Clear braces have been widely used in orthodontic treatment in recent years, and compared to traditional metal braces, clear braces offer advantages such as aesthetics and comfort, making them particularly popular among patients, especially young patients [18]. However, clear braces usage can lead to oral health issues such as gingivitis during treatment [7, 8, 19], which has raised concerns among clinicians and researchers. Gingivitis, as a common oral disease, if not promptly treated, can progress to more severe periodontal diseases, impacting the patient's oral health [7, 8, 19]. Therefore, studying the relationship between clear braces and the incidence of gingivitis and exploring effective preventive measures holds significant clinical and scientific importance.
Previous studies have presented differing views on the relationship between clear braces and the incidence of gingivitis. Some studies have found a higher incidence of gingivitis among users of clear braces, suggesting that clear braces may increase plaque accumulation, leading to gingivitis [7]. However, there are also studies that have not found a significant difference in the incidence of gingivitis with the use of clear braces [8, 15, 20]. In this study, through a comparison of two groups of adolescents and adults, it was found that the incidence of gingivitis was significantly higher in the adolescent group compared to the adult group (Fig. 4). This finding aligns with some previous research results but differs from others. Analyzing the similarities and differences in various research findings can provide a more comprehensive understanding of the impact of clear braces on gingival health.
This study has several strengths in its design. Firstly, the study included a relatively large sample of 120 patients who underwent clear braces orthodontic correction in the Department of Stomatology from June 2018 to September 2023, which allows for a better reflection of real-world situations. Secondly, the study employed a strict grouping method, dividing patients into adolescent and adult groups, further subdivided into study and control groups within each group. Additionally, the study also included routine periodontal treatment and oral hygiene guidance, making the intervention measures comprehensive. By evaluating the GI and the incidence of gingivitis, the study could provide a comprehensive reflection of the impact of clear braces on gingival health.
The results of the study showed that the incidence of gingivitis was significantly higher in the adolescent group compared to the adult group. This finding may be related to the physiological characteristics of adolescents, their oral hygiene habits, and poorer compliance. Adolescents are in a period of growth and development, with significant fluctuations in hormone levels that may make their gums more sensitive to inflammation. Additionally, adolescents may have less disciplined oral hygiene habits compared to adults; improper brushing techniques may lead to plaque accumulation, increasing the risk of gingivitis. Combined with past literature, further analysis of the reasons why adolescents are more prone to gingivitis can provide targeted prevention and intervention measures for clinical practice.
Furthermore, this study also found that the use of clear braces showed significant changes in the gingival health index, especially in the study group of adolescents, where the increase in the GI was more pronounced. This may indicate that while clear braces offer convenience and aesthetics for teeth correction, their impact on the periodontal environment should not be overlooked. Therefore, enhancing personalized oral hygiene education and regular periodontal examinations are crucial for preventing periodontal diseases during orthodontic treatment. The design and use of clear braces should take into account the biomechanical characteristics of teeth to ensure that each tooth's movement is within a safe biological pressure range. Future research should further explore the specific impact of clear braces with different designs on gingival health and how to improve designs to reduce their negative effects on the gums.
This study also found that personalized oral hygiene education played a positive role in reducing the incidence of gingivitis, especially with significant effects observed in the adolescent group. Through the comparison of the study group and the control group, personalized education significantly reduced the occurrence of gingivitis. This indicates that developing personalized oral hygiene guidance plans tailored to individual patient characteristics is an important measure for preventing gingivitis. In clinical practice, it is essential to enhance oral hygiene education for users of clear braces, particularly targeting adolescents with tailored guidance and education based on their specific needs.
The results of this study have significant implications for clinical practice. Firstly, they highlight the need for clinicians to pay attention to the gingival health issues of adolescents when providing clear braces orthodontic treatment. Secondly, there is an emphasis on strengthening personalized oral hygiene education to prevent and reduce the occurrence of gingivitis, ultimately improving patient treatment compliance and outcomes. By implementing personalized oral hygiene guidance, the incidence of gingivitis can be significantly reduced, enhancing the overall effectiveness of clear braces orthodontic treatment.
However, this study does have some limitations. Firstly, while the sample size was relatively large, it is still limited, which may affect the generalizability of the study results. Secondly, the study duration was relatively short, and longer-term changes in gingival health could not be observed. Additionally, the study focused mainly on a specific region, and regional and cultural differences may impact the generalizability of the results. Future research should consider larger-scale, multi-center, long-term follow-up studies to further validate and expand the findings of this study. Furthermore, exploring other related factors such as dietary habits, genetic factors, and psychological factors' impact on the incidence of gingivitis is important.
In conclusion, this study found that adolescents are more prone to developing gingivitis during clear braces orthodontic treatment compared to adults, and personalized oral hygiene education can effectively reduce the incidence of gingivitis. This finding holds significant scientific value and clinical applicability. It is recommended that clinicians pay special attention to the gingival health of adolescent patients during clear braces orthodontic treatment and enhance personalized oral hygiene education to prevent gingivitis. Furthermore, future research in larger and more diverse populations is encouraged to validate and expand these findings to provide a stronger scientific basis for the safety and effectiveness of clear braces orthodontic treatment.