Evaluation of gingival health and pain level in orthodontics treatment with clear aligners: A systematic review and meta-analysis

The aim of the study was to assess the proficiency of clear aligners (CAs), and to evaluate all aspects of this orthodontic procedure including bleeding on probing (BOP), plaque index (PI), gingival index (GI), and probing pocket depth (PD), which all are clinical parameters of gingival inflammation in addition to the pain score. We performed an electronic search in the different databases such as Cochrane CENTRAL for eligible studies, SCOPUS, PubMed, and Web of Science. The quality of the involved trials has been measured according to Cochrane’s risk of bias tool. The following outcomes have been assumed: BOP, PI, GI, probing PD, and pain score. The homogeneous and heterogeneous data have been evaluated using random-effects model and fixed-effects model, consistently. Ten clinical trials have been included in the study. The pooled analysis that The CAs has been associated with a significant decrease in the pain score (standardized mean difference = 0.74 [0.46, 1.02]), (P = 0.0001). No significant variations between post-treatment and pre-treatment group were found regarding plaque index (mean difference [MD] = −0.11 [−0.45, 0.22]), (P = 0.5), BOP (MD = 0.20 [−0.01, 0.41]), (P = 0.06), GI (MD = 0.17 [−0.06, 0.40]), (P = 0.15), and BOP (MD = 0.01 [−0.16, 0.17]), (P = 0.94). Patients treated by CAs showed a noticeable decrease in pain scores. On contrary, there was not any difference between the pre-treatment data and post-treatment data regarding other indices.