Are Clear Aligners as Effective as Braces? What the Evidence Says
A 2019 systematic review of 8 studies found that both clear aligners and braces were effective in treating malocclusion, but aligners were not as effective as braces in producing adequate occlusal contacts, controlling tooth torque and retention. Aligner treatment was shorter in non-extraction cases. The authors rated the evidence as limited and called for more randomised trials.
| Outcome | Clear aligners | Fixed braces |
|---|---|---|
| Overall effectiveness (2019 review) | Effective in treating malocclusion | Effective in treating malocclusion |
| Occlusal contacts, torque control, retention | Not as effective as braces | More effective than aligners |
| Segmented tooth movement | Advantage reported | Not reported as an advantage |
| Treatment duration, non-extraction cases | Shorter (6.31 months, pooled) | Longer |
What the evidence found
1. Both clear aligners and braces were effective in treating malocclusion. 2. Clear aligners were not as effective as braces in producing adequate occlusal contacts, controlling tooth torque and retention. 3. The review also reported weaker transverse (width) gains and more relapse in alignment with clear aligners. 4. Clear aligners showed an advantage in segmented tooth movement. 5. In a meta-analysis of three non-extraction studies, clear aligner treatment was statistically significantly shorter than braces (weighted mean difference -6.31 months, 95% CI -8.37 to -4.24). One study of extraction cases found braces were faster. 6. The pooled difference in Objective Grading System score between aligners and braces was not statistically significant, with high heterogeneity between studies (I-squared 88%).
How good is the evidence?
The review included 8 studies (2 randomised controlled trials and 6 cohort studies; 353 patients treated with clear aligners and 353 with fixed braces; searches to August 2018). The authors note that few randomised trials were available, that confounding could not be fully eliminated, that heterogeneity was high so the pooled results should be interpreted with caution, and that aligner techniques have changed since, with newer studies reporting better aligner outcomes. They conclude that more randomised controlled trials are needed to provide high-quality evidence. Because the searches ended in 2018, this page reflects that review only and should not be read as the current state of the whole field.
Sources
Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019;19:24. doi:10.1186/s12903-018-0695-z (https://doi.org/10.1186/s12903-018-0695-z)
Useful related pages
This page summarises published research for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.
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