Comparison of the Periodontal Status Between Orthodontic Aligner Treatment and Traditional Orthodontic Treatment: A Systematic Review and Meta‐Analysis

BACKGROUND: Orthodontic treatment poses notable challenges to dental health, particularly with traditional fixed appliances, which can lead to plaque buildup and gingival weakening. Clear aligners provide an alternative treatment option, allowing patients to remove them for improved oral hygiene. However, the advantages of aligners over traditional fixed appliances concerning periodontal health are still debated. OBJECTIVE: This meta-analysis aimed to evaluate the comparative effectiveness of clear aligners and traditional fixed appliances in promoting periodontal health among orthodontic patients. METHOD: Studies were collected from various databases, including Web of Science, ScienceDirect, PubMed, Cochrane Library and Google Scholar. Eligibility for inclusion was determined using the PICO criteria, and the ROBINS-I tool was used for non-randomized controlled trials, and ROB for randomized controlled trials to assess the quality of each selected study. RESULTS: The meta-analysis of 11 studies demonstrated significant periodontal improvements in the aligner group across multiple parameters: plaque index (SMD: -1.25; 95% CI: -1.94, -0.57; p = 0.0003), gingivitis index (SMD: -0.68; 95% CI: -1.13, -0.22; p = 0.004), probing depth (SMD: -1.30; 95% CI: -2.22, -0.38; p = 0.006), sulcus bleeding index (SMD: -2.47; 95% CI: -4.97, -0.04; p = 0.05), and papillary bleeding index (SMD: -2.47; 95% CI: -4.97, -0.04; p = 0.05). CONCLUSION: Patients undergoing aligner treatment exhibited superior periodontal health when compared to those with traditional fixed appliances. Improvements were observed across various periodontal parameters, suggesting that aligners may offer periodontal health benefits for orthodontic patients.