Aligner Evidence Nikhilesh Vaid IOF

orthodontics In summary

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

Does wear protocol makes a difference? Nadawi 2021

3rd study- Can we predict the number of refinements needed?

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 Ahmed