Abstract
Objective
To evaluate the available evidence regarding clinical effectiveness of clear aligner treatment (CAT).
Materials and methods
A comprehensive literature search was conducted for systematic reviews investigating effectiveness of CAT published up to July 15, 2021. This was accomplished using different electronic databases. No language restriction was applied. Screening, quality assessment, and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings from moderate and high-quality reviews.
Results
A total of 361 potentially eligible reviews were identified. After excluding the non-relevant/low-quality reviews, 18 systematic reviews were included. CAT was found to be effective for mild to moderate malocclusions, and was associated with inferior outcomes when treating severe cases or with achieving specific tooth movements. There were conflicting results regarding treatment duration; however, CAT may be associated with shorter treatment in mild to moderate cases. Relapse was greater with CAT, while periodontal health was better. The risk of root resorption tended to be lower with CAT. Regarding pain, the results were unclear, although CAT was found to be more comfortable and associated with a reduced impact on eating and chewing.
Conclusions
The level of evidence regarding CAT is moderate; hence, further high-quality randomized clinical trials are required. Evidence supports use of aligners as an alternate to fixed appliances in patients with mild-to-moderate malocclusion but not in severe cases. Advancement in technology could enhance the accuracy of CAT in delivering planned outcomes.
Clinical relevance
CAT can be used effectively for selected cases with mild to moderate malocclusion.
Registration
PROSPERO registration number: CRD42021246855.
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References
Bollen A-M, Cunha-Cruz J, Bakko DW, Huang GJ, Hujoel PP (2008) The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. J Am Dent Assoc 139(4):413–422. https://doi.org/10.14219/jada.archive.2008.0184
Ren Y, Jongsma MA, Mei L, van der Mei HC, Busscher HJ (2014) Orthodontic treatment with fixed appliances and biofilm formation: a potential public health threat? Clin Oral Investig 18(7):1711–1718. https://doi.org/10.1007/s00784-014-1240-3
Sandić MZ, Popović B, Carkić J, Nikolić N, Glišić B (2014) Changes in subgingival microflora after placement and removal of fixed orthodontic appliances. Srp Arh Celok Lek 142(5–6):301–305. https://doi.org/10.2298/SARH1406301Z
Fujiyama K, Honjo T, Suzuki M, Matsuoka S, Deguchi T (2014) Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy. Prog Orthod 15(1):64. https://doi.org/10.1186/s40510-014-0064-7
Azaripour A, Weusmann J, Mahmoodi B, Peppas D, Gerhold-Ay A, Van Noorden CJF, Willershausen B (2015) Braces versus Invisalign®: gingival parameters and patient’s satisfaction during treatment: a cross-sectional study. BMC Oral Health 15(1):69. https://doi.org/10.1186/s12903-015-0060-4
White DW, Julien KC, Jacob H, Campbell PM, Buschang PH (2017) Discomfort associated with Invisalign and traditional brackets: a randomized, prospective trial. Angle Orthod 87(6):801–808. https://doi.org/10.2319/091416-687.1
Kesling HD (1945) The philosophy of the tooth positioning appliance. Am J Orthod Oral Surg 31(6):297–304. https://doi.org/10.1016/0096-6347(45)90101-3
Sheridan JJ, LeDoux W, McMinn R (1993) Essix retainers: fabrication and supervision for permanent retention. J Clin Orthod 27(1):37–45. https://doi.org/10.5005/jp-journals-10021-1138
Meier B, Wiemer KB, Miethke RR (2003) Invisalign: patient profiling-analysis of a prospective survey. J Orofac Orthop 64(5):352–358. https://doi.org/10.1007/s00056-003-0301-z
Kuo E, Miller RJ (2003) Automated custom-manufacturing technology in orthodontics. Am J Orthod Dentofacial Orthop 123(5):578–581. https://doi.org/10.1067/mod.2003.S0889540603000519
Buschang PH, Shaw SG, Ross M, Crosby D, Campbell PM (2014) Comparative time efficiency of aligner therapy and conventional edgewise braces. Angle Orthod 84(3):391–396. https://doi.org/10.2319/062113-466
Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B (2009) How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign®. Am J Orthod Dentofacial Orthop 135(1):27–35. https://doi.org/10.1016/j.ajodo.2007.05.018
Krieger E, Seiferth J, Saric I, Jung BA, Wehrbein H (2011) Accuracy of Invisalign® treatments in the anterior tooth region. First results J Orofac Orthop 72(2):141–149. https://doi.org/10.1007/s00056-011-0017-4
Krieger E, Seiferth J, Marinello I, Jung BA, Wriedt S, Jacobs C, Wehrbein H (2012) Invisalign® treatment in the anterior region: were the predicted tooth movements achieved? J Orofac Orthop 73(5):365–376. https://doi.org/10.1007/s00056-012-0097-9
Flores-Mir C, Brandelli J, Pacheco-Pereira C (2018) Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances. Am J Orthod Dentofacial Orthop 154(5):639–644. https://doi.org/10.1016/j.ajodo.2018.01.013
Abbate GM, Caria MP, Montanari P, Mannu C, Orrù G, Caprioglio A, Levrini L (2015) Periodontal health in teenagers treated with removable aligners and fixed orthodontic appliances. J Orofac Orthop 76(3):240–250. https://doi.org/10.1007/s00056-015-0285-5
Djeu G, Shelton C, Maganzini A (2005) Outcome assessment of Invisalign and traditional orthodontic treatment compared with the American Board of Orthodontics objective grading system. Am J Orthod Dentofacial Orthop 128(3):292–298. https://doi.org/10.1016/j.ajodo.2005.06.002
Giancotti A, Greco M, Mampieri G (2006) Extraction treatment using invisalign technique. Prog Orthod 7(1):32–43
Phan X, Ling PH (2007) Clinical limitations of Invisalign. J Can Dent Assoc 73(3):263–266
Pavoni C, Lione R, Laganà G, Cozza P (2011) Self-ligating versus Invisalign: analysis of dento-alveolar effects. Ann Stomatol (Roma) 2(1–2):23–27
Aligntech Institute: Tooth movement assessment. Available at: https://s3.amazonaws.com/learn-invisalign/docs/us/ToothAssessment.pdf. Accessed on 16th February,2021.
Lagravere MO, Flores-Mir CF (2005) The treatment effects of invisalign orthodontic aligners. J Am Dent Assoc 136(12):1724–1729. https://doi.org/10.14219/jada.archive.2005.0117
Zheng M, Liu R, Ni Z, Yu Z (2017) Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis. Orthod Craniofac Res 20(3):127–133. https://doi.org/10.1111/ocr.12177
Papadimitriou A, Mousoulea S, Gkantidis N, Kloukos D (2018) Clinical effectiveness of Invisalign® orthodontic treatment: a systematic review. Prog Orthod 19(1):37. https://doi.org/10.1186/s40510-018-0235-z
Ke Y, Zhu Y, Zhu M (2019) A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health 19(1):24. https://doi.org/10.1186/s12903-018-0695-z
Papageorgiou SN, Koletsi D, Iliadi A, Peltomaki T, Eliades T (2020) Treatment outcome with orthodontic aligners and fixed appliances: a systematic review with meta-analyses. Eur J Orthod 42(3):331–343. https://doi.org/10.1093/ejo/cjz094
Pithon MM, Baião FCS, Sant Anna LIDA, Paranhos LR, Cople Maia L (2019) Assessment of the effectiveness of invisible aligners compared with conventional appliance in aesthetic and functional orthodontic treatment: a systematic review. J Investig Clini Dent 10(4):e12455. https://doi.org/10.1111/jicd.12455
Robertson L, Kaur H, Fagundes NCF, Romanyk D, Major P, Flores Mir C (2020) Effectiveness of clear aligner therapy for orthodontic treatment: a systematic review. Orthod Craniofac Res 23(2):133–142. https://doi.org/10.1111/ocr.12353
Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL (2015) Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod 85(5):881–889. https://doi.org/10.2319/061614-436.1
Galan-Lopez LG, Barcia-Gonzalezd JB, Plasencia E (2005) A systematic review of the accuracy and efficiency of dental movements with Invisalign. Korean J Orthod 49(3):140–149. https://doi.org/10.4041/kjod.2019.49.3.140
Mortazavi M, Naeim M, Badri A, Sharifi R, Hasheminasab M (2020) An updated systematic review on the effectivity of clear aligner therapy: a review. J Craniomax Res 7(4):165–177. https://doi.org/10.18502/jcr.v7i4.5552
Koletsi D, Iliadi A, Eliades T (2021) Predictability of rotational tooth movement with orthodontic aligners comparing software-based and achieved data: a systematic review and meta-analysis of observational studies. J Orthod DOI: https://doi.org/10.1177/14653125211027266.
Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL (2015) Periodontal health during clear aligners treatment: a systematic review. Eur J Orthod 37(5):539–543. https://doi.org/10.1093/ejo/cju083
Jiang Q, Li J, Mei L, Du J, Levrini L, Abbate GM, Li H (2018) Periodontal health during orthodontic treatment with clear aligners and fixed appliances. J Am Dent Assoc 149(8):712-720.e12. https://doi.org/10.1016/j.adaj.2018.04.010
Lu H, Tang H, Zhou T, Kang N (2018) Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed appliances and Invisalign system. Medicine (Baltimore) 97(13):e0248. https://doi.org/10.1097/MD.0000000000010248
Elhaddaoui R, Qoraich HS, Bahije L, Zaoui F (2017) Orthodontic aligners and root resorption: a systematic review. Int Orthod 15(1):1–12. https://doi.org/10.1016/j.ortho.2016.12.019
Aldeeri A, Alhammad L, Alduham A, Ghassan W, Shafshak S, Fatani E (2018) Association of orthodontic clear aligners with root resorption using three-dimension measurements: a systematic review. J Contemp Dent Pract 19(12):1558–1564. https://doi.org/10.1016/j.ajodo.2014.12.026
Fang X, Qi R, Liu C (2019) Root resorption in orthodontic treatment with clear aligners: a systematic review and meta-analysis. Orthod Craniofac Res 22(4):259–269. https://doi.org/10.1111/ocr.12337
Gandhi V, Mehta S, Gauthier M, Mu J, Kuo C, Nanda R, Yadav S (2021) Comparison of external apical root resorption with clear aligners and pre-adjusted edgewise appliances in non-extraction cases: a systematic review and meta-analysis. Eur J Orthod 43(1):15–24. https://doi.org/10.1093/ejo/cjaa013
Cardoso PC, Espinosa DG, Mecenas P, Flores-Mir CF, Normando D (2020) Pain level between clear aligners and fixed appliances: a systematic review. Prog Orthod 21(1):3. https://doi.org/10.1186/s40510-019-0303-z
Pereira D, Machado V, Botelho J, Proença L, Mendes JJ, Delgado AS (2020) Comparison of pain perception between clear aligners and fixed appliances: a systematic review and meta-analysis. Appl Sci 10:4276. https://doi.org/10.3390/app10124276
Zhang B, Huang X, Huo S, Zhang C, Zhao S, Cen X, Zhao Z (2020) Effect of clear aligners on oral health-related quality of life: a systematic review. Orthod Craniofac Res 23(4):363–370. https://doi.org/10.1111/ocr.12382
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg 8(5):336–341. https://doi.org/10.1016/j.ijsu.2010.02.007
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, Moher D, Tugwell P, Welch V, Kristjansson E, Henry DA (2017) AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ 358:j4008. https://doi.org/10.1136/bmj.j4008
Kravitz ND, Kusnoto B, Agran B, Viana G (2008) Influence of attachments and interproximal reduction on the accuracy of canine rotation with Invisalign. A prospective clinical study Angle Orthod 78(4):682–687. https://doi.org/10.2319/0003-3219(2008)078[0682:IOAAIR]2.0.CO;2
Hennessy J, Al-Awadhi EA (2016) Clear aligners generations and orthodontic tooth movement. J Orthod 43(1):68–76. https://doi.org/10.1179/1465313315Y.0000000004
Jadad AR, Cook DJ, Browman GP (1997) A guide to interpreting discordant systematic reviews. CMAJ 156(10):1411–1416
Yassir YA, El-Angbawi AM, McIntyre GT, Revie GF, Bearn DR (2019a) A randomized clinical trial of the effectiveness of 0.018-inch and 0.022-inch slot orthodontic bracket systems: part 2-quality of treatment. Eur J Orthod 41(2):143–153. DOI: https://doi.org/10.1093/ejo/cjy038.
Deguchi T, Honjo T, Fukunaga T, Miyawaki S, Roberts WE, Takano-Yamamoto T (2005) Clinical assessment of orthodontic outcomes with the peer assessment rating, discrepancy index, objective grading system, and comprehensive clinical assessment. Am J Orthod Dentofacial Orthop 127(4):434–443. https://doi.org/10.1016/j.ajodo.2004.03.030
Hong M, Kook YA, Baek SH, Kim MK (2014) Comparison of treatment outcome assessment for class I malocclusion patients: peer assessment rating versus American Board of Orthodontics-Objective Grading System. J Korean Dent Sci 7(1):6–15. https://doi.org/10.4041/kjod.2016.46.4.199
Yassir YA, El-Angbawi AM, McIntyre GT, Revie GF, Bearn DR (2019b) A randomized clinical trial of the effectiveness of 0.018-inch and 0.022-inch slot orthodontic bracket systems: part 1-duration of treatment. Eur J Orthod 41(2):133–142. DOI: https://doi.org/10.1093/ejo/cjy037.
Weltman B, Vig KWL, Fields HW, Shanker S, Kaizar EE (2010) Root resorption associated with orthodontic tooth movement: a systematic review. Am J Orthod Dentofacial Orthop 137(4):462–476. https://doi.org/10.1016/j.ajodo.2009.06.021
Roscoe MG, Meira JB, Cattaneo PM (2015) Association of orthodontic force system and root resorption: a systematic review. Am J Orthod Dentofacial Orthop 147(5):610–626. https://doi.org/10.1016/j.ajodo.2014.12.026
Yassir YA, McIntyre GT, Bearn DR (2020) Orthodontic treatment and root resorption: an overview of systematic reviews. Eur J Orthod cjaa058. DOI: https://doi.org/10.1093/ejo/cjaa058.
Currell SD, Liaw A, Blackmore Grant PD, Esterman A, Nimmo A (2019) Orthodontic mechanotherapies and their influence on external root resorption: a systematic review. Am J Orthod Dentofacial Orthop 155(3):313–329. https://doi.org/10.1016/j.ajodo.2018.10.015
Krukemeyer AM, Arruda AO, Inglehart MR (2009) Pain and orthodontic treatment patient experiences and provider assessments. Angle Orthod 79(6):1175–1181. https://doi.org/10.2319/121308-632R.1
Oliver RG, Knapman YM (2019) Attitudes to orthodontic treatment. Brit J Orthod 12(4):179–188. https://doi.org/10.1179/bjo.12.4.179
Furstman L, Bernick S (1970) Clinical considerations of the periodontium. Am J Orthod 61(2):138–155. https://doi.org/10.1016/0002-9416(72)90092-9
Grieve WG III, Johnson GK, Moore RN, Reinhardt RA, Dubois LM (1994) Levels in gingival crevicular fluid during human orthodontic tooth movement. Am J Orthod Dentofacial Orthop 105(4):369–374. https://doi.org/10.1016/s0889-5406(94)70131-8
Dray A (1995) Inflammatory mediators of pain. Brit J Anaesth 75(2):125–131. https://doi.org/10.1093/bja/75.2.125
Sergl HG, Klages U, Zentner A (1998) Pain and discomfort during orthodontic treatment: causative factors and effects on compliance. Am J Orthod Dentofacial Orthop 114(6):684–691. https://doi.org/10.1016/s0889-5406(98)70201-x
Sideri S, Papageorgiou SN, Eliades T (2008) Registration in the international prospective register of systematic reviews (PROSPERO) of systematic review protocols was associated with increased review quality. J Clini Epidemiol 100:103–110. https://doi.org/10.1016/j.jclinepi.2018.01.003
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Yassir, Y.A., Nabbat, S.A., McIntyre, G.T. et al. Clinical effectiveness of clear aligner treatment compared to fixed appliance treatment: an overview of systematic reviews. Clin Oral Invest 26, 2353–2370 (2022). https://doi.org/10.1007/s00784-021-04361-1
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DOI: https://doi.org/10.1007/s00784-021-04361-1