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White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta- analysis

journal contribution
submitted on 2024-02-21, 10:43 and posted on 2024-02-21, 10:43 authored by Shailaja Raghavan, Elham S. Abu Alhaija, Mandeep Singh Duggal, Srinivasan Narasimhan, Sadeq Ali Al-Maweri

Objective

To analyse the available evidence regarding the incidence and severity of white spot lesions (WSLs), plaque accumulation and salivary caries-associated bacteria(SCB) in clear aligners (CA) verses conventional fixed (CF) orthodontic appliances.

Methods

Electronic searches of MEDLINE, Scopus, Embase, Google Scholar, Clinical trial registry, OpenGrey and ProQuest were done for all relevant studies. Eligibility criteria were; Randomized Controlled Trials and Non-Randomized Studies that compared the incidence and severity of WSLs, plaque accumulation and SCB between CA and CF appliances in patients undergoing orthodontic treatment. The risk of bias(ROB) and certainty of evidence was assessed independently by two reviewers using Cochrane’s ROB and GRADEpro, respectively. Standardized mean difference (SMD) was used to estimate the effect size using STATA 17 software.

Results

A total of 14 studies met the eligibility criteria, and eight were suitable for meta-analysis. The qualitative results showed lower incidence and severity of WSLs, plaque accumulation, and SCB in CA group compared to CF appliances. The pooled results showed significantly lower plaque accumulation(SMD − 1.58;95%CI:-2.57,0.58;p = 0.002) in CA compared to CF appliances.

Conclusions

A moderate-quality evidence reveals less plaque accumulation and less SCB in CA, which might be related to the reduced incidence and severity of WSLs associated with CA when compared with CF appliances. However, the results of the present study should be interpreted with caution given the high ROB among some of the included studies as well as the marked heterogeneity across the studies.

Clinical relevance

For patients who can be treated with either CA or CF appliances, CA may be a better choice concerning oral health.

Registration

Open Science Framework (DOI:https://doi.org/10.17605/osf.io/kcpvb).

Other Information

Published in: BMC Oral Health
License: https://creativecommons.org/licenses/by/4.0
See article on publisher's website: https://dx.doi.org/10.1186/s12903-023-03257-8

Funding

Open Access funding provided by the Qatar National Library.

History

Language

  • English

Publisher

Springer Nature

Publication Year

  • 2023

License statement

This Item is licensed under the Creative Commons Attribution 4.0 International License.

Institution affiliated with

  • Qatar University
  • Qatar University Health - QU
  • College of Dental Medicine - QU HEALTH
  • Hamad Medical Corporation
  • Hamad Dental Center - HMC

Methodology

Electronic searches of MEDLINE, Scopus, Embase, Google Scholar, Clinical trial registry, OpenGrey and ProQuest were done for all relevant studies. Eligibility criteria were; Randomized Controlled Trials and Non-Randomized Studies that compared the incidence and severity of WSLs, plaque accumulation and SCB between CA and CF appliances in patients undergoing orthodontic treatment. The risk of bias(ROB) and certainty of evidence was assessed independently by two reviewers using Cochrane’s ROB and GRADEpro, respectively. Standardized mean difference (SMD) was used to estimate the effect size using STATA 17 software.

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