Department of Orthodontics, College of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Eur J Orthod. 2023 Feb 10;45(1):11-19. doi: 10.1093/ejo/cjac018.
To assess the effect of clear aligners on the speech of patients undergoing orthodontic therapy through a systematic review of the literature. Search methods and selection criteria: The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) CRD42021278694. An electronic search of the Scopus, Embase, Pubmed, and Web of Science databases was done for papers published between January 2000 till September 2021. Studies that evaluated speech difficulties in patients undergoing orthodontic treatment with clear aligners using objective and subjective analyses were included. The evaluated primary outcome was speech difficulties. Secondary outcomes were time to adaptation and recovery from speech difficulties. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions Handbook guidelines and ROBINS-I tool.
Two hundred and eighty-three articles were screened to identify seven studies (n = 332 patients) that assessed speech difficulty with aligners, of which two were randomized trials. Meta-analysis was not performed due to the heterogeneity in the study designs. Five studies compared speech difficulty with aligners to fixed appliances. Two studies showed a moderate risk of bias and five studies had a serious risk of bias. Level of evidence was downgraded to low due to the methodological insufficiencies and risk of bias in the studies. All seven studies reported that aligners could influence the clarity and delivery of speech, similar to fixed appliances. Various phonemes were affected including /s/,/z/,/zh/,/sh/,/th/,/ch/ on wearing aligners. Errors in articulation of consonants and sibilants were noted with lisping and speech impairment. These speech difficulties were temporary and most patients recovered in 7-14 days while few patients took 30-60 days to recover.
The likelihood of speech difficulties appears high with clear aligners. However, patients adapt quickly and speech returns to normal. The results of this review must be interpreted with caution and more well-designed randomized trials examining long-term effects of aligners on speech are indicated.
Orthodontists should counsel patients opting for clear aligner treatment of the potential transient speech difficulties.
The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) CRD42021278694.
通过系统评价文献评估透明矫正器对正畸治疗患者言语的影响。
本系统评价的方案已在国际前瞻性系统评价注册库（PROSPERO）CRD42021278694 中注册。对 2000 年 1 月至 2021 年 9 月发表的论文，在 Scopus、Embase、Pubmed 和 Web of Science 数据库中进行电子检索。纳入使用客观和主观分析评估接受透明矫正器正畸治疗的患者言语困难的研究。评估的主要结果是言语困难。次要结果是适应和从言语困难中恢复的时间。研究质量根据 Cochrane 干预系统评价手册指南和 ROBINS-I 工具进行评估。
筛选了 283 篇文章，确定了 7 项研究（n=332 名患者）评估了矫正器的言语困难，其中 2 项为随机试验。由于研究设计的异质性，未进行荟萃分析。五项研究比较了矫正器与固定矫正器的言语困难。两项研究存在中度偏倚风险，五项研究存在严重偏倚风险。由于研究方法上的不足和偏倚风险，证据水平被降级为低水平。所有 7 项研究均报告说，矫正器可以影响言语的清晰度和表达，与固定矫正器相似。佩戴矫正器时会影响各种语音，包括/s/、/z/、/zh/、/sh/、/th/、/ch/。还注意到发音错误，出现齿音和咝音，出现口齿不清和言语障碍。这些言语困难是暂时的，大多数患者在 7-14 天内恢复，少数患者需要 30-60 天才能恢复。
使用透明矫正器可能会出现较高的言语困难发生率。然而，患者适应迅速，言语恢复正常。必须谨慎解释本综述的结果，需要更多设计良好的随机试验来检查矫正器对言语的长期影响。
选择透明矫正器治疗的患者，正畸医生应告知其潜在的暂时性言语困难。
本系统评价的方案已在国际前瞻性系统评价注册库（PROSPERO）CRD42021278694 中注册。
