Key points are not available for this paper at this time.
BACKGROUND: Clear aligner therapy (CAT) represents a biomimetic orthodontic approach that uses flexible thermoplastic materials to reproduce the physiological tooth movement and mechanical load distribution of natural tissues. While these materials promote oral hygiene and aesthetic comfort, their long-term biological impact on the caries process remains uncertain. This retrospective study aimed to evaluate changes in the number of decayed teeth (ΔD) before and after clear aligner treatment and to identify duration-dependent risk factors. METHODS: aligners between 2020 and 2024. Baseline and post-treatment panoramic radiographs were analyzed to determine decayed tooth counts. Age, sex, and total aligner count were recorded. Non-parametric tests, multivariable regression, and ROC analysis were used to assess predictors of ΔD. RESULTS: = 0.0037), and each 10-tray increment increased the odds of new decay by 55% (OR = 1.55, 95% CI: 1.26-1.90). ROC analysis identified ≥42 trays as a clinically relevant threshold (AUC = 0.67). CONCLUSIONS: Clear aligner therapy demonstrated a statistically significant yet clinically small increase in caries incidence, primarily related to treatment duration. As a biomimetic orthodontic approach that integrates mechanical and biological dynamics, extended clear aligner use may alter biofilm-surface interactions and salivary conditions over time. Therefore, preventive strategies-such as professional fluoride applications, strict cleaning protocols, and shorter recall intervals-should be emphasized for long-duration treatments to preserve the biological benefits of this biomimetic system.
Yalçın et al. (Wed,) studied this question.