The younger the child, the better for clear aligner therapy? A new study gives insights

You will witness two peculiar subjects being discussed in this article. One, the highly controversial conduct of interceptive orthodontics for kids with mixed dentition, and two, the even more disputed practice of promoting clear aligner treatment in young children.

But first, let’s take a look at what interceptive orthodontics encompasses. Defining this in simple terms would look something like this; “to intercept something” is the act of obstructing or preventing something from happening. Interceptive orthodontics, or more conveniently named preventative orthodontics adheres to the same principle.

Orthodontists use early orthodontic interventions to identify potential malocclusion issues in the developing dentition and suppress or correct any of these unfavorable changes. By intercepting early on when the child’s bite has not completely developed yet, they can successfully eliminate or reduce the severity of bite issues down the line.

While all that is good and dandy, using clear aligners to correct children’s bite issues has been a subject of great contention. This study gives us an insight into the effectiveness of clear aligner treatment for children presenting with mixed dentition.

This 2023 study originates from a team of six researchers from the Department of Orthodontics of Virginia Commonwealth University in the United States. The American Journal of Orthodontics & Dentofacial Orthopedics (AJO-DDO) published this paper.

Clear aligner therapy in the mixed dentition: Indications and practitioner perspectives

by Nicholas M. Lynch, Bhavna Shroff, Caroline K. Carrico, Vincent Sawicki, Morgan Sabol, Steven J. Lindauer

AJO-DDO. 2023; https://doi.org/10.1016/j.ajodo.2022.11.018

Objective of the study

Studies suggest that the jaw bones of children between the ages of 4 and 11 are actively in the growing phase, therefore, pediatric orthodontists believe that by correcting their occlusion at this stage, they can significantly reduce the complexity of orthodontic treatment in the future while also cutting down treatment time and cost.

The authors of this study embarked on this journey to prove or refute this hypothesis.

They listed the objective of this study as:

“To evaluate current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors.”

Materials and methods

They carried out a cross-sectional survey of orthodontists by using a 22-item survey.

The survey was mailed to:

• A representative sample of practicing orthodontists (n=800)
• A randomized subsample of high-aligner-prescribing orthodontists (n=200)

This sample pool was identified from the AAO online data or Align Technologies Invisalign provider website. They sent out the first survey and six weeks later followed up with a repeat mail.

Results

Out of the 1000 orthodontists that were surveyed, 181 responded to the survey over 12 weeks. The resulting response rate was 18.1%.

The results of this survey revealed a few interesting things:

• The total number of patients that were treated with clear aligners was 31% while 69% were being treated with fixed appliances.
• 21% of the patients underwent phase I treatment in the mixed dentition.
• 13% of patients were treated with clear aligner treatment in the mixed dentition (CAMD) while 85% were treated with fixed appliances.
• Most of the respondents were inclined towards the use of fixed appliances rather than CAMD for all clinical issues except spacing and diastemas.
• The least commonly selected reason for CAMD was sagittal correction.
• There were no observed differences between the treatments for compliance or treatment duration between the two treatment options.
• Oral hygiene was better with CAMD than with fixed appliances.

Outcomes

CAMD was found to be much less used as compared to fixed appliances for mixed dentition. However, respondents predicted an increase in their future CAMD.

Most respondents expressed that CAMD was less useful than fixed appliances for growth modification, skeletal expansion, and habit cessation.

Final thoughts

This paper was fully derived from the real-life experiences of practitioners. Due to this, we believe that this study was monumental in the sense that it described what works in the practical world and what does not.

Most orthodontists reportedly did not use CAMD for all forms of interceptive treatment but did use them for simple occlusion problems. This gives us an insight into the ironic popularity/disfavor dynamic of clear aligner use in treating children’s malalignment.

However, since the response rate collected in this study was low, we can only hope that more dentists make use of CAMD over fixed braces. Nevertheless, more research needs to be done on the effectiveness of clear aligners in mixed dentition.