Aligner Evidence Nikhilesh Vaid IOF. Episode 152. August 10th 2022

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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.


Labiolingual movement – 20% ↑

Rotational movement – 12% ↑ (For Canine) 

Extrusive movement – Much reliable than intrusion 



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



Contents: Shanya Kapoor

Editing and production: Farooq Ahme


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