Recently, clear orthodontic aligners have gained attention as devices that may improve oral health outcomes, providing faster treatment and greater comfort compared to conventional fixed braces. This review aimed to systematically assess home-care strategies for maintaining oral hygiene and cleaning aligners during orthodontic therapy. A comprehensive search was conducted across four databases: PubMed, Cochrane Library, Web of Science, and Scopus. The review, registered in PROSPERO as CRD 42024562215, followed PRISMA 2020 guidelines. Eligible studies included prospective trials, randomized controlled trials (RCTs), controlled clinical trials, and in vivo or ex vivo investigations. Studies had to compare invisible orthodontics with fixed appliances or examine home oral hygiene and aligner disinfection methods. Risk of bias was evaluated using RoB-2 for RCTs and randomized crossover trials and ROBINS-I for observational studies.
Eleven studies met inclusion criteria: four RCTs, four crossover studies, and three cross-sectional observational studies. Seven focused on patients undergoing orthodontic treatment, while four specifically investigated aligner hygiene. Cleaning effectiveness was assessed by measuring remaining biofilm on thermoplastic surfaces. Overall, the certainty of evidence was low, highlighting the need for more rigorous research. Combining chemical and mechanical cleaning approaches appears most effective for aligner care. These findings emphasize the importance of personalized home oral hygiene routines for patients undergoing treatment with clear aligners.
