Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta‐analysis

Zheng, Ming‐Hua; Liu, Ran; Ni, Zhenyu; Yu, Zepeng

doi:10.1111/ocr.12177

Cited by 198 publications

(149 citation statements)

References 18 publications

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“…Systematic reviews have evaluated the efficiency of orthodontic treatment with clear aligners and they suggested that the outcomes are not as accurate as those with fixed appliances [14][15][16]. On the other hand, treatment done with clear aligners present some advantages such as overall decreased treatment and chair time in patients with mild to moderate malocclusions [17]. Besides that, studies have shown that gingival health tends to be better, based on the periodontal health index, in patients treated with clear aligners [18,19].…”

Section: Introductionmentioning

confidence: 99%

Pain level between clear aligners and fixed appliances: a systematic review

et al. 2020

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Objectives: To assess if there is any difference in pain levels between orthodontic treatment with clear aligners or fixed appliances. Materials and methods: An electronic search was completed in PubMed, The Cochrane Database, Web of Science, Scopus, Lilacs, Google Scholar, Clinical Trials, and OpenGrey databases without any restrictions until February 2019. All comparative study types contrasting pain levels between clear aligners and fixed appliances were included. The risk of bias (RoB) was assessed using the Newcastle-Ottawa Scale, ROBINS-I-Tool, or ROB 2.0 according to the study design. The level of evidence was assessed through the GRADE tool. Results: After removal of duplicates, exclusion by title and abstract, and reading the full text, only seven articles were included. Five were prospective non-randomized clinical trials (CCT), one was a cross-sectional study, and one was a randomized clinical trial (RCT). Two studies presented a high RoB, three a moderate RoB, and two a low RoB (including the RCT). A meta-analysis was not performed because of clinical, statistical, and methodological heterogeneity. Most of the studies found that pain levels in patients treated with Invisalign were lower than those treated with conventional fixed appliances during the first days of treatment. Differences disappeared thereafter. No evidence was identified for other brands of clear aligners. Conclusions: Based on a moderate level of certainty, orthodontic patients treated with Invisalign appear to feel lower levels of pain than those treated with fixed appliances during the first few days of treatment. Thereafter (up to 3 months), differences were not noted. Malocclusion complexity level among included studies was mild. Pain is one of many considerations and predictability and technical outcome are more important, mainly considering that the difference does not seem to occur after the first months of the orthodontic treatment.

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Section: Introductionmentioning

confidence: 99%

Pain level between clear aligners and fixed appliances: a systematic review

et al. 2020

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“…The efficiency of tooth movement is important to set up the final treatment goals, to calculate treatment times and costs based on the available evidence. There are five previous systematic reviews (SR) that discussed the effectiveness of clear aligners . The first SR, published 14 years ago, only included two studies with high risk of bias (RoB) so it could not conclude anything about predictability of tooth movement with clear aligners.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of the included studies (63%) had a high RoB. Another SR published the same year included only four studies for qualitative analysis pointing towards insufficient evidence with regard to the effectiveness of clear aligner therapy as compared to fixed appliance therapy. Two recently published SRs included articles up to 2017.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of clear aligner therapy for orthodontic treatment: A systematic review

Robertson

Kaur

Fagundes

et al. 2019

Orthod Craniofacial Res

194

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Objective To analyse through a systematic review the effectiveness of clear aligners by assessing: (a) predictability of clear aligners and (b) treatment outcome comparison of clear aligner therapy with fixed appliance therapy. Methods An electronic search was made from January 2014 to April 2019 using MEDLINE, Embase, Web of Science and LILACS databases without any limitations on language. Three reviewers independently assessed the articles. Quality assessment of observational studies and randomized control trial was done by using the ROBINS tool and Cochrane risk of bias tool, respectively. GRADE instrument was used to assess certainty level for each identified outcome. Results Seven eligible articles (one randomized controlled trial and six retrospective cohort) were included in our systematic review. Most of the studies (six out of seven) had a moderate risk of bias and one had a high risk of bias. Conclusions ‘Low to moderate level’ of certainty in regard to specific clear aligner therapy tooth movements’ efficiency was identified. Clear aligners may produce clinically acceptable outcomes that could be comparable to fixed appliance therapy for buccolingual inclination of upper and lower incisors in mild to moderate malocclusions. However, not all potential clinical scenarios have been assessed in the included studies. Most of the tooth movements may not be predictable enough to be accomplished with only one set of trays with clear aligners despite the recent advances in technology.

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“…The CAT is increasing in popularity given its advantages over conventional fixed appliances in terms of esthetics, oral hygiene, comfort for patients, shortened treatment duration, and chair time in mild to moderate cases, despite the higher costs and the unpredictable outcome in certain cases. [3][4][5][6] Numerous studies have investigated the accuracy and efficiency of this technology. Kravitz et al 7 studied 37 nonextraction patients and found that the mean accuracy of tooth movement with Invisalign was only 41%.…”

Section: Introductionmentioning

confidence: 99%

“…Although many studies have researched treatment outcomes, 3,5,10,11 the biomechanical mechanisms by which CAT exerts its effects remain unknown, and it is challenging to assess the force imparted by these clear aligners. Finite element analysis has been used to provide quantitative and detailed data simulating the physiological tissue reactions during treatment, 12 but finite element analysis results depend directly on the input data, the accuracy of the model, and the boundary conditions and solution, while the accepted physical property values of the supporting tissues still include many discrepancies.…”

Section: Introductionmentioning

confidence: 99%