Preformed Elastodontic Appliances: Awareness and Attitude of Orthodontists and General Dental Practitioners.

BACKGROUND: Preformed elastodontic appliances (EAs) have been described as safe, cost-effective, and easy-to-use devices for interceptive orthodontic treatment in growing patients. This study aimed to assess the knowledge and the attitude of dentists toward the use of EAs and to compare the behaviors of orthodontists (Os) with those of general dental practitioners (GDPs). METHODS: An anonymous survey was distributed among dentists through social media. Twenty-two items were divided as follows: characteristics of respondents; general knowledge about EAs; section for EA-users; and section for EA non-users. Chi-squared tests were used to analyze differences in responses between groups. RESULTS: Participants included 226 Os and 168 GDPs. The majority in both groups reported having adequate knowledge about EAs and utilizing them in their practice. GDPs usually use EAs to treat children during the early phase of growth, while Os also use EAs to address orthodontic problems in different stages of dentition, experiencing a chair time reduction compared with traditional appliances. Regarding EA non-users, GDPs seem not to find an application among their patients, whereas Os reported not having enough patient compliance during treatment. CONCLUSIONS: Although treatment with EAs is common among all dentists, differences exist between Os and GDPs in the awareness and application, as well as in the reasons provided for not using EAs.

Attitude of Italian dental practitioners toward bruxism assessment and management: A survey-based study.

INTRODUCTION: Bruxism is a spectrum of masticatory muscles activities. According to the recent evidence and international consensus, there is no indication to treat bruxism unless clinical consequences are present. The aim of the present study was to investigate the approach of Italian dentists to bruxism in their clinical practice. METHODS: An anonymous online survey was developed, composed by 26 items grouped into five sections: (1) Characteristics of the respondent (Q1-Q6); (2) Bruxism frequencies (Q7-Q11); (3) Bruxism assessment (Q12-Q15); (4) Bruxism management (Q16-Q20); (5) Occlusal splints therapy (Q21-Q26). RESULTS: A total of 384 practitioners, including specialists and non-specialists, participated in this survey. The majority of the respondents reported that 1-3 out of ten patients presented with bruxism. The diagnosis is mainly performed with non-instrumental methods, and facial pain and dental wear are the major clinical consequence associated with bruxism. Almost the entire sample of respondents report to offer occlusal splints to bruxism patients, and 41% refer to perform occlusal adjustments. Almost half of the respondents have never proposed any form of cognitive-behavioural therapy. CONCLUSION: The results of the current survey highlighted several inconsistencies in Italian dentists' approaches to bruxism, suggesting the need for better education of practitioners and for the development of a standardized protocol to assess and manage bruxism in dental practices.

Ecological Momentary Assessment of Awake Bruxism Behaviors: A Scoping Review of Findings from Smartphone-Based Studies in Healthy Young Adults.

BACKGROUND: The recent introduction of ecological momentary assessment (EMA) smartphone-based strategies has allowed achieving some interesting data on the frequency of different awake bruxism (AB) behaviors reported by an individual in the natural environment. OBJECTIVE: The present paper aims to review the literature on the reported frequency of AB based on data gathered via smartphone EMA technology. METHODS: On September 2022, a systematic search in the Pubmed, Scopus and Google Scholar databases was performed to identify all peer-reviewed English-language studies assessing awake bruxism behaviors using a smartphone-based Ecological Momentary Assessment. The selected articles were assessed independently by two authors according to a structured reading of the articles' format (PICO). RESULTS: A literature search, for which the search terms "Awake Bruxism" and "Ecological Momentary Assessment" were used, identified 15 articles. Of them, eight fulfilled the inclusion criteria. The results of seven studies using the same smartphone-based app reported a frequency of AB behaviors in the range between 28.3 and 40% over one week, while another investigation adopted a different smartphone-based EMA approach via WhatsApp using a web-based survey program and reported an AB frequency of 58.6%. Most included studies were based on convenience samples with limited age range, highlighting the need for more studies on other population samples. CONCLUSIONS: Despite the methodological limits, the results of the reviewed studies provide a standpoint for comparison for future studies on the epidemiology of awake bruxism behaviors.

Predictability of Maxillary Molar Distalization and Derotation with Clear Aligners: A Prospective Study.

Clear aligners are employed daily for the treatment of Class II malocclusions, when a valid option involves distalization and derotation of the upper first and second molars. Evidence regarding the predictability of these movements is slight, and the treatment outcome that clinicians plan may not be achieved. Therefore, the purpose of this study is to assess the accuracy of distalization and derotation with clear aligners. Geomagic Control X, a 3D quality control software, was used to superimpose digital models of the pre-treatment, post-treatment, and virtual plan (ideal post-treatment) measurements of 16 patients (4 M, 12 F; mean age 25.7 ± 8.8 years). Linear and angular measurement tools were used to calculate the amount of tooth movement prescribed and achieved. Distal displacement of the buccal cusps had an overall accuracy of 69% for the first molar and 75% for the second molar. The accuracy of molar derotation was higher for the first molar (77.5%) than for the second molar (62.7%). The aligners were not able to achieve 100% of the ideal post-treatment result; thus, planning of refinements is often needed. However, clear aligners can be regarded as a valuable option for the distalization of first and second molars.

Three-Dimensional Assessment of Temporomandibular Joint Morphology and Facial Asymmetry in Individuals with Different Vertical Skeletal Growth Patterns.

The aim of the current study was to investigate, by means of Cone-Beam Computed Tomography (CBCT), condyle−fossa relationship, temporomandibular joint (TMJ) morphology and facial asymmetry in subjects with different vertical skeletal growth patterns. CBCT of 56 patients (112 TMJs) were categorized into three groups according to the mandibular plane angle (MP): Hypodivergent (MP ≤ 23°), Normodivergent (23° < MP < 30°), and Hyperdivergent (MP ≥ 30°). TMJ spaces, width and depth of the condyle and thickness of the fossa were measured. Horizontal and vertical measurements were used to assess facial asymmetry. One-way Analysis of Variance (ANOVA) and post-hoc Turkey tests were computed for the between-groups comparison. Statistical significance was set at p < 0.05. Larger anterior joint space and smaller condylar dimensions (medio-lateral diameter and medio-lateral thickness) were observed in the hyperdivergent group compared to the normodivergent and hypodivergent groups. Right condylar distances to midsagittal plane were significantly larger than left distances in all the three groups. A vertical pattern of growth in healthy individuals seems to be associated with condylar position and dimension, while facial asymmetry values do not differ among different vertical groups.

Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea: A systematic review and meta-analysis.

Orthodontic treatment is suggested in growing individuals to correct transverse maxillary deficiency and mandibular retrusion. Since, as a secondary effect, these orthodontic procedures may improve pediatric obstructive sleep apnea (OSA), this systematic review assessed their effects on apnea-hypopnea index (AHI) and oxygen saturation (SaO2). Twenty-five (25) manuscripts were included for qualitative synthesis, 19 were selected for quantitative synthesis. Five interventions were analyzed: rapid maxillary expansion (RME, 15 studies), mandibular advancement (MAA, five studies), myofunctional therapy (MT, four studies), and RME combined with MAA (one study). RME produced a significant AHI reduction and minimum SaO2 increase immediately after active treatment, at six and 12 months from baseline. A significant AHI reduction was also observed six and 12 months after the beginning of MAA treatment. MT showed positive effects, with different protocols. In this systematic review and meta-analysis of data from mainly uncontrolled studies, interceptive orthodontic treatments showed overall favorable effects on respiratory outcomes in pediatric OSA. However, due to the low to very low level of the body evidence, this treatment cannot be suggested as elective for OSA treatment. An orthodontic indication is needed to support this therapy and a careful monitoring is required to ensure positive improvement in OSA parameters.

Class II Malocclusion in Adult Patients: What Are the Effects of the Intermaxillary Elastics with Clear Aligners? A Retrospective Single Center One-Group Longitudinal Study.

Aim: To evaluate the dental effects of the treatment with clear aligners and intermaxillary elastics in adult patients with Class II malocclusion. Material and methods: A sample of 20 Class II patients treated with Invisalign aligners (5 M and 15 F; mean age of 27.6 ± 6.3 years) was included in this single-center one-group longitudinal study. Dental cast and cephalometric records were analyzed before (T0) and after treatment (T1). Data were analyzed with a t-test for paired data (p < 0.05). Results: There was a significant reduction of the Overjet (OVJ= −1.4 ± 0.2; p ≤0.001) and a retroposition of upper incisors (U1-NPo = −1.3 ± 1.7; p < 0.001). Furthermore, distalization of upper molars with an improvement of molar class (U6-PT Vertical = −0.93 ± 0.97; p < 0.001; Molar Relation = −0.75 ± 0.45; p < 0.001) was observed. A good control of the lower and upper incisor inclination was present, highlighted by the non-significant changes in these values (L1-GoGn = −0.12 ± 5.4; p = 0.923; U1-AnsPns = −1.1 ± 8.1; p = 0.551). In the lower arch, an increase in the intermolar diameter (0.6 ± 1.0; p = 0.01) was present. Finally, there were no statistically significant changes in all the skeletal variables (ANPg = 0.005 ± 0.687; p = 0.974; SN/MP = −0.47 ± 1.9; p = 0.298). Conclusions: Treatment with Invisalign aligners shows a reduction of the Overjet, a retroposition of the upper incisors, good control of the lower incisors, and an improvement of the molar relationship.

Comparison between Ecological Momentary Assessment and Questionnaire for Assessing the Frequency of Waking-Time Non-Functional Oral Behaviours.

Over the years, several tools have been proposed to measure oral behaviours (OB). Recently, a smartphone-based application for ecological momentary assessment (EMA) has been introduced to collect real-time data on waking-time OB. The aim of this study was to compare the self-reported frequency of OB by means of a standardised questionnaire with that recorded with a smartphone-based application for EMA. A total of 151 participants, recruited from the general population, were invited to fill in the Oral Behaviour Checklist (OBC). Scores for four questions concerning grinding, clenching, tooth contact, and mandible bracing were computed. Afterwards, participants were provided with a smartphone application for prolonged real-time reporting of OB. One-way analysis of variance (ANOVA) and a general linear mixed model (GLMM) were used to compare the responses to each OBC question with the frequencies of the same condition recorded with the EMA. Results showed significant association between OBC responses and the EMA recordings. In particular, increased frequencies of clenching, grinding, and teeth contact were recorded by individuals who provided higher OBC scores. On the other hand, a nonlinear association was observed for "mandible bracing", pointing out difficulties in the comprehension of this condition.

Effectiveness of surgical procedures in the acceleration of orthodontic tooth movement: Findings from systematic reviews and meta-analyses.

The current overview aimed to summarise the findings provided by systematic reviews (SRs) on the effect of surgical procedures in the acceleration of tooth movement and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs addressing the effects of surgical procedures on the acceleration of tooth movement were included. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Twenty-eight (28) SRs were included. The methodological quality of the included reviews ranged between critically low (6 studies) and high (12 studies). The most common critical weakness in the included reviews was the absence of clearly a-prior established review methods and any significant deviations from the protocol. The most studied surgical procedure was corticotomy, followed by micro-osteoperforation, piezocision and periodontally accelerated osteogenic orthodontics. The majority of the included SRs supported short-term favourable effects of corticotomy on treatment time and tooth movement rate, in the short-term. However, the authors of the included SRs reported that results were based on weak quality evidence. Conflicting results arise from the existent SRs with regards to the effectiveness of piezocision and micro-osteoperforation. Few SRs summarised complications and side effects of surgical techniques, supporting absence of loss of tooth vitality, periodontal problems, or severe root resorption. The current overview of SRs highlighted the need of high quality SRs comparing different surgical approaches for tooth movement acceleration though network meta-analysis, in order to determine the most efficient instrument for orthodontic movement acceleration.

Evaluation of Tooth Movement Accuracy with Aligners: A Prospective Study.

Background. Clear aligners treatment (CAT) is a common solution in orthodontics to treat both simple and complex malocclusions. This study aimed to evaluate the predictability of CAT, comparing the virtually planned and the achieved tooth movement at the end of stage 15, which is often the time of first refinement. Methods. Seventeen patients (mean age: 28.3 years) were enrolled in the study. Torque, tip and rotation were analyzed in 238 maxillary teeth on digital models at Pre-treatment (T0), at the end of stage 15 (T15) and at virtually planned stage 15 (T15i). Prescription, Achieved movement and performance values were calculated to compare the virtually planned and the clinical tooth position. Data were analyzed by means of Student's t test with a level of significance set at p < 0.05. Results. The largest iper-performance was the torque correction of the second molars (+2.3° ± 3.1°), the greatest under-performance was the tip correction of the first molars (−2.3° ± 3.3°), while rotation corrections of all the teeth showed more accurate performance. No significant differences were found between mean Prescription and mean Achieved movement for all the assessed movements (p < 0.05). Conclusions. An accurate evaluation of CAT after the 15th aligner is fundamental in order to individuate the movements that are not matching the digital set-up.

Temporomandibular disorders, neck disability, and oral parafunctions in tinnitus patients: A cross-sectional epidemiological study from Southern Italy.

OBJECTIVE: To assess the prevalence of temporomandibular disorders (TMD) in a sample of tinnitus patients and to determine the association between tinnitus, TMD, neck disability, and oral parafunctions. METHODS: Seventy-nine tinnitus patients were enrolled and underwent standardized clinical examination for TMD. The tinnitus severity was measured with the Tinnitus Handicap Inventory (THI). The oral parafunctions were self-reported with the Oral Behavior Checklist (OBC). The neck disability was recorded with the Neck Disability Index (NDI). RESULTS: More than half of the sample presented TMD, and the most frequent diagnosis was TMD pain. Higher THI was observed in TMD-pain individuals, compared to TMD-free (ß 18.4; 95%CI 6.7, 30.1; p = 0.002). The OBC showed a significant low-to-moderate positive correlation with the THI (rho= 0.368, p = 0.001), while the NDI did not. DISCUSSION: Standardized assessment of TMD and oral behaviors should be integrated into the routine diagnostic evaluations of tinnitus patients.

Referral Patterns in Oral Medicine: A Retrospective Analysis of an Oral Medicine University Center in Southern Italy.

Referral of a patient from one healthcare provider to another is an important part of the medical practice. The aim of this study was to analyze the referral process to the Oral Medicine Unit in a university-based tertiary center in Southern Italy. A chart review of new referrals to the Oral Medicine Unit during a 24-month period was conducted. The following data were recorded: demographic characteristics, medical history, number of physicians seen prior to Oral Medicine assessment, referral source, diagnostic procedures ordered by referrals, reason for referral, site of lesion/condition, final diagnosis. Then, the rates of correct identification for health-care professionals and the appropriateness of the reference diagnosis based on the disease were calculated with descriptive statistic indicators. There were 583 new first consultations. A total of 62.9% of patients were referred by general dental practitioners, 27.4% by physicians, and 9.7% did not have a referral. The most common diseases for referral were immune-mediated diseases (39.6%) and oro-facial pain disorders (25.2%). Only 28.5% of patients had a correct provisional diagnosis. The results of this study show the need to implement curricula in the field of oral medicine among dentistry and medical students, and to support the continuing education among healthcare providers to reduce diagnostic delay for oral diseases.

Effects of acute pain and strain of the periodontium due to orthodontic separation on the occlusal tactile acuity of healthy individuals.

OBJECTIVES: The aim of this study was to assess whether pain and strain of the periodontal ligament (PDL), induced by orthodontic separation, alter the somatosensory ability to perceive small thicknesses between occluding teeth (occlusal tactile acuity, OTA). METHODS: The OTA was tested at baseline (T0), using 9 aluminum foils (range 8-72 µm), randomly placed between the molar teeth, and 1 sham test (without foil), asking the participants whether they felt the foil between their teeth. Afterwards, orthodontic separators were placed, and subjects were randomly assigned to one of the two experimental groups: Group Pain (GP: 18 males; 14 females mean age 25.22 ± 2.28 years) had separators removed after 24 h; Group Strain (GS: 14 males; 17 females, mean age 24.03 ± 3.06 years) had separators removed after 7 days. The OTA measurement was repeated in both groups immediately after orthodontic separators removal (T1). A within-group comparison (T1 vs T0) was performed for each testing thickness (ANOVA for repeated measurements, with Bonferroni correction for multiple testing) (p < 0.005). RESULTS: GP showed statistically significant reduction of the OTA at T1, as compared to T0, for the thicknesses 24 µm (p = 0.004) and 32 µm (p = 0.001). No significant reduction was observed in GS (all p > 0.005). CONCLUSIONS: Acute periodontal pain tends to disturb the tactile ability of the teeth, while strain of the PDL in absence of painful sensation determines a return to OTA baseline values. CLINICAL RELEVANCE: The reduction of OTA might explain the uncomfortable occlusal sensation referred by patients during acute periodontal pain.

Occlusion, orthodontics, and temporomandibular disorders: Cutting edge of the current evidence.

The relationship between occlusion and temporomandibular disorders (TMD) represents one of the major controversies reported in the scientific literature. Nevertheless, sound evidence from large population-based surveys point toward weak and inconsistent associations, supporting that the role of the occlusion in the etiology of TMD should not be overstated. Also, despite the type of device, traditional orthodontic treatment seems to play a neutral role with regard to the onset of TMD: in particular, this therapeutic approach has been reported not to prevent or to increase the risk of TMD development. It is time to shift the concept of occlusion from a purely mechanical interpretation, based on the teeth-to-teeth relationship (peripheral input), to a broader view that includes the interpretation of the input at the level of the central nervous system. In this context, patients' individual adaptability must be considered by clinicians to prevent iatrogenic maladaptive behaviors. Indeed, orthodontists and general dentists should be aware about the multifactorial etiology of TMD and should be instructed regarding the available tools to manage patients before, during, and after any dental or orthodontic intervention.

Short-term effects of the Sander bite-jumping appliance on the pharyngeal airways in subjects with skeletal Class II malocclusion: A retrospective case-control study.

BACKGROUND: Skeletal Class II subjects present often a retruded mandible that might increase the probability of breathing disorders. OBJECTIVE: To evaluate the effects of functional treatment by means of the Sander bite-jumping appliance (BJA) on the upper airways of growing subjects. METHODS: Thirty-four subjects (21 males, 13 females; mean age 11.1 ± 1.2 years) with skeletal Class II malocclusion due to mandibular retrusion were treated with the Sander BJA (BJA group). The control group consisted of thirty-four untreated subjects with skeletal Class II malocclusion (25 males, 9 females; 10.4 ± 1.2 years; CTR group). The effect of the Sander BJA appliance on the airway dimensions was evaluated by comparing lateral cephalograms recorded before (T0) and after (T1) the period of observation/treatment. Within- and between-group comparisons were statistically evaluated according to the distribution of the data (P < .05). RESULTS: The oropharyngeal region (ph_pph) increased in the BJA group (1.8 ± 3.2; P = .001) but the difference respect to the CTR group was not statistically significant (0.73 ± 4.0; P = .314; P = .077). The tongue height (th) increased in the BJA group (2.8 ± 3.7; P < .001), and this increase was statistically significant respect to the CTR group (0.6 ± 4.7; P = .461; P = .038). In the BJA, the Ans_Pns_P angle showed a statistically significant decrease (-3.8 ± 7.8; P = .007) compared to the CTR group (-0.1 ± 5.4; P = .705; P = .026). CONCLUSIONS: The airway dimensions increased for both control subjects and Class II patients treated with Sander BJA due to physiological growth. The Sander BJA induced a statistically significant change in the tongue and soft palate position, but the clinically relevant of these changes is questionable.

"Pressure pain threshold over masticatory muscles and temporomandibular joint in patients with juvenile idiopathic arthritis".

BACKGROUND: Juvenile idiopathic arthritis (JIA) is an autoimmune, chronic, inflammatory joint disease, affecting children and adolescents. Patients with JIA may have pain and fatigue in muscles. There are not studies evaluating the pressure pain thresholds (PPTs) of both masticatory muscles and temporomandibular joint (TMJ) in patients with JIA. OBJECTIVE: This study aimed to investigate PPTs of masticatory muscles and TMJ in subjects with JIA. METHODS: Fifty-one JIA patients and fifty-two healthy subjects were recruited. JIA group was assessed for with a standardised clinical examination for temporomandibular disorders. In all subjects, the PPT was evaluated in the following sites: anterior temporalis (AT) and masseter (MM) muscles, TMJ and thenar (TH) eminence. Comparisons between groups were assessed with unpaired t test and ANOVA (P < .05). RESULTS: Pressure pain thresholds were significantly lower among JIA patients compared with controls (P < .001) for all analysed sites. The presence of TMJ pain at palpation was significantly associated with a lower PPT at TMJ (P = .031). CONCLUSIONS: Patients with JIA have generally lowered pain threshold to mechanical stimulus, which suggests an effect of JIA on nocicepton-modulating processes.

Occlusal tactile acuity in temporomandibular disorder pain patients: A case-control study.

OBJECTIVE: To compare the smallest thickness that can be perceived between occluding teeth (occlusal tactile acuity, OTA) of temporomandibular disorder pain (TMD-P) patients with that of control (CTR) individuals. METHODS: Twenty TMD-P patients (17 women and 3 men, mean age: 31.3 ± 10.4 years) diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and 20 age- and gender-matched controls (17 women and 3 men, mean age: 31.4 ± 10.5 years) were enrolled. The OTA was tested with 10 different thicknesses: 9 aluminium foils (8 µm-72 µm with a constant increment of 8 µm) and 1 sham test (without foil), each thickness being tested 10 times in random order (100 tests in total). The participants were instructed to close their mouth once and to report whether they felt the foil between their molar teeth. A between-group comparison (TMD-P vs CTR) was performed for each testing thickness (analysis of variance for repeated measurements, with Bonferroni multiple correction) (P < .005). RESULTS: Significantly increased OTA was observed in the TMD-P group for the thicknesses between 8 µm and 40 µm, while no significant differences were found for the sham test and for the larger thicknesses tested (from 48 µm to 72 µm). CONCLUSIONS: TMD-pain subjects presented an increased OTA as compared to controls.

Mechanical Properties of Thermoplastic Polymers for Aligner Manufacturing: In Vitro Study.

The use of metal-free thermoplastic materials plays a key role in the orthodontic digital workflow due to the increasing demand for clear aligner treatments. Three thermoplastic polymers commonly used to fabricate clear aligners, namely Duran®, Biolon® and Zendura®, were investigated to evaluate the effect of thermoforming (T.), storage in artificial saliva (S.A.S.) and their combination on their mechanical properties. Elastic modulus and yield stress of the specimens were characterized. Each material was characterized for each condition through tensile tests (ISO527-1). The results showed that thermoforming does not lead to a significant decrease in yield stress, except for Zendura® that showed about a 30% decrease. An increase of the elastic modulus of Duran® and Zendura®, instead, was observed after thermoforming. The same increase was noticed for the yield stress of Duran®. For S.A.S. specimens, the elastic modulus generally decreases compared to supplier condition (A.S.) and simply thermoformed material. A decrease of yield stress, instead, is significant for Zendura®. The results demonstrated that the impact of the operating conditions on the mechanical properties can vary according to the specific polymer. To design reliable and effective orthodontic treatments, the materials should be selected after their mechanical properties are characterized in the simulated intraoral environment.

Impact of Fixed Orthodontic Appliance and Clear Aligners on the Periodontal Health: A Prospective Clinical Study.

This study aimed to evaluate the periodontal health of orthodontic patients with supportive periodontal therapy in a 3 month follow-up. The sample comprised 20 patients (mean age 20.6 ± 8.1 years) in treatment with multibracket fixed appliances (fixed group-FG) and 20 patients (mean age 34.7 ± 12.5 years) in treatment with clear aligners (clear aligners group-CAG). At baseline (T0) and after 3 months (T1), probing depth (PD), plaque index (PI), bleeding on probing (BOP), and gingival recession (REC) were measured. Patients were trained to perform an individualized tooth brushing technique, and every 2 weeks they were re-called to reinforce the oral hygiene instructions. The intra-group comparisons (T1 vs. T0) were calculated with the Wilcoxon signed-rank test, while a linear regression model was used for the inter-group comparisons (FG vs. CAG). The significance level was set at p < 0.05. Statistically significant decrease in both groups was found for PD (FG: Δ, -9.2 inter-quartile range (IQR), -22.5, -5.5; CAG: Δ, -12.6 IQR, -25.4, -4.8), BOP (FG: Δ, -53.5 IQR, -70.5, -37; CAG: Δ, -37.5 IQR, -54.5, -23), and PI (FG: Δ, -17.5 IQR, -62.5, 14.5; CAG: Δ, -24 IQR, -49.5, -5). The result of the linear regression models suggested that the type of appliance did not have any effects on the improvement of periodontal variables. Therefore, patients undergoing orthodontic treatment with fixed appliances and clear aligners did not show differences in gingival health when followed by a dental hygienist.