title: A Comparison of the periodontal health of patients during treatment with the Invisalign system and with fixed lingual appliances.
abstract: OBJECTIVE
  Evaluation of the periodontal health of patients during treatment with the Invisalign system or fixed lingual appliances.
  
  
  METHODS
  The study was designed as a concomitant trial of two groups of consecutive patients. The lingual patients were evaluated between February and May 2005.
  
  
  METHODS
  Thirty patients each with aligners or fixed lingual appliances were examined at three consecutive control visits for their periodontal status. All the Invisalign patients and some of those wearing lingual appliances were patients from the Department of Orthodontics and Dentofacial Orthopedics of the Charité Berlin. The rest were recruited from the practices of two licensed orthodontists. The patients' periodontal health was evaluated in reference to a modified Gingiva, modified Plaque and modified Papillary Bleeding Index; we also measured the sulcus probing depth. All indices were documented buccally in the 1st and 3rd quadrants, and lingually in the 2nd and 4th quadrants from central incisor to first molar. The sulcus probing depth was measured mesially, distally, buccally and lingually in each quadrant's first molar and first premolar. Each control visit was concluded with detailed, individualized instructions in oral hygiene.
  
  
  RESULTS
  Overall, the Invisalign patients demonstrated significantly better modified indices. However, the sulcus probing depths were very similar in both treatment groups.
  
  
  CONCLUSIONS
  Although all the teeth and parts of the keratinized gingiva are covered nearly all day during Invisalign treatment, the periodontal risk is lower than that associated with fixed lingual appliances. This may be due to the fact that aligners are removable, permitting unimpeded oral hygiene. In contrast, the lingual tooth surfaces are very difficult to clean when fitted with a fixed appliance.
authors.affiliation: Institute of Orthodontics, Dentofacial Orthopedics and Pedodontics, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany. rainer-r.miethke@charite.de
authors.forename: Rainer-Reginald
authors.initials: RR
authors.lastname: Miethke
authors.forename: Klaudia
authors.initials: K
authors.lastname: Brauner
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016382:Orthodontic Appliance Design; D010512:Periodontal Index