Invisalign vs.

fixed braces overall impact on periodontal health during orthodontic treatment

Position Paper
Invisalign vs. fixed braces overall impact on
periodontal health during orthodontic treatment
Rachel Brough, Lisa Margerison, & Jordan Whately
July 29, 2016 | EVBP 5500
Carrie Maynard, RDH

Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

Invisalign vs. fixed braces overall impact on

periodontal health during orthodontic treatment

Orthodontic appliances are a quickly expanding topic, with multiple new and innovative
options being explored. This leads to the common question being asked in orthodontic or private
practices whether Invisalign or fixed braces has the same results and which is considered to be a
better and healthier option. The issue that must be determined is: in teens and early adults
undergoing orthodontic treatment, will Invisalign compared to fixed braces have a more positive
impact on periodontal health during orthodontic treatment?

When looking at adolescents and adults undergoing orthodontic treatment, it is important to

understand the fundamentals of Invisalign and fixed braces as well as the basics of proper
periodontal health. Periodontitis is a severe form of gum disease, which can be inflammation of
the tissue around the teeth, which can cause shrinkage, and recession of the gingiva, which leads
to bone, and attachment loss, which will ultimately lead to mobilitys, and loss of the dentition
(Mayo Clinic, 2014). There have been studies in recent history that suggest that oral bacteria and
inflammation associated with progression of periodontitis have also been linked to systemic
disease such as cardiovascular disease which leads to a decreased overall quality of health within
an individual (Mayo Clinic, 2014). This study will affect all those undergoing orthodontic
treatment to better understand the best decision for their dentition during this process.

Early adults should seek out Invisalign treatment over fixed braces with regards to prevention of
periodontal disease and overall periodontal health. Through research studies it has shown that
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Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

that Invisalign is a better option of orthodontic treatment for those clients who value their
periodontal health for short and long term benefits.

In order to better understand why Invisalign is a better treatment option of the clients
periodontium, it is important to explore the alternative option. Fixed braces have typically been
known to be the gold standard of orthodontics because they can effectively deal with more
complex cases. Fixed braces have multiple options of additions to be attached to the braces, to
deal with client specific cases as difficult as they may be. Crooked, misaligned teeth and bite
issues can lead to an increase of build up. This may result or lead to periodontal and or gum
disease, so it is important to create the most ideal bite and occlusion to result in the healthiest
oral cavity.

Invisalign is intended to have the same function as braces in terms of gradual tooth movement,
says Runner. Invisalign has a place in the spectrum of orthodontic treatments for mild to
moderate cases, Joondeph adds (Bren, 2015). Allowing a great alternative for clients with
crooked, misaligned teeth to straighten and realign their teeth to create a healthly oral cavity.

Due to fixed braces being the more well known option, and have longer implementation in
comparison with Invisalign, there is more professional research and first hand experience in the
dental field with fixed braces, creating a larger general knowledge on this method of orthodontic
treatment. Following treatment, both Invisalign and fixed braces do not always guarantee perfect
post retention results. In a study done by Daniel Kuncio; Anthony Maganzinib; Clarence
Sheltonc; Katherine Freeman found maxillary anterior alignment worsened post retention in the
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Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

Invisalign group only. During this period of observation clients treated with Invisalign relapsed
more than those treated with conventional fixed appliances (Kuncio, et al., 2007).

The study showed that both Invisalign and fixed braces had mandibular anterior misalignment
post retention. Post retention results can be influenced by client compliance after treatment with
both Invisalign and fixed braces options.

During the treatment period, the orthodontist does not have to be concerned with patient
compliance in wearing their device because fixed braces are cemented on and cannot be removed
by the client, whereas with Invisalign it is solely up to the client to ensure they are wearing them
an adequate amount of time. Through research and studies, multiple products have been created
to effectively clean in and around fixed braces in all areas of the oral cavity.

During Invisalign treatment the client has the option to remove their appliance while eating and
during their oral hygiene routine. So even though it is up to the client to ensure they are wearing
them an adequate amount of time, they can use a wide range of interdental products and cleaning
products to effectively remove bacteria and build-up rather than being limited as you are with
fixed braces.

Invisalign is a better choice for clients periodontal health and should seek out this
treatment option whenever possible over fixed braces to ensure a better periodontal outcome.
There are multiple reasons and supporting studies on why clients should chose to have Invisalign
over fixed braces. Five specific reasons why clients should choose Invisalign over fixed braces to
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Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

ensure proper periodontal health include: better statistics on modifiable factors (plaque record,
bleeding on probing, and probing depths), clients report they have less discomfort against buccal
mucosa, removable and therefore easier to clean dentition and lastly, they are more aesthetically
pleasing and easier to eat without food being trapped in wires which may lead to decay. The
major factor into assessing periodontal health in orthodontic clients is the difference in the
modifiable factors. If the modifiable factors are high, it is indicated a higher level of periodontal
diseased bacteria that will eventually, if left on tooth surfaces, cause gingival recession and
periodontal bone loss.

The study Periodontal health in teenagers treated with removable aligners and fixed orthodontic
appliances compared the statistical difference between the beginning of treatment in both
Invisalign and fixed braces and their associated plaque scores and bleeding index. In the
beginning of treatment with Invisalign, the plaque score was 24.32 in the full mouth and the
beginning-bleeding index was 17.14 (Abbate, et al., 2015). By the 12 month into the treatment,
the plaque score was 22.42 and the bleeding index was 15.32 (Abbate, et al., 2015). This data
shows that the full mouth bleeding and plaque scores were significantly lower with a p value of
0.01(Abbate, et al., 2015). This is a contrast to the fixed braces group, which also was observed
by the same indices. The fixed braces group plaque record was 22.36 and the bleeding index was
16.56 (Abbate, et al., 2015). The 12-month evaluation exposes that plaque record was 66.16 and
bleeding index was 35.76 (Abbate, et al., 2015). This data when compared with the Invisalign
group shows that the patients under fixed braces treatment have higher modifiable indices, which
will hinder the oral hygiene of that individual (Abbate, et al., 2015).

Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

These statistics show that although there is bone loss noted in both trials, less bone loss was seen
with Invisalign. Another positive characteristic of the Invisalign treatment is that it is a
removable procedure in which oral hygiene routines are less interrupted as they are with fixed
braces. The study surveyed patient compliance in both test groups as found that about half of the
patients maintained their oral health and the other half improved their oral hygiene (Abbate, et
al., 2015). The group using fixed braces was found to have no change in their oral hygiene
behaviours and only one in five patients slightly improved their oral health (Abbate, et al., 2015).

This creates a concern in regards to choosing an orthodontic treatment method, when considering
periodontal health. Fixed braces require immaculate oral hygiene in order to maintain the
cleanliness of the intervention versus Invisalign which can be removed for regular oral hygiene
routines, Invisalign allows for clients to choose from a wide variety of dental aids they suit their
preference, clients receiving treatment with fixed braces are limited to the dental aids that can
accommodate their oral cavity. Due to the lack of ease during cleaning of fixed braces, it is quite
often avoided and or done incorrectly for the length of treatment. Other considerations when
choosing Invisalign over fixed braces involve the client preferences and satisfaction. Aesthetics
are very important to clients undergoing orthodontic treatment and can be a strong influence in a
clients decision.

A study conducted by A. Azaripour, J. Weusmann, B. Mahmoodi, D. Peppas, A. Gerhold-Ay,

C. J. F. Van Noorden and B. Willershausen compared the subjective data on the quality of life in
clients undergoing fixed braces versus invisalign. 36% of people experiencing fixed orthodontic

Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

appliances report impairment in general well being versus a minimal 6% undergoing Invisalign
with a P value of 0.01 (Azaripour, et al., 2015). This statistic shows that clients are staggeringly
more affected by life with fixed braces versus Invisalign. Although this statistic doesnt directly
affect the periodontal health of a client, it affects their morale and if they feel bad about having
their braces, they are less likely to take care of them. This theory is also supported by the survey,
which also states that 26% experience laugh inhibition with fixed braces versus only 6% with
Invisalign. Clients also report that 94% of them would repeat Invisalign treatments again now
knowing what it would be like versus only 74% in fixed braces (Azaripour, et al., 2015). Lastly,
clients also report that there is less gingival irritation with Invisalign, which is important for
clients and the gingiva for proper oral health at 14% versus 56% in fixed braces (Azaripour, et
al., 2015).

Pain and discomfort is a common adverse effect associated with orthodontic treatment especially
fixed braces. A study titled Adverse effects of orthodontic treatment: A clinical perspective
showed that 7095% of orthodontic patients experience pain. This pain could be a reason for
discontinuing treatment; previous studies have indicated that 8% and even up to 30% of
orthodontic patients discontinue treatment because of pain (Talic, 2011). The pain and discomfort
associated with orthodontic treatment is categorized by pressure, tension, or soreness of the teeth
(Talic, 2011). Clients noted that pain can start as early as 4 hours after placement of separators or
orthodontic wire, and the worst pain was found to occur on the second day of treatment (Talic,
2011). Clients who discontinue their treatment increase the risk of re- misaligning or disfiguring
their bite, which can make oral hygiene more difficult and increase gingival disease.
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Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

Through multiple studies it has been shown that Invisalign is the best alternative for
clients who want optimal periodontal health and benefits. Invisalign has proven to allow for
better oral hygiene routines to be implemented, which creates a healthier oral cavity and reduces
the risk of developing a periodontal condition. Invisalign has lower modifiable indices, in
comparison to fixed braces, clients reported less discomfort against buccal mucosa, and were
more aesthetically pleased with their choice of Invisalign.

Dental Hygienists and Orthodontic Practices can provide the research and evidence to their
clients, on the options available to them for orthodontic treatment and their influence on the
periodontal condition, allowing the client to make the best-informed decision.

References:
Abbate, G., Caria, M., Montanari, P., Mannu, C., Orr, G., Caprioglio, A., & Levrini, L. (2015,
May 05). Periodontal health in teenagers treated with removable aligners and fixed
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Invisalign vs. fixed braces overall impact on periodontal health during orthodontic treatment

orthodontic appliances. Retrieved July 28, 2016, from

https://www.researchgate.net/publication/275665387_Periodontal_health_in_teenagers_tre
ated_with_removable_aligners_and_fixed_orthodontic_appliances
Azaripour, A., Weusmann, J., Mahmoodi, B., Peppas, D., Gerhold-Ay, A., Van Noorden, C., &
Willershausen, B. (2015, June 24). Braces versus Invisalign: Gingival parameters and
patients satisfaction during treatment: A cross-sectional study. Retrieved July 28, 2016,
from http://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-015-0060-4
Bollen, A. (2008, August 1). Effects of Malocclusions and Orthodontics on Periodontal Health:
Evidence from a Systematic Review. Retrieved July 28, 2016, from
http://www.jdentaled.org/content/72/8/912.full
Bren, L. (2005, January 1). Straight Talk on Braces. FDA Consumer, (2005).
Djeu, G., Shelton, C., & Maganzini, A. (2005, September 02). Outcome assessment of Invisalign
and traditional orthodontic treatment compared with the American Board of Orthodontics
objective grading system. Retrieved July 28, 2016, from
http://www.ajodo.org/article/S0889-5406(05)00626-8/abstract
Kuncio, D., Maganzini, A., Shelton, C., & Freeman, K. (2007, September). Invisalign and
Traditional Orthodontic Treatment Postretention Outcomes Compared Using the American
Board of Orthodontics Objective Grading System. Retrieved July 28, 2016, from
http://www.angle.org/doi/pdf/10.2319/100106-398.1
Lagravre, M., & Flores-Mir, C. (2005, December 13). The treatment effects of Invisalign
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Mayo Clinic. (2014, February 04). Periodontitis. Retrieved July 28, 2016, from
http://www.mayoclinic.org/diseases-conditions/periodontitis/basics/definition/con20021679
Miethke, R., & Vogt, S. (2005, May 05). A Comparison of the Periodontal Health of Patients
during Treatment with Invisalign System and with Fixed Lingual Appliances. Retrieved
July 28, 2016, from http://link.springer.com/article/10.1007/s00056-005-0436-1
Shalish, M., Cooper-Kazaz, R., Ivgi, I., Canetti, L., Tsur, B., Bachar, E., & Chaushu, S. (2011,
July 12). The European Journal of Orthodontics. Retrieved July 28, 2016, from
http://ejo.oxfordjournals.org/content/34/6/724.short
Talic, N. (2011, January 28). Adverse effects of orthodontic treatment: A clinical perspective.
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