Prevalence of white spot lesions during clear aligner therapy: a systematic review

Abstract Objectives: To determine if an association exists between the prevalence of white spot lesions (WSLs) and orthodontic treatment using clear aligners. Methods: Electronic databases were searched with no restrictions on year. Article selection criteria included human clear aligner studies conducted during the permanent dentition and with a full description of the applied technique and oral hygiene status. Results: The search strategy resulted in a total of 4177 articles. After title and abstract screening, 156 relevant articles were identified from which five remained after the application of the exclusion criteria. The articles were mostly classified as having a low risk of bias. Conclusions: Clear aligner therapy induces a lower development rate of new WSLs than orthodontic treatment by fixed appliances. In patients who have poor oral hygiene and/or existing WSLs, clear aligner treatment could be recommended.