A randomized clinical trial comparing mandibular incisor proclination produced by fixed labial appliances and clear aligners

Objective:To compare the mandibular incisor proclination produced by fixed labial appliances and third generation clear aligners.Materials and Methods:Patients underwent a course of orthodontic treatment using either fixed labial appliances or clear aligners (Invisalign). Mandibular incisor proclination was measured by comparing pretreatment and near-end treatment lateral cephalograms. Eligibility criteria included adult patients with mild mandibular incisor crowding (<4 mm) and Class I skeletal bases (ANB, 1–4°). The main outcome was the cephalometric change in mandibular incisor inclination to the mandibular plane at the end of treatment. Eligible patients picking a sealed opaque envelope, which indicated their group allocation, was used to achieve randomization. Data was analyzed using a Welch two-sample t-test.Results:Forty-four patients (mean age, 26.4 ± 7.7 years) were randomized in a 1:1 ratio to either the fixed labial appliance or the clear aligner group. Baseline characteristics were similar for both groups: Fixed appliance mean crowding was 2.1 ± 1.3 mm vs clear aligner mean crowding, 2.5 ± 1.3 mm; pretreatment mean mandibular incisor inclination for the fixed appliance group was 90.8 ± 5.4° vs 91.6 ± 6.4° for the clear aligner group. Fixed appliances produced 5.3 ± 4.3° of mandibular incisor proclination. Clear aligners proclined the mandibular incisors by 3.4 ± 3.2°. The difference between the two groups was not statistically significant (P > .05).Conclusion:There was no difference in the amount of mandibular incisor proclination produced by clear aligners and fixed labial appliances in mild crowding cases.     

Differences in finished case quality between Invisalign and traditional fixed appliances:: A randomized controlled trial

ObjectivesTo compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances.Materials and MethodsThis randomized controlled trial included 66 patients, 32 aligners, and 34 fixed-appliance patients. The median ages of the aligner and braces patients were 26.7 (interquartile range [IQR]: 9.8) and 25.9 (IQR: 16.6) years, respectively. Pretreatment occlusion was assessed using the ABO Discrepancy Index. Posttreatment (T1) and 6-month retention (T2) occlusions were quantified using the ABO Objective Grading System (OGS) scores.ResultsThe braces group finished treatment significantly (P < .001) earlier (0.4 years) than the aligner group. The median DI scores for the aligner and braces groups were 4.5 and 7.0, respectively, which was a statistically significant (P = .015), but clinically insignificant, difference. There were no statistically significant between-group differences for the total OGS scores or any of the individual component scores at debond (T1) or after 6 months of retention (T2). During the posttreatment period, alignment and overjet worsened significantly in the aligner group, while buccolingual inclinations and occlusal relations improved. Over the same period, alignment worsened in the braces group and buccolingual inclinations improved. There was no statistically significant between-group difference in posttreatment changes of the total OGS scores.ConclusionsWhile patients with simple malocclusions require 4.8 months longer treatment times with aligners than traditional braces, the treatment and 6-month posttreatment occlusal outcomes are similar.     

三种矫治器治疗安氏Ⅱ类2分类对切牙牙根吸收的影响

目的 比较不同矫治器治疗安氏Ⅱ类2分类错牙合畸形患者切牙牙根的吸收状况。方法 选择使用不同矫治器的安氏Ⅱ类2分类成年患者30例,其中传统MBT托槽、自锁托槽以及无托槽隐形矫治器的患者各10例,共计240颗切牙。收集患者治疗前后的锥形束CT(CBCT)影像学资料,并导入Dolphin Imaging软件,Mimics软件以及3-Matics软件测量分析治疗前后切牙牙根吸收情况。结果 传统MBT托槽组和自锁托槽组的上下颌中切牙以及侧切牙的牙齿长度(L)与无托槽隐形矫治器组上下颌中切牙及上颌侧切牙的牙齿长度治疗后较治疗前显著减小,差异具有统计学意义。使用无托槽隐形矫治器的患者下颌侧切牙治疗前后的牙齿长度无显著变化。而三组之间的对比,上下颌中切牙牙齿长度变化无显著统计学差异。无托槽隐形矫治器组上下颌侧切牙的牙齿长度减少量相对更低,差异具有统计学意义(P＜0.05)。此外,无托槽隐形矫治器组平均牙齿长度变化为(-0.37±0.11)mm,显著小于传统MBT托槽组(-1.32±0.47)mm及自锁托槽组(-1.05±0.38)mm。在牙根吸收区域的比较上,各组均表现为腭侧吸收多于唇侧吸收,近中吸收多于远中吸收。结论 无托槽隐形矫治器治疗安氏Ⅱ类2分类错牙合畸形可有效降低切牙牙根吸收严重程度。     

Cephalometric comparison of adult anterior open bite treatment using clear aligners and fixed appliances

Objectives:To compare fixed appliances and clear aligner therapy in correcting anterior open bite and in controlling the vertical dimension in adult patients with hyperdivergent skeletal patterns.Materials and Methods:In this retrospective study, two treatment groups of adult (≥18 years old) hyperdivergent patients (mandibular plane angles of ≥38°) with anterior open bites were included: 17 fixed appliance patients and 36 clear aligner patients. Thirteen cephalometric measurements representing the vertical dimension were reported for each group. A two-sample t-test was used to assess differences in changes in mandibular plane angle and overbite between the two treatment groups.Results:There were no statistical differences found in the magnitude of overbite correction and the changes in any of the cephalometric measurements for vertical control. The clear aligner group showed a slightly greater amount of lower incisor extrusion (P = .009). The main mechanism of open bite correction was similar between the two treatment groups and was accomplished through retroclination of the upper and lower incisors while maintaining the vertical position of the upper and lower molars.Conclusions:Cephalometric comparison of anterior open bite correction and changes in the mandibular plane angle associated with use of clear aligners and fixed appliances did not demonstrate statistically significant differences in adult hyperdivergent patients.     

Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions

ObjectiveTo assess the efficacy and efficiency of treatment in adolescents presenting with mild malocclusions, comparing outcomes using clear aligners to fixed appliances.Materials and MethodsPatients identified retrospectively and consecutively from one private practice had been treated with either clear aligners (Invisalign, Align Technology, Santa Clara, Calif) or fixed appliances (0.022 Damon, Ormco, Orange, Calif; n = 26/group). Assessments of occlusion were made using the American Board of Orthodontics Discrepancy Index (DI) for initial records and Cast-Radiograph Evaluation (CRE) for final records. Number of appointments, number of emergency visits, and overall treatment time were determined from chart reviews. Data were analyzed using Pearson''s correlation, Wilcoxon rank tests, unpaired t-tests, and Chi-square tests, with significance set to P ≤ .05.ResultsPretreatment, the aligner and fixed groups showed no significant difference in overall severity (DI: 11.9 ± 5.3 vs 11.6 ± 4.8) or in any individual DI category. Posttreatment scores showed finishes for the aligner group had fewer discrepancies from ideal relative to the fixed appliance group (CRE: 30.1 ± 8.3 vs 37.0 ± 9.3; P < .01). Patients treated with aligners had fewer appointments (13.7 ± 4.4 vs 19.3 ± 3.6; P < .0001), fewer emergency visits (0.8 ± 1.0 vs 3.6 ± 2.5; P < .0001), and shorter overall treatment time (16.9 ± 5.7 vs 23.4 ± 4.4 months; P < .0001).ConclusionsOutcomes for treatment of mild malocclusions in adolescents showed equivalent effectiveness of clear aligners compared to fixed appliances, with significantly improved results for clear aligner treatment in terms of tooth alignment, occlusal relations, and overjet. Assessment of the number of appointments, number of emergency visits, and overall treatment time showed better outcomes for treatment with clear aligners.     

Discomfort associated with Invisalign and traditional brackets: A randomized,prospective trial

Objective:To evaluate differences in discomfort levels between patients treated with aligners and traditional fixed orthodontic appliances.Materials and Methods:This blinded, prospective, randomized equivalence two-arm parallel trial allocated 41 adult Class I nonextraction patients to either traditional fixed appliance (6 males and 12 females) or aligner (11 males and 12 females) treatment. Patients completed daily discomfort diaries following their initial treatment appointment, after 1 month and after 2 months. They recorded their levels of discomfort at rest, while chewing, and while biting, as well as their analgesic consumption and sleep disturbances.Results:Both treatment modalities demonstrated similar levels of initial discomfort. There were no significant sex differences. Patients in the traditional fixed appliances group reported significantly (P < .05) greater discomfort than patients in the aligner group during the first week of active treatment. There was significantly more discomfort while chewing than when at rest. Traditional patients also reported significantly more discomfort than aligner patients after the first and second monthly adjustment appointments. Discomfort after the subsequent adjustments was consistently lower than after the initial bonding or aligner delivery appointments. A higher percentage of patients in the fixed-appliance group reported taking analgesics during the first week for dental pain, but only the difference on day 2 was statistically significant.Conclusions:Patients treated with traditional fixed appliances reported greater discomfort and consumed more analgesics than patients treated with aligners. This trial was not registered.     

The impact of personality on adult patients' adjustability to orthodontic appliances

Objective:To evaluate the impact of psychological traits on patients'' choice of orthodontic appliances and their adjustability to orthodontic treatment.Materials and Methods:The sample consisted of 68 adult patients divided into three groups (28 buccal, 19 lingual, and 21 clear aligners). Prior to treatment participants filled out the Brief Symptom Inventory to assess symptoms of mental distress and the Narcissistic Vulnerability Scale to assess narcissistic personality traits. During the first week after appliance delivery and on day 14, patients completed a Health-Related Quality of Life questionnaire to assess their perception of pain and four areas of dysfunction. The correlation between personality traits and patients'' reaction to treatment was evaluated.Results:Somatization was the only trait that affected the choice of lingual and clear aligner appliance. Reduced self-esteem regulation was associated with increased pain in all patients, while exploitation was associated with pain in lingual patients. Narcissistic vulnerability slightly influenced patients'' adaptability to orthodontic appliances. Although adjustability to lingual appliances was the most difficult, only two parameters were affected by personality features. In the buccal group, adjustability was affected by numerous parameters. Adaptation to the clear aligner appliance was relatively uneventful and least affected by psychological features.Conclusion:Anxious individuals tend to prefer lingual and clear aligner appliances. The selection of lingual and clear aligner appliances governs the patient''s response and recovery process, leaving little room for the effect of psychological features. On the other hand, the buccal appliance allows for greater impact of personality traits on adjustability.     

Stability of transverse expansion in the mandibular arch.

This was a retrospective, longitudinal cephalometric and cast study of 29 white patients at pretreatment, posttreatment, and an average of 6 years 3 months postretention. The goal was to assess changes with treatment and retention with the expanding mandibular lingual arch appliance in conjunction with fixed edgewise treatment. Seven mandibular cast measurements were assessed, including arch crowding, arch perimeter, arch length, and arch width at the permanent canines, first premolars, second premolars, and first molars. Cephalometric radiographs were digitized, and 16 cephalometric measurements were made. Repeated-measures analysis of variance and 2-sample t tests were used to determine statistically significant changes. It was found that the expanding lingual arch used for less than 6 months with the mandibular fixed edgewise appliance caused an increase in both the transverse and sagittal dimensions of the mandibular dental arch. Transverse expansion was more stable in the posterior region of the mandibular dental arch than in the anterior region. Mandibular intercanine width increase could be maintained only by fixed retention. Although the maxillary and mandibular incisors were advanced and proclined, lip protrusion did not occur.     

Incidence of white spot lesions among patients treated with clear aligners and traditional braces

Objectives:To compare the incidence of white spot lesions (WSLs) among patients treated with aligners and those treated with traditional braces.Materials and Methods:A group of 244 aligner patients (30.4 ± 14 years) was compared to a group of 206 patients (29.2 ± 11.5 years) treated with traditional fixed braces. Consecutive cases in the late mixed or permanent dentitions who had high-quality pre- and posttreatment digital photographs available were included in the study. Each set of photographs was independently evaluated by two investigators to determine pretreatment oral hygiene (OH), fluorosis, and WSLs, as well as changes in OH and WSLs during treatment.Results:Approximately 1.2% of the aligner patients developed WSLs, compared to 26% of the traditionally treated patients. The numbers of WSLs that developed were also significantly (P < .001) less among the aligner patients. The aligner patients developed three new WSLs, while the traditionally treated patients developed 174 WSLs. The incidence of WSLs was greater for the maxillary than for the mandibular teeth, and it was greater for the canines than for the incisors. For the patients treated with traditional braces, fair or poor pretreatment OH, worsening of OH during treatment, preexisting WSLs, and longer treatment duration significantly (P < .05) increased the risk of developing WSLs during treatment.Conclusions:Patients treated with aligners have less risk of developing WSLs than do patients treated with traditional braces, which could be partially due to shorter treatment duration, or better pretreatment OH.     

隐形矫治器对患者龈沟液中AST和ALP水平的影响

目的:探讨无托槽隐形矫治器与固定矫治器对正畸患者龈沟液中天门冬氨酸转氨酶(AST)和碱性磷酸酶(ALP)水平的影响。方法:选取16~35岁正畸患者30例,随机分为两组,每组各15例。实验组采用隐形矫治器,对照组采用直丝弓固定矫治器。分别在治疗前和治疗后6个月,检测各组患者菌斑指数(PLI)、牙龈指数(GI)和探诊深度(PD);收集患者龈沟液,检测AST、ALP水平。结果:矫治后6个月,实验组患者牙周指数、AST、ALP水平均明显低于对照组,差异具有统计学意义(P<0.05)。结论:观察期内,隐形矫治器较固定矫治器更有利于维护患者牙周健康。     

固定矫治器与隐形矫治器对正畸治疗疼痛影响差异的Meta分析

目的    比较在正畸治疗过程中固定矫治器与隐形矫治器对患者疼痛影响的差异。方法    计算机检索Cochrane Library、PubMed、中国知网等数据库,查找使用固定矫治器与隐形矫治器进行正畸治疗的相关文章。通过Meta分析比较在正畸治疗过程中两种矫治器对患者疼痛影响的差异。结果    共纳入11篇相关文献,其中7篇为随机对照试验（RCT）研究,4篇为对照临床试验（CCT）研究。共计患者683例,其中使用隐形矫治器（研究组）患者348例,使用固定矫治器（对照组）患者335例。Meta分析结果显示,矫治器佩戴后1、3、5、7 d,研究组患者的疼痛程度均小于对照组,差异有统计学意义（均P < 0.05）。结论    矫治器初戴1周内,隐形矫治器对患者产生的疼痛程度小于固定矫治器。临床上应用隐形矫治器可能会提高患者依从性与配合度。     

Changes in mandibular incisor position in Class II Division 1 malocclusion treated with premolar extractions

The aim of this study was to investigate the magnitude of mandibular incisor retraction to be expected during full fixed appliance mechanotherapy in Class II Division 1 malocclusions treated with premolar extractions when mandibular incisor retraction was not part of the treatment plan. The material consisted of pretreatment and posttreatment cephalometric films and dental casts of 70 Class II Division 1 malocclusion patients (33 males and 37 females) treated with the preadjusted edgewise appliances. The mandibular first premolars were extracted in 31 subjects, and the mandibular second premolars were extracted in 39. The pretreatment factors that suggested a basis for the extraction choice in the mandibular arch in these patients were found to include the ratio between posterior and anterior facial heights, the maxillary-mandibular plane angle, and the residual space in the mandibular arch. The mandibular incisors were retracted in only 65% of the patients. On average, the mandibular incisors were retracted by 1.02 mm relative to the nasion-pogonion line; there was no significant difference between the 2 extraction groups. Multiple regression analysis showed that the change in the mandibular incisor position is significantly correlated with the residual space in the mandibular arch, the initial distance between the mandibular incisor and the nasion-pogonion line, maxillary-mandibular angle, and the duration of crown labial torque in the mandibular incisors. In combination, these 4 factors could explain 61% of the change in the mandibular incisor position.     

欧米加阻挡曲扩弓法排齐和整平下颌拥挤牙列效果的临床研究

目的 评价下颌非拔牙病例中,澳丝弯制的欧米加阻挡曲扩弓法在传统直丝弓托槽上排齐和整平下颌拥挤牙列方面的临床效果。方法 选择58例正畸患者,年龄19~24岁,随机均分成2组,各29例,一组接受传统矫治方法,另一组采用欧米加阻挡曲扩弓法矫治。每种矫正方法又分为轻-中度拥挤（5 > Ⅱ > 2）和重度拥挤（Ⅱ > 5）两个亚组。下颌治疗结束时间以下牙弓完全排齐和整平为准。头颅侧位片评价下牙弓排齐和整平前后下切牙位置的变化;模型上测量下尖牙间距和下第一恒磨牙间距以反映牙弓宽度的变化。结果 2种排齐和整平的方法获得了相同程度的前牙区和后牙区扩弓量;就重度拥挤病例而言,欧米加阻挡曲扩弓法要明显快于传统方法（P=0.017）;结论 2种方法无论在切牙的唇向移动程度还是尖牙间距和磨牙间距的扩大情况等各方面几乎获得了同样的效果,对于严重拥挤的牙列,欧米加阻挡曲扩弓装置显示出更高的效率,是非常值得推荐的一种矫正方法。     

Class II high angle case for which titanium screws were added after mandibular posterior rotation

In skeletal Class II patients with a high mandibular plane angle, it is well known that posterior rotation of the mandible often occurs during treatment using a preadjusted edgewise appliance. In this case, posterior rotation of the mandible with increased overjet occurred after the buccal inclination of the mandibular 2nd molars. This case report describes a Class II high angle case for which titanium screws were added as an absolute anchorage to improve the posterior rotation of the mandible. To correct the posterior rotation of the mandible, mandibular molars were intruded and the mandibular arch was mesially moved using titanium screws. The treatment results show that titanium screws were useful for improving the posterior rotation of the mandible during treatment using a preadjusted edgewise appliance.     

Comparison of alveolar bone thickness and height after slow expansion using quad-helix or clear aligners

ObjectiveThe study was conducted to investigate the thickness and height of the alveolar bone of individual teeth after slow maxillary expansion (SME) with quad helix or clear aligner appliances and hypothesized that there is no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners.Material and MethodsThis is a retrospective study; the records of 22 patients treated between December 2019 to April 2020 by dental arch expansion using either clear aligners or quad helix appliances were retrieved and studied. The results obtained through cone beam computed tomography (CBCTs) before and immediately after maxillary expansion (2 + 1 mm per side) were analyzed (11 in the Quad Helix group and 11 in the clear aligner). The data collected was analyzed using linear and angular measurements obtained through On-demand 3D App software. Furthermore, Statistical Package for Social Sciences (SPSS) version 25.0 was used to present the findings by mean and standard deviations, and Scheffe’s test was applied for comparing forces.ResultsThe results showed that the mean age of patients in the clear aligner group and Quad Helix was 16.27 ± 0.56 years and 15.5 ± 1.53 years, respectively. There was no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners. This is due to the findings that suggest that there was a decrease in bone height and bone width when treated with a quad helix as compared to clear alignment.ConclusionIt can be concluded that the quad helix SME treatment affects alveolar bone integrity; therefore, clear aligners might be better for treating patients than the quad helix.     

Treatment changes of hypo- and hyperdivergent Class II Herbst patients

Objectives:To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients.Materials and Methods:The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo- or hyperdivergent based on their MPAs. Pre- and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures.Results:The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a “headgear effect.” Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo- and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients.Conclusions:Hypo- and hyperdivergent patients benefit from the Herbst''s headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.     

Treatment effects of the mandibular anterior repositioning appliance in patients with Class II skeletal malocclusions

Objective:To examine the changes produced by the mandibular anterior repositioning appliance (MARA) appliance and compare the treatment effects to an untreated Class II control group.Materials and Methods:Thirty consecutively treated patients were matched with an untreated control group. Lateral cephalograms were taken at T1, 5 months pre-MARA (CVMS 2.7); T2, immediately after MARA removal and prior to placement of full fixed edgewise appliances (CVMS 4.2); and T3, at least 2 years after MARA removal and completion of edgewise treatment (CVMS 5.4). The mean age of the MARA patients was 11.9 years for boys and 10.8 years for girls. Repeated-measures analysis of variance (ANOVA) was used to assess if the samples were morphologically comparable at the outset and to test if there were significant differences between the groups for the various increments of change. Given a significant ANOVA, the source of the difference was explored via Tukey-Kramer tests.Results:Restriction of maxillary growth and no significant mandibular growth were observed with the MARA appliance. The Class II correction was obtained mainly by slight maxillary molar distalization and intrusion, in addition to mesial migration of the lower molars and flaring of the lower incisors. No vertical effect was observed with this appliance.Conclusion:The MARA appliance was effective in the treatment of Class II malocclusions. Restriction of maxillary growth and dentoalveolar changes in the maxillary and mandibular arches were responsible for the correction of the Class II malocclusion. Significant mandibular growth did not contribute to this correction.     

无托槽隐形矫治技术推磨牙向远中的机制与优势

对于轻中度的安氏Ⅱ类错牙合畸形患者,推磨牙向远中是一种常见的治疗方法。随着隐形矫治器的不断发展,应用无托槽隐形矫治技术改善磨牙关系,能达到很高的矫治效率。通过分析患者治疗前后的头颅侧位片及曲面断层片,测量上颌第一、二磨牙的后移量及倾斜角度,发现牙齿的移动方式接近整体移动。文章就无托槽隐形矫治技术推磨牙向远中的机制及优势做一介绍。     

数字化隐形矫正技术治疗33例成人牙周病伴错(牙合)畸形患者的效果评价

目的：比较无托槽隐形矫正器与固定矫正器在治疗牙周病伴错畸形患者中的牙周健康状况。方法：选取牙周病伴错畸形患者33例,随机分为2组,即无托槽隐形矫正器组（实验组,16例）和唇侧固定矫正器组（对照组,17例）。记录2组患者正畸治疗前,治疗后1、3、6、9个月龈沟出血指数（BI）、牙周探诊深度（PD）、菌斑指数（PLI）和牙龈指数（GI）情况。采用SPSS 17.0软件包比较2组间数据差异。结果：对照组BI、PD、PLI和GI正畸开始后1、3、6、9个月均较治疗前增高,差异有统计学意义（P<0.05）。实验组治疗前和开始治疗后1、3、6、9个月各项牙周临床指标差异均无统计学意义（P>0.05）。正畸开始后1、3、6、9个月,实验组BI、PLI、GI均显著低于对照组（P<0.05）;PD略小于对照组,但差异无统计学意义（P>0.05）。结论：与固定矫正相比,无托槽隐形矫正技术更加有利于牙周病伴错畸形患者牙周健康的维护。     

Cytokine levels in gingival crevicular fluid during orthodontic treatment with aligners compared to conventional labial fixed appliances: a 3-week clinical study

Objective: To test the hypothesis that the levels of IL-1ß and TNF-α increased more and IL-1α, IL-2, IL-6, IL-8 increased less, after 3 weeks of treatment with conventional labial fixed appliance and with aligners.

Material and methods: Forty patients who were treated either with labial brackets (n?=?20) or aligners (n?=?20). Gingival crevicular fluid (GCF) samples were collected at baseline and after 21 days. Cytokine levels were evaluated by enzyme-linked immune sorbent assay (ELISA). Plaque index (PI), gingival index (GI), and bleeding on probing (POB) were also examined.

Results: The levels of IL-1α, IL-1ß, IL-2, IL-6, IL-8 and TNF-α in the GCF were significantly increased in both groups. The levels of IL-2, IL-6, IL-8 increased more in patients treated with aligners compared to those treated by labial fixed appliances. There was a statistically significant difference in change of the mean cytokine levels of IL-1α, IL-2, IL-6, IL-8 and TNF-α compared to labial fixed appliances and aligners.

Conclusions: The levels of the six studied cytokines in GCF (IL-1α, IL-1ß, IL-2, IL-6, IL-8 and TNF-α) increased after 3 weeks both after treatment with conventional labial fixed appliance and with aligners. IL-1ß and TNF-α showed a prominent increase compared to the other cytokines in the GCF of teeth by both the labial fixed appliance and aligners. However, there were only minor differences in the changes of the cytokine levels from baseline to 3 weeks between the two groups. There were no differences between the groups regarding PI, GI or POB.