Comparison of Clear Aligners and Fixed Orthodontic Appliances from the Patient's Perspective: A Questionnaire-Based Study

Year 2025, Volume: 52 Issue: 2, 111 - 119, 31.08.2025

Irmak Ocak , Semih Demirci , İsmail Seymen Büşra Uysal

https://doi.org/10.52037/eads.2025.0017

Abstract

Purpose: This study aimed to evaluate and compare the treatment experiences of individuals receiving orthodontic care with either clear aligners or fixed appliances.
Materials and Methods: This cross-sectional study included 90 individuals aged 12–20 years undergoing active orthodontic treatment (clear aligners: n=45; fixed appliances: n=45). A face-to-face questionnaire comprising Likert-type, and multiple-choice items was administered to assess pain, oral hygiene, and ease of appliance use. Non-parametric continuous variables were analyzed with the Mann–Whitney U test, whereas categorical variables were evaluated using Chi-square and linear-by-linear association tests. A p-value of <0.05 was considered statistically significant.
Results: Pain during functional activities was significantly more pronounced in the fixed appliance group. Gingival bleeding and intraoral injuries were also more frequently reported in this group (p=0.004 and p=0.049, respectively). Conversely, speech impairment and halitosis were more commonly observed among clear aligner users (p=0.040 and p=0.007, respectively). Tooth brushing difficulty and the use of auxiliary oral hygiene tools were more prevalent in the fixed appliance group. The frequency of emergency-related additional appointments was significantly lower in the clear aligner group (p=0.023). No statistically significant differences were found between the groups regarding the impact on social life or willingness to recommend the treatment method (p>0.05).
Conclusion: This study demonstrated that clear aligners and fixed appliances exert significantly different effects on patient experience across multiple domains. These findings underscore the importance of incorporating not only biomechanical considerations but also individual patient factors—such as lifestyle, communication needs, and oral hygiene routines—into orthodontic treatment planning.

Keywords

Clear aligner , fixed orthodontics , patient satisfaction , oral hygiene

References

• Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta-analysis. Orthod Craniofac Res. 2017;20(3):127–133. doi:10.1111/ocr.12177.
• Flores-Mir C, Brandelli J, Pacheco-Pereira C. Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances. Am J Orthod Dentofacial Orthop. 2018;154(5):639–644. doi:10.1016/j.ajodo.2018.01.013.
• Qiuying L, Yugui D, Kai Y. Patient Satisfaction and Oral Health-Related Quality of Life in Fixed vs. Clear Aligner Therapy. Ann Orthod Periodont Spec. 2024;4(1):26–31. doi:10.51847/NcuofphBQC.
• Ben Gassem AA. Does Clear Aligner Treatment Result in Different Patient Perceptions of Treatment Process and Outcomes Compared to Conventional/Traditional Fixed Appliance Treatment: A Literature Review. Eur J Dent. 2022;16(2):274–285. doi:10.1055/s-0041-1739441.
• Cardoso PC, Espinosa DG, Mecenas P, Flores-Mir C, Normando D. Pain level between clear aligners and fixed appliances: a systematic review. Prog Orthod. 2020;21(1):3. doi:10.1186/s40510-019-0303-z.
• Kim JE, Kim S, Kim DH. Comparison of oral health status, oral hygiene management behaviours and satisfaction of patients with fixed orthodontic appliance and clear aligner: A quasi-experimental design. Int J Dent Hyg. 2024;22(4):939–948. doi:10.1111/idh.12813.
• von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–1457. doi:10.1016/s0140-6736(07)61602-x.
• Almasoud NN. Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign(®) aligners during the first week of orthodontic treatment. Korean J Orthod. 2018;48(5):326–332. doi:10.4041/kjod.2018.48.5.326.
• Albino JEN. Factors influencing adolescent cooperation in orthodontic treatment. Semin Orthod. 2000;6(4):214–223. doi:10.1053/sodo.2000.19007.
• Yassir YA, McIntyre GT, Bearn DR. The impact of labial fixed appliance orthodontic treatment on patient expectation, experience, and satisfaction: an overview of systematic reviews. Eur J Orthod. 2020;42(3):223–230. doi:10.1093/ejo/cjz043.
• Agrawal M, Sharma S, Rathod P. Periodontally Accelerated Osteogenic Orthodontics (PAOO) vs Osteoperforations (A Review on Periodontal Reactions to Orthodontic Tooth Movement). AJRSP. 2021;3:36–51. doi:10.52132/Ajrsp.e.2021.32.2.
• Shalish M, Cooper-Kazaz R, Ivgi I, Canetti L, Tsur B, Bachar E, et al. Adult patients’ adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign™. Eur J Orthod. 2012;34(6):724–730. doi:10.1093/ejo/cjr086.
• Miller KB, McGorray SP, Womack R, Quintero JC, Perelmuter M, Gibson J, et al. A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment. Am J Orthod Dentofacial Orthop. 2007;131(3):302.e1–302.e9. doi:10.1016/j.ajodo.2006.05.031.
• Pereira D, Machado V, Botelho J, Proença L, Mendes JJ, Delgado AS. Comparison of Pain Perception between Clear Aligners and Fixed Appliances: A Systematic Review and Meta-Analysis. Applied Sciences. 2020;10(12):4276. doi:10.3390/app10124276.
• Jiang Q, Li J, Mei L, Du J, Levrini L, Abbate GM, et al. Periodontal health during orthodontic treatment with clear aligners and fixed appliances: A meta-analysis. J Am Dent Assoc. 2018;149(8):712–720.e12. doi:10.1016/j.adaj.2018.04.010.
• Miethke RR, Brauner K. A Comparison of the periodontal health of patients during treatment with the Invisalign system and with fixed lingual appliances. J Orofac Orthop. 2007;68(3):223–231. doi:10.1007/s00056-007-0655-8.
• Crego-Ruiz M, Jorba-García A. Assessment of the periodontal health status and gingival recession during orthodontic treatment with clear aligners and fixed appliances: A systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal. 2023;28(4):e330–e340. doi:10.4317/medoral.25760.
• Oikonomou E, Foros P, Tagkli A, Rahiotis C, Eliades T, Koletsi D. Impact of Aligners and Fixed Appliances on Oral Health during Orthodontic Treatment: A Systematic Review and Meta-Analysis. Oral Health Prev Dent. 2021;19:659–672. doi:10.3290/j.ohpd.b2403661.
• Buschang PH, Chastain D, Keylor CL, Crosby D, Julien KC. Incidence of white spot lesions among patients treated with clear aligners and traditional braces. Angle Orthod. 2019;89(3):359–364. doi:10.2319/073118-553.1.
• Contaldo M, Lucchese A, Lajolo C, Rupe C, Di Stasio D, Romano A, et al. The Oral Microbiota Changes in Orthodontic Patients and Effects on Oral Health: An Overview. J Clin Med. 2021;10(4):780. doi:10.3390/jcm10040780.
• Wang G, Fang D, Yin X, Flores-Mir C. A 3.5-year follow-up of an unusual case of rampant caries during clear aligner treatment. Aust Orthod J. 2023;39:171–182. doi:10.2478/aoj-2023-0017.
• Lu H, Tang H, Zhou T, Kang N. Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed appliances and Invisalign system: A meta-analysis. Medicine (Baltimore). 2018;97(13):e0248. doi:10.1097/md.0000000000010248.
• Alajmi S, Shaban A, Al-Azemi R. Comparison of Short-Term Oral Impacts Experienced by Patients Treated with Invisalign or Conventional Fixed Orthodontic Appliances. Med Princ Pract. 2020;29(4):382–388. doi:10.1159/000505459.
• Buschang PH, Shaw SG, Ross M, Crosby D, Campbell PM. Comparative time efficiency of aligner therapy and conventional edgewise braces. Angle Orthod. 2014;84(3):391–396. doi:10.2319/062113-466.
• D’Antò V, Bucci R, De Simone V, Huanca Ghislanzoni L, Michelotti A, Rongo R. Evaluation of Tooth Movement Accuracy with Aligners: A Prospective Study. Materials. 2022;15(7):2646. doi:10.3390/ma15072646.