Clear aligners have quickly become one of the most sought-after orthodontic options among patients for their comfort, removability, and discreet appearance. But as their popularity grows, so does the need to understand their long-term impact on periodontal health, particularly on alveolar bone levels. A new study from Kothiwal Dental College and Research Centre, Moradabad, has shed light on this question — and the findings are reassuring for both clinicians and patients.
The retrospective study examined 50 periodontally healthy adults between the ages of 18 and 40 who underwent orthodontic treatment with clear aligners. All cases involved non-extraction expansion, and panoramic radiographs were taken before and after treatment to assess any changes in alveolar bone height around incisors, canines, and first molars.
When the data were analyzed, researchers observed statistically significant changes in bone levels across the dentition. The most notable changes were seen in the mandibular anterior region, with an average reduction of 0.31 mm. Class I and Class II malocclusion cases demonstrated slightly greater remodeling, while changes in Class III cases were not significant. Interestingly, both sex and treatment duration showed a minor influence on bone level changes, but the effect sizes were small enough to be considered clinically negligible. Another important finding was that interproximal stripping — often a concern for clinicians — did not lead to additional bone loss, underscoring its safety when performed correctly.
While the numbers show statistically significant alterations, the study emphasizes that these changes remain minimal from a clinical perspective. Unlike fixed appliances, which have been linked with greater plaque accumulation, gingival inflammation, and root resorption, clear aligners seem to carry clear periodontal benefits. Their removable design makes oral hygiene easier, and the intermittent, lighter forces they deliver may reduce tissue stress compared to continuous forces applied by brackets and wires.
For practicing orthodontists, the message is not that aligners are free of periodontal effects but rather that the changes are minor and manageable. Baseline radiographic evaluation, ongoing monitoring, and meticulous treatment planning remain essential, particularly in expansion cases or treatments expected to last longer. Patient compliance with oral hygiene and aligner wear also continues to play a central role in maintaining periodontal health.
In summary, this research adds to the growing body of evidence supporting clear aligners as a safe and effective orthodontic modality for adults with healthy periodontium. While minor alveolar bone changes do occur, they are unlikely to have clinical significance and are outweighed by the periodontal advantages aligners provide over traditional fixed appliances. For clinicians, the findings offer confidence in recommending clear aligners while reinforcing the importance of careful planning and monitoring throughout treatment.
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