Periodontal parameters in adult

patients with clear aligners

orthodontics treatment versus three
other types of brackets: A
cross‑sectional study

ALIFIAN HARIST RN / 1395013

TUTOR : EVELYN EUNIKE, DRG., SP.ORT
Abstract

OBJECTIVE: To assess the gingival parameters in the clear

aligner treatment versus the three other types of brackets,
i.e., conventional metal, conventional ceramic, and metal
self‑ligating.

MATERIALS AND METHODS:

Eighty patients coming for regular appointments
undergoing orthodontic treatment were included and
devided into 4 groups with 20 patients in each
 RESULT AND CONCLUSION:
CA treatment has better periodontal indices levels
compared to other types of orthodontic treatments such as
CB and the CCB groups; no significant difference with the
SL brackets group. Importance should be given to oral
hygiene instructions before, during, and after the
treatment.
Introduction The aim is aesthetics
and to improve the
appearance of the
person’s smile

requires the use of fixed brackets,

metal wires, and certain other
components which inadvertently
render tooth‑cleaning
cumbersome.

Leads to a change in the

subgingival microbial content
which an increased risk of
periodontal diseases.
 Plaque is a biofilm containing bacterial aggregates which
attaches to the teeth providing it with nutrients and
protection from the host defenses which make a stable
environment. 90% of the plaque cells are Streptococci and/or
Actinomyces

The attachment in orthodontic patients is mainly

associated with the an increased risk of S. mutants
and Lactobacilli colonization

Different bracket types have different physical characteristics

and clinical properties, affecting the amount of biofilm
accumulation on the orthodontics device components, and
consequently, gingivitis and plaque formation.
 According to those manufactures, self‑ligating
brackets are less susceptible to the changes in the
bacterial shift owing to their different shape and lack
of metal ligatures and elastomeric in them.

It must be noticed here that the clear aligner

treatment is not applicable in all kinds of orthodontic
treatment, which usually leads the dentists back to
the use of CB and SL brackets.
Materials and Methods
It was a cross‑sectional study of patients undergoing active orthodontics
treatment of different types (CB, SL, CA, CCB) from different hospitals
during December 2015 to Febuary 2016.

Group I: 20 Group II: 20 Group III: 20 Group IV: 20

patients (13 patients (9 (10 males, 10 patients (8
males, 7 males, 11 females) males, 12
females) with a females) with a patients with a females) with
mean age of mean age of mean age of a mean age
26.65 ± 5.15 27.65 ± 8.15 26.85 ± 5.19 of 26.85 ±
years years years 4.83 years
 Exclusion:
Inclusion: smokers, pregnant, diabetics, or
any patient with a those taking medication affecting
minimum age of 18 gingival health or having
years having Class II, cardiovascular diseases were
Class III skeletal excluded. Also excluded were
patients who used antiseptic
relationship and solutions or mouthwash during
undergoing orthodontic the past 6 months, underwent
treatment for at least 6 any periodontal treatments in the
months with fixed past 6 months, or who had fixed
orthodontic appliances bridges and crowns or extensive
(FOA) on both arches. restorations close to the gingival
margins.
 For our study, we used the following seven
periodontal indices to predict the periodontal
health in all groups
 1. Plaque index (PI) by Silness and Loe in 1964
 2. Gingival index (GI)
 3. Gingival bleeding index (GBI) by Carter and Barnes
(1974)
 4. Sulcus bleeding index (SBI) 1971, Muhlemann and
Son
 5. Papillary bleeding index (PBI)
 6. Basic periodontal examination (BPE) index
 7. Bleeding on probing (BOP) index.
Statistical analysis

We used statistical Package social sciences (SPSS 22.0,

Chicago IL, USA) for data analysis. Descriptive analysis
was carried out to report on frequencies, mean, and
standard deviation. Multivariate and a Bonferroni
correction were performed (P value =< 0.008)
RESULTS
 Plaque Index
Grou n SD P value
p 1vs2 1vs 1vs 2vs3 2vs 3vs
3 4 4 4
CB 2 1, 0,3 0,19 0,0 0,00 0,38 0,0 0,0
0 7 6 3 0 0
CCB 2 1, 0,4
0 6 9
SL 2 1, 0,3
0 5 3
CA 2 0, 0,1
0 2 8 CB CCB SL CA
Total 8 1, 0,7
There0 was
2 a0significantdifference between groups 1 and 4, groups 2 and 4,
and between groups 3 and 4.
There was no significance difference between groups 1 and 2, groups 1 and
3, and group 2 and 3.
RESULTS
 Gingival index
Grou n SD P value
p 1vs 1vs3 1vs 2vs 2vs 3vs
2 4 3 4 4
CB 20 1,26 0,6 0,0 0,00 0,00 0,56 0,0 0,0
7 1 2 0 0
CCB 20 0,85 0,4
9
SL 20 0,76 0,4
8
CA 20 0,00 0,0 CB CCB SL CA
8 2
Total 80 0,72 0,6
5
There was a significant difference between groups 1 and 3, groups 1 and 4,
groups 2 and 4, and groups 3 and 4.
There was no significance difference between groups 1 and 2, and groups 2
and 3.
RESULTS
 Gingival Bleeding Index
Grou n SD P value
p 1vs 1vs 1vs 2vs 2vs 3vs4
2 3 4 3 4
CB 2 11,2 2,7 0,0 0,0 0,0 0,0 0,0 0,37
0 5 6
CCB 2 4,2 3,8
0 8
SL 2 0,7 1,1
0 2
CA 2 0,00 0,0 CB CCB SL CA
0 0
Total 8 4,03 5,0
0 9
There was significant difference between groups 1 and 2,
groups 1 and 3, groups 1 and 4, groups 2 and 3, groups 2 and
4.
There was no significance difference between groups 3 and 4
RESULTS
 Sulcus Bleeding Index
Grou n SD P value
p 1vs2 1vs 1vs 2vs 2vs 3vs4
3 4 3 4
CB 2 1,91 0,6 0,00 0,0 0,0 0,0 0,0 0,01
0 8 4 8
CCB 2 1,32 0,9
0 3
SL 2 0,49 0,5
0 3
CA 2 0,00 0,0
CB CCB SL CA
0 5 2
Total 8 0,93 0,9
0 7
There was a significant difference between groups 1 and 3, groups 1 and 4,
and groups 2 and 4.
There was no significance difference between groups 1 and 2, groups 2
and 3, and between groups 3 and 4.
RESULTS
 Papillary Bleeding Index
Grou n SD P value
p 1vs2 1vs 1vs 2vs3 2vs 3vs4
3 4 4
CB 2 1,63 0,7 0,01 0,0 0,0 0,00 0,0 0,01
0 2 9 2 5
CCB 2 1,15 0,8
0 8
SL 2 0,5 0,5
0 6
CA 2 0,00 0,0 CB CCB SL CA
0 5 2
Total 8 0,82 0,8
0 8
There was statistical difference between groups 1 and 2, groups 1 and 3,
groups 2 and 4, and between groups 1 and 4. There was no statistical
difference between groups 2 and 3 and between groups 3 and 4.
RESULTS
 Basic Periodontal Examination Index
Grou n SD P value
p 1vs 1vs 1vs 2vs 2vs 3vs4
2 3 4 3 4
CB 2 2,2 0,5 0,0 0,0 0,0 0,0 0,0 0,34
0 6
CCB 2 1,08 0,6
0 4
SL 2 0,14 0,1
0 4
CA 2 0,00 0,0 CB CCB SL CA
0 7 1
Total 8 0,85 0,9
0 8
There was a statistical difference between groups 1 and 2, groups 1 and 3,
groups 1 and 4, groups 2 and 3, and between groups 2 and 4.
There was no significant difference between groups 3 and 4.
RESULTS
 Bleeding on Probing Index
Grou n SD P value
p 1vs 1vs 1vs 2vs 2vs 3vs4
2 3 4 3 4
CB 2 0,71 0,0 0,1 0,82 0,7 0,1 0,0 0,87
0 9 9 3 9
CCB 2 3,1 11,
0 5
SL 2 0,3 0,1
0
CB CCB SL CA
CA 2 0,01 0,0
0 1
Total 8 1,02 5,7
0 7
There was no significance difference between groups 1 and 2. There was
no significant difference between groups 1 and 3, groups 1 and 4, groups 2
and 3, groups 2 and 4, and between groups 3 and 4.
 CB cause complications in terms of creating
Discussion retention and increasing the accumulation of
plaque
An increase in the plaque levels leads to
enamel demineralization, which shows up as
white spots, and higher levels of caries and
inflammation of gingival tissues.
The presence of metal ligation wires in the
conventional orthodontic patients plays a role
in the accumulation of dental plaque.

In our study, the data showed that the PI level

in the CB group was higher than the other
groups in the study.

Even though the periodontal indices were

lower in our patients with CB appliances, CB
remains reliable option
 In CA treatment, the plaque levels were
Discussion much lower than patients wearing the
CB.
In our data, we figured that the CA group
shows better levels in all 7 indices
recorded, which could be explained by the
ease of access and better oral hygiene.
The CA group of our study showed better
indices levels, leading to better oral and
gingival health during the treatment
period, as well as better results
aesthetically and functionally

Most of our female patients preferred CA

treatment since it gives them an aesthetic
smile during the treatment period
Discussion

Our study shows the important of the oral

hygiene instructions and the periodontal
health during the orthodontics treatment to
achieve better results.
Conclusion

 Compared to the same levels in the conventional brackets,

the clear aligners treatment showed better periodontal
indices levels (PI, GI, GBI, SBI, PBI, BPE, BOP)
 In the case of self ligating brackets, it shows no significant
difference comparing with clear aligners, implying that the
self ligation brackets are better than other types of brackets
and less than clear aligners in numbers but not significantly
 clear aligners is recommended as this treatment eases the
oral hygiene procedures leads to better oral hygiene.
Thankyou