Effects of Multibracket Orthodontic Treatment versus Clear Aligners on Periodontal Health: An Integrative Review

Objective: This integrative review aimed to identify studies comparing the periodontal health in patients wearing multibracket orthodontic appliances and clear aligners. Materials and methods: An integrative literature search was performed through different databases, PubMed/Medline, PMC, and the Cochrane Library. This work was submitted to a search strategy following the PICO method and included the focus question: "Could the chosen orthodontic appliance change significantly the oral hygiene of the patient, impairing the periodontal health?" This work included analytical and controlled studies on humans published between 2005 and 2020, in the English language, establishing a comparison of the periodontal status in patients undergoing orthodontic multibracket and clear aligners therapies. The main periodontal indexes assessed were plaque index (PI), pocket depth (PD), gingival index (GI), and bleeding on probing (BoP). Results: The electronic research displayed 386 articles on PMC, 106 on PubMed, and 40 on the Cochrane Library. After removal, just 25 articles were selected for full-text screening, but just eight studies were eligible for this integrative review. It was enumerated that 204 patients were treated with aligners and 294 with multibracket orthodontic appliances, mainly elastomeric ligated brackets. Only the plaque index displayed a significant difference between the two groups and general data obtained showed a better control for periodontal health in the clear aligners. Limitations such as age, malocclusion severity, therapeutic choice, and different time measure was observed. In addition, the oral hygiene instruction and follow-up by a professional were different, and the role of malocclusion was not present in the studies. Conclusions: Within the limitations of this study, better results for periodontal health were found in the clear aligners. Therefore, more studies are necessary to affirm that aligners are synonymous with better gingival conditions in comparison with multibracket appliances. Other variables such as oral hygiene instructions, motivation, and supportive treatment tend to be more prevalent than the type of appliance itself in the periodontal evaluation.