Periodontal health: improved during clear aligner treatment suggests review

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The use of clear aligner treatment (CAT) for the provision of orthodontic treatment particularly in adults has increased significantly in recent years. While reviews of the effectiveness of CAT have been published (Dental Elf 24th Nov 2014) no information on side effects was reported.

The aim of this review was to assess whether CAT had any detrimental periodontal effects.


Searches were conducted in the Medline, Embase, Cochrane Central Register of Controlled Clinical trials, Web of Knowledge, Scopus, Google Scholar, and LILACS databases. Two reviewers independently selected studies, prospective studies were considered. Study quality was assessed using a 3-point grading system, described by the Swedish Council on Technology Assessment in Health Care (SBU).


  • 5 studies (1RCT, 4 prospective) involving a total of 281 patients were included.
  • All studies were assessed as moderate quality.
  • A narrative summary of the included studies was provided
  • A significant improvement of 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


The authors concluded

  1. Most of the studies presented with methodological problems: bias and confounding variables, lack of adequate blinding procedures and absence of proper randomization methods. Thus, conclusions with a moderate level of evidence could be drawn from the review process.
  2. Periodontal health, as well as quantity and quality of plaque, were better during CAT than during fixed appliance treatments.
  3. A significant decrease of periodontal indices (GI, PBI, BoP and PPD) during CAT was observed in the analyzed sample of patients.


This review had a broad search strategy and a previously published protocol. However, although they state that only prospective studies will be included they indicate in the discussion that retrospective studies were included despite the table of included studies indicating that all 5 studies were prospective. The authors also report that 280 patents were included in total, yet the information presented in the table suggests that there were only 173 patients. All the included studies involved the use of Invisalign (Align Technology, San Jose, California, USA) and all demonstrated an improvement in periodontal health. However ,the studies are all small and information on the duration of all the studies is not provided. The author’s also note that there were methodological problems with the included studies. Consequently these findings need to be treated with caution as the available evidence is limited.


Original review protocol PROSPERO- 42014009982

Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Periodontal health during clear aligners treatment: a systematic review. Eur J Orthod. 2014 Dec 29. pii: cju083. [Epub ahead of print] Review. PubMed PMID: 25548145.

Dental Elf – 24th Nov 2014- Orthodontic aligners: little evidence to assess their effectiveness

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