Bisphenol-A release from thermoplastic clear aligner materials: A systematic review

Aim: The aim of the present study was to undertake a systematic review of the available evidence on the release of bisphenol-A (BPA) from thermoplastic materials used in the fabrication of clear aligners (CA). Methods: Electronic databases, such as MEDLINE (via PubMed), Google Scholar, Scopus, Cochrane Library, Web of Science, OpenGrey, and the U.S. National Institute of Heath-Clinical Trials, were searched up to 27 October 2022. In vivo/in vitro studies that assessed the release of BPA from different thermoplastic CA materials, with or without a control group, were selected. The risk of bias (RoB) in the randomised controlled trials (RCT) and in vitro studies was assessed using the Cochrane RoB tool and the guidelines for the reporting of pre-clinical studies, respectively. The quality of evidence was determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Pro tool. Results: Six studies were considered for review from a total of 1926 records. This included one RCT and five in vitro studies. Only two studies found leaching of BPA, while four did not report any traces. The RoB was found to be moderate to high. The GRADE evidence level ranged from low to very low. Five of the included studies were conducted in vitro. Significant heterogeneity among the included studies prevented a quantitative synthesis. Conclusion: In light of the available conflicting evidence, BPA release from CAs can neither be confirmed nor denied. Safety remains questionable until high-quality in vivo trials prove otherwise. Registration: PROSPERO CRD42022310434.