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 IV: 20
Group I: 20 Group III: 20 (10
Group II: 20 patients patients (8 males,
patients (13 males, males, 10 females)
(9 males, 11 females) 12 females) with
7 females) with a patients with a
with a mean age of a mean age of
mean age of 26.65 mean age of 26.85
27.65 ± 8.15 years 26.85 ± 4.83
± 5.15 years ± 5.19 years
years
 Inclusion:
any patient with a minimum
age of 18 years having Class
II, Class III skeletal
relationship and undergoing
orthodontic treatment for at
least 6 months with fixed
orthodontic appliances
(FOA) on both arches.
Exclusion:
smokers, pregnant, diabetics, or those
taking medication affecting gingival
health or having cardiovascular diseases
were excluded. Also excluded were
patients who used antiseptic solutions or
mouthwash during the past 6 months,
underwent any periodontal treatments in
the past 6 months, or who had fixed
bridges and crowns or extensive
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
Group n SD P value
1vs2 1vs3 1vs4 2vs3 2vs4 3vs4
CB 20 1,7 0,36 0,19 0,03 0,00 0,38 0,00 0,00

CCB 20 1,6 0,49

SL 20 1,5 0,33

CA 20 0,2 0,18

Total 80 1,2 0,70

CB CCB SL CA

There was a significant difference 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
Group n SD P value
1vs2 1vs3 1vs4 2vs3 2vs4 3vs4
CB 20 1,26 0,67 0,01 0,002 0,00 0,56 0,00 0,00

CCB 20 0,85 0,49

SL 20 0,76 0,48

CA 20 0,008 0,02
CB CCB SL CA
Total 80 0,72 0,65

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
Group n SD P value
1vs2 1vs3 1vs4 2vs3 2vs4 3vs4
CB 20 11,25 2,76 0,0 0,0 0,0 0,0 0,0 0,37

CCB 20 4,2 3,88

SL 20 0,7 1,12

CA 20 0,00 0,00
CB CCB SL CA
Total 80 4,03 5,09

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
Group n SD P value
1vs2 1vs3 1vs4 2vs3 2vs4 3vs4
CB 20 1,91 0,68 0,004 0,0 0,0 0,0 0,0 0,018

CCB 20 1,32 0,93

SL 20 0,49 0,53

CA 20 0,005 0,02

Total 80 0,93 0,97 CB CCB SL CA

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
Group n SD P value
1vs2 1vs3 1vs4 2vs3 2vs4 3vs4
CB 20 1,63 0,72 0,019 0,0 0,0 0,002 0,0 0,015

CCB 20 1,15 0,88

SL 20 0,5 0,56

CA 20 0,005 0,02
CB CCB SL CA
Total 80 0,82 0,88

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
Group n SD P value
1vs2 1vs3 1vs4 2vs3 2vs4 3vs4
CB 20 2,2 0,56 0,0 0,0 0,0 0,0 0,0 0,34

CCB 20 1,08 0,64

SL 20 0,14 0,14

CA 20 0,007 0,01
CB CCB SL CA
Total 80 0,85 0,98

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
Group n SD P value
1vs2 1vs3 1vs4 2vs3 2vs4 3vs4
CB 20 0,71 0,09 0,19 0,82 0,7 0,13 0,09 0,87

CCB 20 3,1 11,5

SL 20 0,3 0,1

CA 20 0,01 0,01
CB CCB SL CA
Total 80 1,02 5,77

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.
Discussion CB cause complications in terms of creating 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
Discussion In CA treatment, the plaque levels were 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
 clearaligners is recommended as this treatment eases the oral hygiene
procedures leads to better oral hygiene.
Thankyou