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  • Writer's pictureGustavo Gameiro

Chewing with Clear Aligners: Separating Fact from Fiction

Introduction: Clear aligners have transformed orthodontic treatment, offering a discreet and convenient alternative to traditional braces in selected cases. Typically, patients are advised to remove their aligners during meals and snacks to prevent damage and maintain hygiene (1). However, a growing number of professionals are advocating for a different approach – chewing with aligners in place. This controversial recommendation promises faster treatment times, but is it supported by scientific evidence?


The Controversy: In recent years, some orthodontic professionals have suggested that wearing clear aligners during meals can accelerate treatment by up to 50%. This bold claim has garnered attention and raised eyebrows within the orthodontic community. However, it's essential to critically examine the evidence behind this recommendation before accepting it as gospel.


Examining the Evidence: Recent studies, purportedly from the same research group, have been cited to support the idea of chewing with aligners. These studies aimed to assess masticatory performance with aligners in place (2,3). It's important to note that these studies focused solely on evaluating the effects of chewing with aligners and did not directly address claims of accelerated treatment. However, upon closer scrutiny, significant limitations come to light. The studies employed specific tests, including a chewing mixing gum test and the use of almonds to evaluate masticatory function. Yet, these tests may be influenced by variables such as saliva flow, which was not adequately controlled. Additionally, the absence of blinding measurements and potential errors in the methodology raise doubts about the reliability of the findings.


Concerns About Aligner Integrity: Beyond the potential impact on treatment duration, there are concerns about the integrity of clear aligners themselves. Aligners and their attachments are vulnerable to biting forces during the chewing cycle, which may lead to deformations over time. These alterations could compromise the aligners' functionality and ultimately affect treatment outcomes.


Biological Response to Chewing: Moreover, the notion that chewing with aligners can stimulate significant bone remodeling raises questions. The brief periods of chewing during meals may not induce the necessary osteoblastic and osteoclastic activity to accelerate treatment. Without robust scientific evidence supporting this claim, it remains speculative at best.


Conclusion: Until we have more robust scientific evidence, it is premature to make promises of accelerated treatment with clear aligners. The limited studies available suffer from significant methodological limitations, and their findings should be interpreted with caution. As orthodontic professionals, it is our responsibility to prioritize patient care and safety above all else. Making unsubstantiated claims about treatment outcomes is not only unethical but also potentially harmful to patients' trust and well-being.


Final Thoughts: Moving forward, it is crucial to conduct further research into the biomechanics of clear aligners and their effects on treatment duration. Only through rigorous scientific inquiry can we ensure that our recommendations are based on sound evidence and prioritize the best interests of our patients.



References: 

  1. https://www.invisalign.com/frequently-asked-questions (Access in May 09/05/2024)

  2. Levrini L, Bocchieri S, Mauceri F, Saran S, Carganico A, Zecca PA, Segù M. Chewing Efficiency Test in Subjects with Clear Aligners. Dent J (Basel). 2023 Mar 1;11(3):68.

  3. Levrini L, Deppieri A, Carganico A, Rodigari G, Saran S, Zecca PA, Cicciù M, Bocchieri S. Chewing Function with Efficiency Tests in Subjects Wearing Clear Aligners. Dent J (Basel). 2024 Mar 1;12(3):57.


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