A Comprehensive Analysis of Periodontal Risk in Clear Aligner Users: Focus on Wear Duration, Patient Compliance, Advancements in AI Technology and Biomarker

Abstract

Clear aligners have become a popular alternative to fixed orthodontic appliances due to their aesthetic and hygienic advantages. However, their long-term impact on periodontal health remains underexplored, particularly concerning wear duration and patient compliance. This review aims to evaluate the periodontal effects of long-term clear aligner use, examine the role of patient compliance and wear time, and explore how emerging technologies like artificial intelligence (AI) and biomarkers can aid in monitoring periodontal risk. A structured narrative review was conducted using recent literature (2019–2024) from databases such as PubMed, Scopus, and ScienceDirect, focused on studies addressing clear aligners, periodontal health, compliance, and digital or biomolecular monitoring tools. Findings indicate that clear aligners are generally associated with improved periodontal outcomes compared to braces, provided patients maintain oral hygiene and wear aligners 20–22 hours daily. Non-compliance increases the risk of gingival inflammation and microbial imbalance. Technological tools, including mobile apps and AI, enhance treatment adherence and enable early detection of periodontal changes. Additionally, biomarkers like IL-1β and MMP-8 offer potential for non-invasive monitoring of inflammation during aligner therapy. Clear aligners are effective and safe when used as directed, with compliance playing a critical role in periodontal outcomes. The integration of AI and biomarker-based monitoring holds promise for personalized, preventive orthodontic care. Further long-term studies are needed to validate these tools in clinical practice.