Oral Health Prev Dent. 2021 Dec 8;19:659-672. doi: 10.3290/j.ohpd.b2403661.
To identify and assess differences in oral hygiene parameters in patients undergoing orthodontic treatment with clear aligners compared to fixed appliances.
Published and unpublished literature was searched in seven databases until May 31st 2021. Representative keywords included 'orthodontic aligner', 'fixed appliance', 'oral hygiene', 'plaque index', 'caries'. Study selection, data extraction, risk of bias and certainty of evidence assessment were undertaken independently by three reviewers. Random effects meta-analyses with respective confidence intervals (95% CI) were conducted, where applicable.
A total of 882 unique records were screened, with a final number of 21 articles being eligible for qualitative synthesis, while 4 of those contributed to meta-analyses. Risk of bias was rated within the range of low to high or serious overall, while certainty of evidence was low to very low according to GRADE. For periodontal parameters, adults undergoing aligner orthodontic treatment presented summary plaque scores 0.58 lower than those treated with fixed appliances, within the first 6 to 12 weeks (4 studies: mean difference: -0.58; 95%CI: -0.82, -0.34; p < 0.001; I2 squared: 71.3%), while no evidence of difference was recorded for inflammation indices. Microbiologic parameters such as presence of S. mutans and lactobacilli were more pronounced in patients with fixed appliances for the first 3 to 6 months (synthesised data from 2 studies).
In the short-term after initiation of orthodontic treatment, patients treated with aligners and no additional attachments/adjuncts presented potentially higher levels of oral health overall. However, the evidence is supported by low to very low certainty.
比较使用透明矫正器和固定矫正器的正畸患者的口腔卫生参数，识别并评估其差异。
截至 2021 年 5 月 31 日，在七个数据库中搜索已发表和未发表的文献。代表性的关键词包括“正畸矫正器”、“固定矫正器”、“口腔卫生”、“菌斑指数”、“龋齿”。研究选择、数据提取、偏倚风险和证据确定性评估由三名评审员独立进行。在适用的情况下，进行了随机效应荟萃分析，并附有各自的置信区间（95%CI）。
总共筛选了 882 条独特的记录，最终有 21 篇文章符合定性综合分析的条件，其中 4 篇文章有助于荟萃分析。偏倚风险总体评定为低至高或严重，而根据 GRADE，证据确定性为低至极低。对于牙周参数，接受矫正器正畸治疗的成年人在最初的 6 至 12 周内，其菌斑评分比接受固定矫正器治疗的成年人低 0.58 分（4 项研究：平均差值：-0.58；95%CI：-0.82，-0.34；p < 0.001；I2 平方：71.3%），而炎症指数则没有差异。在最初的 3 至 6 个月内，使用固定矫正器的患者中，微生物学参数如变形链球菌和乳杆菌的存在更为明显（综合了 2 项研究的数据）。
在正畸治疗开始后的短期内，使用无附加附件/辅助器的透明矫正器治疗的患者总体口腔健康水平可能更高。然而，证据的确定性为低至极低。
