Comparison of Outcomes in Adolescents Treated with Aligners versus Fixed Appliances in an Academic Setting

Abstract

Background: Adolescents are increasingly requesting and being treated with aligners, and there is a need for better information regarding treatment indications and outcomes in this population. Purpose: The aims of this study were to compare treatment efficacy and efficiency, presence and extent of new or larger white spot lesions (WSL), and oral health-related quality of life (OHRQOL) in adolescent patients treated with aligners versus fixed appliances (FA) in an academic dental clinic. Study Design: This cohort study was carried out in the University of Washington (UW) Graduate Orthodontics clinic. 29 adolescent subjects (18 male and 11 female, mean age = 14) treated with aligners and fulfilling the inclusion criteria were recruited and matched 1:1 with adolescent subjects treated with FA. Pre-treatment characteristics were collected, and subjects were contacted to complete a modified OHIP-14 questionnaire to evaluate their OHRQOL. Treatment efficacy was assessed by comparing the peer assessment rating (PAR) scores and treatment efficiency was assessed by comparing the number of emergency visits, de-bonded appliances, appointment visits, and treatment time. Presence and extent of new or larger WSLs were assessed evaluating the incisors from the digital photos using the ImageJ software. Results: The two groups had similar demographic and pre-treatment parameters, as well as post-treatment PAR scores. There was a trend for less de-bonded appliances in the aligner group (mean A = 1.0 vs. FA = 3.0 appliances; p = 0.07), but no significant difference in the treatment time. However, participants in the aligner group had significantly less treatment visits (mean A = 15.7 vs. FA = 21.3 visits; p < 0.001) and emergency visits (mean A = 0.4 vs. FA = 1.0 visits; p = 0.01). Participants in the aligner group had significantly fewer maxillary incisors with new or larger WSLs (p = 0.02), and oral hygiene counselling was provided three times less frequently (p = 0.01) compared to participants in the FA group. Lastly, the groups had similar total OHIP-14 scores, but only 26% of participants in the aligner group reported occasional interruption of meals versus 70% of participants in the FA group (p = 0.02). Conclusions: This study found both groups had similar PAR outcomes and treatment times. However, participants in the aligner group had fewer emergency visits, treatment visits, de-bonded appliances, new or larger WSLs, and interruption of meals compared to participants in the FA group.