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Duration of orthodontic treatment with clear aligners versus fixed appliances in crowding cases: a systematic review

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Abstract

Objective

To critically appraise and assess the currently observed evidence about the difference in orthodontic treatment duration between clear aligners and fixed appliances in crowding cases.

Materials and methods

An electronic search without limitations was conducted from inception to June 2023 covering nine databases: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, Web of Science, Google Scholar, Trip, CINAHL via EBSCO, EMBASE via OVID and ProQuest. Randomized controlled trials (RCTs) and matched non-randomized studies were included in this systematic review. Risk of Bias was assessed via Cochrane’s tool (RoB 2) for RCTs and ROBINS-I tool for non-randomized studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was employed to evaluate the overall quality of evidence.

Results

Out of the 3537 articles initially identified, ten eligible studies were included in this systematic review; six were RCTs. Only one study offered extraction-based treatment, while the other nine adopted non-extraction treatments. According to the GRADE, there is low evidence that treatment duration in mild to moderate crowding cases with clear aligners is similar to that in fixed orthodontic appliances. Meta-analysis was not administered due to high inconsistency.

Conclusions

Based on currently available information, there was no significant difference in the treatment duration between the CA and FA groups in mild to moderate crowding cases. Further well-performed RCTs, especially in severe cases, are required.

Clinical relevance

Time efficiency is an essential outcome measure for clinical orthodontic practice. While the type of appliance used is a critical determinant of treatment duration, orthodontists should be aware of other factors that can significantly impact treatment time, such as patient and treatment-related factors.

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Funding

This study is funded by Damascus University _ funder No. 501100020595.

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Authors and Affiliations

  1. Department of Orthodontics, Faculty of Dentistry, University of Damascus, Al Mazzeh Street, Damascus, Syria

    Ahmad Marwan Alhamwi, Ahmad Sharafeddin Burhan & Mohammad Ibrahim Idris

  2. Department of Pediatric Dentistry, Faculty of Dentistry, Syrian Private University, Damascus, Syria

    Fehmieh Rafik Nawaya

Authors
  1. Ahmad Marwan Alhamwi
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  2. Ahmad Sharafeddin Burhan
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  3. Mohammad Ibrahim Idris
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  4. Fehmieh Rafik Nawaya
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Contributions

AMA and ASB performed the electronic search, assessed full-text articles, conducted study selection, data extraction, and risk of bias evaluation, and wrote the initial draft. FRN co-supervised and helped in the writing stage and resolving disagreements that arose during the risk of bias assessment. MII helped in developing the review question and the writing stage. All authors approved the final version of this manuscript.

Corresponding author

Correspondence to Ahmad Marwan Alhamwi.

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Ethical approval was not required for this systematic review as it was not applicable.

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Alhamwi, A.M., Burhan, A.S., Idris, M.I. et al. Duration of orthodontic treatment with clear aligners versus fixed appliances in crowding cases: a systematic review. Clin Oral Invest 28, 249 (2024). https://doi.org/10.1007/s00784-024-05629-y

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