Aligner Evidence Nikhilesh Vaid IOF
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Join me for a summary of Dr Nikhilesh Vaid’s lecture entitled More Than Meets The EYE! Aligner Evidence Through Clinicians Eye It was part of the first International Orthodontic Foundation online symposium, with Ravi Nanda and co.
Evidence available
There are about 7000 papers available on clear aligner therapy
39 are prospective clinical trials
20 are systematic reviews
What do the systematic review and meta-analysis conclude?
Overall we don’t have sufficient good quality trials and there is a need of more such trials
In addition to that ratio of prospective trials to systematic review is merely 2: 1.
Systemic review topics
Treatment outcomes
Aligners work well for mild to moderate cases.
Alignment with aligners is reasonably competent.
In Vertical sagittal and transverse dimension possess a bit of challenge.
If compared with fixed appliances – doesn’t fit well.
*** Outcomes mainly depend on the measurement criteria.
Deleterious effects
Slight improvement in terms of periodontal effects
Advantageous in external apical root resorption
Some of periodontal indices improved, also no adverse effect was found
Overall need for more studies.
Other effects
Force levels, only in vitro studies available with conflicting results.
Pain level, it was initially lower, thereafter similar, short term
QoL (Quality of life) there were less incidences of eating disturbances.
Nikhilesh conclusion: Although stated in one of systematic review (Papageorgiou) the current evidence doesn’t supports the use of clear aligner therapy.
That this doesn’t meant that it never worked.
So according to Dr Vaid its on us to be able to gather some evidence.
Nikhilesh’s research: Effectiveness, wear, refinement
1st study – Are aligner effective
A Prospective clinical trial on the premise of question asked in first clinical paper of aligner by Dr Kravitz 2009 and repeated 2020. How well does the aligner work, Dr Vaid and colleagues studied as to how it has improved over years.
Maxillary –
Labiolingual movement – 20% ↑
Rotational movement – 12% ↑ (For Canine)
Extrusive movement – Much reliable than intrusion
Mandibular–
Lingual movement (Linearly) – Slight decrease ↓ (For canine)
Intrusive movement -Not much improvement.
Deep bite Overall nearly 50 % of efficacy with clinical superimpositions.
Outcomes: Unpublished data – Comparing its efficacy by comparative evaluation with ABO-OGS score.
60 % of cases pass Vs 78.9% of labial indirect fixed appliances Vs 88.2% lingual appliances
Lingual >> Aligner >> Labial (*Digitally stimulated)
Nikhilesh conclusion: Clincheck is just the graphical representation, not depicting the exact story as to how well patient has been treated.
Does wear protocol makes a difference? Nadawi 2021
RCT
Comparison between 3 groups – 7-day wear, 10-day wear and 14-day wear.
Results
No difference
linear values
Favour 10-14 days
Angular values (Posterior)
“Dynamic aligner change”
Customized dynamic protocol for each patient. (Likely to optimise efficacy) Hansa I 2021
3rd study- Can we predict the number of refinements needed?
Intention to know the number of refinements needed, for planning treatment timeline.
Multicentre retrospective cohort study. (3 centres; 511 patients)
Nearly 60% needed – 1 -3 series of refinements
16% no refinements
27.8 1 refinement – most common
16% needed – 4 or more refinements
10% – Transition to braces.
Nikhilesh’s conclusion:
Refinements are non-negotiable.
Patients will be requiring nearly double the number of initially decided aligners.
Planned Vs total aligners 108.11%
Greater refinements class 3, deep bite, crowding, posterior crossbites
Contributions
Contents: Shanya Kapoor
Editing and production: Farooq Ahme
