also studied the microbial changes during clear aligner treatment (CAT), comparing the oral bacterial communities of twenty-five patients before and 6 months after the beginning of the treatment. After this initial development, the bacterial biofilm develops into more diverse bacteria encased in a thick extracellular polymeric substance, with irregular calcifications. They showed that the initial biofilm (first 12 hours for slow plaque formers and first 6 hours for fast plaque formers) was composed of a majority of coccoid species. studied the ultrastructure and morphology of biofilms on aligners in “fast” and “slow” plaque formers. also analyzed intra-oral aged aligners and found abrasion at the cusp tips, adsorption of integuments and localized calcification of the precipitated biofilm at stagnation sites. demonstrated chemical and physical changes on aligners when they are worn: after 14 days, aligners showed microcracks and abraded and delaminated areas conducive to bacterial adhesion and growth, as well as localized calcified biofilm deposits and loss of transparency. showed that the surface of the aligner itself tends to be corrugated, presenting scratch marks, microabrasions and peaks, even if it is new, and these irregularities are the starting point of bacterial adhesion and development. Moreover, bacterial adhesion to aligners appears to be increased by the shape of the aligner, which contains grooves and ridges. demonstrated that the initial microbial adhesion and biofilm formation of aerobic and anaerobic oral species were similar between enamel, metal orthodontic brackets and aligner materials. Īlthough clear aligner orthodontic treatment demonstrated encouraging results in terms of the plaque index and gingival health control compared to classic fixed orthodontic treatment, bacteria can form oral biofilms on the surface of the aligners. As aligners meet patients’ needs for discreet and comfortable orthodontic appliances, demand has increased over the past decade, and several studies have been carried out on clear aligners, including their clinical efficacy, but also their comfort in terms of social life and practicality. Orthodontic procedures require the use of orthodontic appliances which can be fixed or removable, such as acrylic-based appliances or clear aligners. Further research is needed to define the most preventive oral health care protocol. (4) Conclusion: Although the determination of the most remarkable method of cleaning and disinfection was impossible because no direct comparison was conducted between all these methods, a multi-step protocol, including the combination of a mechanical and a chemical method, seems to be the most effective approach. Different cleaning and disinfection methods were studied such as mechanical methods (brushing with toothpaste or vibration), chemical methods/pharmaceutical products (chlorhexidine antibacterial substance, anionic or cationic detergents or effervescent tablets) or combinations of both. (3) Results: Among the 221 articles screened in the search process, 4 studies were included in the review, all designed as crossover studies (single arm without randomization with the same sequence of different cleaning and disinfection protocols for each participant). In case of disagreement, a third author was solicited throughout the selection process. The article selection, data extraction and risk of bias assessment were performed by two independent blinded review authors. Prospective studies, including randomized controlled trials (RCTs), crossover studies (COSs) and controlled clinical trials (CCTs), published in the English language without time restrictions, evaluating the efficacy of cleaning and disinfection protocols for clear orthodontic aligners by comparing them with a placebo or a negative control, were included. (2) Methods: A systematic review of the literature was conducted across four databases following the PRISMA guidelines up to May 2021, combining an electronic and a manual search. Therefore, preventive oral health care requires a cleaning and disinfection procedure for aligners. (1) Background: Clear orthodontic aligners support the development of oral biofilms, which could lead to interferences with the oral microbiota already existing and the deterioration of oral health, with the development of dental caries, periodontal disease and even systemic infections.
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