The Effectiveness of Clear Aligners Versus Fixed Aligners in Malocclusion Patients Undergoing Orthodontic Treatment: A Systematic Review and Meta-Analysis

Malocclusion is one of the most significant dental issues that interferes with daily life activities. However, direct comparison between orthodontic treatment with clear aligners (CAs) and fixed aligners (FAs) is not yet established. We aimed to assess the impact of CA versus FA in patients with malocclusion. We searched PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from inception until October 2025 to identify randomized controlled trials (RCTs) comparing the impact of CA versus FA in malocclusion patients. The primary outcome of interest was the mean change of quality-of-health measures using the Oral Health Impact Profile-14 (OHIP-14) survey, while secondary outcomes were mean change in pain levels and in the objective grading system (OGS). Continuous outcomes were pooled as standardized mean difference (SMD) with its 95% confidence intervals (CIs) in a random-effects model. Stata/MP (StataCorp LLC., College Station, Texas, United States) was used to analyse all outcomes. We included seven RCTs comprising 402 patients in the analysis. Patients treated with CA had better OGS scores in buccolingual inclination and marginal ridges domains compared to those treated with FA (SMD= 0.74, 95%CI: 0.28-1.2, p <0.001, and 0.42, 95%CI: 0.16-0.68, p <0.001). However, there were no significant differences in other studied outcomes. Malocclusion patients treated with CA had a better clinical profile compared to those treated with FAs. Further long-term RCTs with standard malocclusion types are needed.