{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:09:28Z","timestamp":1789992568220,"version":"4.0.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Dent. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Dental caries is one of the most prevalent chronic conditions worldwide, significantly affecting public health and individual quality of life. Orthodontic treatments, particularly fixed appliances, may increase caries risk due to plaque retention and changes in the oral microbiota. Clear aligners, such as Invisalign\u00ae, represent a removable alternative that may facilitate oral hygiene and oral health. however, their impact on caries development remains a question to be investigate to understand the real opportunity in treating patients reducing the risk of caries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically evaluate the effect of clear aligner therapy on dental caries risk and cariological outcomes compared with fixed or traditional removable orthodontic appliances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature search was conducted up to June 2025 in PubMed\/MEDLINE and Web of Science. Original clinical studies comparing clear aligners with fixed or traditional removable appliances were included according to predefined PICOS criteria. Outcomes of interest included DMFT scores, caries incidence, white spot lesions, enamel demineralization, and cariogenic bacterial profiles. Study selection and data extraction were performed independently by two reviewers, with disagreements resolved by a third reviewer. Risk of bias was assessed using ROBINS-I.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Three studies met the inclusion criteria (two case\u2013control studies and one prospective cohort study). Two case\u2013control studies reported a significantly greater increase in DMFT scores in patients treated with fixed appliances compared with clear aligners, while no significant differences in proximal caries incidence were observed. The cohort study found no significant differences in salivary levels of\n                      <jats:italic>Streptococcus mutans<\/jats:italic>\n                      and Lactobacilli between treatment modalities. Overall, no evidence of an increased caries risk associated with clear aligners was identified; however, the certainty of evidence was low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clear aligner therapy does not appear to be associated with a higher risk of dental caries compared with fixed or traditional removable appliances. Nevertheless, the limited number of studies and their methodological limitations highlight the need for well-designed prospective investigations with standardized caries outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdmed.2026.1920698","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:24:39Z","timestamp":1789989879000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of clear aligners therapy on dental caries: a systematic review"],"prefix":"10.3389","volume":"7","author":[{"given":"Silvia","family":"Caruso","sequence":"first","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Viarchi","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Ciavarella","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Foggia","place":["Foggia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Tepedino","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Caruso","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gatto","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia T.","family":"Truppa","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Mattei","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L\u2019Aquila","place":["L\u2019Aquila, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Severino","sequence":"additional","affiliation":[{"name":"Section of Odontostomatologic Surgery, Department of Medicine and Surgery, University of Perugia","place":["Perugia, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1177\/0022034513490168","article-title":"Global burden of oral conditions in 1990-2010: a systematic analysis","volume":"92","author":"Marcenes","year":"2013","journal-title":"J Dent Res"},{"key":"B2","year":"2018"},{"key":"B3","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1186\/s12903-025-05543-z","article-title":"Real-world dental health of Ukrainian war refugee children and adolescents in Umbria, Italy: preliminary data","volume":"25","author":"Cianetti","year":"2025","journal-title":"BMC Oral Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"17030","DOI":"10.1038\/nrdp.2017.30","article-title":"Dental caries","volume":"3","author":"Pitts","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"B5","first-page":"201","article-title":"Biofilm and orthodontic therapy","volume-title":"Monographs in Oral Science","author":"M\u00fcller","year":"2021"},{"key":"B6","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1186\/s12903-023-03257-8","article-title":"White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta-analysis","volume":"23","author":"Raghavan","year":"2023","journal-title":"BMC Oral Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"37","DOI":"10.23804\/ejpd.2025.S04","article-title":"Caries risk assessment in children: experimental study on the effectiveness of the C.A.M.B.R.A. system","volume":"26","author":"Caruso","year":"2025","journal-title":"Eur J Paediatr Dent"},{"key":"B8","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13643-023-02437-5","article-title":"An evaluation of the invisalign\u00ae aligner technique and consideration of the force system: a systematic review","volume":"13","author":"Caruso","year":"2024","journal-title":"Syst Rev"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.14219\/jada.archive.2005.0117","article-title":"The treatment effects of invisalign orthodontic aligners: a systematic review","volume":"136","author":"Lagrav\u00e8re","year":"2005","journal-title":"J Am Dent Assoc"},{"key":"B10","doi-asserted-by":"publisher","first-page":"30","DOI":"10.4274\/TurkJOrthod.2024.2023.140","article-title":"Comparative study of proximal caries formation and decay, missing, filled teeth scores in clear aligners and fixed orthodontic treatments","volume":"38","author":"\u00c7etin","year":"2025","journal-title":"Turk J Orthod"},{"key":"B11","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1016\/j.identj.2023.03.012","article-title":"Impact of clear aligners on oral health and oral microbiome during orthodontic treatment","volume":"73","author":"Rouzi","year":"2023","journal-title":"Int Dent J"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"Br Med J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1186\/s12903-024-05063-2","article-title":"Effects of clear aligners and traditional removable appliances on oral microbiome in mixed dentition: a comparative study","volume":"24","author":"Chen","year":"2024","journal-title":"BMC Oral Health"},{"key":"B15","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s40510-018-0230-4","article-title":"Salivary levels of cariogenic bacterial species during orthodontic treatment with thermoplastic aligners or fixed appliances: a prospective cohort study","volume":"19","author":"Sifakakis","year":"2018","journal-title":"Prog Orthod"},{"key":"B16","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3390\/dj13020070","article-title":"Orthodontic treatment with fixed appliances versus aligners: an experimental study of periodontal aspects","volume":"13","author":"Giannini","year":"2025","journal-title":"Dent J (Basel)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0228798","DOI":"10.1371\/journal.pone.0228798","article-title":"Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: an observational study","volume":"15","author":"Mummolo","year":"2020","journal-title":"PLoS One"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1738047","DOI":"10.3389\/fcimb.2025.1738047","article-title":"Comparison of the effects of clear aligners and fixed appliances on the oral microbiota and reactive oxygen species: a prospective study","volume":"15","author":"Xu","year":"2026","journal-title":"Front Cell Infect Microbiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1080\/19424396.2013.12222284","article-title":"Salivary biomarkers for caries risk assessment","volume":"41","author":"Guo","year":"2013","journal-title":"J Calif Dent Assoc"},{"key":"B20","doi-asserted-by":"publisher","first-page":"375","DOI":"10.3390\/dj12120375","article-title":"A review of white spot lesions: development and treatment with resin infiltration","volume":"12","author":"Prada","year":"2024","journal-title":"Dent J (Basel)"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2579836","DOI":"10.1080\/20002297.2025.2579836","article-title":"Effects of removable clear dental aligners on the composition of the oral microbiome","volume":"17","author":"Peregrina","year":"2025","journal-title":"J Oral Microbiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e70265","DOI":"10.1002\/cre2.70265","article-title":"Impact of clear aligners on the oral microbiome: a systematic review of current evidence","volume":"12","author":"Tabone","year":"2026","journal-title":"Clin Exp Dent Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"13429","DOI":"10.3390\/ijerph182413429","article-title":"Perspectives on social and environmental determinants of oral health","volume":"18","author":"De Abreu","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B24","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/s40510-022-00453-0","article-title":"Predictability of orthodontic tooth movement with aligners: effect of treatment design","volume":"24","author":"Castroflorio","year":"2023","journal-title":"Prog Orthod"},{"key":"B25","doi-asserted-by":"publisher","first-page":"526","DOI":"10.3390\/dj13110526","article-title":"Evaluation of the impact of probiotic supplementation on gingival inflammation in subjects undergoing orthodontic treatment with fixed appliances or clear aligners: a randomized, single-blind pilot study","volume":"13","author":"Lanzetti","year":"2025","journal-title":"Dent J (Basel)"}],"container-title":["Frontiers in Dental Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdmed.2026.1920698\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:24:40Z","timestamp":1789989880000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdmed.2026.1920698\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":25,"alternative-id":["10.3389\/fdmed.2026.1920698"],"URL":"https:\/\/doi.org\/10.3389\/fdmed.2026.1920698","relation":{},"ISSN":["2673-4915"],"issn-type":[{"value":"2673-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"1920698"}}