The Effect of Initial Orthodontic Therapy with Clear Aligners and Fixed Appliances on Microbial Profiles and Clinical Parameters

Abstract

Background Orthodontic appliances hinder proper oral hygiene, leading to plaque retention and biofilm formation which can cause dental diseases. This study investigates the initial impact of orthodontic treatment with fixed appliances versus clear aligners on microbial profiles and gingival/plaque indices.Methods Nine patients were included in this small-scale prospective longitudinal pilot study – five in treatment with fixed appliances and four with clear aligners. Plaque biofilm samples were collected subgingivally, supragingivally and from clear aligner trays, and gingival and plaque indices were recorded at six timepoints over 3 months. DNA was extracted and next-generation 16S rRNA sequencing of the V4 region was performed.Results Fixed appliance patients showed higher plaque and gingival index scores early on (p ≤ 0.05) and higher levels of oral pathogens (p ≤ 0.05). Microbiological analysis revealed distinct microbial communities on clear aligner trays, with health- and disease-associated microbes present at significantly different levels (p ≤ 0.05) compared to intraoral plaque samples.Conclusions Patients undergoing orthodontic therapy with fixed appliances had higher levels of plaque retention and oral pathogens. Clear aligner patients’ had microbial profiles with more oral health-associated species and lower gingival/plaque indices. However, the biofilm on clear aligner trays requires further study, and the small sample size limits the conclusiveness of all findings.Implications Dentists may consider clear aligners as an alternative to fixed appliances, with potential benefits in plaque accumulation and oral microbial composition. All patients undergoing orthodontic therapy should practice good oral hygiene to prevent plaque retention and reduce oral pathogen colonization.Continuing Education Credit Available: A CDA Continuing Education quiz is online for this article: https://www.cdapresents360.com/learn/catalog/view/20The practice worksheet is available online: https://doi.org/10.1080/19424396.2024.2423594

Keywords

• Oral microbiome
• plaque
• orthodontics
• fixed appliances
• clear aligners
• clinical parameters