing of periodontal disease and dental caries. However, can we say with surety that aligner therapy does not fester the development of periodontal disease or negatively impacts oral health?
Experts suggest that periodontal reaction to orthodontic appliances depends on a wide array of factors such as host resistance, the presence of systemic conditions, and the amount and composition of dental plaque. Other lifestyle factors like smoking can also compromise periodontal support.
Considering that all teeth and keratinized gingiva are covered with aligners all day long, it is bound to affect periodontal health in some way or the other. This study relays a better understanding of the effects of clear aligner treatment on periodontal health and subsequently oral health.
This study was conducted by a team from Italy and published in the European Journal of Orthodontics.
Periodontal health during clear aligners treatment: a systematic review.
Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL.
Eur J Orthod. 2015 Oct;37(5):539-43. doi: 10.1093/ejo/cju083. Epub 2014 Dec 29.
What they asked
The authors aimed:
“To perform a systematic review of the existing literature in order to assess periodontal health during CAT.”
What they did
They did a systematic search in the medical literature through the following databases: Pubmed, Pubmed Central, National Library of Medicine’s Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACS to identify all peer-reviewed papers potentially relevant to the review.
A modified version of the ‘PICO approach was used to extract data from the selected papers. In this modified version, PICOS was used: Population (Participants), Intervention (or Exposure for observational studies), Comparator, Outcomes, and Study design.
The primary outcome was the periodontal effects of CAT evaluated on the basis of periodontal index variations detected during CAT. The secondary outcomes included the eventual CAT orthodontic movements with detrimental effects on dental and periodontal structures.
The risk of bias was assessed according to the Centre for Reviews and Dissemination (CRD) criteria. A 3-point grading system as described by the Swedish Council on Technology Assessment in Health Care (SBU was used to rate the quality of the selected papers.
What they found out
Through the search, they identified 5 studies that were relevant according to the eligibility criteria. 4 of these studies were prospective non-randomized and one was prospective. The sample size in individual studies ranged from 11 to 60 subjects with a total of 173 subjects.
According to the SBU tool, the quality of the collected evidence was moderate (grade B) in all five studies. A significant improvement in the periodontal health indexes was revealed, in particular when CAT was compared to fixed appliances. No periodontal CAT adverse effects were observed in the selected studies.
What we can conclude
From an entirely clinical standpoint, the use of removable appliances can very well minimize the orthodontics-related negative effects on periodontal health. That could be further confirmed by the results of this study. Through this review, we are able to establish that periodontal health indexes significantly improved during clear aligner therapy. However, the results from this study should be interpreted with caution owing to the total number, quality, and heterogeneity of the included studies.