Page 16 - GP Fall 2024

An Umbrella Review: Clear Aligners vs.
Fixed Appliances for Orthodontics

Authors: Negin Rezaie, and Analia Veitz-Keenan, DDS, FAGD

Abstract witnessed a significant advancement in or- the study also points out that clear aligners,
Introduction: Orthodontic treatment mo- thodontic therapy with the FDA’s approval while reducing treatment duration and the
dalities for arch expansion include remov- of Align Technology’s Invisalign, intro- frequency of unscheduled appointments,
able aligners and traditional fixed applianc- ducing clear aligners as a less noticeable fall short in areas critical to complex ortho-
es, each with distinct mechanical properties and more comfortable treatment option. dontic corrections such as torque control
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influencing treatment outcomes. Systemat- These aligners, favored for their aesthetic and occlusal contact establishment. Sup-
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ic reviews have examined these modalities’ appeal, meet the growing demand for less porting this, Djeu et al. (2005) found that
comparative effectiveness, focusing on invasive orthodontic solutions. While the Invisalign was particularly deficient in its
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orthodontic movements, pain perception, concept of clear aligners was initially intro- ability to correct large anteroposterior dis-
and post-treatment stability. Due to the duced by Dr. Harold Kesling in 1946, sig- crepancies and occlusal contacts, further
variability of the methodology and results, nificant technological advancements have emphasizing the advantages of fixed ap-
it is important for practices to evaluate the since transformed his early designs to meet pliances in handling more challenging or-
current evidence and summarize their find- contemporary clinical demands. 2 thodontic cases. This study indicates that
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ings. This umbrella review aims to assess Invisalign patients had a 27% lower pass-
the current evidence regarding using in- Debating the Effectiveness of Clear ing rate according to the Objective Grad-
visible or clear aligners compared to con- Aligners in Complex Dental Movements: ing System (OGS) used by the American
ventional or traditional fixed appliances for Despite their popularity, the effectiveness Board of Orthodontics, highlighting specif-
orthodontic treatment. of clear aligners, particularly in complex ic weaknesses in buccolingual inclination,
dental movements, has been a subject of occlusal contacts, occlusal relationships,
Methodology: For this type of review, a debate within the orthodontic community. and overjet management compared to brac-
systematic methodology was used to search According to Rossini et al. (2015), clear es.
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for systematic reviews in several databases, aligners effectively control anterior intru-
such as PubMed, Epistemonikos, and Trip- sion, with a mean intrusion reported at 0.72 Purpose and Scope of the Umbrella Re-
Database. mm. However, they struggle with rotations view:
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and certain extrusions, achieving only 30% Given these contrasting capabilities, this
The AMSTAR tool for systematic reviews accuracy in extrusion control. Additionally, umbrella review synthesizes existing sys-
was used to appraise each review’s meth- Sfondrini et al. (2018) assessed the bucco- tematic reviews to comprehensively com-
odological quality; for data extraction, a lingual inclination control of upper central pare clear aligners and fixed appliances.
special form was created to help determine incisors. They found that while conven- By examining effectiveness, patient satis-
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the relevant results concerning and assess- tional brackets showed the highest numeric faction, and clinical applicability, the re-
ing the effectiveness of the treatment and variation in incisal position changes, align- view will delineate conditions under which
patients’ and clinicians’ satisfaction with ers reported the lowest values, indicating a each modality might be preferable, aiding
each technique. potential limitation in achieving the desired clinicians in making informed decisions
torque. Although the differences were not that align with patient needs and treat-
Results: After the search and removing statistically significant, this underscores the ment goals. This synthesis will clarify the
duplicates, 12 systematic reviews were se- need for precise appliance selection based strengths and limitations of each treatment
lected for this review. The selected reviews on specific treatment goals. Upper molar and enhance orthodontic treatment strate-
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were addressed using clear aligners com- distalization showed an 88% predictability gies, aligning clinical expectations with
pared to conventional fixed techniques, when a bodily movement of at least 1.5 mm real-world outcomes.
evaluating different outcomes in terms of was prescribed. Despite these capabilities,
effectiveness, pain, and speech. the rotation of rounded teeth remained a Methodology:
significant challenge, highlighting a condi- This umbrella review primarily utilized
Conclusions: As time passes, the number tional efficacy that necessitates a nuanced MEDLINE through PubMed, Scopus, and
of systematic reviews on this specific top- understanding through further comparative the Cochrane Library—including CEN-
ic is exponential, and multiple companies studies. 1 TRAL and the Cochrane Database of Sys-
in the market promote clear aligners as the tematic Reviews—to identify comparative
unique solution. The results of this umbrel- Fixed Appliances: The Gold Standard in analyses of Invisalign and traditional brac-
la review will compare and contrast the Orthodontics: es regarding arch expansion. We included
current evidence. In contrast, fixed appliances have consis- studies that provided insights into treat-
tently maintained their status as the gold ment efficacy, patient-reported pain levels,
Background: standard in orthodontics, offering signif- and other pertinent orthodontic outcomes.
icant control over tooth movement. Addi Rigorous data extraction and critical ap-
Introduction to Orthodontic Treatments et al. (2023) detail that these appliances praisal methods were applied to filter and
and the Rise of Clear Aligners: are particularly effective in achieving pre- integrate the evidence from the literature
Orthodontic treatments aim to correct mal- cise occlusal contacts and managing teeth selected.
occlusions and enhance dental aesthetics, torque, both crucial for the long-term sta-
traditionally relying on fixed appliances bility of orthodontic outcomes. However,
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for comprehensive results. The late 1990s
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