{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:32:39Z","timestamp":1772087559166,"version":"3.50.1"},"reference-count":40,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dentistry Journal"],"abstract":"<jats:p>Background: Clear aligner (CA) therapy has been increasingly adopted as an alternative to fixed orthodontic appliances. However, evidence regarding its periodontal effects, including gingival inflammation, biofilm composition, and the potential role of aligner marginal edge design, remains insufficiently mapped. The objective of this scoping review was to map and synthesize available clinical and laboratory evidence on periodontal and biological outcomes associated with CA therapy, with particular attention to the potential influence of aligner marginal edge design. Methods: This scoping review followed PRISMA-ScR and the Population\u2013Concept\u2013Context (PCC) framework. PubMed, Scopus, and Web of Science were searched from 1 January 2015 to 24 October 2025. A total of 1587 records were identified; after deduplication, 770 unique records were screened by title and abstract, followed by full-text assessment of potentially eligible articles. Twenty-five primary studies published between 2020 and 2025 met eligibility criteria and were included in the review. Results: The final synthesis comprised clinical investigations, laboratory studies, and case reports. Clinical periodontal indices and inflammatory biomarkers were assessed using heterogeneous protocols and timepoints. Only three studies specifically addressed aligner marginal edge design; one directly compared margin configurations, reporting differences in local gingival response, with substantial diversity in study design precluding quantitative synthesis. Conclusions: Available evidence on periodontal outcomes during CA therapy is methodologically heterogeneous. Investigations of aligner marginal edge design remain scarce. Standardized assessment protocols and targeted clinical studies are needed to establish the periodontal relevance of trimline configurations.<\/jats:p>","DOI":"10.3390\/dj14030130","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T08:54:56Z","timestamp":1771923296000},"page":"130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clear Aligner Therapy and Marginal Edge Design: Clinical and Laboratory Evidence on Periodontal and Biological Outcomes\u2014A Scoping Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5869-0389","authenticated-orcid":false,"given":"Emilia (Prodea)","family":"Rusu","sequence":"first","affiliation":[{"name":"Doctoral School (IOSUD), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana-Petra","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"Department of Oral Rehabilitation and Occlusology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca Lumini\u021ba","family":"Erhan","sequence":"additional","affiliation":[{"name":"Doctoral School, Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5193-4944","authenticated-orcid":false,"given":"Eugen","family":"Bud","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"P\u0103curar","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-4299","authenticated-orcid":false,"given":"Lumini\u021ba","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"Department of Periodontology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"241","DOI":"10.5152\/TurkJOrthod.2019.18083","article-title":"Orthodontic treatment with clear aligners and the scientific reality behind their marketing: A literature review","volume":"32","author":"Tamer","year":"2019","journal-title":"Turk. J. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4103\/jos.jos_30_23","article-title":"Clear aligner therapy: Up to date review article","volume":"12","author":"AlMogbel","year":"2023","journal-title":"J. Orthod. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","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":"ref_4","first-page":"80","article-title":"Clear aligners vs. fixed appliances in the management of mild to moderate malocclusion: A review of treatment efficacy, stability, and patient-centered outcomes","volume":"8","year":"2025","journal-title":"Dent. Res. Oral. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2321124","DOI":"10.1590\/2177-6709.28.1.e2321124.oar","article-title":"Edge level of aligners and periodontal health: A clinical perspective study in young patients","volume":"28","author":"Favero","year":"2023","journal-title":"Dent. Press J. Orthod."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Alasiri, M.M., Almalki, A., Alotaibi, S., Alshehri, A., Alkhuraiji, A.A., and Thomas, J.T. (2024). Association between gingival phenotype and periodontal disease severity: A comparative longitudinal study among patients undergoing fixed orthodontic therapy and Invisalign treatment. Healthcare, 12.","DOI":"10.3390\/healthcare12060656"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bucur, S.M., Bud, E., Decusar\u0103, M., and Olteanu, C.D. (2024). Retrospective study on orthodontic gingival recession correction using clear aligners. Medicina, 60.","DOI":"10.3390\/medicina60122024"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"452","DOI":"10.2319\/020524-91.1","article-title":"Class III correction and enhanced periodontal health with aligner treatment in a 53-year-old patient","volume":"95","author":"Almagrami","year":"2025","journal-title":"Angle Orthod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s00056-021-00359-2","article-title":"Comparison of cytokine level changes in gingival crevicular fluid between the aligner and pendulum appliance during early molar distalization: A single-center, prospective, observational study","volume":"84","author":"Chen","year":"2021","journal-title":"J. Orofac. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"212","DOI":"10.2319\/050224-347.1","article-title":"Evaluation of IL-8 and IL-6 levels in gingival crevicular fluid of individuals undergoing clear aligner therapy","volume":"95","author":"Tunca","year":"2025","journal-title":"Angle Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s00784-025-06212-9","article-title":"Oral health in adolescents: Periodontal inflammatory biomarkers during orthodontic clear aligner therapy","volume":"29","author":"Kredig","year":"2025","journal-title":"Clin. Oral. Investig."},{"key":"ref_12","unstructured":"Nawaf, S.F. (2023). Effect of Orthodontic Appliance on Oral Environment and Microbiome. [Master\u2019s Thesis, College of Dentistry, University of Baghdad]."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Mulimani, P., and Popowics, T. (2022). Effect of orthodontic appliances on the oral environment and microbiome. Front. Dent. Med., 3.","DOI":"10.3389\/fdmed.2022.924835"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Peters, M.D.J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A.C., and Khalil, H. (2024). Chapter 10: Scoping Reviews. JBI Manual for Evidence Synthesis, JBI.","DOI":"10.46658\/JBIMES-24-09"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.11124\/JBIES-20-00167","article-title":"Updated Methodological Guidance for the Conduct of Scoping Reviews","volume":"18","author":"Peters","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Pango Madariaga, A.C., Bucci, R., Rongo, R., Simeon, V., D\u2019Ant\u00f2, V., and Valletta, R. (2020). Impact of fixed orthodontic appliance and clear aligners on the periodontal health: A prospective clinical study. Dent. J., 8.","DOI":"10.3390\/dj8010004"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"6725","DOI":"10.1007\/s00784-023-05281-y","article-title":"Characteristics of oral microbiota and oral health in the patients treated with clear aligners: A prospective study","volume":"27","author":"Rouzi","year":"2023","journal-title":"Clin. Oral. Investig."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S4750","DOI":"10.4103\/jpbs.jpbs_874_24","article-title":"Comparative analysis of alkaline phosphatase levels in gingival crevicular fluid: A three-time point study comparing clear aligners and fixed orthodontic appliances","volume":"16","author":"Pisarla","year":"2025","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1053\/j.sodo.2023.11.013","article-title":"Clear aligners\u2014An efficient tool in the combined ortho-perio treatment of gingival recessions","volume":"30","author":"Leibovich","year":"2024","journal-title":"Semin. Orthod."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Cenzato, N., Occhipinti, C., D\u2019Amici, E., Savadori, P., Baldini, B., and Maspero, C. (2024). Microbiological analysis of plaque and its composition in three patient groups under different orthodontic treatments. Dent. J., 12.","DOI":"10.3390\/dj12060168"},{"key":"ref_22","first-page":"S3790","article-title":"Comparative study of periodontal health in patients with fixed braces versus clear aligners","volume":"16","author":"Annamalaisamy","year":"2024","journal-title":"J. Pharm. Bioallied Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105335","DOI":"10.1016\/j.jdent.2024.105335","article-title":"Dimensional changes of the gingival tissues induced by clear aligners and fixed orthodontic appliances","volume":"151","author":"Romito","year":"2024","journal-title":"J. Dent."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"293","DOI":"10.4041\/kjod.2021.51.4.293","article-title":"Effectiveness of Invisalign\u00ae aligners in the treatment of severe gingival recession: A case report","volume":"51","author":"Figueiredo","year":"2021","journal-title":"Korean J. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.54589\/aol.33\/2\/069","article-title":"Expansion treatment using Invisalign\u00ae: Periodontal health status and maxillary buccal bone changes. A clinical and tomographic evaluation","volume":"33","author":"Barreda","year":"2020","journal-title":"Acta Odontol. Latinoam."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Giannini, L., Galbiati, G., Tartaglia, F.C., Grecolini, M.E., Maspero, C., and Biagi, R. (2025). Orthodontic treatment with fixed appliances versus aligners: An experimental study of periodontal aspects. Dent. J., 13.","DOI":"10.3390\/dj13020070"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Alnazeh, A.A., Kamran, M.A., Aseeri, Y., Alrwuili, M.R., Aljabab, M.A., Baig, E.A., and Hameed, M.S. (2023). Levels of inflammatory and bone metabolic markers in the gingival crevicular fluid of individuals undergoing fixed orthodontic treatment in comparison to those utilizing Invisalign. Medicina, 59.","DOI":"10.3390\/medicina59122107"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Bober, P., Talian, I., Mihalik, D., Verbov\u00e1, G., and Sabo, J. (2023). MALDI-TOF\/MS profiling of whole saliva and gingival crevicular fluid in patients with the Invisalign system and fixed orthodontic appliances. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043252"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Nemec, M., Behm, C., Sedlak, M., Nemec-Neuner, H., Nguyen, P.Q., Jonke, E., and Andrukhov, O. (2023). Effects of the saliva of patients undergoing orthodontic treatment with Invisalign and brackets on human gingival fibroblasts and oral epithelial cells. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237440"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4103\/jos.JOS_54_17","article-title":"Periodontal parameters in adult patients with clear aligner orthodontic treatment versus three other types of brackets: A cross-sectional study","volume":"9","author":"Rabah","year":"2020","journal-title":"J. Orthod. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ravera, S., Castroflorio, T., Mantovani, E., Sedran, A., Cugliari, G., and Deregibus, A. (2024). Periodontal outcomes and digital data integration of orthodontic treatment with clear aligners: A prospective pilot study. Appl. Sci., 14.","DOI":"10.3390\/app14010116"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1111\/ocr.12916","article-title":"Proton-nuclear magnetic resonance metabolomics of gingival crevicular fluid during orthodontic tooth movement with aligners","volume":"28","author":"Domini","year":"2025","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"335","DOI":"10.2319\/091722-649.1","article-title":"Role of six cytokines and bone metabolism biomarkers in gingival crevicular fluid in patients undergoing fixed orthodontic appliance treatment in comparison with aligners: A clinical study","volume":"93","author":"Kamran","year":"2023","journal-title":"Angle Orthod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/ocr.12427","article-title":"Short-term variation in the subgingival microbiota in two groups of patients treated with clear aligners and vestibular fixed appliances: A longitudinal study","volume":"24","author":"Lombardo","year":"2021","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.adaj.2018.04.010","article-title":"Periodontal health during orthodontic treatment with clear aligners and fixed appliances: A meta-analysis","volume":"149","author":"Jiang","year":"2018","journal-title":"J. Am. Dent. Assoc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"374","DOI":"10.4041\/kjod22.272","article-title":"Periodontal health status, oral microbiome, white-spot lesions and oral health related to quality of life\u2014Clear aligners versus fixed appliances: A systematic review, meta-analysis and meta-regression","volume":"53","author":"Garcovich","year":"2023","journal-title":"Korean J. Orthod."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Di Spirito, F., D\u2019Ambrosio, F., Cannat\u00e0, D., D\u2019Ant\u00f2, V., Giordano, F., and Martina, S. (2023). Impact of clear aligners versus fixed appliances on periodontal status of patients undergoing orthodontic treatment: A systematic review of systematic reviews. Healthcare, 11.","DOI":"10.3390\/healthcare11091340"},{"key":"ref_38","first-page":"e357","article-title":"Periodontal health comparing clear aligners versus fixed appliances: A systematic review and meta-analysis","volume":"28","year":"2023","journal-title":"Med. Oral. Patol. Oral. Cir. Bucal."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Dipalma, G., Inchingolo, A., Fiore, A., Balestriere, L., Nardelli, P., Casamassima, L., Di Venere, D., Palermo, A., Inchingolo, F., and Inchingolo, A.M. (2025). The Differential Impact of Clear Aligners and Fixed Orthodontic Appliances on Periodontal Health: A Systematic Review. Children, 12.","DOI":"10.3390\/children12020138"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s40510-025-00560-8","article-title":"Exploring the impact of orthodontic appliances on the oral microbiome and inflammatory parameters","volume":"26","author":"Nemec","year":"2025","journal-title":"Prog. Orthod."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/3\/130\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T05:19:59Z","timestamp":1772083199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/3\/130"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["dj14030130"],"URL":"https:\/\/doi.org\/10.3390\/dj14030130","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]}}}