The dynamics of the oral microbiome and oral health among patients receiving clear aligner orthodontic treatment

Oral Dis. 2020 Mar;26(2):473-483. doi: 10.1111/odi.13175. Epub 2020 Jan 8.


Objectives: This 6-month prospective clinical study assessed the impacts of Invisalign appliances on the oral bacterial community and oral health of patients.

Methods: Salivary samples were obtained from twenty-five adult patients receiving Invisalign aligner treatment before the treatment (Group B) and at a 6-month follow-up (Group P). The bacterial composition of each sample was determined using Illumina MiSeq sequencing of the bacterial 16S rRNA. Intra- and intergroup biodiversity was analyzed. Clinical periodontal parameters and daily oral hygiene habits were recorded.

Results: Reduction in plaque, increased daily brushing frequency, and decreased dessert intake were observed in Group P compared with that in Group B. A total of 1,853,952 valid reads were obtained from the 50 salivary samples, with 37,904 sequences per sample. No significant differences were detected in the intra- and intergroup biodiversity comparisons between the two groups. By clustering, 8,885 OTUs were identified and categorized into six major phyla: Firmicutes, Proteobacteria, Bacteroidetes, Fusobacteria, Actinobacteria, and Candidate_division_TM7_norank. At the genus level, compared with Group B, Group P demonstrated significantly increased Bacillus abundance and decreased Prevotella abundance.

Conclusions: Our results suggested that the general biodiversity and salivary microbial community structure did not change significantly and that patients had increased beneficial oral hygiene habits and awareness during the first six months of Invisalign treatment. Hence, on the basis of this study, it appears that Invisalign aligner treatment did not induce deterioration of oral health nor significant biodiversity changes in oral bacterial communities, assuming that detailed oral hygiene instructions for both teeth and aligners were provided.

Keywords: 16S rRNA gene sequencing; invisalign; microbial community.

MeSH terms

  • Adult
  • Bacteria / classification*
  • Bacteria / genetics
  • Bacteria / isolation & purification
  • Female
  • Humans
  • Male
  • Microbiota*
  • Mouth / microbiology*
  • Oral Health*
  • Orthodontic Appliances, Removable*
  • Prospective Studies
  • RNA, Ribosomal, 16S / genetics
  • Saliva / microbiology*
  • Young Adult


  • RNA, Ribosomal, 16S