Maxillary anterior retraction with clear aligner: a retrospective comparative cohort study of efficiency between periodontally healthy and stable periodontitis patients.

OBJECTIVE

This retrospective comparative cohort study aimed to evaluate the efficiency of maxillary anterior tooth retraction using clear aligners in patients with stable periodontitis compared to periodontally healthy individuals, addressing clinical concerns regarding the efficacy of aligner therapy in this population.

METHODS

This retrospective study included 33 patients with stable periodontitis (SP) and 33 periodontally healthy (PH) individuals who underwent clear aligner treatment. Pre-treatment virtual setups and post-treatment actual models were superimposed in three dimensions using Geomagic Wrap 2021 software. Anterior tooth retraction efficiency was calculated as (actual tooth movement / predicted tooth movement) × 100%. Univariate analyses were performed, followed by multivariable analyses using Generalized Estimating Equations (GEE) to identify predictors influencing efficiency.

RESULTS

No significant difference was detected in maxillary anterior retraction efficiency between the two groups (SP: 56.6%, PH: 52.0%, P = 0.245). However, the factors influencing efficiency differed significantly. In the SP group, efficiency was significantly correlated with treatment design parameters, including the number of aligner steps, amount of predicted tooth movement and auxiliary traction. In contrast, efficiency in the PH group was mainly associated with patient-related physiological factors, such as age and tooth type.

CONCLUSION

Within the limitations of this retrospective study (crown-level measurement), anterior tooth retraction efficiency with clear aligners did not differ significantly between patients with stable periodontitis and periodontally healthy individuals under strict periodontal maintenance. Clinical planning should be individualized: precise biomechanical design is essential for patients with stable periodontitis, whereas physiological factors warrant greater consideration in periodontally healthy patients. These findings support the feasibility of clear aligner therapy in well-maintained periodontitis patients and highlight the need for differentiated treatment planning.