IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 1 Ver. 13 January. (2018), PP 19-22 www.iosrjournals.org DOI: 10.9790/0853-1701131922 www.iosrjournals.org 19 | Page The Effect of Fixed Orthodontic Appliances Versus Clear Aligner on Periodontal Health: A Review of the Literature *Fatemah AlAhmari 1 , Faiza AlOtaibi 2 1 (Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia) 2 (Department of Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia) Corresponding Author: *Fatemah AlAhmari Abstract: Over the past few decades, orthodontic treatment in adults has become more common. Clear aligner treatment (CAT) has been cited as a safe, aesthetic and comfortable orthodontic procedure for adult patients. The aim of this review is to evaluate the impact of fixed orthodontic appliances (FOA) and clear aligner on periodontal health during orthodontic treatment. Periodontal health, as well as quantity and quality of plaque, were better during CAT than during FOA treatment. FOA promote the accumulation of bacterial plaque as the appliance complicates oral hygiene. The keys to maintenance of a healthy periodontium during orthodontic treatment are oral hygiene instructions reinforcement and a stringent recall system. Keywords: Clear aligners, Fixed orthodontic Appliance, Removable Appliance, Periodontal health --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 0-01-2018 Date of acceptance: 26-01-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Orthodontic treatment aims at providing an acceptable functional and aesthetic occlusion with appropriate tooth movements. These movements are strongly related to interactions of teeth with their supportive periodontal tissues [1]. In the majority of patients, particularly during childhood and adolescence, fixed orthodontic appliance (FOA) is the treatment of choice. Because of esthetics reasons, this treatment is not very popular for adult orthodontics. Therefore, other orthodontic techniques have been developed to increase esthetics and simplify oral hygiene procedures [2]. Orthodontic therapy may favor an unpredicted accumulation of bacterial plaque on the dental surfaces in particular when fixed appliances are employed during the treatment [3]. The use of removable appliances can minimize the orthodontics-related negative effects on periodontal health allowing patients easier oral hygiene procedures [4]. The aim of this review is to evaluate the impact of FOA and clear aligner on periodontal health during orthodontic treatment. II. Fixed Orthodontic Appliance Fixed appliances have become an integral part of comprehensive orthodontic treatment as versatile tools that enable three-dimensional control of tooth movement. Orthodontic treatment of malocclusions and craniofacial abnormalities may improve mastication, phonation, facial aesthetics, with beneficial effects on the general and oral health, individual’s comfort and self-esteem. However, orthodontic treatment is associated with a number of adverse effects, such as root resorption, pain, pulpal changes, periodontal disease, and temporomandibular dysfunction [5]. Fixed appliances and rough-surfaced adhesives in the oral cavity act as a plaque trap and gingival irritants [6]. Although new appliances as well as new bonding techniques and material have been developed, it has not yet been possible to decrease dental plaque retention [7]. III. Removable Clear Aligner The possibility of using clear overlay orthodontic appliances was introduced in 1946, when Kesling devised the concept of using a series of thermoplastic tooth positioners to progressively move misaligned teeth to improved positions [2]. In 1997, Align Technology (Santa Clara, Calif) adapted and incorporated modern technologies to introduce the clear aligner treatment (CAT) rendering Kesling’s concept a feasible orthodontic treatment option [8]. Its main components are clear plastic splints that cover all of the teeth and the marginal aspects of the gingiva and gradually move the teeth into an ideal position. A recent systematic review stated that CAT aligns and levels the arches; it is effective in controlling anterior intrusion but not anterior extrusion; it is effective in controlling posterior buccolingual inclination but not anterior buccolingual inclination; it is effective in controlling upper molar bodily movements of about 1.5 mm; and it is not effective in controlling rotation of rounded teeth in particular [1]. CAT seems to be a safe procedure for periodontal tissues with respect to fixed appliance treatment techniques, with particular reference to the amount of possible plaque retention. This seems