White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta- analysis

Abstract

Objective To analyse the available evidence regarding the incidence and severity of white spot lesions (WSLs), plaque accumulation and salivary caries-associated bacteria(SCB) in clear aligners (CA) verses conventional fixed (CF) orthodontic appliances. Methods Electronic searches of MEDLINE, Scopus, Embase, Google Scholar, Clinical trial registry, OpenGrey and ProQuest were done for all relevant studies. Eligibility criteria were; Randomized Controlled Trials and Non-Randomized Studies that compared the incidence and severity of WSLs, plaque accumulation and SCB between CA and CF appliances in patients undergoing orthodontic treatment. The risk of bias(ROB) and certainty of evidence was assessed independently by two reviewers using Cochrane’s ROB and GRADEpro, respectively. Standardized mean difference (SMD) was used to estimate the effect size using STATA 17 software. Results A total of 14 studies met the eligibility criteria, and eight were suitable for meta-analysis. The qualitative results showed lower incidence and severity of WSLs, plaque accumulation, and SCB in CA group compared to CF appliances. The pooled results showed significantly lower plaque accumulation(SMD − 1.58;95%CI:-2.57,0.58;p = 0.002) in CA compared to CF appliances. Conclusions A moderate-quality evidence reveals less plaque accumulation and less SCB in CA, which might be related to the reduced incidence and severity of WSLs associated with CA when compared with CF appliances. However, the results of the present study should be interpreted with caution given the high ROB among some of the included studies as well as the marked heterogeneity across the studies. Clinical relevance For patients who can be treated with either CA or CF appliances, CA may be a better choice concerning oral health. Registration Open Science Framework (DOI:https://doi.org/10.17605/osf.io/kcpvb).

Conformation Effect on the Mechanical and Microbiological Behavior of Invisible Orthodontic Aligners

“…Coatings such as those containing lactoferrin or silver, gold, or copper nanoparticles may not discriminate between different types of bacteria, highlighting the importance of exploring bacteriostatic systems that prevent bacterial adsorption on the surface [ 31 ]. Therefore, further work should be conducted on bacteriostatic systems that do not allow adsorption of bacteria on the surface, such as polyethylene glycol coatings, which is an effective bacteriostatic agent [ 32 , 33 ]. The materials from which aligners are made are changing, and new materials are being used.…”

Correlation between salivary cytokine profiles and white spot lesions in adolescent patients receiving clear aligner orthodontic treatment

“…With an increasing number of patients choosing nonbracketed invisible orthodontic treatment, patients and doctors should pay more attention to the prevention and treatment of complications and the potential risks after treatment [ 7 ]. During clinical treatment, we found that in the invisible orthodontic group, many adolescent patients had white spot lesions after wearing the invisible orthodontic appliance, and the prevalence of this phenomenon in this group may not be lower than that in fixed orthodontic patients [ 8 ]. The etiology may be related to the ability of the invisible orthodontic appliance to disrupt homeostasis of the oral environment in adolescent patients and induce a series of inflammatory responses caused by changes in the microflora; the inflammatory factors involved in this process are the focus of this study [ 9 , 10 ].…”

Biomechanical Effects of Different Auxiliary–Aligner Designs on the Rotation of an Upper Canine: A Finite Element Analysis of a Specific Patient

“…According to the literature, we classified this patient in the "high-risk" group for the onset of WSL [26], so we decided to treat her with a set of aligners. Moderate-quality evidence reveals less plaque accumulation and less salivary caries-associated bacteria in clear aligners, which might be related to the reduced incidence and severity of WSLs associated with CA when compared with fixed-multibracket appliances [27].…”