Fixed Appliances Research Articles

Perception about Clear Aligner Therapy among Patients Seeking Orthodontic Treatment in Public Tertiary Care Dental Hospital-Cross-Sectional Survey

Aim: Aim of the study is to assess perception about clear aligner therapy among patients seeking orthodontic treatment in public tertiary care dental hospital.  Material and Methods: This cross-sectional survey was conducted using a questionnaire that had been framed and tested for reliability and validity. It was used to collect information on the socio-demographic profile and the perspectives of orthodontic patients regarding Clear Aligner Therapy. Participants had been informed about the study, and only those who had consented were administered the questionnaire. The structured questionnaire consisted of 23 closed-ended questions, and the data was collected using Google Forms.  Results: Data from 294 patients were assessed, comprising 159 females (54.1%) and 134 males (45.6%), all between the ages of 15 and 45. Of these, 92% were aware of Clear Aligner Therapy (CAT). 31.3% patients perceived CAT to be less effective than fixed appliance (FA) therapy, with only 19.3% being aware of the cost of CAT. Additionally, 30.4% believed that CAT would result in a longer treatment duration compared to fixed appliances. However, 59.6% preferred CAT over fixed appliances for aesthetic reasons, and 78.6% favored CAT for better oral hygiene maintenance.  Conclusion: As Clear Aligner Therapy (CAT) represents one of the latest advancements in orthodontics, there is a pressing need to increase education and awareness among the general population to improve their understanding of this treatment option.

Comparative evaluation of alveolar bone remodeling and root length changes in fixed appliances versus clear aligners: A retrospective cohort study on skeletal Class III malocclusion treatment

The retrospective study examined changes in the root length and alveolar bone surrounding maxillary incisors in patients with skeletal Class III malocclusion treated by surgical orthodontic treatment with either fixed appliances (FAs) or clear aligners (CAs). A total of 60 subjects were divided based on appliance type used. Cone beam computed tomography scans were taken at three stages: before treatment, after presurgical orthodontic treatment, and post-treatment for both groups. Vertical alveolar bone level and horizontal alveolar bone thickness (ABT) were measured at four heights (3, 6, and 9 mm from the cementoenamel junction, and the root apex), along with root length, at these time points. Both groups showed a decrease in root length, with the CA group experiencing a significantly smaller reduction (0.4 ± 0.79 mm) compared with the FA group (0.64 ± 0.8 mm; P = 0.02). The FA group demonstrated more significant reduction in palatal ABT (P < 0.05) and greater root resorption, whereas the CA group exhibited considerable labial marginal bone resorption (P = 0.007) and a notable decrease in labiolingual inclination (P = 0.042). The findings suggest that FA and CA might lead to decreased ABT and significant root resorption, with FA therapy likely resulting in more pronounced effects. Both modalities led to notable vertical bone loss, particularly, on the labial side of the maxillary incisors in the CA group during postsurgical orthodontic treatment. Preventing iatrogenic deterioration of periodontal support surrounding the incisors is crucial during presurgical and postsurgical phases.

Panoramic evaluation of external root resorption in mandibular molars during orthodontic treatment: a comparison between root-filled and vital teeth treated with fixed appliances or clear aligners

BackgroundThis investigation compared the extent of external apical root resorption (EARR) in root-filled teeth (RFT) and their contralateral vital pulp teeth (VPT) counterparts during orthodontic treatment (OT) with clear aligner (CA) treatment or fixed appliance (FA) treatment.MethodsSixty-six patients with similar baseline American Board of Orthodontics (ABO) discrepancy index scores were divided into two groups: 37 patients (21 females, 16 males; mean age 17.45 ± 2.67 years) in the FA group, and 29 patients (18 females, 11 males; mean age 18.33 ± 1.96 years) in the CA group. Digital panoramic radiographs captured pre- and post-OT were used to measure tooth lengths and root surface measurements in mandibular molars. EARR in both RFT and contralateral VPT was evaluated pre- and post-OT. Statistical analysis employed paired t-tests, independent t-tests, and analysis of covariance (ANCOVA) (p < .05).ResultsAll teeth exhibited varying degrees of EARR following OT. FA treatment resulted in significantly longer treatment duration (p < .05) and greater EARR compared to CA treatment (p < .05). Moreover, statistically significant differences in EARR were observed within both groups between RFT and VPT (p < .05).ConclusionsComparison of pre- and post-OT radiographs revealed different degrees of EARR in all teeth. CA treatment resulted in less frequent and less severe EARR compared to FA treatment. RFT demonstrated greater resistance to EARR than VPT in both treatment groups.

Orthodontic pain with fixed appliances and clear aligners: A 6-month comparison

This prospective study compared pain perception, intensity, and analgesic use among patients treated with fixed appliances (FAs) and clear aligners (CAs) over 6 months. Digital surveys were collected from 87 adult patients treated with CA or FA from 2 orthodontic offices. The 7-item survey was sent at 3-time points (preappointment, 2-day postappointment, and 7-day postappointment) for each appointment. Wilcoxon, t test, and Fisher exact chi-square tests were performed with significance set at 0.05. The FA group had a higher rate and intensity of pain 2 days after the second, third, and fifth appointments (P<0.030). At 7 days postappointment, the FA group had a higher rate and intensity of pain for the first and fifth appointments. Dull pain was reported the most in both groups, with a proportion of FA patients reporting throbbing (31%) or sharp (20%) pain (P= 0.035) at 2 days postappointment. The CA group reported the most pain at rest, whereas the FA group reported chewing as the most painful (P= 0.002). The FA group had a higher rate of analgesic consumption after the first appointment (P= 0.037). Both the FA and CA groups experienced similar rates and intensities of pain 2 days after the delivery of appliances at the first appointment. Although CA pain intensity remained minimal, FA pain peaked 2 days postappointment whenever a new orthodontic stimulus was introduced and remained elevated 7 days postappointment when that stimulus was a new archwire material.

Comparative assessment of external apical root resorption between subjects treated with clear aligners and fixed orthodontic appliances: A systematic review and meta-analysis.

This review aims to collate and analyze the existing evidence on the comparison of external apical root resorption (EARR) in subjects treated with clear aligners (CAs) and fixed appliances (FA). An electronic search was conducted in six databases for articles published in all languages until July 2023. Studies that evaluated EARR in subjects treated with CAs and FAs were included. The RoB 2 tool for RCTs and the ROBINS-I tool for non-randomized studies were used to analyze the risk of bias (ROB). A random effects meta-analysis was performed to assess EARR extent in maxillary and mandibular anterior teeth for subjects treated with CAs and FAs. Ten studies (eight retrospective, one RCT, and one CCT) were included in this review, out of which six studies reported a moderate ROB, one reported a serious ROB, and three reported a low ROB on qualitative analysis. The quantitative analysis of six studies revealed a significant intergroup difference (P<0.05) in the mean EARR for maxillary central (SMD=-0.62, P<0.00001) and lateral incisors (SMD=-0.47, P=0.01) with a moderate heterogeneity (I2=56%), as well as the mandibular central incisors (SMD=-0.27, P=0.04) with high heterogeneity (I2=79%). EARR was lower in subjects treated with CAs than FAs. A moderate quality of the available evidence suggests that EARR was less evident in subjects treated with CAs when compared with FAs.

Comparison of treatment effects between clear aligners and fixed appliances in patients treated with miniscrew-assisted molar distalization.

The biomechanics in achieving molar distalization may differ between fixed appliances and clear aligners in the control of tooth movement. The objective of this study was to compare the treatment effects between clear aligners (CA) and fixed appliances (FA) in patients treated with miniscrew-assisted molar distalization. The sample consisted of 46 subjects with mild-to-moderate crowding. A total of 22 patients treated with clear aligners (age, 25.66 ± 6.11 years old) and 24 patients treated with fixed appliances (age, 24.04 ± 4.95 years old) for miniscrew-assisted molar distalization were included in this study. The dental and skeletal changes were evaluated by the pre- and post-treatment lateral cephalograms. Significant changes were found with the vertical variables SN-OP angle (2.24 ± 3.22°, P < .05) and SN-MP angle (0.73 ± 1.15°, P < .05) for the FA group when compared with the CA group (SN-OP angle 0.41 ± 2.26° and SN-MP angle -0.21 ± 1.38°, P > .05). Both treatment groups achieved a 2-3mm. molar distalization with significant intrusion of the upper molars. The CA group showed significantly less distal tipping of molars (U6^PP angle -2.29 ± 3.29° and L6^MP angle -2.92 ± 2.49°, P < .05) compared to the FA group (-5.24 ± 4.28° and -5.53 ± 5.03°, P < .05). In addition, significant retraction and lingual inclination of the upper and lower incisors were found in both groups. The changes of tooth position were evaluated by 2D lateral cephalograms, not 3D measurements. Compared to fixed appliances, clear aligners seemed to have better control of vertical dimension and distal tipping of molars in patients treated with miniscrew-assisted molar distalization.

A Comparative Analysis of Mechanical Properties of Polyetheretherketone (PEEK) vs. Standard Materials Used in Orthodontic Fixed Appliances: A Systematic Review.

Polyetheretherketone (PEEK), an organic thermoplastic polymer, has gained interest in dentistry due to its excellent mechanical strength, flexibility, and biocompatibility. Furthermore, the ability to utilize CAD/CAM in the fabrication of PEEK enhances accuracy, reliability, and efficiency while also saving time. Hence, several orthodontic studies have explored the utilization of PEEK in various applications, such as archwires, brackets, fixed lingual retainers, palatal expansion devices, transpalatal arches, Tübingen palatal plates, different types of space maintainers, mini-implant insertion guides, and more. However, a complete systematic review of the available data comparing the performance of PEEK with traditional orthodontic materials has not yet been conducted. Therefore, this systematic review seeks to assess if PEEK material meets the required mechanical criteria to serve as an alternative to conventional orthodontic appliances. To ensure clarity and precision, this review will specifically concentrate on fixed appliances. This systemic review followed the PRISMA guidelines and utilized databases including PubMed/MEDLINE, Embase, Springer, Web of Science, and Wiley. Searches were restricted to English language articles from January 2013 to February 2024. Keywords such as "Polyetheretherketone" or "PEEK" and "Orthodontic" or "Orthodontic device" or "Orthodontic materials" were employed across all databases. Nine studies were incorporated, covering orthodontic archwires, brackets, and fixed lingual retainers. Based on the reviewed literature, PEEK demonstrates promising potential in orthodontic fixed appliances, offering advantages in force delivery, friction reduction, and aesthetic appeal. Further research is needed to fully explore its capabilities and optimize its application in clinical practice.

Cost-minimization analysis of conventional fixed appliances in comparison with Invisalign System

Due to the high prevalence of malocclusion and social disparity existent in Brazil, orthodontic procedures, such as corrective orthodontic treatments with fixed appliances (FA) need to be incorporated into the Unified Health System (SUS). However, Invisalign System (IS) have been developed to perform satisfactory esthetic orthodontic treatment. This new approach raises questions about the economic feasibility of orthodontic treatment in the public services. Objective/methodology: cost-minimization economic evaluation was carry by microcosting (down-top) of direct medical costs for the two treatment options. Results: The treatment with the conventional fixed appliance (FA) was R$ 2,214.60, and for the Invisalign System (IS) the treatment cost was R$ 5.934,52, for the treatment of Class I and II of Angle with low crowding. Conclusion: In terms of cost, the Invisalign System is a more expensive. Meanwhile, is imperative for the public services to evaluate economic resources and clinical benefits such as clinical time consumed, patient capacity, and number of maintenance appointments required during orthodontic treatment. Therefore, another alternative as “in office” aligners manufactured by orthodontists could be consider as a cheaper, and better option for public services.

Root Resorption during Orthodontic Treatment with Clear Aligners vs. Fixed Appliances—A Systematic Review

The external apical root resorption that occurs during orthodontic treatment was the focus of this study, using either fixed appliances (FA) or clear aligners (CA). Using the Boolean keywords “APICAL ROOT RESORPTION” and “CLEAR ALIGNERS”, the study searched PubMed, Scopus, and Web of Science, with a restriction to English-language publications. A total of 50 publications were found by the computerized search, but after eliminating duplicates, completing reviews, and determining eligibility, only 9 papers could be used in the study. In conclusion, apical root resorption (ARR) is a frequent consequence of orthodontic tooth movement that mainly affects the lower incisors, which may compromise the success of the procedure and the health of the patient’s teeth. Several variables, including the type of tooth, have an impact on the severity of ARR.

Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis

ObjectiveThis study aimed to compare the pain intensity and impacts on oral health-related quality of life (OHRQoL) between orthodontic patients treated with clear aligners (CAs) and fixed appliances (FAs).MethodsA systematic search was conducted up to December 2022 using PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Embase. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) comparing pain intensity or OHRQoL between patients treated with CAs and FAs were included. The risk of bias (RoB) of individual studies was evaluated using the Cochrane RoB tool 2.0 and ROBINS-I tool for RCTs and non-RCTs, respectively. Further, meta-analyses were separately conducted for each included study using the total oral health impact profile (OHIP)-14 and visual analog scale (VAS) scores to evaluate OHRQoL and pain intensity, respectively.ResultsOverall, 12 studies (5 RCTs and 7 non-RCTs) were included in the study. Subgroup analyses conducted according to the total OHIP-14 scores revealed that patients treated with CAs had higher OHRQoL at 1 week, 1 month, and 6 months of the treatment. Meanwhile, subgroup analyses conducted according to the VAS scores revealed that pain levels were lower in the CA group only at 3 and 4 days of the treatment.ConclusionsPatients treated with clear aligners had higher OHRQoL than those treated with fixed appliances during orthodontic treatment. However, OHRQoL appeared to be similar between the two groups at the end of the treatment. Moreover, patients treated with clear aligners experienced lesser pain than those treated with fixed appliances on the third and fourth day after the initial treatment. The difference in pain intensity between the two treatment modalities was not noted at other time points.

Salivary microbiomes vary among orthodontic appliances and associate with clinical periodontal parameters.

To investigate the salivary bacterial communities during the first 6-month orthodontic treatment with Clear Aligners (CA) and Fixed Appliances (FA), and its correlation with clinical periodontal parameters. Saliva and periodontal parameters were sampled from individuals wearing CA or FA before treatment (T0), and after 3- (T3) and 6-month (T6) treatments. Salivary bacterial communities characterized based on the 16S rRNA V3-V4 region were compared between FA and CA and correlated with clinical periodontal parameters. Probing Depth (PD) significantly increased at T6 in the FA group versus T0, whereas it remained stable in the CA group. The Shannon and Pielou indices were significantly higher in the FA group and significantly positively correlated with periodontal inflammation parameters. β-diversity analysis revealed distinct communities between the FA group and CA group at T6. The relative abundances of 3 genera and 15 species were significantly higher in the FA group. Among the above appliance-type related taxa, bacterial genera Selenomonas, Stomatobaculum, Olsenella and Faecalicoccus and bacterial species Selenomonas_sputigena, Dialister_invisus, Olsenella_profus, Prevotella_buccae, Cryptobacterium_curtum and Clostridium_spiroforme were significantly positively associated with periodontal parameters. Orthodontic treatments trigger appliance-related salivary bacterial communities, highlighting the importance of developing appliance-orientated periodontal strategies during orthodontic treatments. Salivary bacterial communities harboured by patients wearing FA possess higher bacterial parameters which were associated with increasing PD, PI and Gingival Index.

Clear aligner therapy in the mixed dentition: Indications and practitioner perspectives

This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors. An original, 22-item survey was mailed to a randomized, nationally representative sample of practicing orthodontists (n= 800) and a specific, randomized subsample of high-aligner-prescribing orthodontists (n= 200). Questions assessed respondents' demographic information, experience with clear aligner therapy, and perceived advantages and disadvantages of CAMD compared with fixed appliances (FAs). Responses were compared using McNemar's chi-square and paired t tests to assess CAMD vs FAs. One thousand orthodontists were surveyed, and 181 (18.1%) responded over 12 weeks. CAMD use was less common than mixed dentition FAs, but most respondents predicted an increase in their future CAMD use (57.9%). Among respondents using CAMD, the number of patients with mixed dentition treated with clear aligners was significantly lower than the number of total patients with clear aligners (23.7% vs 43.8%; P<0.0001). Fewer respondents considered skeletal expansion, growth modification, sagittal correction, and habit cessation feasible indications for CAMD compared with FAs (P<0.0001). Perceived compliance was similar for CAMD and FAs (P= 0.5841), but perceived oral hygiene was significantly better with CAMD (P<0.0001). CAMD is an increasingly common treatment modality for children. Most surveyed orthodontists reported limited indications for CAMD compared with FAs but perceived noticeable benefits for oral hygiene with CAMD.

A quantitative three-dimensional comparative study of alveolar bone changes and apical root resorption between clear aligners and fixed orthodontic appliances

BackgroundThis study aimed to evaluate and compare the alveolar bone changes and to investigate the prevalence and severity of orthodontically induced inflammatory root resorption (OIIRR) of maxillary incisors in patients who received treatment with clear aligners (CA) versus conventional fixed appliances (FA), using cone-beam computed tomography (CBCT).MethodsOne hundred sixty maxillary incisors from 40 patients with similar baseline characteristics based on the American Board of Orthodontics discrepancy index scores were divided into the CA and FA groups. The dentoalveolar quantitative changes were analyzed using pre- (T0) and post-treatment (T1) CBCT. The measured parameters included alveolar bone thickness (ABT), alveolar bone height (ABH), root length (OIIRR), and maxillary incisor inclinations.ResultsPost-treatment, the average palatal and total ABT significantly decreased in central and lateral incisors in the FA group. In contrast, the CA group’s average labial ABT of the lateral incisors decreased considerably. Regarding the ABH, both groups showed significant labial and palatal marginal bone resorption. In both groups, root lengths significantly decreased after treatment (p < 0.005). The inter-group comparison revealed that ABT and root length had significantly decreased in the FA group compared to the CA group, while the ABH showed no significant difference between the two groups. The mean absolute reductions of ABT and OIIRR in the CA group were significantly less (− 0.01 ± 0.89 and 0.31 ± 0.42) than those in the FA group (0.20 ± 0.82 and 0.68 ± 0.97), respectively.ConclusionsCA and FA treatments appear to cause a significant ABT reduction and a statistically significant increased OIIRR in the maxillary incisor region, with a greater extent expected with FA treatment. However, the increased OIIRR values in the majority of both groups’ cases were not clinically significant. Both treatment modalities resulted in a significant ABH reduction, with the highest found in the labial side of lateral incisors in the CA group.

Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting

The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables. Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P<0.05). Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P<0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ= 0.93 and 0.92). The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis.

The aim was to assess periodontal health maintenance and gingival recessions development in patients undergoing an orthodontic treatment with clear aligners (CA) and fixed appliances (FA). An electronic search in MEDLINE, Scopus, The Cochrane Library, and Web of Science was performed up to September 2022 to identify all potential articles. Two investigators independently selected the studies according to the inclusion criteria. Prospective and retrospective studies assessing the periodontal health status and gingival recession development during the orthodontic treatment with buccal FA and CA were included. Case series, cross-sectional studies, and studies with less than two months of follow-up were excluded. Two investigators independently extracted the data from included articles and assessed risk of bias across studies using the Cochrane Collaboration tool. Qualitative and quantitative analyses of the data were performed. Pairwise meta-analysis using a random-effects model were used to compare periodontal indices between FA and CA treatment in different follow-up periods. From the 129 potential studies, finally 12 studies were included. Only 8 could be included in the quantitative analysis. CA seems to slightly maintain better periodontal health indices. Only plaque index in a mid-term follow-up (mean difference (MD): -0.99; 95%; Confidence interval (CI) [-1.94 to -0.03]; P=.04; I2=99%), and pocket probing depth at a long-term follow-up (MD: -0.93mm; 95% CI [-1.16 to 0.7]; P<0.0001) reported statistically significant results favoring CA. Up to the date there is not enough evidence to conclude that CA maintains better periodontal health during an orthodontic treatment than FA.

Cross-sectional evaluation of periodontal inflammation and oral hygiene status between fixed appliances and Invisalign in patients affected by craniofacial anomalies.

The objective of this cross-sectional study was to compare the difference in the oral health status and oral hygiene of orthodontic treatment with aligners (AL) and with fixed appliances (FA) in patients affected by craniofacial anomalies (CFA). The sample consisted of 100 Caucasian patients affected by various CFA from two different hospitals. Fifty patients treated with AL were matched for sex, age and CFA with a control sample of 50 patients treated with FA. Patients' periodontal conditions were evaluated in both samples. O'Leary Plaque Control Record, bleeding on probing (BOP) and DMT/dmft Index were evaluated in both samples. The FA group presented an O'Leary Plaque Control Record of 60% ± 30, while AL presented an O'Leary Plaque Control Record of 40% ± 29.7 (p-value=0.02), BOP was 22.1% ± 14 in FA and 12% ± 0.13 in AL (p-value=0.03). The DMFT/dmft was not statistically different (p-value=0.13). p-value was set at <0.039. The study shows that the sample with FA presented a higher O'Leary Plaque Control Record and BOP compared to the AL sample. AL might, therefore, be an interesting alternative to FA in patients with CFA, who generally have a lower level of oral hygiene.

PERIODONTAL STATUS DURING THE ORTHODONTIC TREATMENT WITH REMOVABLE AND FIXED APPLIANCES

PERIODONTAL STATUS DURING THE ORTHODONTIC TREATMENT WITH REMOVABLE AND FIXED APPLIANCES

Salivary and Plaque Microbiomes During Treatment With Different Orthodontic Appliances

Background: This study investigated the microbial changes during treatment with clear aligners (CA) and fixed appliances (FA) and evaluated the utility of saliva as a diagnostic marker in orthodontic patients.Methods: Ten patients each were enrolled in the FA and CA groups. Plaque (PI) and gingival indices (GI) were measured at baseline, three, six and 12 months. Saliva and plaque samples were collected at each time point for determination of the respective microbial community composition via 16S rRNA sequencing.Results: PI and GI increased significantly over time only in FA patients. While alpha diversity was similar for FA or CA patients, beta diversity and microbial community composition analysis revealed significant differences between saliva and plaque for both treatment groups. Further analysis of the relative abundance of certain health- and disease-associated genera present in the saliva and plaque of FA and CA patients correlated with the clinical parameters.Conclusions: Clinical parameters significantly worsened during orthodontic treatment with FA but not CA. The microbial composition of plaque and saliva differed significantly between treatment groups. However, the changes in abundance of some individual genera were similar in both saliva and plaque in correlation with the corresponding clinical parameters. These genera show potential as biomarkers for health and disease.Practical implications: Monitoring of the microbial community composition during orthodontic treatment could reduce the risk of oral disease development. While the microbial composition of saliva is not reflective of the plaque communities implicated in oral health and disease, individual marker genera show promise as biomarkers.

The Effectiveness of In-house Clear Aligners and Traditional Fixed Appliances in Achieving Good Occlusion in Complex Orthodontic Cases: A Randomized Control Clinical Trial.

Objective: To compare the effectiveness and efficiency of the in-house clear aligners with the traditional fixed appliances in treating premolar-extraction-based complex cases.Materials and methods: A single-centered, 2-arm parallel-group randomized controlled clinical trial was conducted on thirty-six (12 males, 24 females; mean age: 21.24 ± 2.33) patients with severe crowding who required orthodontic treatment with four first premolars extraction. The patients were equally and randomly divided into two groups: The in-house clear aligners (CA) group and the fixed appliances (FA) group. All the measurements were made on the pre-and post-treatment dental cast models. The effectiveness was evaluated using Little's irregularity index (LII) and the Peer Assessment Rating index (PAR). The efficiency was evaluated by studying the treatment duration. Two sample t-tests and chi-square tests were used to test for significant differences between the two groups. Bonferroni correction was applied, and the adjusted alpha level was set at 0.006. Results: Before treatment, there were no significant differences between the two groups regarding LII in the upper and lower jaws (p˃0.006). After treatment, the mean LII decreased in both groups, with no significant differences between the two studied groups (p˃0.006). There were no significant differences in all studied PAR domains between the two groups (p˃0.006). The mean score reduction in the CA group was 28.39 (±8.51) points, whereas it was 26.39 (±5.76) points in the FA group, with no significant differences between the two groups. All the patients in this study were improved. However, a great improvement was achieved in 88.9% of the patients in the CA group and 91.7% in the FA group, with no significant differences between them (p=0.674). The average treatment duration in the CA group was 23.27 (±5.28) months, whereas the average was 26.20 (±5.27) in the FA group, with no significant difference between the two groups.Conclusion: In-house clear aligners can be effective as fixed appliances in achieving good occlusion when treating complex orthodontic cases when suitable teeth movement protocol is used.

The Effect of Treatment With Clear Aligners Versus Fixed Appliances on Oral Health-Related Quality of Life in Patients With Severe Crowding: A One-Year Follow-Up Randomized Controlled Clinical Trial.

ObjectiveTo compare the level of oral health-related quality of life (OHRQoL) between patients receiving clear aligners or fixed appliances within one year of follow-up using Oral Health Impact Profile 14 (OHIP-14), a validated self-administered questionnaire.Materials and methodsA single-centered, two-arm parallel-group randomized controlled clinical trial was conducted on 36 adult patients (19 females, 17 males; age range: 18 to 25 years) who had severe crowding and require orthodontic treatment with first premolars extraction. The patients were equally and randomly divided into two groups: The clear aligners (CA) group and the fixed appliances (FA) group. OHRQoL was assessed using the OHIP-14 tool at various times during comprehensive orthodontic therapy: baseline (T0), one week (T1), two weeks (T2), one month (T3), 6 months (T4), and 12 months (T5) after starting the active orthodontic treatment. Mann-Whitney U test or Friedman test were used to detect significant differences. The level of significance was set at 5%. ResultsAll of the selected patients entered the statistical analysis stage. There were no significant differences between the CA and FA groups for the psychological discomfort, psychological disability, social disability, and handicap (P˃0.05) at almost all assessment times. For the functional limitation, physical pain, physical disability, and the overall score, there were significant differences between the studied groups (P˂0.05), with the FA group having higher mean scores than the CA group in all of the assessment times.ConclusionPatients' treatment with clear aligners has less impact on OHRQoL than those treated using conventional fixed appliances during the first year of treatment.