Volume 30, Issue 174, August 2026

Complications and Adverse Effects of Clear Aligners versus Fixed Orthodontic Appliances: A Literature Review

Jakub Papierz^1♦, Katarzyna Cybulska¹, Julia Banaszczyk¹, Erwin Górski¹, Stanisław Janczarski¹, Gabriela Królczyk⁴, Aleksandra Pietrzyk², Mikołaj Cezary Krajewski³

¹Institute of Dentistry of the Central Clinical Hospital of the Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland
²Centralna Wojskowa Przychodnia Lekarska CePeLek SPZOZ, 78 Koszykowa Street, 00-911 Warszawa, Poland
³Jessenius Faculty of Medicine, Comenius University Bratislava, Malá Hora 10701/4A, 036 01 Martin, Slovakia
⁴Zespół Przychodni Specjalistycznych Sp. z o.o., 1 Skłodowskiej-Curie Street, 33-100 Tarnów, Poland

^♦Corresponding author
Jakub Papierz, Institute of Dentistry of the Central Clinical Hospital of the Medical University of Łódź, Pomorska 251, 92-213 Łódź, Poland

ABSTRACT

Introduction and Objectives: Treatment of malocclusion with clear aligners (CAs) and fixed appliances (FAs) differs in biological, physiological, and biomechanical aspects. As a result of an increasing demand for aesthetic orthodontic treatment and patient comfort, this work highlights cases when CA is less likely to cause complications than FA treatment. Results: Scientific literature states that CAs do not cause enamel demineralization, have lower risks of WSL development, and maintain periodontal health better than FAs. CAs protect teeth from EARR by applying controlled intermittent force system. Besides, there is a decreased pain experience, decreased use of analgesics, and higher OHRQoL in CAs treatment. On the other hand, CAs cannot manage complex tooth movements, including tooth rotation, bodily movement, and bite correction. This leads to posterior open bite problem. Moreover, the maintenance of occlusal contacts, attachment placement, and patient compliance continue to be problematic. Conclusions: CAs present a reliable, predictable, and safe tool for treating patients who are more susceptible to periodontal disease and root resorption. Although advances in CAD/CAM technology and polymer development are promising, further clinical studies should be performed before declaring CAs as a standard treatment for any malocclusion.

Keywords: clear aligners; fixed appliances; orthodontic complications; root resorption; periodontal health; white spot lesions

Medical Science, 2026, 30, e171ms3965

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Published: 27 August 2026