COMPARATIVE ANALYSIS OF PERIODONTAL TISSUE STATUS DURING ORTHODONTIC TREATMENT WITH ALIGNERS AND VESTIBULAR BRACKET SYSTEMS
DOI:
https://doi.org/10.32782/2786-7684/2026-2-3Keywords:
periodontal health, orthodontic appliances, oral hygiene, gingivalinflammation, dental plaque, preventive support, periodontal risks, clinical indicesAbstract
Introduction. The relevance of this study is driven by the increasing prevalence of orthodontic treatment among the adult population and the need to ensure not only functional and esthetic outcomes but also the preservation of periodontal health as a key determinant of long-term treatment stability. The expanding use of alignersalongside traditional vestibularbracket systems underscores the need for a scientifically grounded comparative analysis of their effects on periodontaltissues, as existing evidence remains fragmented and clinical outcomes are inconsistent. The aim of this study is to determine the specific features of changes in periodontal tissue status in patients undergoing orthodontic treatment depending on the type of orthodontic appliance and to substantiate approaches for minimizing periodontal risks. Results. The baseline condition of periodontaltissues was assessed, revealing that a substantial proportion of patients initiate orthodontic treatment with initial inflammatory changes in the absence of clinical signs of tissuedestruction. It was established that during treatment, the type of orthodonticappliance determines different dynamics of periodontal parameters. The use of aligners was shown to be associated with moderate and predominantly transient changes, whereas vestibularbracket systems were linked to persistent dental plaque accumulation and prolonged elevation of gingivalindices. It was experimentally confirmed that the first months of orthodontic treatment represent the most critical period for the development of inflammatory changes. Conclusions. Periodontal risks associated with orthodontic treatment were found to have not only a behavioral but also an appliancerelated nature. The feasibility of a differentiated selection of orthodontic appliances and the intensification of preventive support at the early stages of treatment was substantiated. Prospects for further research include the evaluation of the long-term impact of chronic inflammatory changes in periodontaltissues on the stability of orthodontic outcomes and the development of individualized preventive protocols that take into account the type of orthodonticappliance and patient risk profiles.
References
Thota H, Vanteddu H, Singavarapu H, Sunkara P, Pillutla CKD, Vanteddu H IV, Pillutla CKD. Comparative evaluation of oral health status in patients undergoing orthodontic treatment with clear aligner therapy versus conventional fixed appliance therapy: an umbrella review. Cureus. 2026;18(2):e103744. doi:10.7759/cureus.103744.
Xu M, Li G, Tian J, Xie F, Zuo J, Hu J, Wang W. Comparison of the effects of clear aligners and fixed appliances on the oral microbiota and reactive oxygen species: a prospective study. Front Cell Infect Microbiol. 2025;15:1738047. doi:10.3389/fcimb.2025.1738047.
Sen S, Wani MA, Kour J, Siddiqui S, Chatterjee S, Devi A. Comparative evaluation of periodontal pathogen load and health in patients treated with fixed orthodontic appliances versus clear aligners: a prospective clinical study. Cureus. 2025;17(9):e93016. doi:10.7759/cureus.93016.
Lombardo L, Palone M, Scapoli L, Siciliani G, Carinci F. Short-term variation in the subgingivalmicrobiota in two groups of patients treated with clear aligners and vestibular fixed appliances: a longitudinal study. OrthodCraniofacRes. 2021;24(2):251-260. doi:10.1111/ocr.12427.
Favero R, Libralato L, Balestro F, Volpato A, Favero L. Edge level of aligners and periodontal health: a clinical perspective study in young patients. Dental Press J Orthod. 2023;28(1):e2321124. doi:10.1590/2177-6709.28.1.e2321124.oar.
Bucur SM, Bud E, Decusară M, Olteanu CD. Retrospective study on orthodonticgingivalrecession correction using clear aligners. Medicina (Kaunas). 2024;60(12):2024. doi:10.3390/medicina60122024.
Romito M, Nota A, Ferrini F, DalPorto G, Mangano FG, Tecco S. Dimensional changes of the gingivaltissues induced by clear aligners and fixed orthodontic appliances. J Dent. 2024;151:105335. doi:10.1016/j.jdent.2024.105335.
Giannini L, Galbiati G, Tartaglia FC, Grecolini ME, Maspero C, Biagi R. Orthodontic treatment with fixed appliances versus aligners: an experimental study of periodontal aspects. Dent J (Basel). 2025;13(2):70. doi:10.3390/dj13020070.
Di Spirito F, D’Ambrosio F, Cannatà D, D’Antò V, Giordano F, Martina S. Impact of clear aligners versus fixed appliances on periodontal status of patients undergoingorthodontic treatment: a systematic review of systematic reviews. Healthcare (Basel). 2023;11(9):1340. doi:10.3390/healthcare11091340.
Issa FHKM, Issa ZHKM, Rabah AF, Hu L. Periodontal parameters in adult patients with clear alignersorthodontic treatment versus three other types of brackets: a cross-sectional study. J OrthodSci. 2020;9(1):4. doi:10.4103/jos.JOS_54_17.
Antonio-Zancajo L, Montero J, Garcovich D, Alvarado-Lorenzo M, Albaladejo A, Alvarado-Lorenzo A. Comparative analysis of periodontalpain according to the type of precision orthodontic appliances: vestibular, lingual and aligners. A prospective clinical study. Biology (Basel). 2021;10(5):379. doi:10.3390/biology10050379.
Alvarado-Lorenzo A, Antonio-Zancajo L, Baptista H, ColinoGallardo P, Albaladejo-Martinez A, Garcovich D, Alcón S. Comparative analysis of periodontalpain and quality of life in patients with fixed multibracket appliances and aligners (Invisalign®): longitudinal clinical study. BMC Oral Health. 2023;23:850. doi:10.1186/s12903-023-03565-z.
Alcón S, Curto A, Alvarado M, Albaladejo A, Garcovich D, Alvarado-Lorenzo A. Comparative analysis of periodontalpain using two different orthodontictechniques, fixed multibrackets and removablealigners: a longitudinal clinical study with monthly follow-ups for 12 months. ApplSci. 2021;11(24):12013. doi:10.3390/app112412013.
Samulak R, Suwała M, Górski B, Machoy M. Evaluating clear aligners versus fixed appliances for periodontal patients: a comprehensive narrative review of current evidence. ApplSci. 2024;14(21):9931. doi:10.3390/app14219931.
Dipalma G, Inchingolo AD, Fiore A, Balestriere L, Nardelli P, Casamassima L, Inchingolo AM. The differential impact of clear aligners and fixed orthodontic appliances on periodontal health: a systematic review. Children (Basel). 2025;12(2):138. doi:10.3390/children12020138.
Oikonomou E, Foros P, Tagkli A, Rahiotis C, Eliades T, Koletsi D. Impact of aligners and fixed appliances on oral health during orthodontic treatment: a systematic review and meta-analysis. Oral Health PrevDent. 2021;19:b2403661. doi:10.3290/j.ohpd.b2403661.
Kim JE, Kim S, Kim DH. Comparison of oral health status, oral hygiene management behaviours and satisfaction of patients with fixed orthodonticappliance and clear aligner: a quasi-experimental design. Int J DentHyg. 2024;22(4):939-948. doi:10.1111/idh.12813.
Alasiri MM, Almalki A, Alotaibi S, Alshehri A, Alkhuraiji AA, Thomas JT. Association between gingivalphenotype and periodontaldisease severity: a comparative longitudinal study among patients undergoing fixed orthodontic therapy and Invisalign treatment. Healthcare (Basel). 2024;12(6):656. doi:10.3390/healthcare12060656.
Motulsky H. Intuitive biostatistics: a nonmathematical guide to statistical thinking. 2nd ed. Oxford: Oxford University Press; 2014. 540 p. URL: https://books.google.com/books?id=ZLDWAgAAQBAJ
Sullivan LM. Essentials of biostatistics in public health. 4th ed. Burlington: Jones & Bartlett Learning; 2023. 400 p. URL: https://books.google.com/books?id=lMq8EAAAQBAJ






