Management of complex orthodontic cases using aligners: A comparative study

Clear aligners are increasingly being used for complex malocclusions; however, adequate outcome data comparing them with fixed appliances in high-difficulty cases is still limited. Therefore, it is of interest to compare occlusal outcomes, efficiency and patient-reported experience between clear aligners and fixed appliances in complex orthodontic cases. Using a prospective comparative design, complex cases were randomly assigned to treatment with clear aligner therapy or conventional fixed appliances and assessed by Peer Assessment Rating (PAR) score change, length of treatment time needed, burden of appointments required, refinements/finishes and OHIP-14. Both modalities produced clinically significant occlusal correction; however, fixed appliances showed increased efficiency in extraction heavy biomechanics while aligners showed increased initial patient-reported comfort and oral health related quality of life. Aligners may be useful in complex cases when biomechanics has been well-staged and compliance is high and yet fixed appliances might still be beneficial in providing efficiency benefits in hard-to-root control and extraction space closure.