CC BY-NC-ND 4.0 · Eur J Dent 2015; 09(03): 404-410
DOI: 10.4103/1305-7456.163218
Original Article
Dental Investigation Society

Periodontal health status in patients treated with the Invisalign® system and fixed orthodontic appliances: A 3 months clinical and microbiological evaluation

Luca Levrini
1   Department of Morphological and Surgical Sciences, University of Insubria, Varese, Italy
Alessandro Mangano
2   Oro Cranio Facial Disease and Medicine Research Centre, University of Insubria, Varese, Italy
Paola Montanari
1   Department of Morphological and Surgical Sciences, University of Insubria, Varese, Italy
Silvia Margherini
1   Department of Morphological and Surgical Sciences, University of Insubria, Varese, Italy
Alberto Caprioglio
1   Department of Morphological and Surgical Sciences, University of Insubria, Varese, Italy
Gian Marco Abbate
1   Department of Morphological and Surgical Sciences, University of Insubria, Varese, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
04 September 2019 (online)


Objective: The aim of this prospective study was to compare the periodontal health and the microbiological changes via real-time polymerase chain reaction (PCR) in patients treated with fixed orthodontic appliances and Invisalign® system (Align Technology, Santa Clara, California). Materials and Methods: Seventy-seven patients were enrolled in this study and divided into three groups (Invisalign® group, fixed orthodontic appliances group and control group). Plaque index, probing depth, bleeding on probing were assessed. Total biofilm mass and periodontal pathogens were analyzed and detected via real-time PCR. All these data were analyzed at the T0 (beginning of the treatment) T1 (1-month) and T2 (3 months); and statistically compared using the Mann–Whitney test for independent groups. Results: After 1-month and after 3 months of treatment there was only one sample with periodontopathic anaerobes found in patient treated using fixed orthodontic appliances. The Invisalign® group showed better results in terms of periodontal health and total biofilm mass compared to the fixed orthodontic appliance group. A statistical significant difference (P < 0.05) at the T2 in the total biofilm mass was found between the two groups. Conclusion: Patients undergoing orthodontic treatment with the Invisalign® System show a superior periodontal health in the short-term when compared to patients in treatment with fixed orthodontic appliances. Invisalign® should be considered as a first treatment option in patients with risk of developing periodontal disease.


  • 1 Bollen AM, Cunha-Cruz J, Bakko DW, Huang GJ, Hujoel PP. The effects of orthodontic therapy on periodontal health: A systematic review of controlled evidence. J Am Dent Assoc 2008; 139: 413-22
  • 2 Liu H, Sun J, Dong Y, Lu H, Zhou H, Hansen BF. et al. Periodontal health and relative quantity of subgingival Porphyromonas gingivalis during orthodontic treatment. Angle Orthod 2011; 81: 609-15
  • 3 Baka ZM, Basciftci FA, Arslan U. Effects of 2 bracket and ligation types on plaque retention: A quantitative microbiologic analysis with real-time polymerase chain reaction. Am J Orthod Dentofacial Orthop 2013; 144: 260-7
  • 4 Ren Y, Vissink A. Cytokines in crevicular fluid and orthodontic tooth movement. Eur J Oral Sci 2008; 116: 89-97
  • 5 Van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Longitudinal changes in microbiology and clinical periodontal variables after placement of fixed orthodontic appliances. J Periodontol 2008; 79: 2078-86
  • 6 Atack NE, Sandy JR, Addy M. Periodontal and microbiological changes associated with the placement of orthodontic appliances. A review. J Periodontol 1996; 67: 78-85
  • 7 Zachrisson BU, Alnaes L. Periodontal condition in orthodontically treated and untreated individuals. II. Alveolar bone loss: Radiographic findings. Angle Orthod 1974; 44: 48-55
  • 8 Gomes SC, Varela CC, da Veiga SL, Rösing CK, Oppermann RV. Periodontal conditions in subjects following orthodontic therapy. A preliminary study. Eur J Orthod 2007; 29: 477-81
  • 9 Socransky SS, Haffajee AD. The bacterial etiology of destructive periodontal disease: Current concepts. J Periodontol 1992; 63: 322-31
  • 10 Petti S, Barbato E, Simonetti D'ArcaA. Effect of orthodontic therapy with fixed and removable appliances on oral microbiota: A six-month longitudinal study. New Microbiol 1997; 20: 55-62
  • 11 Miethke RR, Brauner K. A Comparison of the periodontal health of patients during treatment with the Invisalign system and with fixed lingual appliances. J Orofac Orthop 2007; 68: 223-31
  • 12 Miethke RR, Vogt S. A comparison of the periodontal health of patients during treatment with the Invisalign system and with fixed orthodontic appliances. J Orofac Orthop 2005; 66: 219-29
  • 13 Dannan A. An update on periodontic-orthodontic interrelationships. J Indian Soc Periodontol 2010; 14: 66-71
  • 14 Boyd RL, Miller R, Vlaskalic V. The Invisalign system in adult orthodontics: Mild crowding and space closure cases. J Clin Orthod 2000; 34: 203-12
  • 15 Jervøe-Storm PM, Koltzscher M, Falk W, Dörfler A, Jepsen S. Comparison of culture and real-time PCR for detection and quantification of five putative periodontopathogenic bacteria in subgingival plaque samples. J Clin Periodontol 2005; 32: 778-83
  • 16 Lau L, Sanz M, Herrera D, Morillo JM, Martín C, Silva A. Quantitative real-time polymerase chain reaction versus culture: A comparison between two methods for the detection and quantification of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythensis in subgingival plaque samples. J Clin Periodontol 2004; 31: 1061-9
  • 17 Jordan C, LeBlanc DJ. Influences of orthodontic appliances on oral populations of mutans streptococci . Oral Microbiol Immunol 2002; 17: 65-71
  • 18 Naranjo AA, Triviño ML, Jaramillo A, Betancourth M, Botero JE. Changes in the subgingival microbiota and periodontal parameters before and 3 months after bracket placement. Am J Orthod Dentofacial Orthop 2006; 130: 275.e17-22
  • 19 Levrini L, Abbate GM, Migliori F, Orrù G, Sauro S, Caprioglio A. Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed or removable appliances. A microbiological and preliminary clinical study. Cumhuriyet Dent J 2013; 16: 296-307
  • 20 Alfuriji S, Alhazmi N, Alhamlan N, Al-Ehaideb A, Alruwaithi M, Alkatheeri N. et al. The effect of orthodontic therapy on periodontal health: A review of the literature. Int J Dent 2014; 2014: 585048
  • 21 Little R. The irregularity index: A quantitative score of mandibular anterior alignment. Am J Orthod Dentofacial Orthop 1975; 68: 554-63
  • 22 Loe H, Silness J. Periodontal disease in pregnancy. I. prevalence and severity. Acta Odontol Scand 1963; 21: 533-51
  • 23 Mumghamba EG, Pitiphat W, Matee MI, Simon E, Merchant AT. The usefulness of using Ramfjord teeth in predicting periodontal status of a Tanzanian adult population. J Clin Periodontol 2004; 31: 16-8
  • 24 Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964; 22: 121-35
  • 25 Jervøe-Storm PM, AlAhdab H, Koltzscher M, Fimmers R, Jepsen S. Quantification of periodontal pathogens by paper point sampling from the coronal and apical aspect of periodontal lesions by real-time PCR. Clin Oral Investig 2010; 14: 533-41
  • 26 Bommarito S, Peyret N, SantaLucia Jr J. Thermodynamic parameters for DNA sequences with dangling ends. Nucleic Acids Res 2000; 28: 1929-34
  • 27 Orrù G, Marini MF, Ciusa ML, Isola D, Cotti M, Baldoni M. et al. Usefulness of real time PCR for the differentiation and quantification of 652 and JP2 Actinobacillus actinomycetemcomitans genotypes in dental plaque and saliva. BMC Infect Dis 2006; 6: 98
  • 28 Marsh PD. Plaque mediated diseases. In: Marsh PD, Martin MV. editors. Oral Microbiology. 5th ed.. Edinburgh, London, UK: Churchill Livingstone; 2009: p. 120
  • 29 Ristic M, Vlahovic SvabicM, Sasic M, Zelic O. Clinical and microbiological effects of fixed orthodontic appliances on periodontal tissues in adolescents. Orthod Craniofac Res 2007; 10: 187-95
  • 30 Ghijselings E, Coucke W, Verdonck A, Teughels W, Quirynen M, Pauwels M. et al. Long-term changes in microbiology and clinical periodontal variables after completion of fixed orthodontic appliances. Orthod Craniofac Res 2014; 17: 49-59
  • 31 Dannan A. An update on periodontic-orthodontic interrelationships. J Indian Soc Periodontol 2010; 14: 66-71
  • 32 Demling A, Demling C, Schwestka-Polly R, Stiesch M, Heuer W. Short-term influence of lingual orthodontic therapy on microbial parameters and periodontal status. A preliminary study. Angle Orthod 2010; 80: 480-4
  • 33 Germano F, Bramanti E, Arcuri C, Cecchetti F, Cicciù M. Atomic force microscopy of bacteria from periodontal subgingival biofilm: Preliminary study results. Eur J Dent 2013; 7: 152-8
  • 34 Karkhanechi M, Chow D, Sipkin J, Sherman D, Boylan RJ, Norman RG. et al. Periodontal status of adult patients treated with fixed buccal appliances and removable aligners over one year of active orthodontic therapy. Angle Orthod 2013; 83: 146-51
  • 35 Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Periodontal health during clear Aligners treatment: A systematic review. Eur J Orthod. 2014 ;
  • 36 Abbate GM, Caria MP, Montanari P, Mannu C, Orrù G, Caprioglio A. et al. Periodontal health in teenagers treated with removable aligners and fixed orthodontic appliances. J Orofac Orthop 2015; 76: 240-50
  • 37 Low B, Lee W, Seneviratne CJ, Samaranayake LP, Hägg U. Ultrastructure and morphology of biofilms on thermoplastic orthodontic appliances in ‘fast’ and ‘slow’ plaque formers. Eur J Orthod 2011; 33: 577-83
  • 38 Erdemir EO, Hendek MK, Keceli HG, Apan TZ. Crevicular fluid levels of interleukin-8, interleukin-17 and soluble intercellular adhesion molecule-1 after regenerative periodontal therapy. Eur J Dent 2015; 9: 60-5