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Conclusions:
This umbrella review has critically assessed the evidence that compares the effectiveness of clear aligners versus traditional fixed ap-
pliances in orthodontic treatment, drawing on a diverse array of systematic reviews. The evidence demonstrates that clear aligners offer
significant advantages in patient esthetics and comfort, making them a popular choice for mild to moderate malocclusions. However,
traditional fixed appliances retain a pivotal role in complex dental corrections due to their superior precision in tooth movement. The
review underscores the importance of tailoring orthodontic treatment to individual patient needs, considering the specific clinical sce-
nario and patient preferences. As technology advances, the capabilities of clear aligners are expanding, suggesting a future where their
use could become more widespread, even in complex cases. Nonetheless, the decision between aligners and fixed appliances should be
based on a comprehensive evaluation of the current evidence, with a clear understanding that both modalities have their place in modern
orthodontic practice. This review calls for ongoing research to further refine our understanding of these treatments, ensuring that ortho-
dontic care continues to evolve in line with technological advancements and patient expectations.
Study ID Intervention Comparison Outcome Inclusion Risk of bias Appropriate Number of AMSTAR Author’s
Criteria assessment Statistical articles TOTAL conclusions
methods out of
Rossini Clear Aligners Conventional Teeth movement RCT+ Prospective Yes 11 16/16 CAT effectively aligns
2015 Braces arches and manages
specific tooth move-
ments but struggles with
anterior extrusion, certain
inclinations, and rotating
rounded teeth. Interpret
findings cautiously due to
study limitations.
Ke 2019 Clear Aligners Fixed Treatment effec- Studies comparing Yes Meta-analysis 8 12.5/16 Clear aligners and fixed
Appliances tiveness and effi- clear aligners with fixed and qualitative appliances effectively
ciency, including appliances for orthodontic synthesis treat malocclusion;
occlusal contacts, treatment however, fixed appliances
teeth alignment, excel in occlusal contacts
and treatment and teeth torque, while
duration clear aligners are better
for segmented teeth
movement and offer
shorter treatment times.
Pithon Invisible Conventional Effectiveness in Controlled clinical trials with Yes MINORS and 4 9/16 Invisible aligners are
2019 Aligners Braces aesthetic and orthodontic patients Cochrane effective for dental align-
functional ortho- tools used ment but have limitations
dontic treatment, in anterior/posterior
especially dental and vertical corrections
compared to braces.
alignment
Robertson Clear Fixed Predictability and Studies on predictability Yes ROBINS-I and 7 - Clear aligners provide
2019 Aligners Appliances effectiveness of and effectiveness from Cochrane risk clinically acceptable
tooth movements 2014-2019 of bias tool outcomes for certain
tooth movements, but
not all movements are
predictable.
Ali Baeshen Clear Aligner Fixed Speech assessed Individuals undergoing Yes, using the Co- Meta-analy- 7 studies 11/16 Speech difficulties may
2023 Therapy appliance qualitatively and orthodontic treatment with chrane Handbook sis was not (n = 332 occur with clear aligners,
treatment or objectively, focus- clear aligners, evaluating for Systematic performed due patients) but typically resolve as
No treatment ing on difficulties, speech difficulties using Reviews of Inter- to heteroge- included patients adapt. Caution is
adaptation, and objective and subjective ventions guidelines neity in study advised in interpretation,
recovery. analyses. and ROBINS-I designs. highlighting the need for
tool. more in-depth studies on
long-term speech effects.
Cardoso Clear Aligners Fixed Pain experience Studies comparing pain Yes Meta-analysis 12 13/16 CA associated with lower
2020 (CA) Appliances during orthodontic levels between CA and FA and qualitative pain levels compared to
(FA) treatment synthesis FA during orthodontic
treatment.
Papageorgiou Orthodontic Fixed Treatment Studies on any-age Yes Random-ef- 11 11.5/16 Aligners yield poorer
2020 Aligners Appliances outcome humans comparing fects model for results than fixed
(ABO-OGS), full-arch orthodontic meta-analyses appliances in adults, with
patient satisfaction, treatment with aligners vs. no difference in treatment
treatment duration, fixed appliances. time. More studies on
and adverse adverse effects are
effects needed.
Oikonomou Clear Aligners Fixed Oral hygiene Studies comparing clear Yes Meta-analysis 21 12/16 Short-term, aligners may
2021 Appliances parameters, aligners and fixed appliances, and qualitative lead to better oral health
plaque index, focusing on oral hygiene synthesis compared to fixed appli-
caries and plaque index. ances, but evidence is of
low to very low certainty.
Crego-Ruiz Clear Aligners Fixed Periodontal Studies assessing Yes Qualitative and 12 11.5/16 Limited evidence
2023 appliances health status and periodontal health and quantitative suggests clear aligners
gingival recession gingival recession in analyses, and fixed appliances
during orthodontic patients treated with random-effects have similar impacts on
treatment clear aligners vs. fixed model for periodontal health during
appliances. meta-analysis orthodontic treatment.
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