Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

91 questions · 99 findings · 13 reviews · Orthodontics

No studies found 17 · 17.2%GRADE not reported 29 · 29.3%Very low 33 · 33.3%Low 17 · 17.2%Moderate 3 · 3%High 0 · 0%

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

S. mutans presence (CFU > 10^5) · Adults undergoing orthodontic treatment

Aligners probably lower the risk of high S. mutans counts versus fixed appliances in adults at 3 months (RR 0.07, 95% CI 0.01 to 0.49; low certainty).

2 findings from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Gingival index (GI) · Adults undergoing orthodontic treatment

A single study found no significant difference in gingival index between aligners and fixed appliances in adults at 6-12 weeks (MD -0.10, 95% CI -0.35 to 0.15; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

White spot lesions (WSLs), tooth level · Adults undergoing orthodontic treatment

A single study reported a lower risk of white spot lesions (tooth level) with aligners versus fixed appliances in adults at 3 months (RR 0.72, 95% CI 0.60 to 0.86; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Percentage of bleeding on probing (BOP) · Adults undergoing orthodontic treatment

No clear difference in bleeding on probing between aligners and fixed appliances in adults at 6-12 weeks (MD -0.26, 95% CI -0.77 to 0.26; very low certainty).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Gingival inflammation-related index · Adolescents/teenagers undergoing orthodontic treatment

A single study reported lower simplified gingival index with aligners versus fixed appliances in adolescents at 1 month (MD -8.46, 95% CI -10.47 to -6.45; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Probing pocket depth (PPD/PD) · Adults undergoing orthodontic treatment

Aligners may reduce pocket depth compared with fixed appliances in adults at 6-12 weeks (MD -0.42 mm, 95% CI -0.71 to -0.12; very low certainty).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

White spot lesions (WSLs), patient level · Adolescents/teenagers undergoing orthodontic treatment

A single study found no significant difference in white spot lesion formation (patient level) between aligners and fixed appliances in adolescents at 9 months (RR 0.33, 95% CI 0.10 to 1.04; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

S. mutans presence · Adolescents/teenagers undergoing orthodontic treatment

A single study found no significant difference in S. mutans presence between aligners and fixed appliances in adolescents at 1 month (RR 0.86, 95% CI 0.64 to 1.14; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Full-mouth bleeding score (FMBS) · Adolescents/teenagers undergoing orthodontic treatment

A single study reported a lower full-mouth bleeding score with aligners versus fixed appliances in adolescents at 12 months (MD -20.44, 95% CI -22.98 to -17.90; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Lesion area (decalcification area, pixels) · Adults undergoing orthodontic treatment

A single study reported a larger decalcification lesion area with aligners versus fixed appliances in adults at 3 months (MD 80.50 pixels, 95% CI 60.52 to 100.48; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

S. mutans counts (5th-root transformed) · Adolescents/teenagers undergoing orthodontic treatment

A single study found no significant difference in S. mutans counts between aligners and fixed appliances in adolescents at 1 month (MD -2.22, 95% CI -6.82 to 2.38; ungraded).

1 finding from 1 review