Thursday, February 22, 2018

Debunking the Myth of Superior Oral Hygiene with Invisalign



Debunking the Myth of Superior Oral Hygiene with Invisalign.

 

With the advent of direct advertising to the public, one item that has continuously been claimed is that Clear Aligners such as Invisalign, Clear Correct, ClearPath or a dozen other brands provide better oral hygiene for orthodontic patients.  This mantra has been echoed by dentists working to compete against their specialist colleagues offering true traditional orthodontics with braces and other appliances.  But is this based in truth or just another hollow advertising promise by the companies and dentists providing these other products?  Let’s look at one such ad from an aligner company:
 
 


First, no one is doubting the esthetics of clear aligners; and they can move teeth into better alignment, just not as quickly, not as efficient and certainly not to the same degree in many, many cases.  Additionally the idea/myth of minimal appointments and few visits should be a red flag pointing to the fact that they are used as a mail-order type of appliance with little oversight by dental assistants (often trained in a few minutes to place aligners) and even less from the doctors themselves. 
 
And teeth, believe it or not, will not move faster because of an aligner, ever.  That is because aligners are removable and they get loose from function in the mouth and constant removal and replacement.   In fact, there are many studies that debunk much of the advertising concerning aligners (see previous Blog article  Does Invisalign work?) so these companies have skipped the Orthodontists and advertise directly to General Dentists and the public through TV ads and radio. 
 

Putting that aside, I want to focus on the advertisement claim of “No Effect on Oral Hygiene” and the most current research to address this myth. 

 

In the February 2018 issue of the American Journal of Orthodontics and Dentofacial Orthopedics (AJODO), this very question has been answered with a prospective, randomized clinical trial comparing not only clear aligners with traditional braces, but also traditional braces with self-ligating braces (also a company that has claimed better oral hygiene). (1)

 

No evidence of differences in oral hygiene levels among clear aligners, self-ligating brackets, and traditional elastomeric ligated brackets after 18 months of active orthodontic treatment.”(1)

 

The observations made in this study contradict popular beliefs that removable appliances have a minimal effect on periodontal health

  

This study was set up using 71 patients (41 boys, 30 girls with a mean age of 15.6 years old).  27 patients were treated with Invisalign aligners, 22 patients were treated with self-ligating braces and the last 22 patients were treated with traditional braces. 


 

Oral hygiene was studied before treatment, at 9mo into treatment, and 18mo after treatment.


Results revealed “No evidence of differences in oral hygiene levels among clear aligners, self-ligating brackets, and traditional elastomeric ligated brackets after 18 months of active orthodontic treatment.”
 

In fact, the researches point out that “The observations made in this study contradict popular beliefs that removable appliances have a minimal effect on periodontal health

 

In discussion, the authors point out that this confirms previous research that covering the teeth with aligners prevents self-cleaning effects of tongue and saliva (below).

 

“The continuous coverage of all surfaces of the teeth including 1 to 2 mm of gingiva by aligners has been shown to prevent the flushing effect of saliva on dental tissues” (2)

 

It is also mentioned from other previous studies that, “insufficient saliva secretion reduces the self-cleansing mechanisms of the oral cavity and limits the antimicrobial effects of the residual saliva.x37Lara-Carrillo, E., Montiel-Bastida, N.M., Sánchez-Pérez, L., and Alanís-Tavira, J. Effect of orthodontic treatment on saliva, plaque and the levels of Streptococcus mutans and Lactobacillus. Med Oral Patol Oral Cir Bucal. 2010; 15: e924–e929

Crossref | PubMed | Scopus (31) | Google ScholarSee all References
x38Türköz, C., Canigür Bavbek, N., Kale Varlik, S., and Akça, G. Influence of thermoplastic retainers on Streptococcus mutans and Lactobacillus adhesion. Am J Orthod Dentofacial Orthop. 2012; 141: 598–603

Abstract | Full Text | Full Text PDF | PubMed | Scopus (6) | Google ScholarSee all References
This can potentially lead to greater accumulation of dental plaque. Furthermore, the margins of aligners are almost never perfectly smooth. This can irritate the marginal gingiva.” (3, 4)

 

So once again, even though you may hear it and see it in advertisements, online resources or even word of mouth, true research shows that oral hygiene concerns should not be a factor in choosing aligners v. traditional true Orthodontics (i.e. Braces).


 

* https://doi.org/10.1016/j.ajodo.2017.10.009   

1. Aditya Chhibber,a Sachin Agarwal,b Sumit Yadav,c Chia-Ling Kuo,d and Madhur Upadhyayc

Norwalk, Ohio, Melbourne, Australia, and Farmington, Conn, Which orthodontic appliance is best for oral hygiene? A randomized clinical trial, (Am J Orthod Dentofacial Orthop 2018;153:175-83)

2. Addy, M., Shaw, W.C., Hansford, P., and Hopkins, M. The effect of orthodontic appliances on the distribution of Candida and plaque in adolescents. Br J Orthod. 1982; 9: 158–163

3. Lara-Carrillo, E., Montiel-Bastida, N.M., Sánchez-Pérez, L., and Alanís-Tavira, J. Effect of orthodontic treatment on saliva, plaque and the levels of Streptococcus mutans and Lactobacillus. Med Oral Patol Oral Cir Bucal. 2010; 15: e924–e929

4. Türköz, C., Canigür Bavbek, N., Kale Varlik, S., and Akça, G. Influence of thermoplastic retainers on Streptococcus mutans and Lactobacillus adhesion. Am J Orthod Dentofacial Orthop. 2012; 141: 598–603

 
If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35th street and MoPac.
 
 

Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 20 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com. 

 

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