ABSTRACT
Background:
Orthodontic treatment in adults has gained popularity with the advent of clear aligners as an alternative to conventional braces.
Materials and Methods:
A total of 100 adult patients requiring orthodontic treatment were enrolled in this study and divided into two groups: 50 patients were treated with clear aligners (Group A) and 50 with conventional braces (Group B). The treatment duration, number of visits, and patient satisfaction were recorded. The primary outcome measured was the alignment of teeth, assessed using the Peer Assessment Rating (PAR) index at baseline and after 12 months of treatment. Secondary outcomes included the duration of treatment and patient-reported discomfort.
Results:
After 12 months of treatment, Group A (clear aligners) showed a 75% reduction in the PAR index, while Group B (conventional braces) showed an 80% reduction. The average treatment duration was 14.5 months for Group A and 16.2 months for Group B. Patient satisfaction was higher in Group A, with 85% of patients reporting high satisfaction compared to 65% in Group B. Discomfort levels were lower in Group A, with a mean score of 2.3 on a 10-point scale, compared to 5.6 in Group B.
Conclusion:
Clear aligners and conventional braces are both effective in achieving desired orthodontic outcomes in adults. However, clear aligners offer a shorter treatment duration, lower discomfort levels, and higher patient satisfaction, making them a preferable option for adult orthodontic patients.
KEYWORDS: Adult orthodontic treatment, clear aligners, conventional braces, orthodontic outcomes, patient satisfaction, Peer Assessment Rating (PAR), treatment duration
INTRODUCTION
Orthodontic treatment has long been associated with adolescence, but there has been a notable increase in the demand for orthodontic interventions among adults in recent years. This trend can be attributed to a greater awareness of the aesthetic and functional benefits of well-aligned teeth, as well as advancements in orthodontic technologies that offer more discreet treatment options. Conventional braces, which have been the mainstay of orthodontic treatment for decades, involve the use of metal brackets and wires to gradually move teeth into the desired position. While effective, they are often associated with discomfort, dietary restrictions, and aesthetic concerns, particularly among adult patients who may be more self-conscious about their appearance during treatment.[1,2]
The introduction of clear aligners has revolutionized orthodontic treatment by offering a nearly invisible alternative to traditional braces. Clear aligners are custom-made, removable plastic trays that apply controlled pressure to teeth, gradually guiding them into their correct positions. These aligners are designed to be changed every one to two weeks, with each new set moving the teeth closer to the final desired alignment.[3] The appeal of clear aligners lies in their aesthetic advantage, reduced discomfort, and the ability to remove them during meals and for oral hygiene, which contributes to better overall patient satisfaction.[4,5]
Despite the growing popularity of clear aligners, there is ongoing debate regarding their efficiency compared to conventional braces, particularly in achieving complex tooth movements. Some studies suggest that clear aligners may be less effective in treating certain malocclusions and that treatment outcomes may be less predictable compared to traditional braces.[6] However, other research has demonstrated comparable or even superior results with clear aligners, especially in cases requiring mild to moderate alignment.[7]
MATERIALS AND METHODS
A total of 100 adult patients, aged 18–50 years, requiring orthodontic treatment were enrolled and randomly assigned to one of two groups: Group A (n = 50), treated with Invisalign® clear aligners, and Group B (n = 50), treated with conventional metal braces. Inclusion criteria included mild to moderate malocclusion, good oral health, and no prior orthodontic treatment, while exclusion criteria were severe malocclusion, periodontal disease, and systemic conditions potentially affecting treatment outcomes. Group A patients wore custom-made aligners for 20–22 h daily, changing them every one to two weeks, with an estimated treatment duration of 12–18 months. Group B patients received conventional metal braces with regular archwire adjustments, also for an estimated 12–18 months.
The primary outcome measure was dental alignment improvement, assessed using the Peer Assessment Rating (PAR) index, recorded at baseline and after 12 months of treatment. Secondary outcome measures included treatment duration, patient satisfaction, and discomfort levels. Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY).
RESULTS
A total of 100 patients were enrolled and completed the study, with 50 patients in the clear aligners group (Group A) and 50 patients in the conventional braces group (Group B). The results are summarized in Tables 1–4.
Table 1.
Demographic Characteristics of the Study Participants
| Characteristic | Group A (Clear Aligners) | Group B (conventional braces) | P |
|---|---|---|---|
| Number of patients | 50 | 50 | - |
| Mean Age (years) | 29.8±7.2 | 30.4±6.9 | 0.63 |
| Gender (M/F) | 22/28 | 24/26 | 0.68 |
| Baseline PAR score | 22.4±4.1 | 23.1±3.9 | 0.44 |
Table 4.
Discomfort Levels at Different Stages of Treatment
| Treatment Stage | Group A (Clear Aligners) | Group B (Conventional Braces) |
|---|---|---|
| Beginning of Treatment | 3.1±1.5 | 6.8±2.1 |
| Middle of Treatment | 2.5±1.3 | 5.4±1.7 |
| End of Treatment | 1.3±0.8 | 4.5±1.5 |
Table 2.
Comparison of Treatment Outcomes between Group A and Group B
| Outcome Measure | Group A (Clear Aligners) | Group B (Conventional Braces) | P |
|---|---|---|---|
| PAR Score Reduction (%) | 75.3±10.5 | 80.2±9.8 | 0.02* |
| Treatment Duration (months) | 14.5±2.3 | 16.2±2.6 | 0.01* |
| Patient Satisfaction (1-10) | 8.5±1.2 | 7.2±1.5 | 0.001* |
| Discomfort Level (VAS 0-10) | 2.3±1.1 | 5.6±1.8 | 0.0001* |
*Statistically significant at P<0.05
Table 3.
Patient Satisfaction Breakdown
| Satisfaction Aspect | Group A (Clear Aligners) | Group B (Conventional Braces) |
|---|---|---|
| Aesthetic Satisfaction | 9.2±0.8 | 6.5±1.2 |
| Comfort | 8.7±1.1 | 6.8±1.4 |
| Ease of Use | 8.9±1.0 | 7.1±1.3 |
INTERPRETATION OF RESULTS
PAR Score Reduction: The reduction in the PAR score was significant in both groups, indicating effective alignment of teeth. However, conventional braces (Group B) showed a slightly higher percentage reduction in PAR scores compared to clear aligners (Group A) (P = 0.02).
Treatment Duration: The average treatment duration was significantly shorter in the clear aligners group (14.5 months) compared to the conventional braces group (16.2 months) (P = 0.01).
Patient Satisfaction: Patients treated with clear aligners reported significantly higher overall satisfaction (mean score 8.5) compared to those with conventional braces (mean score 7.2) (P = 0.001). Aesthetic satisfaction and comfort were particularly higher in the clear aligners group.
Discomfort Levels: Clear aligners were associated with significantly lower discomfort levels throughout the treatment period compared to conventional braces, as indicated by lower visual analog scale (VAS) scores at all stages (P < 0.05).
DISCUSSION
The reduction in the PAR score, which reflects the alignment of teeth, was significant in both groups. Previous studies have reported similar findings, indicating that conventional braces are particularly effective in treating severe malocclusions and providing more predictable outcomes.[1,2] However, the difference in PAR score reduction between the two groups in this study, while statistically significant, may not be clinically significant for patients with mild to moderate malocclusions, which are commonly treated with clear aligners.
A significant advantage of clear aligners observed in this study was the shorter treatment duration. Patients treated with clear aligners completed their treatment on average 1.7 months earlier than those treated with conventional braces (P = 0.01). This finding aligns with previous research, which suggests that clear aligners can expedite treatment, particularly in cases requiring less complex movements.[3,4] The ability to remove aligners during meals and for oral hygiene may contribute to better compliance and more efficient tooth movement, leading to shorter overall treatment times.
Patient satisfaction was significantly higher in the clear aligners group compared to the conventional braces group (P = 0.001). This higher satisfaction can be attributed to the aesthetic appeal, comfort, and convenience associated with clear aligners. Patients appreciate the near-invisible appearance of aligners, which allows them to undergo orthodontic treatment discreetly, an important consideration for adult patients.[5] The ability to remove the aligners also contributed to better oral hygiene and fewer dietary restrictions, further enhancing satisfaction.[6] These factors are consistent with other studies that have found clear aligners to be preferred by patients over conventional braces due to these advantages.[7]
One of the most significant findings of this study was the lower discomfort reported by patients using clear aligners. Discomfort levels, measured using a VAS, were significantly lower in the clear aligners group at all stages of treatment (P < 0.05).
CONCLUSION
In conclusion, while both clear aligners and conventional braces are effective in improving dental alignment, this study highlights the advantages of clear aligners in terms of shorter treatment duration, higher patient satisfaction, and reduced discomfort.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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