What do systematic reviews say?

Herbal mouthwash vs placebo

Herbal mouthwash reduced some plaque-related indices versus placebo, with low-certainty evidence.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  PI was significantly reduced compared to placebo [56]; VPI was significantly reduced compared to placebo [41]; PI was insignificantly reduced compared to placebo [19].
  3 studies
  Low

Fluoride mouthwash vs Blank control

Short-term fluoride mouthwash reduced Mutans streptococci, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  Colony count of MS was significantly reduced compared to baseline according to two studies [33; 34].
  2 studies
  Very low
• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≥ 12 months
  Colony count of MS was similar to blank control according to two studies [37; 59].
  2 studies
  Very low

Chlorhexidine mouthwash vs Placebo mouthwash

Chlorhexidine mouthwash may reduce pocket probing depth versus placebo in the short term (low certainty).

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  <=3 months (short-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
  PD was significantly reduced except mid-lingual site compared to placebo [32]. The changes of PD were significantly higher compared to placebo [56].
  2 studies
  Low

Clear aligners (Invisalign / thermoformed aligners) vs Conventional orthodontic appliance treatment

Most studies reported a lower incidence of white spot lesions with clear aligners than fixed appliances, but heterogeneous assessment methods precluded meta-analysis (ungraded).

• White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed… 2023 All outcomes

  End of orthodontic treatment (varying) · University/hospital orthodontic clinics and private practice (multiple countries)
  Not meta-analyzed (heterogeneous methods; tooth-based vs patient-based incidence). 4 studies assessed WSL incidence; 3 (Albhaisi 2020 [12]; Buschang 2019 [29]; Dallel 2020 [30]) reported a lower risk of developing WSLs…
  4 studies
  GRADE not reported

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

The review found no eligible studies for this question.

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Cost of treatment was not investigated in any of the included studies.
  Studies not reported
  No studies found

Hawley removable retainer vs Clear plastic removable retainer

The review found no eligible studies for this question.

• Retention procedures for stabilising tooth position after treatment with orthodontic braces 2023 · Cochrane All outcomes

  12 months · lower arch
  Not measured
  0 studies
  No studies found

Light-emitting diode (LED) photobiomodulation vs Conventional orthodontic appliance treatment

It is very uncertain whether light-emitting diode (LED) photobiomodulation changes patient perception of pain and discomfort (VAS 0 to 100 mm) compared with conventional orthodontic appliance treatment (very low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes

  First visit
  MD -0.80 [-2.20, 0.62]
  1 study · 39 participants
  Very low

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Siriphan 2019 (lateral cephalometric radiographs): rate of molar movement and tipping, and canine rotation and tipping were not significantly different between groups (P>0.05).
  1 study
  GRADE not reported

Low‐level laser therapy vs Conventional orthodontic appliance treatment

It is very uncertain whether low level laser therapy (LLLT) changes rate of orthodontic tooth movement during space closure stage… compared with conventional orthodontic appliance treatment (very low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes

  Space closure stage
  MD 0.18 [0.10, 0.26]
  1 study · 45 participants
  Very low

Full-time clear plastic (removable) retainer vs Part-time wear of clear plastic (thermoplastic) removable retainer

• Retention procedures for stabilising tooth position after treatment with orthodontic braces 2023 · Cochrane All outcomes

  12 months · upper and lower arches
  no estimate extracted
  3 studies
  GRADE not reported

Light vibrational forces (LVF) vs Conventional orthodontic appliance treatment

Light vibrational forces (LVF) showed no clear difference in patient perception of pain and discomfort (VAS 0 to 100 mm),… compared with conventional orthodontic appliance treatment (placebo or no adjunct) (low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes

  Immediately after ligation of initial archwire (also 4-8h, 1, 3, 7 days)
  MD 2.56 [-2.35, 7.47]
  3 studies · 153 participants
  Low

CAD/CAM nitinol fixed (bonded) retainer vs Multistrand / spiral wire fixed (bonded) retainer

It is very uncertain whether CAD/CAM nitinol fixed (bonded) retainer changes survival of retainers (failure, lower arch) compared with conventional/analogue multistrand fixed (bonded) retainer (very low certainty).

• Retention procedures for stabilising tooth position after treatment with orthodontic braces 2023 · Cochrane All outcomes

  12 months · lower arch
  RR 1.29 [0.67, 2.49]
  1 study · 41 participants
  Very low

Chlorhexidine mouthwash vs Blank control

Chlorhexidine mouthwash may reduce the Plaque Index versus blank control in the short term (WMD -0.70, 95% CI -1.12 to -0.27), but the evidence is very uncertain (very low certainty).

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  <=3 months (short-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
  WMD -0.70 [-1.12, -0.27]
  4 studies · 188 participants
  Very low

Full-time clear plastic (removable) retainer vs Any type of fixed (bonded) retainer

It is very uncertain whether full-time clear plastic (removable) retainer changes survival of retainers (failure, lower arch) compared with any type of fixed (bonded) retainer (very low certainty).

• Retention procedures for stabilising tooth position after treatment with orthodontic braces 2023 · Cochrane All outcomes

  12 months · lower arch
  RR 3.42 [1.38, 8.47]
  1 study · 77 participants
  Very low

Low‐level laser therapy vs Conventional orthodontic appliance treatment

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  SoF states harms/side effects Not reported; Ghaffer 2022 (the only LLLT study to assess harms) reported no serious harms other than gingivitis associated with plaque accumulation.
  1 study
  GRADE not reported

Cetylpyridinium chloride mouthwash vs Blank control

CPC mouthwash may reduce plaque-related indexes versus blank control in the short term, but the evidence is very uncertain (very low certainty).

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  <=3 months (short-term) · Orthodontic patients undergoing orthodontic treatment (randomized controlled trials; multiple countries)
  BBPI was significantly reduced compared to blank control [47]. PI was significantly reduced compared to blank control [50]. The amount of dental plaque was significantly reduced compared to baseline [38].
  3 studies
  Very low

Low‐level laser therapy vs Conventional orthodontic appliance treatment

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes
  Abellan 2021 assessed periodontal health (plaque index, pocket depth, bleeding on probing) after intrusion of maxillary molars; no evidence of significant difference with LLLT. Statistical test results not published.
  1 study
  GRADE not reported

Fibre-reinforced composite fixed (bonded) retainer vs Multistrand / spiral wire fixed (bonded) retainer

Fibre-reinforced composite fixed (bonded) retainer showed no clear difference in survival of retainers (failure, lower arch) compared with multistrand / spiral wire fixed (bonded) retainer (low certainty).

• Retention procedures for stabilising tooth position after treatment with orthodontic braces 2023 · Cochrane All outcomes

  12 months · lower arch
  RR 1.01 [0.84, 1.21]
  7 studies · 1337 participants
  Low

Low‐level laser therapy vs Conventional orthodontic appliance treatment

It is very uncertain whether low level laser therapy (LLLT) changes total number of orthodontic appliance adjustment appointments during… compared with conventional orthodontic appliance treatment (very low certainty).

• Non‐surgical adjunctive interventions for accelerating tooth movement in patients undergoing orthodontic treatment 2023 · Cochrane All outcomes

  Alignment stage
  MD -2.25 [-2.52, -1.97]
  2 studies · 125 participants
  Very low

Herbal mouthwash vs placebo

Herbal mouthwash reduced Mutans streptococci versus placebo, but certainty is very low.

• The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment:… 2023 All outcomes

  ≤ 3 months
  Colony count of MS was significantly reduced compared to placebo [52]; colony count was slightly reduced compared to placebo in a short time in one study [40].
  2 studies
  Very low