Clear aligner interface properties, oral microbial ecology, and strategies for biofilm control and caries-risk mitigation: a scoping review
- 1Xiangya Stomatological Hospital and Xiangya School of Stomatology, Central South University, Changsha, China
- 2Hunan Key Laboratory of Oral Health Research, Changsha, China
Abstract
BackgroundClear aligners create an aligner–tooth interface that may retain saliva, microorganisms, and dietary substrates. Evidence linking interface properties, oral microecological responses, and preventive interventions remains fragmented.ObjectiveTo map and synthesize evidence on clear aligner interface properties and microbial adhesion, oral microbial ecology during clear aligner wear, and strategies for biofilm control and caries-risk mitigation.MethodsFollowing Joanna Briggs Institute methodology and PRISMA-ScR guidance, PubMed, Embase, and Web of Science Core Collection were searched from inception to August 31, 2026, without language restrictions. Backward and forward citation searching supplemented database searches. Original clinical, in vitro, and ex vivo studies involving active clear aligner treatment, associated materials or interfaces, or clear-aligner-specific interventions were eligible when they reported microbial, biofilm, microbiome, metabolomic, caries-related, or mineral outcomes. Two reviewers independently screened records; two authors charted and verified data. Findings were synthesized descriptively within three evidence domains.ResultsOf 988 records, 132 reports were included. Because reports could contribute to more than one domain, 62 informed interface properties and microbial adhesion, 47 oral microbial ecology during wear, and 76 biofilm control and caries-risk mitigation. No single polymer, manufacturing method, or surface parameter consistently predicted microbial adhesion or biofilm formation. Outcomes reflected interactions among material characteristics, local topography, salivary conditioning, aging and exposure, microbial species, and experimental models. Clinical microbial responses were compartment- and time-dependent. Salivary and tooth-associated communities often remained relatively stable at the community level, whereas the inner aligner surface sometimes exhibited localized taxonomic, functional, metabolic, and pH-related changes. Investigated interventions included cleaning, antimicrobial and antifouling interface modifications, anticaries and remineralizing approaches, probiotics, and environment-responsive systems. Although many strategies reduced microbial burden, biofilm-related outcomes, acidogenicity, or mineral loss under tested conditions, evidence was predominantly short-term and preclinical. Assessments of durability, material performance, and safety were heterogeneous.ConclusionsClear aligner–microbiota interactions appear context-dependent rather than uniformly favorable or unfavorable. Evidence neither establishes causal relationships between interface or microecological changes and clinical disease nor identifies a universally superior intervention. More standardized, clinically representative evidence may clarify their clinical relevance and inform preventive management during clear aligner treatment.
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BibTeX
@article{li2026clear,
title = {{Clear aligner interface properties, oral microbial ecology, and strategies for biofilm control and caries-risk mitigation: a scoping review}},
author = {Zhuoyue Li and Zhuoyue Li and Yuanchao Yang and Yuanchao Yang and Bingshi Liu and Bingshi Liu and Jiaman Sun and Jiaman Sun and Xinchen Tang and Xinchen Tang and Yan Yang and Yan Yang},
journal = {Frontiers in Cellular and Infection Microbiology},
year = {2026},
month = oct,
doi = {10.3389/fcimb.2026.1951083},
url = {https://doi.org/10.3389/fcimb.2026.1951083},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clear aligner interface properties, oral microbial ecology, and strategies for biofilm control and caries-risk mitigation: a scoping review
AU - Zhuoyue Li
AU - Zhuoyue Li
AU - Yuanchao Yang
AU - Yuanchao Yang
AU - Bingshi Liu
AU - Bingshi Liu
AU - Jiaman Sun
AU - Jiaman Sun
AU - Xinchen Tang
AU - Xinchen Tang
AU - Yan Yang
AU - Yan Yang
PY - 2026
DA - 2026/10/23
JO - Frontiers in Cellular and Infection Microbiology
DO - 10.3389/fcimb.2026.1951083
UR - https://doi.org/10.3389/fcimb.2026.1951083
AB - BackgroundClear aligners create an aligner–tooth interface that may retain saliva, microorganisms, and dietary substrates. Evidence linking interface properties, oral microecological responses, and preventive interventions remains fragmented.ObjectiveTo map and synthesize evidence on clear aligner interface properties and microbial adhesion, oral microbial ecology during clear aligner wear, and strategies for biofilm control and caries-risk mitigation.MethodsFollowing Joanna Briggs Institute methodology and PRISMA-ScR guidance, PubMed, Embase, and Web of Science Core Collection were searched from inception to August 31, 2026, without language restrictions. Backward and forward citation searching supplemented database searches. Original clinical, in vitro, and ex vivo studies involving active clear aligner treatment, associated materials or interfaces, or clear-aligner-specific interventions were eligible when they reported microbial, biofilm, microbiome, metabolomic, caries-related, or mineral outcomes. Two reviewers independently screened records; two authors charted and verified data. Findings were synthesized descriptively within three evidence domains.ResultsOf 988 records, 132 reports were included. Because reports could contribute to more than one domain, 62 informed interface properties and microbial adhesion, 47 oral microbial ecology during wear, and 76 biofilm control and caries-risk mitigation. No single polymer, manufacturing method, or surface parameter consistently predicted microbial adhesion or biofilm formation. Outcomes reflected interactions among material characteristics, local topography, salivary conditioning, aging and exposure, microbial species, and experimental models. Clinical microbial responses were compartment- and time-dependent. Salivary and tooth-associated communities often remained relatively stable at the community level, whereas the inner aligner surface sometimes exhibited localized taxonomic, functional, metabolic, and pH-related changes. Investigated interventions included cleaning, antimicrobial and antifouling interface modifications, anticaries and remineralizing approaches, probiotics, and environment-responsive systems. Although many strategies reduced microbial burden, biofilm-related outcomes, acidogenicity, or mineral loss under tested conditions, evidence was predominantly short-term and preclinical. Assessments of durability, material performance, and safety were heterogeneous.ConclusionsClear aligner–microbiota interactions appear context-dependent rather than uniformly favorable or unfavorable. Evidence neither establishes causal relationships between interface or microecological changes and clinical disease nor identifies a universally superior intervention. More standardized, clinically representative evidence may clarify their clinical relevance and inform preventive management during clear aligner treatment.
SN - 2235-2988
ER -