Comparison of the effectiveness and efficiency of clear aligners and fixed appliances in the pre-surgical orthodontic treatment of skeletal class III: a retrospective cohort study

Abstract

Abstract Objective This retrospective cohort study aims to compare the performance of clear aligners (CAs) with fixed appliances (FAs) in pre-surgical orthodontics of skeletal class III malocclusion patients. Materials and Methods Ninety-five patients were included in the study, and were divided into four groups: extraction with CA, extraction with FA, non-extraction with CA, and non-extraction with FA. The effectiveness of the treatments was measured using several parameters, including the PAR index, arch width coordination, incisor up-righting, root parallelism, root resorption, and bone dehiscence. The efficiency of the treatments was evaluated by comparing the duration of pre-surgical treatment and the number of follow-up visits. Results CAs were found to be as effective as FAs in the pre-surgical orthodontics of skeletal class III malocclusion. However, there are significant differences in treatment duration and follow-up visits between the two groups. The treatment duration was significantly shorter in CA groups than that in FA groups (409.21 ± 172.01 vs. 548.29 ± 208.14 days, P = 0.015 for non-extractions while 536.16 ± 195.78 vs. 768.32 ± 316.83 days, P = 0.009 for extractions). Similarly, the number of follow-up visits were statistically lower in the CA groups as well (7.58 ± 3.24 vs. 16.08 ± 5.28 visits, P = 0.001 for non-extractions, while 9.37 ± 3.73 vs. 22.39 ± 10.08 visits, P = 0.001 for extractions). Furthermore, the non-extraction with CA group showed better U1-SN reduction than the non-extraction with FA group (1.46 ± 5.57 VS -2.52 ± 6.11 degrees, P = 0.023). Conclusions CAs are an effective alternative to FAs for pre-surgical orthodontic treatment of skeletal class III malocclusion patients. Moreover, they offer high efficiency by shortening treatment duration and reducing the number of follow-up visits. Clinical relevance CAs can be a highly efficient and effective option in pre-surgical orthodontic of skeletal class III malocclusion.