Risk Factors of Composite Attachment Loss in Orthodontic Patients during Orthodontic Clear Aligner Therapy: A Prospective Study

Background. The composite attachment loss during orthodontic clear aligner therapy is an adverse event that commonly happens in our daily practice. However, there is a lack of related statistical analysis and studies analyzing the related risk factors. Therefore, the aim of this study is to assess the incidence of attachment loss during orthodontic clear aligner therapy and to identify rick factors that may predict such event. Materials and Methods. The demographics and clinical variables of 94 patients undergoing clear aligner therapy (27 males and 67 females; average age: 27.60 ± 0.86 years) were recorded. Both patient‐related and tooth‐related attachment loss was recorded. The chi‐squared test and logistic regressive analysis were applied to identify the potential risk factors. SPSS for Mac (version 23.0, IBM, USA) was used for statistical analyses. P < 0.05 was considered statistically significant. Results. Our study suggested that the risk factors for attachment loss include frequent aligner removal (≥ 5 times a day) (losing rate = 60.0%, P = 0.005), aligner wear time less than 18 hours a day (losing rate = 50.8%, P = 0.014), eating without aligners inserted (losing rate = 47.9%, P = 0.034), utilizing aligner tray seaters (losing rate = 48.2%, P = 0.006), and unilateral mastication (losing rate = 52.1%, P = 0.002). The multivariable logistic regression analysis indicates that aligner wear time less than 18 hours a day (P = 0.020, B = 0.925), using aligner tray seaters (P = 0.007, B = 1.168), and unilateral mastication (P = 0.034, B = −0.458) were considered independent factors that can predict the composite attachment loss in orthodontic clear aligner therapy. Conclusion. Wearing aligner less than 18 hours a day, using aligner tray seaters, and unilateral mastication may contribute to increased incidence of composite attachment loss during orthodontic clear aligner therapy.