Clear aligner treatment among patients with compromised periodontal tissue

Published:October 28, 2023DOI:https://doi.org/10.1053/j.sodo.2023.10.003

 

Abstract

The aesthetic advances associated with clear aligner therapy (CAT) encourage the adult population, often affected by periodontal disease (PD), to seek orthodontic treatment. The literature states that it is possible to conduct orthodontic treatment in patients with compromised periodontal tissue through fixed appliances (FA) if the inflammation is controlled. It is now necessary to elucidate the role of CAT in this context. This narrative review aims to discuss the impact of orthodontic treatment with CAT in patients with healthy and compromised periodontal tissue. Regarding periodontal health, there is no evidence showing differences in the levels of periodontal disease pathogens in the oral microbiome of FA and CAT users. The presence or type of orthodontic appliance may not result in poor periodontal health among adolescents and adults with good oral hygiene and the absence of systematic conditions associated with PD. The predisposition to PD is highly associated with individual factors, including oral hygiene habits, smoking and hormonal changes, rather than the type of brackets. Considering patients with compromised periodontal tissue without active inflammation, CAT is a viable treatment option that can provide good periodontal health indices, in the same way as the treatment performed with FA. More important than the type of appliance are individual factors, including oral hygiene habits, clinical control of the periodontal condition, and the orthodontic biomechanics performed. New randomized clinical studies, which evaluate the effects of hygiene control and patient-related factors, may elucidate this issue.