Impact of Clear Aligners on Gingivitis Incidence and Prevention Strategies in Adolescents and Adults: An Observational Study

Impact of Clear Aligners on Gingivitis Incidence and Prevention Strategies in Adolescents and Adults: An Observational Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Clear Aligners on Gingivitis Incidence and Prevention Strategies in Adolescents and Adults: An Observational Study Haiying Zhang, Shuangyan Bi, Xiaojun Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4643869/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jan, 2025 Read the published version in BMC Oral Health → Version 1 posted 4 You are reading this latest preprint version Abstract Objective: This study aims to analyze the differences in gingivitis incidence among adolescents and adults using clear aligners for orthodontic correction and to evaluate the effectiveness of prevention strategies on orthodontic outcomes. Methods: This observational study included 120 patients undergoing clear aligner orthodontic treatment from June 2018 to September 2023. Participants were divided into an adolescent group (66 cases) and an adult group (54 cases), each further split into a study group and a control group. Routine periodontal treatment and personalized oral hygiene education were provided, and the incidence of gingivitis was evaluated six months post-treatment. Results: The incidence of gingivitis was significantly higher in the adolescent group compared to the adult group (P<0.05). Specifically, within the adolescent group, the study group exhibited a higher gingival index (GI) than the control group (P<0.05), while the difference in the adult group was not significant. Conclusion: Adolescents using clear aligners are more prone to gingivitis compared to adults. Personalized oral hygiene education significantly reduces gingivitis incidence, particularly in adolescents. Clear Aligners Orthodontics Gingivitis Prevention Periodontal Treatment Oral Hygiene Figures Figure 1 Figure 2 Figure 3 Figure 4 Highlights This study provides a detailed comparison for the first time of the impact of clear braces correction on gingival health in adolescents and adults. The analysis focuses on the direct association between the use of orthodontic appliances and the occurrence of gingivitis, identifying scientific questions and research objectives. It is clearly pointed out that the incidence of gingivitis in the adolescent group is significantly higher than in the adult group, providing important data for orthodontic treatment. Personalized oral hygiene education was found to effectively reduce the incidence of gingivitis in the adolescent group. The importance and scientific value of developing prevention strategies for different age groups are emphasized, providing guiding significance for clinical orthodontic treatment. Introduction Orthodontic treatment in dentistry is not only an important field of modern dental medicine but also a key factor affecting individual social and psychological health and overall quality of life [ 1 , 2 , 3 ]. Orthodontic treatment, by adjusting the position of teeth and jaws, can improve bite relationships and oral function and significantly enhance facial aesthetics for patients [ 4 ]. With the advancement of medical technology, clear braces technology - as an innovative method of orthodontic treatment - is gradually becoming the preferred orthodontic method for adolescent and adult patients due to its excellent concealment and comfort. This technology uses transparent aligners designed and manufactured with computer assistance to precisely control tooth movement without being noticeable, optimizing treatment outcomes [ 5 , 6 ]. Despite the numerous advantages of clear braces, a high incidence of gingivitis during orthodontic treatment is a significant issue that cannot be ignored [ 7 , 8 , 9 ]. The presence of appliances and attachments not only increases the difficulty of teeth cleaning but may also lead to the accumulation of dental plaque [ 10 , 11 ]. Attachments bonded to the tooth surfaces and excess adhesive may impede effective brushing, leading to the buildup of dental plaque and food debris, thereby causing gingivitis [ 12 , 13 , 14 ]. Additionally, discomfort in the gums when first using the aligners may lead to symptoms such as redness and swelling [ 15 ]. Therefore, although clear braces offer new possibilities for orthodontic treatment, they also bring new challenges, particularly in the management of periodontal health. In order to address these challenges, personalized oral health guidance and dental health education are particularly important [ 16 , 17 ]. These measures can significantly reduce the incidence of gingivitis, especially in the special population of adolescents. Adolescents often have deficiencies in independence and compliance, and they need treatment under the shared supervision of parents and healthcare professionals. Parental support and cooperation, as well as regular monitoring and professional guidance from doctors, are crucial factors in preventing gingivitis during orthodontic treatment. Through comprehensive education and management measures, not only can the occurrence of gingivitis be effectively reduced, but the safety and effectiveness of the entire orthodontic treatment can also be enhanced. With the improvement of living standards and the increasing emphasis on health and aesthetics, there is a growing demand from the public for high-quality dental orthodontic treatment. Orthodontic treatment is no longer limited to just "straightening teeth," but also considers the functional and aesthetic aspects of treatment and its impact on oral and overall health. The development of clear braces orthodontic technology not only provides new treatment options but also advances scientific research and clinical practice in the field of orthodontics. In response to the potential gingivitis issues that may arise during the use of clear braces, this study analyzed in detail the incidence of gingivitis before and after orthodontic treatment in 120 patients, exploring its impact on periodontal health and provide more scientific guidance and optimized orthodontic solutions for clinical practice. The purpose of this study is to comprehensively evaluate the application effectiveness of clear braces orthodontic technology in different populations, particularly in the prevention and management of gingivitis. By deeply analyzing the mechanisms and influencing factors of gingivitis and evaluating the effectiveness of various prevention measures, this study aims to provide more refined health management strategies for orthodontic treatment, ensuring that patients can enjoy a safe and effective treatment process while pursuing aesthetics. Materials and Methods Criteria for Participant Selection This study included 120 patients who underwent clear braces orthodontic treatment in the Department of Stomatology from June 2018 to September 2023. These patients were divided into two groups: an adolescent group of 66 cases, with an average age of approximately 14.2 years, and an adult group of 54 cases, with an average age of approximately 25.7 years. Each group was further divided into a study group and a control group, with 33 cases in each subgroup for the adolescent group and 27 cases in each subgroup for the adult group. The inclusion criteria for the study were as follows: 1. Patients had no systemic diseases or history of metal allergies. 2. Patients had not been exposed to nickel-contaminated environments. 3. There were no other metal restorations in the oral cavity. 4. Patients did not have a history of alcohol consumption or smoking. 5. Body mass index (BMI) was within normal range. 6. Apart from the third molars, there were no impacted or congenitally missing teeth. 7. Patients could understand the purpose of the study and actively participate in the research process. 8. Consent had been obtained from the patients and their guardians. By applying these detailed selection criteria, the adaptability and consistency of the study subjects were ensured, providing a reliable foundation for the study results (Fig. 1 ). Experimental Control and Random All study participants were randomly assigned to either the study group or the control group using a computer-generated random number table upon being enrolled in the study. This random assignment was conducted to ensure that they were evenly distributed between the two groups. Participants were not informed of which group they belonged to, and all assessments and treatments were carried out by specifically trained medical staff following standard operating procedures. Detailed Definition and Measurement of Variables The Gingival Index (GI) score was assessed using standardized periodontal probes and specific guidelines, such as the AAP Periodontal Disease Classification System. The GI categorizes the severity of gingivitis into four levels, 0–3, where 0 represents gingival health, 1 represents mild inflammation, 2 represents moderate inflammation, and 3 represents severe inflammation. Baseline measurement: Initial assessment was conducted before orthodontic treatment to ensure that all participants had a GI score of 0. Follow-up assessments: Evaluation performed at each follow-up visit after the start of treatment (every 1.5 months) until the end of the study. Post-treatment assessment: Final GI assessment conducted immediately after the completion of orthodontic treatment and compared with baseline and interim assessment results. Data recording and storage: All data were electronically recorded and kept by a data manager in a secure database for future statistical analysis and validation. Specific Process In this study, all participants underwent a comprehensive periodontal health assessment before orthodontic treatment, including supra- and subgingival scaling and root planing, to ensure that the GI for each patient was 0 prior to wearing the orthodontic appliance. The assessment and treatment were administered by periodontal specialists who had received specific training using standardized periodontal tools (ultrasonic scalers and hand scalers). Tooth selection for pre-treatment assessment followed the Ramfjord teeth index (teeth 16, 21, 24, 36, 41, 44), which served as representative teeth for regular periodontal health tracking. The control group patients maintained their daily lifestyle throughout the study period. At each follow-up visit, the entire dentition of the patients was coated with alkaline fuchsin solution, followed by rinsing. The same periodontal specialist then performed necessary supra- and subgingival scaling and root planing treatments based on the periodontal health condition to eliminate factors contributing to periodontal disease. The study group received personalized oral hygiene education and guidance on self-care techniques at each follow-up visit, including proper brushing techniques, flossing, and the use of oral irrigation devices. Both groups had a follow-up interval of every 1.5 months. At follow-up visits, all patients were assessed for GI by the same experienced periodontal specialist following the guidelines of Clinical Periodontology, 2nd edition. The scoring criteria for GI were defined as follows: 0 indicated healthy gums; 1 indicated mild inflammation with slight color change and swelling, no bleeding upon probing; 2 indicated moderate inflammation with redness and significant swelling, bleeding upon probing; 3 indicated severe inflammation with marked redness, swelling, or ulceration, and spontaneous bleeding. After six months of orthodontic treatment, another oral examination was conducted, and the GI value was measured again to evaluate changes in gingival health during the treatment period. Statistical Processing In order to enhance the rigor and reliability of the statistical analysis, this study first conducted tests for normality on the data (such as the Shapiro-Wilk test) to ensure that the data met the requirements of normal distribution before using t-tests. Additionally, a test for homogeneity of variances (Levene's test) was performed to decide whether to use the equal variance or unequal variance version of the t-test. Multiple comparison correction methods, such as Bonferroni correction, were employed to reduce Type I errors for comparisons between multiple groups. All statistical analyses were carried out using the latest version of the SPSS software to ensure the accuracy and efficiency of the analysis. A significance level of P < 0.05 was considered statistically significant. Results Comparison of the Incidence Rate of Gingivitis in Different Age Groups Based on the data collected in this study (Table 1 ), we compared the incidence of gingivitis in the adolescent group and the adult group after using clear braces for correction. The results showed that in the adolescent group, out of 66 cases, 26 cases developed gingivitis (Fig. 2 a), accounting for 39.39%, while in the adult group, out of 54 cases, 38 cases had gingivitis (Fig. 2 b), reaching a rate of 70.04%. Overall, among the 120 patients, 54 cases experienced gingivitis, resulting in an overall incidence rate of 50.00% (Fig. 2 c). Table 1 Comparison of Gingivitis Incidence Between Adolescents and Adults. Group Number of Gingivitis Cases Number of Normal Cases Total Percentage (%) Adolescent Group 26 40 66 39.39 Adult Group 38 16 54 70.04 Total 54 56 120 50.00 2 11.45 P-value < 0.05 The results of the chi-square test used in the statistical analysis showed a P-value less than 0.05, indicating a significant difference in the incidence of gingivitis between the adolescent group and the adult group. Specifically, the incidence of gingivitis in the adult group was significantly higher than in the adolescent group. This result may be related to differences in adaptation to the orthodontic appliance, oral hygiene habits, and physiological responses between adults and adolescents. In conclusion, during the process of clear braces correction, the incidence of gingivitis in adult patients is significantly higher than in adolescent patients. This finding highlights the importance for adults undergoing clear braces correction to pay closer attention to the management of periodontal health and the implementation of preventive measures. Analysis of GI Changes during Clear Braces Correction In this study, we conducted a comparative analysis of the GI) in the study group and control group of the adolescent and adult groups before and after treatment (Table 2 ). The data showed that the changes in GI before and after treatment exhibited statistically significant differences among the groups. Table 2 Comparison of Gingival Index (GI) Between Study and Control Groups in Adolescents and Adults. Group Number of Cases GI t-value P-value Before Treatment During Treatment Adolescent Group Control Group 33 0.15 ± 0.07 0.59 ± 0.19 -2.12 < 0.05 Study Group 33 0.17 ± 0.05 1.49 ± 0.25 -5.32 0.05 0.05 Study Group 27 1.18 ± 0.14 1.42 ± 0.20 -2.21 0.05 > 0.05 In the adolescent group, in the control group, the GI increased from an average of 0.15 before treatment to 0.59 during treatment, with the standard deviation increasing from 0.07 to 0.19. The t-value was − 2.12, and the P-value was less than 0.05, indicating a significant increase in the risk of gingivitis during treatment. In the study group, the GI increased from 0.17 to 1.49, with a standard deviation increase from 0.05 to 0.25. The t-value was − 5.32, with a P-value less than 0.05, showing a more significant change. The comparison of GI during treatment between the two groups had a t-value of -2.78, with a P-value less than 0.05, indicating a more significant increase in the risk of gingivitis in the study group. In the adult group, in the control group, the GI increased from 1.19 before treatment to 1.42 during treatment, with the standard deviation increasing from 0.17 to 0.21. The t-value was − 2.03, and the P-value was greater than 0.05, indicating that the change was not statistically significant. Similarly, in the study group, the GI increased from 1.18 to 1.42, with a standard deviation increase from 0.14 to 0.20. The t-value was − 2.21, but the P-value was less than 0.05, indicating that the change in GI in this group was statistically significant. The comparison of GI between the two groups in the adult group had a t-value close to zero, and the P-value was greater than 0.05, showing no significant difference in the change before and after treatment. In summary, the use of clear braces in the adolescent group resulted in a more significant increase in the risk of gingivitis, while in the adult group, although the study group showed some increase in risk, the change in the control group was not significant (Fig. 3 ). This result emphasizes the need for more effective preventive measures to manage gingival health during clear braces correction in adolescents Discussion 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. Declarations Ethical Statement This study was approved by the Clinical Ethics Committee of Zhaoqing Medical College (No. 202004031206). Funding This study was supported by Zhaoqing Science and Technology Innovation Guidance Category Project ((2020) No. 26 202004031206). Acknowledgment We would like to thank the Zhaoqing Science and Technology Innovation Guidance Category Project ((2020) No. 26 202004031206) for their financial support, which made this study possible. We also express our gratitude to the staff at Zhuhai Times Xianghua Dental Clinic and Zhengzhou Stomatological Hospital for their assistance with patient recruitment and data collection. Special thanks to all the patients who participated in this study for their cooperation and commitment. Additionally, we appreciate the valuable input and support from our colleagues at Zhaoqing Medical College. Conflict of Interest The authors declare that they have no conflicts of interest regarding the publication of this paper. Data Availability The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request. Author Contributions Haiying Zhang and Shuangyan Bi conceived and designed the study. Xiaojun Zhang, Shuangyan Bi, and Haiying Zhang performed the experiments. Xiaojun Zhang and Haiying Zhang analyzed the data. Haiying Zhang and Shuangyan Bi wrote the manuscript. All authors reviewed and approved the final version of the manuscript. References Park JH, Kim JH, Rogowski L, Al Shami S, Howell SEI. Implementation of teledentistry for orthodontic practices. J World Fed Orthod. 2021;10(1):9–13. 10.1016/j.ejwf.2021.01.002 . Siddiqui TA, Sukhia RH, Ghandhi D. Artificial intelligence in dentistry, orthodontics and Orthognathic surgery: A literature review. J Pak Med Assoc. 2022;72(Suppl 1):S91–6. 10.47391/JPMA.AKU-18 . Fernandes EC, Nascimento Júnior MB, Paiva Tôrres ACS, Nóbrega FJO, Santos PB. The 100 most-cited articles in orthodontic journals in the last 20 years. Am J Orthod Dentofac Orthop. 2022;161(3):e260–76. 10.1016/j.ajodo.2021.08.016 . Ahmed M, Shaikh A, Fida M. Evaluation of conformity of preformed orthodontic archwires and dental arch form. Dent Press J Orthod. 2019;24(1):44–52. 10.1590/2177-6709.24.1.044-052.oar . Lyu X, Cao X, Yan J, Zeng R, Tan J. Biomechanical effects of clear aligners with different thicknesses and gingival-margin morphology for appliance design optimization. Am J Orthod Dentofac Orthop. 2023;164(2):239–52. 10.1016/j.ajodo.2022.12.014 . Shirey N, Mendonca G, Groth C, Kim-Berman H. Comparison of mechanical properties of 3-dimensional printed and thermoformed orthodontic aligners. Am J Orthod Dentofac Orthop. 2023;163(5):720–8. 10.1016/j.ajodo.2022.12.008 . Santonocito S, Polizzi A. Oral Microbiota Changes during Orthodontic Treatment. Front Biosci (Elite Ed). 2022;14(3):19. 10.31083/j.fbe1403019 . Rouzi M, Zhang X, Jiang Q, Long H, Lai W, Li X. Impact of Clear Aligners on Oral Health and Oral Microbiome During Orthodontic Treatment. Int Dent J. 2023;73(5):603–11. 10.1016/j.identj.2023.03.012 . Castroflorio T, Sedran A, Parrini S et al. Predictability of orthodontic tooth movement with aligners: effect of treatment design [published correction appears in Prog Orthod. 2023;24(1):47. 10.1186/s40510-023-00499-8] . Prog Orthod. 2023;24(1):2. Published 2023 Jan 16. doi:10.1186/s40510-022-00453-0. Kramer A, Splieth C. Health promotion through structured oral hygiene and good tooth alignment. GMS Hyg Infect Control. 2022;17. 10.3205/dgkh000411 . :Doc08. Published 2022 May 10. Al Hariri MH, Karkoutly M, Al Kurdi S, Alkassar M, Bshara N. The efficacy of the dental Water Jet, orthodontic, and conventional toothbrushes in plaque removal around orthodontic braces in adolescents: A randomized controlled trial. Clin Exp Dent Res. 2023;9(4):606–13. 10.1002/cre2.752 . Mehrotra N, Singh S. Periodontitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 1, 2023. Alzanbaqi SD, Alogaiel RM, Alasmari MA, et al. Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses. Int J Environ Res Public Health. 2022;19(5):2838. 10.3390/ijerph19052838 . Published 2022 Feb 28. Verhoeff MC, Eikenboom D, Koutris M, et al. Parkinson's disease and oral health: A systematic review. Arch Oral Biol. 2023;151:105712. 10.1016/j.archoralbio.2023.105712 . Martin C, Littlewood SJ, Millett DT, et al. Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database Syst Rev. 2023;5(5):CD002283. 10.1002/14651858.CD002283.pub5 . Published 2023 May 22. Aminoshariae A, Nosrat A, Nagendrababu V, et al. Artificial Intelligence in Endodontic Education. J Endod. 2024;50(5):562–78. 10.1016/j.joen.2024.02.011 . Upton JEM, Lanser BJ, Bird JA, Nowak-Węgrzyn A. Baked Milk and Baked Egg Survey: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. J Allergy Clin Immunol Pract. 2023;11(8):2335–e23444. 10.1016/j.jaip.2023.04.055 . Kau CH, Wang Z, Wang J, Krishnan DG. Contemporary management of an orthodontic-orthognathic patient with limited time availability in an orthodontic office setting: Case report. J Orthod. 2020;47(3):257–64. 10.1177/1465312520934488 . Putrino A, Barbato E, Galluccio G. Clear Aligners: Between Evolution and Efficiency-A Scoping Review. Int J Environ Res Public Health. 2021;18(6):2870. Published 2021 Mar 11. 10.3390/ijerph18062870 . Gopalakrishnan U, Felicita S, Ronald B, Appavoo E, Patil S. Microbial Corrosion in Orthodontics. J Contemp Dent Pract. 2022;23(6):569–71. Published 2022 Jun 1. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Jan, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 10 Jul, 2024 Editor assigned by journal 28 Jun, 2024 Submission checks completed at journal 28 Jun, 2024 First submitted to journal 26 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4643869","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":325144530,"identity":"fb99d7fc-95df-4ab7-a544-012da692337a","order_by":0,"name":"Haiying Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBACAwYGNhCdwMDMwHCAgcGGh5+/gTQtaTKSMw4QqwUCDtsYNCTgVA0G5tLtzx783FGbx9/OY3i44Nd5HgOGA4wfPubg1mI550C6Ye+Z48USh3kMDs/su81jztzALDlzGx6H3Ug4JsHbdiyxAaSFt+c2j2XDATZmXrxaEtsk/wK1zIdoOcdjcCCBkJZkNmnetprEDSAtPD8OEKMljU1atu1A4sbDbAWHeRuSeSRnHGwm4Jf0Z5Jv2+oS550/vPkzzx87e37+5oMfPuLRAgWHgZjDgIGxDcRhbCCoHgjqgJj9AQPDH2IUj4JRMApGwUgDAFSTWial+mmlAAAAAElFTkSuQmCC","orcid":"","institution":"Zhaoqing Medical College","correspondingAuthor":true,"prefix":"","firstName":"Haiying","middleName":"","lastName":"Zhang","suffix":""},{"id":325144532,"identity":"70899f7e-c3da-4aaf-8003-0cbf141d8390","order_by":1,"name":"Shuangyan Bi","email":"","orcid":"","institution":"Zhuhai Times Xianghua Dental Clinic","correspondingAuthor":false,"prefix":"","firstName":"Shuangyan","middleName":"","lastName":"Bi","suffix":""},{"id":325144533,"identity":"0680b0cc-3144-48b5-863e-89f4ace7d00c","order_by":2,"name":"Xiaojun Zhang","email":"","orcid":"","institution":"Zhengzhou Stomatological Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaojun","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-06-26 15:52:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4643869/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4643869/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-05439-y","type":"published","date":"2025-01-16T15:57:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":61192997,"identity":"ada53bac-9463-4570-a308-23bedd563d73","added_by":"auto","created_at":"2024-07-26 20:56:10","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97020,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSelection Criteria and Grouping of Study Participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4643869/v1/7b261bec72a1a740b9f5e8ac.jpg"},{"id":61192998,"identity":"7d39d4ac-e653-409f-8b27-ed456c0e427b","added_by":"auto","created_at":"2024-07-26 20:56:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55520,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of Gingivitis Incidence between Adolescents and Adults\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4643869/v1/a2f7c4bbcfe5b04992ad1344.jpg"},{"id":61193000,"identity":"61eac111-aa4b-4f9a-8d89-e854263db1e8","added_by":"auto","created_at":"2024-07-26 20:56:10","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":89935,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGI Before and During Treatment by Group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4643869/v1/e417b0d19943329e9ff5fa8e.jpg"},{"id":61192999,"identity":"ada7d3a2-c468-4019-9cb7-722584031275","added_by":"auto","created_at":"2024-07-26 20:56:10","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1013845,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMechanism of Gingivitis Occurrence during Clear Aligner Orthodontic\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"fig4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4643869/v1/181b23be9967a291b059d516.jpeg"},{"id":74284600,"identity":"84ae8901-cbd1-48b6-8246-f5ea0433b4d1","added_by":"auto","created_at":"2025-01-20 16:09:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2025589,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4643869/v1/c3acd9a9-2af5-4e70-98b0-172b76f3a5e3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Clear Aligners on Gingivitis Incidence and Prevention Strategies in Adolescents and Adults: An Observational Study","fulltext":[{"header":"Highlights","content":"\u003col\u003e\n \u003cli\u003eThis study provides a detailed comparison for the first time of the impact of clear braces correction on gingival health in adolescents and adults.\u003c/li\u003e\n \u003cli\u003eThe analysis focuses on the direct association between the use of orthodontic appliances and the occurrence of gingivitis, identifying scientific questions and research objectives.\u003c/li\u003e\n \u003cli\u003eIt is clearly pointed out that the incidence of gingivitis in the adolescent group is significantly higher than in the adult group, providing important data for orthodontic treatment.\u003c/li\u003e\n \u003cli\u003ePersonalized oral hygiene education was found to effectively reduce the incidence of gingivitis in the adolescent group.\u003c/li\u003e\n \u003cli\u003eThe importance and scientific value of developing prevention strategies for different age groups are emphasized, providing guiding significance for clinical orthodontic treatment.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Introduction","content":"\u003cp\u003eOrthodontic treatment in dentistry is not only an important field of modern dental medicine but also a key factor affecting individual social and psychological health and overall quality of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Orthodontic treatment, by adjusting the position of teeth and jaws, can improve bite relationships and oral function and significantly enhance facial aesthetics for patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. With the advancement of medical technology, clear braces technology - as an innovative method of orthodontic treatment - is gradually becoming the preferred orthodontic method for adolescent and adult patients due to its excellent concealment and comfort. This technology uses transparent aligners designed and manufactured with computer assistance to precisely control tooth movement without being noticeable, optimizing treatment outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the numerous advantages of clear braces, a high incidence of gingivitis during orthodontic treatment is a significant issue that cannot be ignored [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The presence of appliances and attachments not only increases the difficulty of teeth cleaning but may also lead to the accumulation of dental plaque [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Attachments bonded to the tooth surfaces and excess adhesive may impede effective brushing, leading to the buildup of dental plaque and food debris, thereby causing gingivitis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, discomfort in the gums when first using the aligners may lead to symptoms such as redness and swelling [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Therefore, although clear braces offer new possibilities for orthodontic treatment, they also bring new challenges, particularly in the management of periodontal health.\u003c/p\u003e \u003cp\u003eIn order to address these challenges, personalized oral health guidance and dental health education are particularly important [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. These measures can significantly reduce the incidence of gingivitis, especially in the special population of adolescents. Adolescents often have deficiencies in independence and compliance, and they need treatment under the shared supervision of parents and healthcare professionals. Parental support and cooperation, as well as regular monitoring and professional guidance from doctors, are crucial factors in preventing gingivitis during orthodontic treatment. Through comprehensive education and management measures, not only can the occurrence of gingivitis be effectively reduced, but the safety and effectiveness of the entire orthodontic treatment can also be enhanced.\u003c/p\u003e \u003cp\u003eWith the improvement of living standards and the increasing emphasis on health and aesthetics, there is a growing demand from the public for high-quality dental orthodontic treatment. Orthodontic treatment is no longer limited to just \"straightening teeth,\" but also considers the functional and aesthetic aspects of treatment and its impact on oral and overall health. The development of clear braces orthodontic technology not only provides new treatment options but also advances scientific research and clinical practice in the field of orthodontics. In response to the potential gingivitis issues that may arise during the use of clear braces, this study analyzed in detail the incidence of gingivitis before and after orthodontic treatment in 120 patients, exploring its impact on periodontal health and provide more scientific guidance and optimized orthodontic solutions for clinical practice.\u003c/p\u003e \u003cp\u003eThe purpose of this study is to comprehensively evaluate the application effectiveness of clear braces orthodontic technology in different populations, particularly in the prevention and management of gingivitis. By deeply analyzing the mechanisms and influencing factors of gingivitis and evaluating the effectiveness of various prevention measures, this study aims to provide more refined health management strategies for orthodontic treatment, ensuring that patients can enjoy a safe and effective treatment process while pursuing aesthetics.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eCriteria for Participant Selection\u003c/h2\u003e \u003cp\u003eThis study included 120 patients who underwent clear braces orthodontic treatment in the Department of Stomatology from June 2018 to September 2023. These patients were divided into two groups: an adolescent group of 66 cases, with an average age of approximately 14.2 years, and an adult group of 54 cases, with an average age of approximately 25.7 years. Each group was further divided into a study group and a control group, with 33 cases in each subgroup for the adolescent group and 27 cases in each subgroup for the adult group. The inclusion criteria for the study were as follows: 1. Patients had no systemic diseases or history of metal allergies. 2. Patients had not been exposed to nickel-contaminated environments. 3. There were no other metal restorations in the oral cavity. 4. Patients did not have a history of alcohol consumption or smoking. 5. Body mass index (BMI) was within normal range. 6. Apart from the third molars, there were no impacted or congenitally missing teeth. 7. Patients could understand the purpose of the study and actively participate in the research process. 8. Consent had been obtained from the patients and their guardians.\u003c/p\u003e \u003cp\u003eBy applying these detailed selection criteria, the adaptability and consistency of the study subjects were ensured, providing a reliable foundation for the study results (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eExperimental Control and Random\u003c/h2\u003e \u003cp\u003eAll study participants were randomly assigned to either the study group or the control group using a computer-generated random number table upon being enrolled in the study. This random assignment was conducted to ensure that they were evenly distributed between the two groups. Participants were not informed of which group they belonged to, and all assessments and treatments were carried out by specifically trained medical staff following standard operating procedures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eDetailed Definition and Measurement of Variables\u003c/h2\u003e \u003cp\u003e The Gingival Index (GI) score was assessed using standardized periodontal probes and specific guidelines, such as the AAP Periodontal Disease Classification System. The GI categorizes the severity of gingivitis into four levels, 0\u0026ndash;3, where 0 represents gingival health, 1 represents mild inflammation, 2 represents moderate inflammation, and 3 represents severe inflammation.\u003c/p\u003e \u003cp\u003eBaseline measurement: Initial assessment was conducted before orthodontic treatment to ensure that all participants had a GI score of 0. Follow-up assessments: Evaluation performed at each follow-up visit after the start of treatment (every 1.5 months) until the end of the study. Post-treatment assessment: Final GI assessment conducted immediately after the completion of orthodontic treatment and compared with baseline and interim assessment results.\u003c/p\u003e \u003cp\u003eData recording and storage: All data were electronically recorded and kept by a data manager in a secure database for future statistical analysis and validation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSpecific Process\u003c/h2\u003e \u003cp\u003eIn this study, all participants underwent a comprehensive periodontal health assessment before orthodontic treatment, including supra- and subgingival scaling and root planing, to ensure that the GI for each patient was 0 prior to wearing the orthodontic appliance. The assessment and treatment were administered by periodontal specialists who had received specific training using standardized periodontal tools (ultrasonic scalers and hand scalers). Tooth selection for pre-treatment assessment followed the Ramfjord teeth index (teeth 16, 21, 24, 36, 41, 44), which served as representative teeth for regular periodontal health tracking.\u003c/p\u003e \u003cp\u003eThe control group patients maintained their daily lifestyle throughout the study period. At each follow-up visit, the entire dentition of the patients was coated with alkaline fuchsin solution, followed by rinsing. The same periodontal specialist then performed necessary supra- and subgingival scaling and root planing treatments based on the periodontal health condition to eliminate factors contributing to periodontal disease. The study group received personalized oral hygiene education and guidance on self-care techniques at each follow-up visit, including proper brushing techniques, flossing, and the use of oral irrigation devices.\u003c/p\u003e \u003cp\u003eBoth groups had a follow-up interval of every 1.5 months. At follow-up visits, all patients were assessed for GI by the same experienced periodontal specialist following the guidelines of Clinical Periodontology, 2nd edition. The scoring criteria for GI were defined as follows: 0 indicated healthy gums; 1 indicated mild inflammation with slight color change and swelling, no bleeding upon probing; 2 indicated moderate inflammation with redness and significant swelling, bleeding upon probing; 3 indicated severe inflammation with marked redness, swelling, or ulceration, and spontaneous bleeding. After six months of orthodontic treatment, another oral examination was conducted, and the GI value was measured again to evaluate changes in gingival health during the treatment period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Processing\u003c/h2\u003e \u003cp\u003eIn order to enhance the rigor and reliability of the statistical analysis, this study first conducted tests for normality on the data (such as the Shapiro-Wilk test) to ensure that the data met the requirements of normal distribution before using t-tests. Additionally, a test for homogeneity of variances (Levene's test) was performed to decide whether to use the equal variance or unequal variance version of the t-test. Multiple comparison correction methods, such as Bonferroni correction, were employed to reduce Type I errors for comparisons between multiple groups. All statistical analyses were carried out using the latest version of the SPSS software to ensure the accuracy and efficiency of the analysis. A significance level of P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the Incidence Rate of Gingivitis in Different Age Groups\u003c/h2\u003e \u003cp\u003eBased on the data collected in this study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), we compared the incidence of gingivitis in the adolescent group and the adult group after using clear braces for correction. The results showed that in the adolescent group, out of 66 cases, 26 cases developed gingivitis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea), accounting for 39.39%, while in the adult group, out of 54 cases, 38 cases had gingivitis (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb), reaching a rate of 70.04%. Overall, among the 120 patients, 54 cases experienced gingivitis, resulting in an overall incidence rate of 50.00% (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ec).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Gingivitis Incidence Between Adolescents and Adults.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of Gingivitis Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of Normal Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescent Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdult Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of the chi-square test used in the statistical analysis showed a P-value less than 0.05, indicating a significant difference in the incidence of gingivitis between the adolescent group and the adult group. Specifically, the incidence of gingivitis in the adult group was significantly higher than in the adolescent group. This result may be related to differences in adaptation to the orthodontic appliance, oral hygiene habits, and physiological responses between adults and adolescents.\u003c/p\u003e \u003cp\u003eIn conclusion, during the process of clear braces correction, the incidence of gingivitis in adult patients is significantly higher than in adolescent patients. This finding highlights the importance for adults undergoing clear braces correction to pay closer attention to the management of periodontal health and the implementation of preventive measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of GI Changes during Clear Braces Correction\u003c/h2\u003e \u003cp\u003eIn this study, we conducted a comparative analysis of the GI) in the study group and control group of the adolescent and adult groups before and after treatment (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The data showed that the changes in GI before and after treatment exhibited statistically significant differences among the groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Gingival Index (GI) Between Study and Control Groups in Adolescents and Adults.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of Cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eGI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBefore Treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDuring Treatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdolescent Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-5.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdult Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.19\u0026thinsp;\u0026plusmn;\u0026thinsp;0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudy Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.42\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-2.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the adolescent group, in the control group, the GI increased from an average of 0.15 before treatment to 0.59 during treatment, with the standard deviation increasing from 0.07 to 0.19. The t-value was \u0026minus;\u0026thinsp;2.12, and the P-value was less than 0.05, indicating a significant increase in the risk of gingivitis during treatment. In the study group, the GI increased from 0.17 to 1.49, with a standard deviation increase from 0.05 to 0.25. The t-value was \u0026minus;\u0026thinsp;5.32, with a P-value less than 0.05, showing a more significant change. The comparison of GI during treatment between the two groups had a t-value of -2.78, with a P-value less than 0.05, indicating a more significant increase in the risk of gingivitis in the study group.\u003c/p\u003e \u003cp\u003eIn the adult group, in the control group, the GI increased from 1.19 before treatment to 1.42 during treatment, with the standard deviation increasing from 0.17 to 0.21. The t-value was \u0026minus;\u0026thinsp;2.03, and the P-value was greater than 0.05, indicating that the change was not statistically significant. Similarly, in the study group, the GI increased from 1.18 to 1.42, with a standard deviation increase from 0.14 to 0.20. The t-value was \u0026minus;\u0026thinsp;2.21, but the P-value was less than 0.05, indicating that the change in GI in this group was statistically significant. The comparison of GI between the two groups in the adult group had a t-value close to zero, and the P-value was greater than 0.05, showing no significant difference in the change before and after treatment.\u003c/p\u003e \u003cp\u003eIn summary, the use of clear braces in the adolescent group resulted in a more significant increase in the risk of gingivitis, while in the adult group, although the study group showed some increase in risk, the change in the control group was not significant (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). This result emphasizes the need for more effective preventive measures to manage gingival health during clear braces correction in adolescents\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eClear 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 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, clear braces usage can lead to oral health issues such as gingivitis during treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], 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 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, studying the relationship between clear braces and the incidence of gingivitis and exploring effective preventive measures holds significant clinical and scientific importance.\u003c/p\u003e \u003cp\u003ePrevious 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 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, there are also studies that have not found a significant difference in the incidence of gingivitis with the use of clear braces [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. 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.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). 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.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis 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.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eFurthermore, 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.\u003c/p\u003e \u003cp\u003e 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.\u003c/p\u003e \u003cp\u003eThe 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.\u003c/p\u003e \u003cp\u003eHowever, 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.\u003c/p\u003e \u003cp\u003eIn 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.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Clinical Ethics Committee of Zhaoqing Medical College (No. 202004031206).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Zhaoqing Science and Technology Innovation Guidance Category Project ((2020) No. 26 202004031206).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank the Zhaoqing Science and Technology Innovation Guidance Category Project ((2020) No. 26 202004031206) for their financial support, which made this study possible. We also express our gratitude to the staff at Zhuhai Times Xianghua Dental Clinic and Zhengzhou Stomatological Hospital for their assistance with patient recruitment and data collection. Special thanks to all the patients who participated in this study for their cooperation and commitment. Additionally, we appreciate the valuable input and support from our colleagues at Zhaoqing Medical College.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest regarding the publication of this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHaiying Zhang and Shuangyan Bi conceived and designed the study. Xiaojun Zhang, Shuangyan Bi, and Haiying Zhang performed the experiments. Xiaojun Zhang and Haiying Zhang analyzed the data. Haiying Zhang and Shuangyan Bi wrote the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePark JH, Kim JH, Rogowski L, Al Shami S, Howell SEI. Implementation of teledentistry for orthodontic practices. J World Fed Orthod. 2021;10(1):9\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejwf.2021.01.002\u003c/span\u003e\u003cspan address=\"10.1016/j.ejwf.2021.01.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiddiqui TA, Sukhia RH, Ghandhi D. Artificial intelligence in dentistry, orthodontics and Orthognathic surgery: A literature review. J Pak Med Assoc. 2022;72(Suppl 1):S91\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.47391/JPMA.AKU-18\u003c/span\u003e\u003cspan address=\"10.47391/JPMA.AKU-18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFernandes EC, Nascimento J\u0026uacute;nior MB, Paiva T\u0026ocirc;rres ACS, N\u0026oacute;brega FJO, Santos PB. The 100 most-cited articles in orthodontic journals in the last 20 years. Am J Orthod Dentofac Orthop. 2022;161(3):e260\u0026ndash;76. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajodo.2021.08.016\u003c/span\u003e\u003cspan address=\"10.1016/j.ajodo.2021.08.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed M, Shaikh A, Fida M. Evaluation of conformity of preformed orthodontic archwires and dental arch form. Dent Press J Orthod. 2019;24(1):44\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/2177-6709.24.1.044-052.oar\u003c/span\u003e\u003cspan address=\"10.1590/2177-6709.24.1.044-052.oar\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLyu X, Cao X, Yan J, Zeng R, Tan J. Biomechanical effects of clear aligners with different thicknesses and gingival-margin morphology for appliance design optimization. Am J Orthod Dentofac Orthop. 2023;164(2):239\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajodo.2022.12.014\u003c/span\u003e\u003cspan address=\"10.1016/j.ajodo.2022.12.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShirey N, Mendonca G, Groth C, Kim-Berman H. Comparison of mechanical properties of 3-dimensional printed and thermoformed orthodontic aligners. Am J Orthod Dentofac Orthop. 2023;163(5):720\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ajodo.2022.12.008\u003c/span\u003e\u003cspan address=\"10.1016/j.ajodo.2022.12.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantonocito S, Polizzi A. Oral Microbiota Changes during Orthodontic Treatment. Front Biosci (Elite Ed). 2022;14(3):19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.31083/j.fbe1403019\u003c/span\u003e\u003cspan address=\"10.31083/j.fbe1403019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRouzi M, Zhang X, Jiang Q, Long H, Lai W, Li X. Impact of Clear Aligners on Oral Health and Oral Microbiome During Orthodontic Treatment. Int Dent J. 2023;73(5):603\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.identj.2023.03.012\u003c/span\u003e\u003cspan address=\"10.1016/j.identj.2023.03.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCastroflorio T, Sedran A, Parrini S et al. Predictability of orthodontic tooth movement with aligners: effect of treatment design [published correction appears in Prog Orthod. 2023;24(1):47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s40510-023-00499-8]\u003c/span\u003e\u003cspan address=\"10.1186/s40510-023-00499-8]\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Prog Orthod. 2023;24(1):2. Published 2023 Jan 16. doi:10.1186/s40510-022-00453-0.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKramer A, Splieth C. Health promotion through structured oral hygiene and good tooth alignment. GMS Hyg Infect Control. 2022;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3205/dgkh000411\u003c/span\u003e\u003cspan address=\"10.3205/dgkh000411\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. :Doc08. Published 2022 May 10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl Hariri MH, Karkoutly M, Al Kurdi S, Alkassar M, Bshara N. The efficacy of the dental Water Jet, orthodontic, and conventional toothbrushes in plaque removal around orthodontic braces in adolescents: A randomized controlled trial. Clin Exp Dent Res. 2023;9(4):606\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cre2.752\u003c/span\u003e\u003cspan address=\"10.1002/cre2.752\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehrotra N, Singh S. Periodontitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 1, 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlzanbaqi SD, Alogaiel RM, Alasmari MA, et al. Zirconia Crowns for Primary Teeth: A Systematic Review and Meta-Analyses. Int J Environ Res Public Health. 2022;19(5):2838. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph19052838\u003c/span\u003e\u003cspan address=\"10.3390/ijerph19052838\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2022 Feb 28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerhoeff MC, Eikenboom D, Koutris M, et al. Parkinson's disease and oral health: A systematic review. Arch Oral Biol. 2023;151:105712. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.archoralbio.2023.105712\u003c/span\u003e\u003cspan address=\"10.1016/j.archoralbio.2023.105712\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMartin C, Littlewood SJ, Millett DT, et al. Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database Syst Rev. 2023;5(5):CD002283. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD002283.pub5\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD002283.pub5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Published 2023 May 22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAminoshariae A, Nosrat A, Nagendrababu V, et al. Artificial Intelligence in Endodontic Education. J Endod. 2024;50(5):562\u0026ndash;78. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.joen.2024.02.011\u003c/span\u003e\u003cspan address=\"10.1016/j.joen.2024.02.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUpton JEM, Lanser BJ, Bird JA, Nowak-Węgrzyn A. Baked Milk and Baked Egg Survey: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. J Allergy Clin Immunol Pract. 2023;11(8):2335\u0026ndash;e23444. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jaip.2023.04.055\u003c/span\u003e\u003cspan address=\"10.1016/j.jaip.2023.04.055\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKau CH, Wang Z, Wang J, Krishnan DG. Contemporary management of an orthodontic-orthognathic patient with limited time availability in an orthodontic office setting: Case report. J Orthod. 2020;47(3):257\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1465312520934488\u003c/span\u003e\u003cspan address=\"10.1177/1465312520934488\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePutrino A, Barbato E, Galluccio G. Clear Aligners: Between Evolution and Efficiency-A Scoping Review. Int J Environ Res Public Health. 2021;18(6):2870. Published 2021 Mar 11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph18062870\u003c/span\u003e\u003cspan address=\"10.3390/ijerph18062870\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGopalakrishnan U, Felicita S, Ronald B, Appavoo E, Patil S. Microbial Corrosion in Orthodontics. J Contemp Dent Pract. 2022;23(6):569\u0026ndash;71. Published 2022 Jun 1.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Clear Aligners, Orthodontics, Gingivitis, Prevention, Periodontal Treatment, Oral Hygiene","lastPublishedDoi":"10.21203/rs.3.rs-4643869/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4643869/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aims to analyze the differences in gingivitis incidence among adolescents and adults using clear aligners for orthodontic correction and to evaluate the effectiveness of prevention strategies on orthodontic outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis observational study included 120 patients undergoing clear aligner orthodontic treatment from June 2018 to September 2023. Participants were divided into an adolescent group (66 cases) and an adult group (54 cases), each further split into a study group and a control group. Routine periodontal treatment and personalized oral hygiene education were provided, and the incidence of gingivitis was evaluated six months post-treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe incidence of gingivitis was significantly higher in the adolescent group compared to the adult group (P\u0026lt;0.05). Specifically, within the adolescent group, the study group exhibited a higher gingival index (GI) than the control group (P\u0026lt;0.05), while the difference in the adult group was not significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eAdolescents using clear aligners are more prone to gingivitis compared to adults. Personalized oral hygiene education significantly reduces gingivitis incidence, particularly in adolescents.\u003c/p\u003e","manuscriptTitle":"Impact of Clear Aligners on Gingivitis Incidence and Prevention Strategies in Adolescents and Adults: An Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-26 20:56:05","doi":"10.21203/rs.3.rs-4643869/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-10T10:30:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-28T07:16:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-28T07:15:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-06-26T15:50:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61122bab-8f4e-4682-b09a-f6e870612a20","owner":[],"postedDate":"July 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:01:44+00:00","versionOfRecord":{"articleIdentity":"rs-4643869","link":"https://doi.org/10.1186/s12903-025-05439-y","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-01-16 15:57:29","publishedOnDateReadable":"January 16th, 2025"},"versionCreatedAt":"2024-07-26 20:56:05","video":"","vorDoi":"10.1186/s12903-025-05439-y","vorDoiUrl":"https://doi.org/10.1186/s12903-025-05439-y","workflowStages":[]},"version":"v1","identity":"rs-4643869","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4643869","identity":"rs-4643869","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}