Clear aligner therapy versus conventional brackets: Oral impacts over time

Abstract

Background: The objective is to compare the impact of clear aligner treatment (CAT) versus
conventional fixed appliance treatment (FAT) on oral health‑related quality of life (OHRQoL)
among adults at five‑time points: pretreatment (T0), 1 week (T1), 1 month after (T2), and 6 months
after (T3) treatment initiation, and in the long‑term follow‑up (T4).
Materials and Methods: Search terms were based on Medical Subject Headings (MeSH)
and non‑MeSH. Potentially eligible studies compared OHRQoL in clear aligner (CA) and fixed
appliance (FA) patients. In February 2023, Scopus, Web of Science, Cochrane, and PubMed were
searched for published studies. Nine out of 94 shortlisted papers were eligible for a systematic
review. Of these nine papers, five studies were considered for a meta‑analysis.
Results: At T0, CA and FA patients had similar oral health impact profile (OHIP)‑14 questionnaire
scores with a standard mean difference (SMD) of 0.105 (confidence interval [CI]: −1.029–1.48). The
SMD of the OHRQoL related to T1, T2, and T3 was −3.119 (CI: −0.145, 0.355), −1.527 (CI: −5.597,
−0.64), and − 2.331 (CI: −1.906, −1.148). T4 showed no difference between groups (SMD = 0.007,
CI: CI: −4.286, −0.376). Regarding the OHIP‑14 domains, functional limitations remained consistent
in both groups across all time intervals. Psychological discomfort exhibited a notable difference only
at T2. Throughout the treatment, CAT showed significantly lower levels of physical, psychological,
and social disability, as well as handicap, though these differences did not persist beyond T4. Notably,
physical pain was the sole domain that remained elevated in the FAT group up to T4.
Conclusion: During the 1st day of the orthodontic treatment, both the CA and FA groups had
comparable OHRQoL statuses. However, as time passed, the CA group notably improved their
OHRQoL compared to the FA group. Interestingly, after a year or the completion of treatment,
both groups eventually reached similar OHRQoL levels. Nevertheless, it is worth noting that FA
patients continued to experience more physical pain even a year later.
Key Words: Adult, oral health, orthodontic appliances, orthodontic brackets, quality of life,removable

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Sara Hashemi: Pubmed,Google Scholar