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

Abstract

Introduction: This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors. Methods: An original, 22-item survey was mailed to a randomized, nationally representative sample of practicing orthodontists (n = 800) and a specific, randomized subsample of high-aligner-prescribing orthodontists (n = 200). Questions assessed respondents’ demographic information, experience with clear aligner therapy, and perceived advantages and disadvantages of CAMD compared with fixed appliances (FAs). Responses were compared using McNemar's chi-square and paired t tests to assess CAMD vs FAs. Results: One thousand orthodontists were surveyed, and 181 (18.1%) responded over 12 weeks. CAMD use was less common than mixed dentition FAs, but most respondents predicted an increase in their future CAMD use (57.9%). Among respondents using CAMD, the number of patients with mixed dentition treated with clear aligners was significantly lower than the number of total patients with clear aligners (23.7% vs 43.8%; P <0.0001). Fewer respondents considered skeletal expansion, growth modification, sagittal correction, and habit cessation feasible indications for CAMD compared with FAs (P <0.0001). Perceived compliance was similar for CAMD and FAs (P = 0.5841), but perceived oral hygiene was significantly better with CAMD (P <0.0001). Conclusions: CAMD is an increasingly common treatment modality for children. Most surveyed orthodontists reported limited indications for CAMD compared with FAs but perceived noticeable benefits for oral hygiene with CAMD.