An Umbrella Review for Assessment of Treatment Effectiveness of Clear Aligners Compared to Conventional Fixed Appliances in Orthodontic Patients

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Abstract
Introduction: Orthodontic improvements, mainly through the previous decade, have led to a substantial rise in patients’ esthetic needs. Traditional orthodontic procedures have been linked with a compromise in facial appearance, which increases concern among patients pursuing orthodontic treatment. Methods: PubMed, MEDLINE, Google Scholar, and Cochrane Library of Systematic Reviews databases were searched using appropriate entry terms and Boolean operators. Search strategy was conducted till June 2022 for systematic reviews and meta-analyses. Publications were systematically assessed for eligibility, and two observers independently graded the methodologic quality using AMSTAR-2 tool. For each meta-analysis, we estimated the summary effect size by the use of random-effects and fixed-effects models and the 95% confidence interval. We estimated the between-study heterogeneity expressed by I 2 (defined as large for I 2 ≥50%), evidence of small-study effects (i.e., large studies had significantly more conservative results than smaller studies), and evidence of excess significance bias (i.e., more studies than expected with significant results). Results: Overall, 16 unique systematic reviews and meta-analyses following the eligibility criteria were selected for umbrella review. The results of qualitative analysis of studies revealed that 4 studies had a critically low risk of bias, 11 showed low risk, and 1 study had moderate risk. The results of the meta-analysis favored clear aligners with respect to oral hygiene and root resorption parameters. When tooth movements were considered, the results favored conventional orthodontic treatment. Conclusion: Clear aligner therapy (CAT) has significant advantages with regard to efficiency (treatment time, chair time) in mild-moderate malocclusion cases. The overall accuracy of CAT when compared to fixed orthodontic treatment was found to be 55-82%.

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