| Author(s) year . | Study design . | Sample . | Time-point of analysis . | Conclusion . |
|---|---|---|---|---|
| Alajmi et al 2020 [36] | Cross-sectional | N = 60 (30 CA, 30 FA) | 1 week after routine appointment | |
| Alcon et al 2021 [27] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | In the first month, labial FA patients reported more pain than CA patients. From the second month onward, CA patients reported more pain. |
| Alfawal et al 2022 [42] | Prospective randomised clinical trial | N = 44 (22 CA, 22 FA) | Pre- treatment, 1 week, 1 month, 3 months, then 6 months after appliance insert | CA patients reported better OHRQOL and shorter treatment duration than FA patients. |
| Alfawzan 2024 [37] | Prospective randomised clinical trial | N = 100 (50 CA, 50 LFA) | Over 12 months | CA showed better patient acceptance and compliance, making them a preferable option for comfort, though the difference was not significant. |
| Almasoud 2018 [38] | Prospective | N = 64 (32 CA, 32 FA) | 4h, 24h, 3 days and 7 days post appliance insert | In the first week of treatment, Invisalign patients reported less pain than those with passive self-ligating FA. |
| AlSeraidi et al 2021 [57] | Prospective | N = 117 (39 CA, 41 FA, 37 LFA) | 6–9 weeks after appliance insert | CA patients reported the highest OHRQOL scores, followed by LFA then FA appliance patients. |
| Alvarado-Lorenzo et al 2023 [28] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | Differences in the degree, location and type of pain occur based on the type of orthodontic technique used. No statistically significant differences in quality of life between CA and FA patients were found. |
| Angelopoulous et al 2021 [29] | Prospective longitudinal | N = 47 (21 CA, 26 LFA) | Pre-treatment, day 1 and 3 months after appliance insert | Both CA and LFA patients reported quality of life disturbances. LFA patients experienced disturbances that persisted beyond 3 months, while CA patients had greater speech issues that resolved after 3 months. |
| Antonio-Zancajo et al 2020 [23] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | MPQ at 4h, 8h, 24h, 2–7 days after appliance insert. OHIP-14 after first month of treatment. | CA patients demonstrated significantly higher quality of life compared to LFA and ‘low-friction’ FA groups, while these differences were only slightly higher when compared to lingual FA patients. |
| Antonio-Zancajo et al 2021 [24] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | At 4h, 8h, 24h, 2–7 days after starting treatment | Pain was most common in both anterior arches, especially the anterior maxilla, followed by the mandible. FA patients reported mild to moderate pain while CA, LFA and ‘low-friction’ FA groups reported mild pain in the first 24 hours. |
| Basseer et al 2021 [39] | Cross-sectional | N= 150 (32 CA, 118 FA) | Mid-treatment, 1 week after orthodontic review | FA caused more severe pain, sleeping difficulty, sores, and food impaction compared to CA. |
| Bräscher et al 2016 [30] | Cross-sectional | N = 72 (CA only) | 17 ± 9.3 months into treatment | CA patients reported significant reductions in pain intensity, duration, pressure on insertion, improved comfort and reduced impairment with the SmartTrack® material. |
| Caldas et al 2024 [58] | Cross-sectional | N= 94 (CA only) | 1–3 months, 3–6 months and >6 months into treatment | Pain severity significantly affected OHRQOL in adults using CA, however patient satisfaction remained high regardless of this. |
| Chan et al 2024 [48] | Prospective longitudinal | N = 87 (59 CA, 28 FA) | Pre-treatment, 2 days and 7 days after appliance insert over 6 months | Both CA and FA patients experienced similar levels of pain 2 days after commencing treatment. Pain remained minimal in CA patients however pain peaked 2 days after the appointment with each new orthodontic stimulus in FA patients. |
| Correa et al 2024 [25] | Prospective | N= 80 (40 CA, 40 FA) | Pre-treatment and 1 month after starting treatment | Bracket treatment negatively affected OHRQOL one month after starting treatment while CA had no impact on OHRQOL. Anxiety levels were not affected by the orthodontic system used during the first month of treatment. |
| Diddge et al 2020 [55] | Prospective randomised clinical trial | N= 36 (12 CA, 12 FA, 12 self-ligating FA) | 4h, 24h, day 3 and day 4 post-appliance insert | CA patients reported less pain than FA and LFA patients in the first week of treatment. |
| Falconi et al 2020 [31] | Prospective | N= 30 (CA only) | Immediately after CA insert and 24h later | Significant phonetic changes were not seen with F22 aligners. |
| Flores-Mir et al 2018 [44] | Cross-sectional | N= 122 (Number of CA and FA patients not specified) | Immediately after de-banding | Both bracket-based and CA patients experienced similar satisfaction, however CA scored higher for eating and chewing. |
| Fraundorf et al 2022 [45] | Prospective | N= 44 (24 CA, 20 FA) | Pre-treatment, immediately after starting, and at 2 months later | CA significantly affects speech and does not return to normal after 2 months despite some adaptation. |
| Fujiyama et al 2014 [52] | Prospective | N = 145 (38 CA, 55 FA, 52 EIG) | 60s, 6h, 12h, 1–7 days, 3 weeks and 5 weeks after appliance insert, and on completion | CA patients may experience less pain than FA during the initial stages of treatment. Tray deformation must be closely monitored with CA to avoid pain and discomfort for patients. |
| Gao et al 2021 [51] | Prospective | N= 110 (55 CA, 55FA) | Pre-treatment and 2 weeks after commencing treatment | CA patients experienced less pain, less anxiety and higher OHRQOL than FA patients. |
| Hakami 2023 [43] | Cross-sectional | N = 69 (33 CA, 36 FA) | Patients at different stages of treatment | No statistically significant differences were found in sleep quality with different orthodontic appliances. |
| Jaber et al 2022 [40] | Prospective randomised controlled trial | N= 36 (18 CA, 18 FA) | Pre-treatment, 1 week, 2 weeks, 1 month, 6 months, 12 months post appliance insert | OHRQOL was less affected in CA patients than FA patients during the first year of treatment. |
| Johal et al 2024 [32] | Cross-sectional | N = 22 (8 CA, 8 FA, 6 LFA) | 2–6 months and >6 months into treatment then post-treatment | FA, CA and LFA appliances affect adults’ quality of life, particularly in relation to functional and psychosocial aspects. |
| Kumari et al 2024 [56] | Prospective | N = 500 (125 CA, 125 FA, 125 ceramic FA, 125 LFA) | 6–9 weeks after appliance insert | More LFA patients switched to CA, followed by the FA and ceramic FA groups. CA patients reported fewer issues compared to patients in other groups. |
| Lee 2020 [53] | Cross-sectional | N = 30 (10 CA, 10 FA, 10 DTC aligners) | Patients who had completed treatment within the last 12 months | Most patients had positive experiences with orthodontic treatment, leading to increased self-confidence and dental health awareness. |
| Miller et al 2007 [46] | Prospective | N = 60 (33 CA, 27 FA) | Pre-treatment, then daily for 1 week | Adults treated with CA experienced less pain and fewer disruptions to their lives in the first week compared to FA patients. |
| Pachecho-Pereira et al 2018 [47] | Prospective | N = 81 (CA only) | Survey open for 22 months | Improvements in appearance and eating were linked to patient satisfaction, the doctor-patient relationship correlated more with overall satisfaction. |
| Saccomanno et al 2022 [33] | Cross-sectional | N = 257 (67.7% CA, 13% FA, 11.6% ceramic FA, 1.6% LFA) | Patients at various stages of treatment | Relapse after orthodontic treatment increases the need for re-treatment. Oral hygiene habits significantly improve during orthodontic treatment, particularly with CA. |
| Saccomanno et al 2022 [34] | Cross-sectional | N = 175 (CA only) | Previous CA patients | CA offers adults better aesthetics, comfort and satisfaction compared to FA. |
| Schaefer et al 2010 [35] | Prospective | N= 31 (CA only) | At 1st, 3rd, 4th, 6th and 8th visits (3–5 week intervals) | Invisalign® treatment causes only minimal disturbances to overall oral health and quality of life. |
| Shalish et al 2012 [41] | Prospective | N = 68 (21 CA, 28 FA, 19 LFA) | Daily for 1st week and day 14 | Invisalign® patients experienced higher pain levels in the first day after appliance insertion but had fewer oral symptoms, disturbances to daily activities and oral dysfunction compared to the FA group. |
| Wang et al 2023 [54] | Cross-sectional | N = 40 (Number of CA and FA patients not specified) | Pre-treatment and immediately after appliance insert | CA and FA immediately affected perioral soft tissues and speech. |
| Xu et al 2022 [6] | Prospective | N = 102 (62 CA in initial treatment, 40 in refinement) | Pre-treatment then every day for the first week of wearing the initial set of aligners | Pain, anxiety and quality of life were at their lowest during the first first 2 days of CA, but improved over the first week. Factors such as optimised attachments, the number of aligner sets, ICON, and the need for elastics influenced these outcomes. |
| Wexler et al 2020 [49] | Cross-sectional | N = 470 (DTC only) | Patients at different stages of treatment | While many survey respondents would have preferred treatment from a dentist or orthodontist, DTC aligners were chosen for cost and convenience. |
| White et al 2017 [50] | Prospective randomised clinical trial | N = 40 (22 CA, 18 FA) | Immediately after commencing, daily for 1 week, then 4 days after two adjustment visits | FA patients reported more discomfort and used more analgesics compared to those treated with CA. |
| Zamora-Martinez et al 2021 [26] | Prospective longitudinal | N = 120 (30 CA, 30 FA, 30 ceramic FA, 30 LFA) | Pre-treatment, 6 months after commencing and on completion | Patients experienced a significant drop in quality of life during treatment but saw significant improvements by the end of treatment. |
| Author(s) year . | Study design . | Sample . | Time-point of analysis . | Conclusion . |
|---|---|---|---|---|
| Alajmi et al 2020 [36] | Cross-sectional | N = 60 (30 CA, 30 FA) | 1 week after routine appointment | |
| Alcon et al 2021 [27] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | In the first month, labial FA patients reported more pain than CA patients. From the second month onward, CA patients reported more pain. |
| Alfawal et al 2022 [42] | Prospective randomised clinical trial | N = 44 (22 CA, 22 FA) | Pre- treatment, 1 week, 1 month, 3 months, then 6 months after appliance insert | CA patients reported better OHRQOL and shorter treatment duration than FA patients. |
| Alfawzan 2024 [37] | Prospective randomised clinical trial | N = 100 (50 CA, 50 LFA) | Over 12 months | CA showed better patient acceptance and compliance, making them a preferable option for comfort, though the difference was not significant. |
| Almasoud 2018 [38] | Prospective | N = 64 (32 CA, 32 FA) | 4h, 24h, 3 days and 7 days post appliance insert | In the first week of treatment, Invisalign patients reported less pain than those with passive self-ligating FA. |
| AlSeraidi et al 2021 [57] | Prospective | N = 117 (39 CA, 41 FA, 37 LFA) | 6–9 weeks after appliance insert | CA patients reported the highest OHRQOL scores, followed by LFA then FA appliance patients. |
| Alvarado-Lorenzo et al 2023 [28] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | Differences in the degree, location and type of pain occur based on the type of orthodontic technique used. No statistically significant differences in quality of life between CA and FA patients were found. |
| Angelopoulous et al 2021 [29] | Prospective longitudinal | N = 47 (21 CA, 26 LFA) | Pre-treatment, day 1 and 3 months after appliance insert | Both CA and LFA patients reported quality of life disturbances. LFA patients experienced disturbances that persisted beyond 3 months, while CA patients had greater speech issues that resolved after 3 months. |
| Antonio-Zancajo et al 2020 [23] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | MPQ at 4h, 8h, 24h, 2–7 days after appliance insert. OHIP-14 after first month of treatment. | CA patients demonstrated significantly higher quality of life compared to LFA and ‘low-friction’ FA groups, while these differences were only slightly higher when compared to lingual FA patients. |
| Antonio-Zancajo et al 2021 [24] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | At 4h, 8h, 24h, 2–7 days after starting treatment | Pain was most common in both anterior arches, especially the anterior maxilla, followed by the mandible. FA patients reported mild to moderate pain while CA, LFA and ‘low-friction’ FA groups reported mild pain in the first 24 hours. |
| Basseer et al 2021 [39] | Cross-sectional | N= 150 (32 CA, 118 FA) | Mid-treatment, 1 week after orthodontic review | FA caused more severe pain, sleeping difficulty, sores, and food impaction compared to CA. |
| Bräscher et al 2016 [30] | Cross-sectional | N = 72 (CA only) | 17 ± 9.3 months into treatment | CA patients reported significant reductions in pain intensity, duration, pressure on insertion, improved comfort and reduced impairment with the SmartTrack® material. |
| Caldas et al 2024 [58] | Cross-sectional | N= 94 (CA only) | 1–3 months, 3–6 months and >6 months into treatment | Pain severity significantly affected OHRQOL in adults using CA, however patient satisfaction remained high regardless of this. |
| Chan et al 2024 [48] | Prospective longitudinal | N = 87 (59 CA, 28 FA) | Pre-treatment, 2 days and 7 days after appliance insert over 6 months | Both CA and FA patients experienced similar levels of pain 2 days after commencing treatment. Pain remained minimal in CA patients however pain peaked 2 days after the appointment with each new orthodontic stimulus in FA patients. |
| Correa et al 2024 [25] | Prospective | N= 80 (40 CA, 40 FA) | Pre-treatment and 1 month after starting treatment | Bracket treatment negatively affected OHRQOL one month after starting treatment while CA had no impact on OHRQOL. Anxiety levels were not affected by the orthodontic system used during the first month of treatment. |
| Diddge et al 2020 [55] | Prospective randomised clinical trial | N= 36 (12 CA, 12 FA, 12 self-ligating FA) | 4h, 24h, day 3 and day 4 post-appliance insert | CA patients reported less pain than FA and LFA patients in the first week of treatment. |
| Falconi et al 2020 [31] | Prospective | N= 30 (CA only) | Immediately after CA insert and 24h later | Significant phonetic changes were not seen with F22 aligners. |
| Flores-Mir et al 2018 [44] | Cross-sectional | N= 122 (Number of CA and FA patients not specified) | Immediately after de-banding | Both bracket-based and CA patients experienced similar satisfaction, however CA scored higher for eating and chewing. |
| Fraundorf et al 2022 [45] | Prospective | N= 44 (24 CA, 20 FA) | Pre-treatment, immediately after starting, and at 2 months later | CA significantly affects speech and does not return to normal after 2 months despite some adaptation. |
| Fujiyama et al 2014 [52] | Prospective | N = 145 (38 CA, 55 FA, 52 EIG) | 60s, 6h, 12h, 1–7 days, 3 weeks and 5 weeks after appliance insert, and on completion | CA patients may experience less pain than FA during the initial stages of treatment. Tray deformation must be closely monitored with CA to avoid pain and discomfort for patients. |
| Gao et al 2021 [51] | Prospective | N= 110 (55 CA, 55FA) | Pre-treatment and 2 weeks after commencing treatment | CA patients experienced less pain, less anxiety and higher OHRQOL than FA patients. |
| Hakami 2023 [43] | Cross-sectional | N = 69 (33 CA, 36 FA) | Patients at different stages of treatment | No statistically significant differences were found in sleep quality with different orthodontic appliances. |
| Jaber et al 2022 [40] | Prospective randomised controlled trial | N= 36 (18 CA, 18 FA) | Pre-treatment, 1 week, 2 weeks, 1 month, 6 months, 12 months post appliance insert | OHRQOL was less affected in CA patients than FA patients during the first year of treatment. |
| Johal et al 2024 [32] | Cross-sectional | N = 22 (8 CA, 8 FA, 6 LFA) | 2–6 months and >6 months into treatment then post-treatment | FA, CA and LFA appliances affect adults’ quality of life, particularly in relation to functional and psychosocial aspects. |
| Kumari et al 2024 [56] | Prospective | N = 500 (125 CA, 125 FA, 125 ceramic FA, 125 LFA) | 6–9 weeks after appliance insert | More LFA patients switched to CA, followed by the FA and ceramic FA groups. CA patients reported fewer issues compared to patients in other groups. |
| Lee 2020 [53] | Cross-sectional | N = 30 (10 CA, 10 FA, 10 DTC aligners) | Patients who had completed treatment within the last 12 months | Most patients had positive experiences with orthodontic treatment, leading to increased self-confidence and dental health awareness. |
| Miller et al 2007 [46] | Prospective | N = 60 (33 CA, 27 FA) | Pre-treatment, then daily for 1 week | Adults treated with CA experienced less pain and fewer disruptions to their lives in the first week compared to FA patients. |
| Pachecho-Pereira et al 2018 [47] | Prospective | N = 81 (CA only) | Survey open for 22 months | Improvements in appearance and eating were linked to patient satisfaction, the doctor-patient relationship correlated more with overall satisfaction. |
| Saccomanno et al 2022 [33] | Cross-sectional | N = 257 (67.7% CA, 13% FA, 11.6% ceramic FA, 1.6% LFA) | Patients at various stages of treatment | Relapse after orthodontic treatment increases the need for re-treatment. Oral hygiene habits significantly improve during orthodontic treatment, particularly with CA. |
| Saccomanno et al 2022 [34] | Cross-sectional | N = 175 (CA only) | Previous CA patients | CA offers adults better aesthetics, comfort and satisfaction compared to FA. |
| Schaefer et al 2010 [35] | Prospective | N= 31 (CA only) | At 1st, 3rd, 4th, 6th and 8th visits (3–5 week intervals) | Invisalign® treatment causes only minimal disturbances to overall oral health and quality of life. |
| Shalish et al 2012 [41] | Prospective | N = 68 (21 CA, 28 FA, 19 LFA) | Daily for 1st week and day 14 | Invisalign® patients experienced higher pain levels in the first day after appliance insertion but had fewer oral symptoms, disturbances to daily activities and oral dysfunction compared to the FA group. |
| Wang et al 2023 [54] | Cross-sectional | N = 40 (Number of CA and FA patients not specified) | Pre-treatment and immediately after appliance insert | CA and FA immediately affected perioral soft tissues and speech. |
| Xu et al 2022 [6] | Prospective | N = 102 (62 CA in initial treatment, 40 in refinement) | Pre-treatment then every day for the first week of wearing the initial set of aligners | Pain, anxiety and quality of life were at their lowest during the first first 2 days of CA, but improved over the first week. Factors such as optimised attachments, the number of aligner sets, ICON, and the need for elastics influenced these outcomes. |
| Wexler et al 2020 [49] | Cross-sectional | N = 470 (DTC only) | Patients at different stages of treatment | While many survey respondents would have preferred treatment from a dentist or orthodontist, DTC aligners were chosen for cost and convenience. |
| White et al 2017 [50] | Prospective randomised clinical trial | N = 40 (22 CA, 18 FA) | Immediately after commencing, daily for 1 week, then 4 days after two adjustment visits | FA patients reported more discomfort and used more analgesics compared to those treated with CA. |
| Zamora-Martinez et al 2021 [26] | Prospective longitudinal | N = 120 (30 CA, 30 FA, 30 ceramic FA, 30 LFA) | Pre-treatment, 6 months after commencing and on completion | Patients experienced a significant drop in quality of life during treatment but saw significant improvements by the end of treatment. |
Key: FA = Fixed appliances, CA = Clear aligners, LFA = Lingual fixed appliances, EIG = Edgewise and Invisalign Group, DTC = Direct-to-consumer aligners
| Author(s) year . | Study design . | Sample . | Time-point of analysis . | Conclusion . |
|---|---|---|---|---|
| Alajmi et al 2020 [36] | Cross-sectional | N = 60 (30 CA, 30 FA) | 1 week after routine appointment | |
| Alcon et al 2021 [27] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | In the first month, labial FA patients reported more pain than CA patients. From the second month onward, CA patients reported more pain. |
| Alfawal et al 2022 [42] | Prospective randomised clinical trial | N = 44 (22 CA, 22 FA) | Pre- treatment, 1 week, 1 month, 3 months, then 6 months after appliance insert | CA patients reported better OHRQOL and shorter treatment duration than FA patients. |
| Alfawzan 2024 [37] | Prospective randomised clinical trial | N = 100 (50 CA, 50 LFA) | Over 12 months | CA showed better patient acceptance and compliance, making them a preferable option for comfort, though the difference was not significant. |
| Almasoud 2018 [38] | Prospective | N = 64 (32 CA, 32 FA) | 4h, 24h, 3 days and 7 days post appliance insert | In the first week of treatment, Invisalign patients reported less pain than those with passive self-ligating FA. |
| AlSeraidi et al 2021 [57] | Prospective | N = 117 (39 CA, 41 FA, 37 LFA) | 6–9 weeks after appliance insert | CA patients reported the highest OHRQOL scores, followed by LFA then FA appliance patients. |
| Alvarado-Lorenzo et al 2023 [28] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | Differences in the degree, location and type of pain occur based on the type of orthodontic technique used. No statistically significant differences in quality of life between CA and FA patients were found. |
| Angelopoulous et al 2021 [29] | Prospective longitudinal | N = 47 (21 CA, 26 LFA) | Pre-treatment, day 1 and 3 months after appliance insert | Both CA and LFA patients reported quality of life disturbances. LFA patients experienced disturbances that persisted beyond 3 months, while CA patients had greater speech issues that resolved after 3 months. |
| Antonio-Zancajo et al 2020 [23] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | MPQ at 4h, 8h, 24h, 2–7 days after appliance insert. OHIP-14 after first month of treatment. | CA patients demonstrated significantly higher quality of life compared to LFA and ‘low-friction’ FA groups, while these differences were only slightly higher when compared to lingual FA patients. |
| Antonio-Zancajo et al 2021 [24] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | At 4h, 8h, 24h, 2–7 days after starting treatment | Pain was most common in both anterior arches, especially the anterior maxilla, followed by the mandible. FA patients reported mild to moderate pain while CA, LFA and ‘low-friction’ FA groups reported mild pain in the first 24 hours. |
| Basseer et al 2021 [39] | Cross-sectional | N= 150 (32 CA, 118 FA) | Mid-treatment, 1 week after orthodontic review | FA caused more severe pain, sleeping difficulty, sores, and food impaction compared to CA. |
| Bräscher et al 2016 [30] | Cross-sectional | N = 72 (CA only) | 17 ± 9.3 months into treatment | CA patients reported significant reductions in pain intensity, duration, pressure on insertion, improved comfort and reduced impairment with the SmartTrack® material. |
| Caldas et al 2024 [58] | Cross-sectional | N= 94 (CA only) | 1–3 months, 3–6 months and >6 months into treatment | Pain severity significantly affected OHRQOL in adults using CA, however patient satisfaction remained high regardless of this. |
| Chan et al 2024 [48] | Prospective longitudinal | N = 87 (59 CA, 28 FA) | Pre-treatment, 2 days and 7 days after appliance insert over 6 months | Both CA and FA patients experienced similar levels of pain 2 days after commencing treatment. Pain remained minimal in CA patients however pain peaked 2 days after the appointment with each new orthodontic stimulus in FA patients. |
| Correa et al 2024 [25] | Prospective | N= 80 (40 CA, 40 FA) | Pre-treatment and 1 month after starting treatment | Bracket treatment negatively affected OHRQOL one month after starting treatment while CA had no impact on OHRQOL. Anxiety levels were not affected by the orthodontic system used during the first month of treatment. |
| Diddge et al 2020 [55] | Prospective randomised clinical trial | N= 36 (12 CA, 12 FA, 12 self-ligating FA) | 4h, 24h, day 3 and day 4 post-appliance insert | CA patients reported less pain than FA and LFA patients in the first week of treatment. |
| Falconi et al 2020 [31] | Prospective | N= 30 (CA only) | Immediately after CA insert and 24h later | Significant phonetic changes were not seen with F22 aligners. |
| Flores-Mir et al 2018 [44] | Cross-sectional | N= 122 (Number of CA and FA patients not specified) | Immediately after de-banding | Both bracket-based and CA patients experienced similar satisfaction, however CA scored higher for eating and chewing. |
| Fraundorf et al 2022 [45] | Prospective | N= 44 (24 CA, 20 FA) | Pre-treatment, immediately after starting, and at 2 months later | CA significantly affects speech and does not return to normal after 2 months despite some adaptation. |
| Fujiyama et al 2014 [52] | Prospective | N = 145 (38 CA, 55 FA, 52 EIG) | 60s, 6h, 12h, 1–7 days, 3 weeks and 5 weeks after appliance insert, and on completion | CA patients may experience less pain than FA during the initial stages of treatment. Tray deformation must be closely monitored with CA to avoid pain and discomfort for patients. |
| Gao et al 2021 [51] | Prospective | N= 110 (55 CA, 55FA) | Pre-treatment and 2 weeks after commencing treatment | CA patients experienced less pain, less anxiety and higher OHRQOL than FA patients. |
| Hakami 2023 [43] | Cross-sectional | N = 69 (33 CA, 36 FA) | Patients at different stages of treatment | No statistically significant differences were found in sleep quality with different orthodontic appliances. |
| Jaber et al 2022 [40] | Prospective randomised controlled trial | N= 36 (18 CA, 18 FA) | Pre-treatment, 1 week, 2 weeks, 1 month, 6 months, 12 months post appliance insert | OHRQOL was less affected in CA patients than FA patients during the first year of treatment. |
| Johal et al 2024 [32] | Cross-sectional | N = 22 (8 CA, 8 FA, 6 LFA) | 2–6 months and >6 months into treatment then post-treatment | FA, CA and LFA appliances affect adults’ quality of life, particularly in relation to functional and psychosocial aspects. |
| Kumari et al 2024 [56] | Prospective | N = 500 (125 CA, 125 FA, 125 ceramic FA, 125 LFA) | 6–9 weeks after appliance insert | More LFA patients switched to CA, followed by the FA and ceramic FA groups. CA patients reported fewer issues compared to patients in other groups. |
| Lee 2020 [53] | Cross-sectional | N = 30 (10 CA, 10 FA, 10 DTC aligners) | Patients who had completed treatment within the last 12 months | Most patients had positive experiences with orthodontic treatment, leading to increased self-confidence and dental health awareness. |
| Miller et al 2007 [46] | Prospective | N = 60 (33 CA, 27 FA) | Pre-treatment, then daily for 1 week | Adults treated with CA experienced less pain and fewer disruptions to their lives in the first week compared to FA patients. |
| Pachecho-Pereira et al 2018 [47] | Prospective | N = 81 (CA only) | Survey open for 22 months | Improvements in appearance and eating were linked to patient satisfaction, the doctor-patient relationship correlated more with overall satisfaction. |
| Saccomanno et al 2022 [33] | Cross-sectional | N = 257 (67.7% CA, 13% FA, 11.6% ceramic FA, 1.6% LFA) | Patients at various stages of treatment | Relapse after orthodontic treatment increases the need for re-treatment. Oral hygiene habits significantly improve during orthodontic treatment, particularly with CA. |
| Saccomanno et al 2022 [34] | Cross-sectional | N = 175 (CA only) | Previous CA patients | CA offers adults better aesthetics, comfort and satisfaction compared to FA. |
| Schaefer et al 2010 [35] | Prospective | N= 31 (CA only) | At 1st, 3rd, 4th, 6th and 8th visits (3–5 week intervals) | Invisalign® treatment causes only minimal disturbances to overall oral health and quality of life. |
| Shalish et al 2012 [41] | Prospective | N = 68 (21 CA, 28 FA, 19 LFA) | Daily for 1st week and day 14 | Invisalign® patients experienced higher pain levels in the first day after appliance insertion but had fewer oral symptoms, disturbances to daily activities and oral dysfunction compared to the FA group. |
| Wang et al 2023 [54] | Cross-sectional | N = 40 (Number of CA and FA patients not specified) | Pre-treatment and immediately after appliance insert | CA and FA immediately affected perioral soft tissues and speech. |
| Xu et al 2022 [6] | Prospective | N = 102 (62 CA in initial treatment, 40 in refinement) | Pre-treatment then every day for the first week of wearing the initial set of aligners | Pain, anxiety and quality of life were at their lowest during the first first 2 days of CA, but improved over the first week. Factors such as optimised attachments, the number of aligner sets, ICON, and the need for elastics influenced these outcomes. |
| Wexler et al 2020 [49] | Cross-sectional | N = 470 (DTC only) | Patients at different stages of treatment | While many survey respondents would have preferred treatment from a dentist or orthodontist, DTC aligners were chosen for cost and convenience. |
| White et al 2017 [50] | Prospective randomised clinical trial | N = 40 (22 CA, 18 FA) | Immediately after commencing, daily for 1 week, then 4 days after two adjustment visits | FA patients reported more discomfort and used more analgesics compared to those treated with CA. |
| Zamora-Martinez et al 2021 [26] | Prospective longitudinal | N = 120 (30 CA, 30 FA, 30 ceramic FA, 30 LFA) | Pre-treatment, 6 months after commencing and on completion | Patients experienced a significant drop in quality of life during treatment but saw significant improvements by the end of treatment. |
| Author(s) year . | Study design . | Sample . | Time-point of analysis . | Conclusion . |
|---|---|---|---|---|
| Alajmi et al 2020 [36] | Cross-sectional | N = 60 (30 CA, 30 FA) | 1 week after routine appointment | |
| Alcon et al 2021 [27] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | In the first month, labial FA patients reported more pain than CA patients. From the second month onward, CA patients reported more pain. |
| Alfawal et al 2022 [42] | Prospective randomised clinical trial | N = 44 (22 CA, 22 FA) | Pre- treatment, 1 week, 1 month, 3 months, then 6 months after appliance insert | CA patients reported better OHRQOL and shorter treatment duration than FA patients. |
| Alfawzan 2024 [37] | Prospective randomised clinical trial | N = 100 (50 CA, 50 LFA) | Over 12 months | CA showed better patient acceptance and compliance, making them a preferable option for comfort, though the difference was not significant. |
| Almasoud 2018 [38] | Prospective | N = 64 (32 CA, 32 FA) | 4h, 24h, 3 days and 7 days post appliance insert | In the first week of treatment, Invisalign patients reported less pain than those with passive self-ligating FA. |
| AlSeraidi et al 2021 [57] | Prospective | N = 117 (39 CA, 41 FA, 37 LFA) | 6–9 weeks after appliance insert | CA patients reported the highest OHRQOL scores, followed by LFA then FA appliance patients. |
| Alvarado-Lorenzo et al 2023 [28] | Prospective longitudinal | N = 140 (70 CA, 70 FA) | Over 12 months | Differences in the degree, location and type of pain occur based on the type of orthodontic technique used. No statistically significant differences in quality of life between CA and FA patients were found. |
| Angelopoulous et al 2021 [29] | Prospective longitudinal | N = 47 (21 CA, 26 LFA) | Pre-treatment, day 1 and 3 months after appliance insert | Both CA and LFA patients reported quality of life disturbances. LFA patients experienced disturbances that persisted beyond 3 months, while CA patients had greater speech issues that resolved after 3 months. |
| Antonio-Zancajo et al 2020 [23] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | MPQ at 4h, 8h, 24h, 2–7 days after appliance insert. OHIP-14 after first month of treatment. | CA patients demonstrated significantly higher quality of life compared to LFA and ‘low-friction’ FA groups, while these differences were only slightly higher when compared to lingual FA patients. |
| Antonio-Zancajo et al 2021 [24] | Prospective | N= 120 (30 CA, 30 FA, 30 ‘low-friction’ FA, 30 LFA) | At 4h, 8h, 24h, 2–7 days after starting treatment | Pain was most common in both anterior arches, especially the anterior maxilla, followed by the mandible. FA patients reported mild to moderate pain while CA, LFA and ‘low-friction’ FA groups reported mild pain in the first 24 hours. |
| Basseer et al 2021 [39] | Cross-sectional | N= 150 (32 CA, 118 FA) | Mid-treatment, 1 week after orthodontic review | FA caused more severe pain, sleeping difficulty, sores, and food impaction compared to CA. |
| Bräscher et al 2016 [30] | Cross-sectional | N = 72 (CA only) | 17 ± 9.3 months into treatment | CA patients reported significant reductions in pain intensity, duration, pressure on insertion, improved comfort and reduced impairment with the SmartTrack® material. |
| Caldas et al 2024 [58] | Cross-sectional | N= 94 (CA only) | 1–3 months, 3–6 months and >6 months into treatment | Pain severity significantly affected OHRQOL in adults using CA, however patient satisfaction remained high regardless of this. |
| Chan et al 2024 [48] | Prospective longitudinal | N = 87 (59 CA, 28 FA) | Pre-treatment, 2 days and 7 days after appliance insert over 6 months | Both CA and FA patients experienced similar levels of pain 2 days after commencing treatment. Pain remained minimal in CA patients however pain peaked 2 days after the appointment with each new orthodontic stimulus in FA patients. |
| Correa et al 2024 [25] | Prospective | N= 80 (40 CA, 40 FA) | Pre-treatment and 1 month after starting treatment | Bracket treatment negatively affected OHRQOL one month after starting treatment while CA had no impact on OHRQOL. Anxiety levels were not affected by the orthodontic system used during the first month of treatment. |
| Diddge et al 2020 [55] | Prospective randomised clinical trial | N= 36 (12 CA, 12 FA, 12 self-ligating FA) | 4h, 24h, day 3 and day 4 post-appliance insert | CA patients reported less pain than FA and LFA patients in the first week of treatment. |
| Falconi et al 2020 [31] | Prospective | N= 30 (CA only) | Immediately after CA insert and 24h later | Significant phonetic changes were not seen with F22 aligners. |
| Flores-Mir et al 2018 [44] | Cross-sectional | N= 122 (Number of CA and FA patients not specified) | Immediately after de-banding | Both bracket-based and CA patients experienced similar satisfaction, however CA scored higher for eating and chewing. |
| Fraundorf et al 2022 [45] | Prospective | N= 44 (24 CA, 20 FA) | Pre-treatment, immediately after starting, and at 2 months later | CA significantly affects speech and does not return to normal after 2 months despite some adaptation. |
| Fujiyama et al 2014 [52] | Prospective | N = 145 (38 CA, 55 FA, 52 EIG) | 60s, 6h, 12h, 1–7 days, 3 weeks and 5 weeks after appliance insert, and on completion | CA patients may experience less pain than FA during the initial stages of treatment. Tray deformation must be closely monitored with CA to avoid pain and discomfort for patients. |
| Gao et al 2021 [51] | Prospective | N= 110 (55 CA, 55FA) | Pre-treatment and 2 weeks after commencing treatment | CA patients experienced less pain, less anxiety and higher OHRQOL than FA patients. |
| Hakami 2023 [43] | Cross-sectional | N = 69 (33 CA, 36 FA) | Patients at different stages of treatment | No statistically significant differences were found in sleep quality with different orthodontic appliances. |
| Jaber et al 2022 [40] | Prospective randomised controlled trial | N= 36 (18 CA, 18 FA) | Pre-treatment, 1 week, 2 weeks, 1 month, 6 months, 12 months post appliance insert | OHRQOL was less affected in CA patients than FA patients during the first year of treatment. |
| Johal et al 2024 [32] | Cross-sectional | N = 22 (8 CA, 8 FA, 6 LFA) | 2–6 months and >6 months into treatment then post-treatment | FA, CA and LFA appliances affect adults’ quality of life, particularly in relation to functional and psychosocial aspects. |
| Kumari et al 2024 [56] | Prospective | N = 500 (125 CA, 125 FA, 125 ceramic FA, 125 LFA) | 6–9 weeks after appliance insert | More LFA patients switched to CA, followed by the FA and ceramic FA groups. CA patients reported fewer issues compared to patients in other groups. |
| Lee 2020 [53] | Cross-sectional | N = 30 (10 CA, 10 FA, 10 DTC aligners) | Patients who had completed treatment within the last 12 months | Most patients had positive experiences with orthodontic treatment, leading to increased self-confidence and dental health awareness. |
| Miller et al 2007 [46] | Prospective | N = 60 (33 CA, 27 FA) | Pre-treatment, then daily for 1 week | Adults treated with CA experienced less pain and fewer disruptions to their lives in the first week compared to FA patients. |
| Pachecho-Pereira et al 2018 [47] | Prospective | N = 81 (CA only) | Survey open for 22 months | Improvements in appearance and eating were linked to patient satisfaction, the doctor-patient relationship correlated more with overall satisfaction. |
| Saccomanno et al 2022 [33] | Cross-sectional | N = 257 (67.7% CA, 13% FA, 11.6% ceramic FA, 1.6% LFA) | Patients at various stages of treatment | Relapse after orthodontic treatment increases the need for re-treatment. Oral hygiene habits significantly improve during orthodontic treatment, particularly with CA. |
| Saccomanno et al 2022 [34] | Cross-sectional | N = 175 (CA only) | Previous CA patients | CA offers adults better aesthetics, comfort and satisfaction compared to FA. |
| Schaefer et al 2010 [35] | Prospective | N= 31 (CA only) | At 1st, 3rd, 4th, 6th and 8th visits (3–5 week intervals) | Invisalign® treatment causes only minimal disturbances to overall oral health and quality of life. |
| Shalish et al 2012 [41] | Prospective | N = 68 (21 CA, 28 FA, 19 LFA) | Daily for 1st week and day 14 | Invisalign® patients experienced higher pain levels in the first day after appliance insertion but had fewer oral symptoms, disturbances to daily activities and oral dysfunction compared to the FA group. |
| Wang et al 2023 [54] | Cross-sectional | N = 40 (Number of CA and FA patients not specified) | Pre-treatment and immediately after appliance insert | CA and FA immediately affected perioral soft tissues and speech. |
| Xu et al 2022 [6] | Prospective | N = 102 (62 CA in initial treatment, 40 in refinement) | Pre-treatment then every day for the first week of wearing the initial set of aligners | Pain, anxiety and quality of life were at their lowest during the first first 2 days of CA, but improved over the first week. Factors such as optimised attachments, the number of aligner sets, ICON, and the need for elastics influenced these outcomes. |
| Wexler et al 2020 [49] | Cross-sectional | N = 470 (DTC only) | Patients at different stages of treatment | While many survey respondents would have preferred treatment from a dentist or orthodontist, DTC aligners were chosen for cost and convenience. |
| White et al 2017 [50] | Prospective randomised clinical trial | N = 40 (22 CA, 18 FA) | Immediately after commencing, daily for 1 week, then 4 days after two adjustment visits | FA patients reported more discomfort and used more analgesics compared to those treated with CA. |
| Zamora-Martinez et al 2021 [26] | Prospective longitudinal | N = 120 (30 CA, 30 FA, 30 ceramic FA, 30 LFA) | Pre-treatment, 6 months after commencing and on completion | Patients experienced a significant drop in quality of life during treatment but saw significant improvements by the end of treatment. |
Key: FA = Fixed appliances, CA = Clear aligners, LFA = Lingual fixed appliances, EIG = Edgewise and Invisalign Group, DTC = Direct-to-consumer aligners
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