Volume 9, Issue 10, October– 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24OCT622

Perception about Clear Aligner

Therapy among Patients Seeking Orthodontic
Treatment in Public Tertiary Care Dental
Hospital-Cross-Sectional Survey
Dr. Harshavardhan S1; Dr. M.D. Sofitha2; Dr. B. Balashanmugam3
Dr. Chandralekha G4*; Dr. Keerthana Manikandan5; Dr. Aswini Chandra M C6
Post Graduate Student1; Associate Professor2; Professor and Head3
Post Graduate Student4; Post Graduate Student5
Department of Orthodontics and Dentofacial Orthopaedics,
Tamil Nadu Government Dental College & Hospital, Chennai - 600 003.

Corresponding Author:- Dr. Chandralekha G4*

Abstract:- Keywords:- Clear Aligner, CAT Therapy, Fixed Appliance,

Perception, Translucent Removable.
 Aim:
Aim of the study is to assess perception about clear I. INTRODUCTION
aligner therapy among patients seeking orthodontic
treatment in public tertiary care dental hospital. Esthetics, function, and stability are the primary goals in
orthodontic treatment. With the rising demand for esthetic
 Material and Methods: solutions, clear aligners have emerged as a significant
This cross-sectional survey was conducted using a advancement in orthodontics. They offer distinct advantages
questionnaire that had been framed and tested for over traditional fixed appliances, particularly in terms of
reliability and validity. It was used to collect information appearance, as they are more aesthetically pleasing and can
on the socio-demographic profile and the perspectives of be removed during socially sensitive situations(1-4).
orthodontic patients regarding Clear Aligner Therapy. Additionally, clear aligners do not impose food restrictions, a
Participants had been informed about the study, and only common drawback of fixed appliances. From the operator's
those who had consented were administered the perspective, aligner therapy requires less chairside time and
questionnaire. The structured questionnaire consisted of fewer patient visits, allowing orthodontists to manage a
23 closed-ended questions, and the data was collected higher patient load more efficiently(5,6).
using Google Forms.
However, the custom design and fabrication of clear
 Results: aligners involve advanced technology (such as 3D imaging
Data from 294 patients were assessed, comprising and printing), can make them more expensive than traditional
159 females (54.1%) and 134 males (45.6%), all between braces(3). Since clear aligners are removable, their
the ages of 15 and 45. Of these, 92% were aware of Clear effectiveness depends heavily on patient compliance. Patients
Aligner Therapy (CAT). 31.3% patients perceived CAT need to wear the aligners for 20-22 hours a day for them to
to be less effective than fixed appliance (FA) therapy, with work as intended, and failure to do so can prolong treatment
only 19.3% being aware of the cost of CAT. Additionally, time(7). Clear aligners are great for treating mild to moderate
30.4% believed that CAT would result in a longer cases of crowding or spacing, but they may not be effective
treatment duration compared to fixed appliances. for severe malocclusions or cases requiring more complex
However, 59.6% preferred CAT over fixed appliances for tooth movements, such as large rotations or significant
aesthetic reasons, and 78.6% favored CAT for better oral vertical changes(8).
hygiene maintenance.
Patients' knowledge and perception of different
 Conclusion: orthodontic appliances are often influenced by aesthetics.
As Clear Aligner Therapy (CAT) represents one of Studies show that many patients, especially adults, prioritize
the latest advancements in orthodontics, there is a the visual aspect of treatment when choosing an orthodontic
pressing need to increase education and awareness among option(9). Orthodontic aligners have become one of the most
the general population to improve their understanding of popular options requested by patients.
this treatment option.

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Volume 9, Issue 10, October– 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24OCT622

In 1946, Dr. H.D. Kesling introduced a revolutionary  Study Center:

concept in orthodontics: the use of sequential thermoplastic
tooth positioners to gradually move misaligned teeth into  Department of Orthodontics and Dentofacial
better positions. This idea laid the groundwork for what we Orthopaedics,
now recognize as clear aligner therapy(10). In 1959, Dr.  Tamil Nadu Government Dental College and Hospital,
Antony Nahoum expanded on Kesling's foundational idea of Chennai – 600 003.
sequential tooth movement by introducing the first
documented clear thermoplastic appliance. Nahoum's  Study Duration:
appliance was vacuum-formed, allowing it to firmly adapt to
the patient's dental cast. (11).  Six months.

Later in the year 1970, Dr. Richard Ponitz introduced  Ethical Clearance:
the concept of the "invisible retainer, which was designed
primarily for retention purposes(12). In 1985, Dr. James A.  Ethical approval was given by Tamil Nadu Government
McNamara built on the work of Ponitz by modifying the Dental College and Hospital,
vacuum-forming technique used to create the "invisible  Chennai – 600 003 with IERB Reference No:
retainer." McNamara introduced the use of a Biostar machine, 57/III/IERB/2024/TNGDCH.
which utilized positive air pressure to fabricate the retainers.
He used a 1 mm thick Biocryl sheet, a durable and  Study Sample:
transparent material, to create retainers that were both clear The sample size for the study was calculated to be 284,
and effective for final detailing and retention(13). In 1993, with a 95% confidence level. However, to account for
Sheridan further modified it by reducing the thickness to potential dropouts or exclusions, a total of 304 patients were
0.030 and introduced the “Essix appliance”(11). In 1997, two initially recruited. Of these, 294 participants met the inclusion
Stanford graduates, Zia Chishti and Kelsey Wirth, along with criteria and were ultimately included in the study.
two orthodontists, founded Align Technology (Santa Clara,
CA, USA).  Inclusion Criteria:
With the raising esthetic demands clear aligner therapy,  Patients willing to participate
it is important to assess the knowledge and perceptions of the
 Patients in age group 12-45 years
general population regarding this treatment. Educating
patients is essential, as it helps orthodontists provide more  Exclusion Criteria:
effective care and ensures better treatment outcomes.
Therefore, the aim of the present study is to assess the
 Participants who are not giving informed consent
perceptions of patients seeking orthodontic treatment at a
public tertiary care dental hospital regarding clear aligner  Patients who have systemic illness, mentally retarded and
therapy. unable to answer a questionnaire.

 Methodology:
II. MATERIALS & METHODS
This study is designed as a cross-sectional survey. A
 Study Design: structured questionnaire will be developed, rigorously tested
for reliability and validity, and used to gather information
Cross-sectional survey to assess perception about clear
about the socio-demographic profile and perspectives of
aligner therapy among patients seeking orthodontic treatment
orthodontic patients regarding Clear Aligner Therapy (CAT).
in public tertiary care dental hospital.
Before administering the questionnaire, participants will be
informed about the study's purpose, and only those willing to
participate will be included. The structured questionnaire
consisted of 23 closed-ended questions, and the data was
collected using Google Forms.

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Volume 9, Issue 10, October– 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24OCT622

III. RESULTS

Fig 1 Responses to Questions on Clear Aligner Therapy (% of Patients)

Fig 2 Patient Perception on the Efficiency of CAT

Fig 3 How many Hours should you Wear a Clear Aligner in a Day?

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Volume 9, Issue 10, October– 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24OCT622

Fig 4 Bar Chart showing the Preference of CAT Therapy

Fig 5 Which Appliance is more Comfortable to Maintain Oral Hygiene?

Fig 6 What according to you is the total time duration of clear aligner treatment

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Volume 9, Issue 10, October– 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24OCT622

Fig 7 Bar chart showing the various responses to questions on Clear Aligner therapy

IV. DISCUSSION comparable to fixed appliance therapy, particularly in the

buccolingual inclination of the upper and lower incisors in
Patients are increasingly seeking not only the perfect cases of mild to moderate malocclusions(21).
smile as the outcome of their treatment but also a more
aesthetically pleasing and comfortable experience during the When it comes to treatment duration, 30% of people
process. To meet this demand, innovative solutions like believe that clear aligner therapy will take longer than fixed
orthodontic aligners have been introduced, offering a subtle appliance therapy. However, there is some controversy
and effective alternative to traditional braces(14). surrounding aligner therapy. While some believe that clear
aligners take longer than fixed appliances to achieve
The current study found that 87% of respondents were results(22), others favor aligners for their perceived
already aware of aligner treatments, highlighting their efficiency and convenience(23).
growing popularity. This increase in awareness can largely be
attributed to marketing strategies that target patients directly Recent systematic review shows that there was no
through various media, including magazines, television, and statistically significant difference in the treatment duration
the Internet(15). Notably, 43.5% of respondents in this study between the CAT and FA groups in mild to moderate
reported learning about clear aligners through social media, crowding cases (24).
while 21% became aware through commercials. Furthermore,
the study revealed that the majority of participants who were Moreover, the majority of participants(50.3%)found
aware of aligners were young, aged between 18 and 29 - a clear aligners to be more aesthetically pleasing than
demographic often targeted by advertising campaigns. When traditional braces, a result consistent with findings from other
it came to aligners, women demonstrated greater awareness studies.(25,26). One of the key advantages promoted for clear
than men. Women are often more self-conscious about their aligners is the ease of maintaining oral hygiene, as they are
appearance when looking in the mirror and may feel awkward removable appliances. In this study, 78.6% of patients also
about their smile, making them more likely to seek aesthetic expressed a preference for this feature. Most participants in
dental solutions(16). this study were unaware of the cost of clear aligner treatment.

In terms of efficiency, previous studies have shown that Most participants in this study were unaware of the cost
aligners may be less effective than fixed appliances for of aligner treatment, and many did not know that multiple
certain types of orthodontic treatments(17,18). In this study, trays are used throughout the treatment or the required
31% of participants perceived clear aligner therapy (CAT) to duration for wearing the aligners. Most of the patients who
be less effective than fixed appliance therapy. However participated in this study were between the ages of 18 and 29
recent advancements in materials and biomechanical and came from a middle-class socioeconomic background.
techniques in aligner therapy have led to increased efficiency, Despite the cost, many participants preferred aligners for
making aligners a more effective option in orthodontic aesthetic reasons. As a result, aligners are gaining popularity,
treatment(17,19,20). Recent study shows that, clear aligners particularly among the younger population.
can produce clinically acceptable outcomes that are

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Volume 9, Issue 10, October– 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24OCT622

V. LIMITATIONS [6]. Miller KB, McGorray SP, Womack R, Quintero JC,

Perelmuter M, Gibson J, et al. A comparison of
It is a cross-sectional study design, which does not treatment impacts between Invisalign aligner and
establish a time-based relationship between exposure and fixed appliance therapy during the first week of
outcomes. Additionally, the study faced geographical treatment. Am J Orthod Dentofacial
restrictions. Future research could benefit from a larger Orthop. 2007;131:302.e1–9.
sample size and a more diverse ethnic representation, doi: 10.1016/j.ajodo.2006.05.031.
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results. Another potential limitation is the self-reported nature Orthodontics. 5th ed. St. Louis: Mosby; 2013. pp.
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desirability biases. [8]. Drake C, McGorray S, Dolce C, Nair M, Wheeler T.
Orthodontic Tooth Movement with Clear
VI. CONCLUSION Aligners. ISRN Dent. 2012 doi: 10.5402/2012/657973.
doi: 10.5402/2012/657973.
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aligner therapy among patients is notably low, with much of perceptions of adults wearing orthodontic appliances:
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Nil. Index in an orthodontic treatment-seeking population:
a cross-sectional study. Journal of Orthodontics 48:
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The nature and accuracy of Instagram posts
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ISSN No:-2456-2165 https://doi.org/10.38124/ijisrt/IJISRT24OCT622

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