Removable Appliances Research Articles

Evolution of orthodontic services in the Brazilian Unified Health System: a time series analysis (2011-2022).

Although malocclusion is the third most prevalent oral health condition, orthodontics is not part of the minimum list of mandatory specialties to be offered in the Dental Specialty Centers of the Brazilian public health system, but rather as optional. Since the acknowledgment of this field as a part of the Brazilian Unified Health System (SUS), access to orthodontic procedures has become optional by municipal governments. Therefore, this study analyzed the evolution of orthodontic procedure provision within SUS from 2011 to 2022. We conducted a retrospective observational study of time series analysis trends on the number of orthodontic procedures and municipalities offering them. The presentation of findings followed the recommendations of the Reporting of Studies Conducted using Observational Routinely Collected Data. Secondary data from 2011 to 2022 were collected from the SUS Department of Informatics. Orthodontic procedures were organized by year, region, state, and municipality. The study applied descriptive analyses, and the Prais-Winsten generalized linear regressions for time series analysis. The quantity of municipalities offering orthodontic procedures have shown a small increasing during period analyzed (from 128 to 157). Northeast and South macro-regions have increased consistently the municipalities with orthodontic offering. All regions showed stable trends for each procedure, except for the South, which exhibited increasing rates of space maintainer placement (Annual Percentage Change (APC): 72.95; 95% CI: 31.6, 127.3) and maintenance sessions (APC: 15.40; 95% CI: 4.5, 27.5). The study showed decreasing trends for appliance removal in the South (APC: -38.07; 95% CI: -47.1, -27.5) and Northeast (APC: -25.19; 95% CI: -36.5, -11.9) regions. From 2011 to 2022, there was a small increase in number of municipalities offering orthodontic procedures in the Brazilian public health system, in addition to a stationary trend for almost all types of procedures.

Impact of Different Orthodontic Appliances on Mandibular Condyle, Anterior Region of Mandibular, and Maxillary Sinus Using Panoramic Radiography.

BACKGROUND This retrospective study of 44 patients requiring removable functional dental appliances aimed to compare the use of a maxillary expansion device, twinblock/monoblock, face mask, and chincup on maxillary sinus dimensions, mandibular anterior region bone density (MABD), and mandibular condyle head bone formation (MCBF) using panoramic radiography. MATERIAL AND METHODS The patients were divided into 4 groups based on the treatment modalities used: group A, maxillary expansion device (n=11); group B, twinblock/monoblock (n=11); group C, face mask (n=11); and group D, chincup (n=11). MABD and MCBF were assessed using the fractal analysis method, while maxillary sinus dimensions were compared using the ImageJ program. Different groups of patients were tested by the Mann-Whitney U test, with Bonferroni correction. RESULTS Group A showed an increase in MABD, MCBF, and average maxillary sinus indentation base length (MSIL) and a decrease in average planar base length (MSPL) and maxillary sinus area (MSA) (P<0.05). Group B showed an increase in MABD, MSIL, MSPL, MSA, and MCBF (P<0.05). Group C showed an increase in MABD, MSIL, MSPL, and MCBF, with a decrease in MSA (P>0.05). Group D showed an increase in MCBF, MABD, MSIL, and MSA, with a decrease in MSPL at the end of treatment, compared with pretreatment (P<0.05). CONCLUSIONS Orthodontic treatment with different removable functional dental appliances has varying effects on the mandible and maxilla. Possible changes in the maxilla and mandible should be considered before treatments with removable functional dental appliances.

Accuracy of 3-dimensional surgical guide for endodontic microsurgery with a new design concept: A cadaver study.

Despite the high success rate of endodontic microsurgery (EMS), it is difficult to suggest EMS as a general treatment option considering the difficulty of the procedure. A surgical guide has been proposed to overcome this problem. This study aimed to evaluate the stability of the surgical guide of a new design concept, as well as the accuracy of root resection, and to introduce the manufacturing method of the newly designed surgical guide. The experiment was conducted on 59 roots (9 in the maxillary and 50 in the mandibular region) of adult human cadavers. The surgical guide was designed using CAD/CAM design software based on cone-beam computed tomography (CBCT) images and optical scan files. Unlike conventional surgical guides, the surgical guide proposed herein was designed to act as a tooth-bone-supported removable appliance. Two different types of guides were prepared: the osteotomy guide (O guide) for separation of the cortical bone above the root tip with a trephine bur with an outer diameter of 6 mm and the root resection guide (R guide) for resection of the root tip with a trephine bur with an outer diameter of 4 mm. For stability evaluation, the guides were pressed at five predetermined locations after installation and checked for the presence of any movement. For accuracy evaluation, the length at which the root tip was cut was measured and examined by overlapping the preoperative and postoperative CBCT images. Of the 15 R guides, 14 were stably installed without mobility. For the R guide group, the root tip was resected with an average of 3.2 mm, showing better results than the no-guide group with an average of 4.0 mm. The newly designed surgical guide of this study can be applied more stably, enabling root resection to be performed more accurately and simply according to the preoperative plan than when performed without a guide.

Effects of clear aligners and traditional removable appliances on oral microbiome in mixed dentition: a comparative study

BackgroundThis prospective study aims to investigate the comparative effects of clear aligners (CA) and traditional removable appliances (RA) on the cariogenic risk of patients in mixed dentition, focusing on the oral microbiome.Methods25 children were included and assigned into CA and RA groups. Supragingival plaque and saliva samples were collected, and clinical parameters including Decay-missing-filled teeth index (DMFT), Plaque Index (PI) and Gorelick Index (GI) were recorded before treatment (T0) and after 6-month follow-up (T1). DNA was extracted from supragingival plaque and saliva and analyzed via 16S rDNA gene sequencing.ResultsClinical parameters showed no statistically significant difference between groups at each time point or within group over time (p > 0.05). In both RA and CA groups, saliva exhibited significantly higher alpha diversity compared to supragingival plaque at T1, as indicated by the significantly higher Chao1 and Shannon indexes (p < 0.05). Regarding beta diversity, significant difference was observed in saliva and supragingival plaque samples between T0 and T1 within group RA (p < 0.05, Adonis), whereas no such significance was noted in the CA group (p > 0.05, Adonis). At the genus level, Lactobacillus exhibited a statistically significant increase in saliva and supragingival plaque of group RA from T0 to T1 (p < 0.05), and an increasing trend in the group CA without statistical significance (p > 0.05). At T1, Lactobacillus levels were comparable between groups, whereas species-level analysis revealed distinct cariogenic species.ConclusionBoth clear aligners and traditional removable appliances resulted in elevated cariogenic risk of patients in mixed dentition at the microbial level. Distinct alterations in cariogenic species were observed to be induced by various orthodontic appliances.

Comparison of acceptability of orthodontic appliances in children in mixed dentition treated with removable acrylic appliances and Invisalign first: a cross-sectional study

PurposeThis study aimed to compare the acceptability of removable acrylic appliances (RA) and Invisalign First (IF) clear aligners (Aligntech, USA) among children undergoing orthodontic treatment during the mixed dentition period, considering the severity of malocclusions.MethodsA total of 40 patients, aged 6 to 13 years, were recruited for the study. Malocclusion severity was evaluated using the Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC). Patients completed the "Acceptance of Orthodontic Appliance Scale (AOAS)" via a face-to-face Google survey. To assess the reliability of the AOAS, the survey was resent to five patients after three months for a second response, and reliability analysis was conducted. Additionally, inter-rater reliability was evaluated by having all patients independently assessed by a second researcher. Data were analyzed using SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05.ResultsAlthough no significant difference was found in IOTN-DHC scores, the IF group demonstrated significantly higher AOAS scores compared to the RA group (p = 0.014). Survey responses revealed noticeable distinctions between groups regarding speaking discomfort, preference for orthodontic appliances, and facial appearance comfort. A negative correlation (r = -0.477, p = 0.034) was observed between malocclusion severity and appliance acceptance.Clinical significanceThis study underscores the significant superiority and advantage of IF over RA among pediatric orthodontic patients during the mixed dentition period.

Perda precoce dos elementos 11 e 12 por trauma dental, com intervenção ortodôntica preventiva na odontopediatria: relato de caso

Dental trauma is one that affects the hard tissues embraced, supporting structures or soft tissues in the oral cavity. It is observed more frequently in male children of school age (07 to 12 years old). The most affected teeth in the trauma taken are central and lateral incisors. With regard to tooth avulsions, the protection of children's bone tissue favors a higher frequency in this population than in the adult population. Dental avulsion occurs after displacement of the element out of its alveolus. There is a break in the blood supply to the pulp of the tooth and when this happens the chance of replantation achieved is totally impossible. Thus bringing several harms to the patient such as difficulty in speech, poor aesthetics, or even mesialize or distalize some other acquired element. Space maintainers are used as removable or fixed appliances to treat malocclusion or esthetic defects. They are braces made of acrylics with two extended teeth. Choosing a removable appliance comes with benefits such as better hygiene, satisfactory aesthetics, low cost, and maintenance of the cervico-occlusal space, in addition to the mesio-distal space. The objective of this study was to report a clinical case of avulsion of element 11 and 12 caused by trauma in childhood with the use of a space maintainer. We conclude that it is possible to treat a patient with dentoalveolar trauma with intervention using a space maintainer, since in the present case success was obtained in the selection of therapy, restoring aesthetics and function to the patient. Thus reducing possible orthodontic problems of the child, with follow-up until his/her old age.

Upper airways changes associated with orthodontic molar distalization by Pendulum appliance in adolescent patients: a multicenter retrospective cephalometric study

ObjectivesThe purpose of this multicenter retrospective study was to perform a two-dimensional analysis of upper airway changes in adolescent patients following molar distalization with the Pendulum appliance.Materials and methodsThe study involved the cephalometric analysis of 88 patients, retrospectively categorized into two groups: skeletal Class II with a dental Class II molar relationship (36 patients, mean age 12.6 ± 1.1 years) and skeletal Class I with a dental Class II molar relationship (54 patients, mean age 12.3 ± 1.2 years). Changes were observed using lateral radiographs before (T0) and after Pendulum appliance removal (T1); treatment time averaged 7 months. Upper airways were subsequently analyzed by tracing lateral radiographs. The Shapiro-Wilk test showed a normal distribution of the data, therefore parametric tests were used for statistical analysis. Intragroup changes between T0 and T1 were evaluated using paired t-tests, and intergroup differences were assessed using independent student t-tests; statistical significance was set at 0.05.ResultsStatistically significant differences were observed in the skeletal measurements that characterized both groups, particularly in ANB and Wits appraisal, at T0 (P < 0.001). After molar distalization, Class I and Class II groups reported no statistically significant differences with changes almost equal to zero between timepoints (P > 0.05). Additionally, intergroup comparisons of airway changes at T1 did not show statistically significant differences (P > 0.05).ConclusionsThe Pendulum appliance does not significantly change the upper airway dimensions in Class I and Class II malocclusion patients, thereby minimizing potential respiratory risks.

Importance of an Evaluation Phase When Increasing the Occlusal Vertical Dimension: A Systematic Review.

To assess whether an evaluation period is necessary for patient and clinical success when increasing the occlusal vertical dimension (OVD) for a full mouth rehabilitation. A systematic search was conducted in six databases: MEDLINE, Web of Science, Scopus, CENTRAL, VHL, and EMBASE. The eligibility criteria of this systematic review used the PICO framework to address the following research question: "In dentate adults requiring an increase in occlusal vertical dimension (OVD) (P), is an evaluation period of the new OVD (I) superior to no evaluation period (C) in terms of success (O)?" Study characteristics, survival, and success rates were extracted from each article. No language restrictions were applied. Study quality was appraised using Cochrane's Risk of Bias 2 tool and Newcastle-Ottawa Scale (NOS) according to the study design. The electronic search yielded 1188 titles after duplicates were removed. One RCT and 103 non-comparative articles were found relevant to the search question. Out of the 103 articles, 80 had an evaluation phase and 23 did not. The included RCT revealed that removable devices tended to cause chewing difficulties, unclear speech, and esthetic discomfort. Therefore, the use of a removable appliance to functionally or esthetically evaluate OVD was not indicated prior to the definitive treatment. Esthetics was the highest reported parameter preoperatively for the non-comparative studies, at 85% with an evaluation and 86% without. At present, there is lack of evidence that an evaluation period improves clinical and patient-reported outcomes when increasing OVD for full mouth rehabilitations. Thus, an increase in OVD can be successful with or without an evaluation phase. The evaluation phase helps the clinician manage patient expectations and assist with the treatment sequencing. This phase is most effective with fixed restoration, such as temporary crowns or adhesive restorations. However, there is limited evidence that this phase improves clinical or patient-reported outcomes.

Survey - Based Study For Common Retention Practices Among Orthodontists In North Macedonia

Background: Orthodontic therapy always ends with retention to prevent the return of the final occlusal outcome and to maintain the teeth in the correct position after the end of orthodontic therapy. This research aimed to survey retention practices, factors affecting retention protocol and differences regarding retention among orthodontists in North Macedonia. Material and methods: 150 questionnaire copies were distributed by mail or personally to orthodontics in North Macedonia. The survey included 24 single or multiple-answer questions, about retention system, frequently used fixed and removable retainers in certain malocclusions, the duration of the retention period, retainer supervision, instructions for patients, and the need for retention guidelines in order to determine habits and knowledge, and reasons for choosing a particular retention regime. Results : Out of 150 questionnaires, 93 were appropriately filled out and returned, so response rate was 62%. 90% give oral information about retention, only 25% informed their patients both oral and written. The most preferred retainer in maxilla (54%) was vacuum-formed appliance, than removable acrylic plate appliance (41%) and only 9% bonded retainer. In mandible, mostly used are VFR (45%), then acrylic plate appliance (29%), bonded retainers (20%). Dual retention was used more in upper jaw. The retention period was 4 to 5 years or lifelong; the choice of retention device in 77% depended on malocclusion. The reason for the choice of VFR are availability (50,5%), quality (36,56%), low-cost (33,3%). Protocol was influenced by clinical experience (75%), knowledge from residency (58%), courses (56%) and from colleagues (40%). 83% made changes in retention protocol in past years, in appliance time (20%) or in retention period (19%). 95,7% of the surveyed orthodontists believe that general guidelines for retention are needed. Conclusions: The most preferred retainers in North Macedonia were vacuum-formed appliance, than removable acrylic plate appliance and at least bonded retainer. Combination of fixed and removable appliance in mandible were used less than in upper jaw. Reason for choosing was malocclusion. Retention protocols are influenced mostly by the clinical experience. Common retention guidelines are required for most orthodontists.

Decompression treatment of dentigerous cyst with removable drainage appliance

Decompression treatment of dentigerous cyst with removable drainage appliance

Creating an emergence profile by using removable interim appliance

Creating an emergence profile by using removable interim appliance

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: complementary results for a controlled clinical trial.

To evaluate the effect of rapid palatal expansion (RPE) using Haas-type expanders on children's oral health-related quality of life (OHRQOL) and compare said effect with that previously reported for the use of Hyrax-type expanders. Forty participants aged 8-10 years with transverse maxillary deficiency were treated using Haas appliances. OHRQOL was measured using the CPQ8 - 10 before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after appliance removal (T3). Generalized mixed models were fitted to assess the effect of the Haas-type expander compared to previously collected data (a nontreated and a Hyrax-type expander-treated group). RPE with Haas-type appliances had a negative impact on overall OHRQOL at T1 and T2 (P = 0.001), and a positive impact at T3 (P = 0.001). The Haas-type expander had a significantly greater negative impact on OHRQOL than the Hyrax-type appliance during RPE. At T1, overall scores using the Haas-type expander were 1.08 times the scores using the Hyrax-type expander (i.e., 8% increase; 95% CI, 1.01-1.17; P = 0.033). Patients using the Haas appliance had 1.24 times the scores of those using Hyrax-type devices for the oral symptoms domain at T1 (i.e., 24% increase; 95% CI, 1.06-1.46; P = 0.009). Correction of the transverse maxillary deficiency by RPE using the Haas appliance in children 8-10 years improves OHRQOL. The Haas- and Hyrax-type devices temporarily worsen OHRQOL during treatment, however, the negative impact is less with the Hyrax-type expander than with the Haas-type expander, because it causes fewer negative oral symptoms. From a patient-centered perspective, the use of the Hyrax over the Haas appliance may be suggested as it causes less negative oral symptoms during use.

Accuracy of full arch scans using the iTero Element 2® intra-oral scanner: A clinical study.

To investigate the accuracy of full arch scans taken using the iTero Element 2® under clinical settings. Prospective clinical study. A customised upper removable appliance (URA) with four spheres (A-D) was fabricated from a maxillary arch iTero® scan for a 24-year-old patient. Six linear values were measured on the URA using a high-accuracy coordinate measuring machine. A total of 60 intra-oral iTero® scans were taken by two operators (HA and AS) with the test URA inserted to the participant's maxillary dentition at T1 and T2. Geomagic Control X software was used to measure the six linear distances between the reference spheres (1-4) in all scans. Comparisons between distances on full arch scans to true distances on the URA were made to evaluate accuracy. The median distance to the prepared bench top URA mean was significantly away from zero for each operator and timepoint across all measurements except AD versus 14 and BD versus 24. Statistically significant, although clinically non-significant, differences in median linear distances in relation to the prepared benchtop URA were observed between evaluators in segments AB versus 12 (operator 1 -0.021 mm vs. operator 2 -0.06 mm) and AC vs. 13 (operator 1 -0.044 mm vs. operator 2 -0.167 mm) at T1. The accuracy of scanners is defined as the trueness and precision of the captured scans to the dental arches. The accuracy of iTero Element 2® is acceptable for diagnosis and treatment planning in orthodontics. Length and location of the scanned segment and scanning sequence 'protocol' affect accuracy.

Expression patterns of interleukin-6 and microRNA-146A during orthodontic relapse in a rat model.

In this study, we established an experimental rat model to simulate orthodontic tooth movement relapse and a human periodontal ligament stem cell (PDLScs) model. Our aim was to explore the relationship between microRNA-146a (miR-146a) expression in periodontal tissue, the inflammatory factor interleukin-6 (IL-6), and orthodontic relapse subsequent to mechanical intervention. In the animal experiment, a total of 30 healthy male Wistar rats were randomly allocated to either the control group (n=6) or the model group (n=24). In the model group, the orthodontic appliance was removed 14 days after force application. Gingival crevicular fluid (GcF) and periodontal tissue samples were collected at intervals of days 0, 7, 14, and 21 following removal of the orthodontic appliance to assess alterations in miR-146a and IL-6 expressions. In the in vitro cell culture study, human premolar tooth tissue was isolated 24 hours following the addition of the transfection reagent to harvest PDLScs. Reverse transcription quantitative polymerase chain reaction was employed to evaluate the expression levels of the miRNA-146a gene, while Western blot analysis was utilized to assess the production of the IL-6 protein. As a result in comparison to the control group, the protein expression of IL-6 notably escalated to its peak value in the model-day 7 group (p<0.05). Subsequently, although experiencing a slight decline, the IL-6 expression in the model-day 14 group remained significantly elevated compared to control group (p<0.05). In the model-day 21 group, the protein expression of IL-6 approached that of the control group, with no significant difference observed (p>0.05). conversely, in relation to the control group, the gene expression of miR-146a drastically decreased to its lowest point in the model-day 7 group (p<0.05). While exhibiting a slight increase, the miR-146a expression in the model-day 14 group remained significantly diminished compared to control group (p<0.05). Following the identification of human periodontal ligament cells (hPDLcs) through immunofluorescence in the in vitro study, a subsequent experiment was conducted to specifically inhibit miR-146a expression. In comparison to the control group, the protein expression of IL-6 demonstrated a significant increase in the anti-miRNA oligodeoxyribonucleotide (AMO) group, where miR-146a expression was effectively suppressed (p<0.05). Throughout the process of orthodontic tooth movement relapse in rats, there was a notable reduction in the gene expression of miR-146a, accompanied by a significant increase in the expression of IL-6.

Nonnutritive Sucking Treatment With Removable Orthodontic Appliances

Nonnutritive Sucking Treatment With Removable Orthodontic Appliances

In vitro antifungal and physicochemical properties of polymerized acrylic resin containing strontium-modified phosphate-based glass

Acrylic resins are widely used as the main components in removable orthodontic appliances. However, poor oral hygiene and maintenance of orthodontic appliances provide a suitable environment for the growth of pathogenic microorganisms. In this study, strontium-modified phosphate-based glass (Sr-PBG) was added to orthodontic acrylic resin at 0% (control), 3.75%, 7.5%, and 15% by weight to evaluate the surface and physicochemical properties of the novel material and its in vitro antifungal effect against Candida albicans (C. albicans). Surface microhardness and contact angle did not vary between the control and 3.75% Sr-PBG groups (p > 0.05), and the flexural strength was lower in the experimental groups than in the control group (p < 0.05), but no difference was found with Sr-PBG content (p > 0.05). All experimental groups showed an antifungal effect at 24 and 48 h compared to that in the control group (p < 0.05). This study demonstrated that 3.75% Sr-PBG exhibits antifungal effects against C. albicans along with suitable physicochemical properties, which may help to minimize the risk of adverse effects associated with harmful microbial living on removable orthodontic appliances and promote the use of various materials.

Effectiveness of removable expander appliances in posterior crossbite: A review of the literature

Objective: To evaluate the effectiveness of removable expander appliances in the treatment of posterior crossbite by reviewing and analyzing clinical studies, scientific articles and published case reports. Background: Posterior crossbite is a dental malocclusion characterized by a transverse misalignment of the upper and lower teeth, where the upper teeth bite into the lower teeth. This condition can affect one or more dental organs and if left untreated, can lead to functional and esthetic problems, as well as imbalances in maxillofacial growth. Early correction of posterior crossbite is crucial to avoid future complications such as uneven tooth wear, temporomandibular dysfunction and facial asymmetries, and different treatment methods have been used, including removable appliances. Methodology: The research was structured from a search tree (PubMed, Scielo, Google Scholar, Dialnet, Scopus), with keywords such as: removable expandable appliance; posterior crossbite; removable orthodontics; treatment efficacy AND posterior crossbite; posterior crossbite NOT fixed appliance. Conclusions: Removable expander appliances are an effective option for treating posterior crossbite in children. Studies show that these devices correct malocclusion, promote maxillary growth and improve dental alignment. The effectiveness of the treatment depends on the cooperation of the child and parents. The choice of appliance should be based on a careful evaluation of the patient's needs, considering cooperation, severity of the malocclusion and the preferences of the patient and the orthodontist.

Autism spectrum disorder and compliance with a removable orthodontic functional appliance: A case report

Autism spectrum disorder and compliance with a removable orthodontic functional appliance: A case report

Evaluation of Orthodontic Retention Protocols and Their Impact on Treatment Stability: Insights from a Tertiary Care Study

ABSTRACT Context: The goals of orthodontic therapy are to provide stable treatment results and the best possible tooth alignment. Orthodontic retention regimens are essential for avoiding relapses after treatment; however, there is ongoing discussion on the best regimen. Methods: Orthodontic patients treated at a tertiary care center were the subject of a retrospective analysis. Information was gathered about follow-up evaluations, treatment techniques, patient demographics, and retention procedures. Relapse rates and occlusal characteristics were among the objective variables used to evaluate treatment stability. A statistical analysis evaluated the effectiveness of various retention strategies. Findings: When it came to preserving treatment stability, fixed retainers outperformed detachable appliances, Hawley retainers, and Essix retainers. The mean changes in occlusal parameters and relapse rates were greater for removable appliances, but the performance of Hawley and Essix retainers was moderate. Significant variations in retention techniques were verified by statistical analysis, with fixed retainers outperforming alternative detachable retainers and removable appliances. In conclusion, compared to alternative detachable retainers and removable equipment, fixed retainers are more successful in preserving treatment stability. Retention protocols, however, must to be established with each patient’s needs and treatment preferences in mind. The length of patient compliance and retention has a crucial role in determining the stability of therapy, underscoring the significance of patient education and continued monitoring. To improve long-term treatment results and optimize orthodontic retention techniques, further research and technical developments are required.

Microbial Changes in the Periodontal Environment Due to Orthodontic Appliances: A Review.

Orthodontic appliances significantly influence the microbiological dynamics within the oral cavity, transforming symbiotic relationships into dysbiotic states that can lead to periodontal diseases. This review synthesizes current findings on how orthodontic treatments, particularly fixed and removable appliances, foster niches for bacterial accumulation and complicate oral hygiene maintenance. Advanced culture-independent methods were employed to identify shifts toward anaerobic and pathogenic bacteria, with fixed appliances showing a more pronounced impact compared to clear aligners. The study underscores the importance of meticulous oral hygiene practices and routine dental monitoring to manage these microbial shifts effectively. By highlighting the relationship between appliance type, surface characteristics, treatment duration, and microbial changes, this review aims to enhance dental professionals' understanding of periodontal risks associated with orthodontic appliances and strategies to mitigate these risks. The findings are intended to guide clinicians in optimizing orthodontic care to prevent plaque-associated diseases, ensuring better periodontal health outcomes for patients undergoing orthodontic treatment.