Safety Tool—A Multifunctional Aligner Tool

Objective To survey clear aligner therapy (CAT) procedures and protocols of orthodontists in New Zealand. Methods One hundred and ten full members of the New Zealand Association of Orthodontists were invited to complete an e-survey. The questions related to respondent demographics, aligner choice and use, CAT planning and treatment protocols, case selection, patient-reported CAT problems and relevant respondent opinions. The reasons for respondents not providing CAT were also surveyed. Results The response rate was 70%. Most respondents (88.3%; N = 68) reported that they used CAT as a treatment modality with 43.15% ( N = 29) treating between 1 and 20 patients per year. The predominant CAT system was the Invisalign appliance (70.3%; N = 45) with 49.2% ( N = 32) stating that they used more than one CAT system. The respondents reported the areas which were always or mostly in need of amendment prior to acceptance of the CAT treatment plan were attachments (75.6%; N = 50) and final tooth positions (62.1%; N = 41). A median of 0% (IQR: 0, 1) of initial digital treatment plans were approved without changes according to the respondents with a median of 90% (IQR: 80, 99) of CAT patients requiring an additional aligner phase. Almost 80% (78.1%; N = 50) indicated that they were not comfortable in treating cases with increased overbite and 66.7% ( N = 44) rarely or never carried out premolar extractions when using CAT. A remote monitoring system was mostly or always used by 32.4% ( N = 21) of respondents in conjunction with CAT. Concern regarding patient compliance with CAT protocols was expressed by 43.5% ( N = 22). That fixed appliances provided better treatment outcomes was a moderate or major influence on the decision of all respondents ( N = 8) who did not provide CAT. Conclusion Although CAT provision by orthodontists is commonplace among orthodontists in New Zealand, there is wide variation in its usage and procedures.

Objectives: Over the last two decades, clear aligners have become a mainstay in contemporary orthodontic practice primarily due to improvements in digital and 3D printing technologies, a growing interest in esthetic orthodontics, especially in the adult population, and aggressive manufacturer marketing internationally. Material and Methods: PubMed, Google Scholar, Cochrane Library, and EMBASE databases were searched from January 1998 to November 2021. The search terms used were “Invisalign” OR “clear aligner.” A total of 7000 records were searched, of which 369 potentially relevant articles were retrieved in full. 190 studies met the selection criteria following screening and were included in the scoping review. Results: This review scopes and analyses published orthodontic literature about CA according to a year-wise distribution into 3 groups, 2001–2010/2011–2020/2021. Most of the studies were published in the period between 2011 and 2020, with 138 studies accounting for 73%. The year 2021 followed, with 31 studies accounting for 16%, which was greater than the number of studies published in 10 years from 2001 to 2010. Studies were also classified based on the study designs with most of the published studies representing the lowest level of evidence including case reports, case series, narrative reviews, expert opinions, and editorials accounting for 137 studies, whereas case-control studies were the least reported studies with only 4 studies reported in the literature. In addition, they were categorized into seven main domains: (1) Biological considerations associated with clear aligner therapy (CAT), (2) Treatment outcomes considerations associated with CAT, (3) Geometrical considerations associated with CAT (clinical), (4) Biomechanical considerations associated with CAT (Laboratory/Finite element analysis), (5) Biomaterial considerations associated with CAT, (6) Patient education and experience and aesthetic and social perception of CAT, and (7) Miscellaneous. Treatment outcome considerations associated with CAT had the greatest percentage representing 36% of the total published domains, while the final place was occupied by the biomechanical considerations associated with CAT accounting for only 4% of the published domains about CAT. Conclusion: Treatment outcome was the domain most commonly reported by studies accounting for (36%). Most of the published studies are at the lowest level of evidence including case reports, case series, narrative reviews, and expert opinions. The vast majority of studies utilized only a single clear aligner brand. There is a greater need for research that studies CAT from a holistic perspective.

ABSTRACTObjectivesThe primary aim of the investigation was to survey clear aligner therapy (CAT) use among general dentists in Australia. A secondary aim was to evaluate the factors that influenced general dentists in Australia not to provide CAT.Material and MethodsGeneral dentists registered with the Australian Health Practitioner Regulation Agency were invited to participate in a structured cross‐sectional electronic survey. The survey covered demographics, preferred CAT systems and practices, relevant treatment planning and retention protocols, patient‐reported CAT issues, pertinent respondent opinions, and reasons for not providing CAT. Descriptive statistics were computed via GraphPad Prism v10 (GraphPad Software Inc., La Jolla, CA, USA).ResultsMost of the 264 (n = 172; 65.2%) respondents indicated that they provided CAT. The majority (n = 82; 58.6%) reported that they treated between 1 and 20 patients with CAT annually. Invisalign was the most used system (n = 83; 61.2%), with 55 (41.7%), indicating that they used more than one system. Most (n = 124; 98.4%) were comfortable using CAT for mild crowding, whereas 73.4% (n = 94) were not comfortable in treating severe crowding with CAT. The median (IQR) number of patients per respondent treated with extraction of a permanent incisor or premolar was 0 (0). Issues regarding tooth positions were reportedly always or mostly in need of change in the initial treatment plan by 68.7%. Problems regarding patient compliance with CAT wear protocols (n = 67; 45.6%) and the predictability of treatment outcomes (n = 31; 21.1%) were the most identified themes of the free‐text comments. Over 80% of those who did not provide CAT indicated that they preferred to refer to an orthodontist for management.ConclusionAlmost two‐thirds of the respondents provided CAT. Invisalign was the most used system. The majority use CAT combined with nonextraction treatment. Most of those who did not provide CAT preferred to refer to an orthodontist for patient management.

To investigate clear aligner therapy (CAT) practice among orthodontists in the British Orthodontic Society (BOS). A cross-sectional online survey. An electronic survey was distributed to members of the BOS in 2022. The survey comprised questions regarding respondent demographics, general use of CAT, the choice of proprietary CAT appliances, CAT planning, case selection, treatment protocols and orthodontist-reported CAT problems. Overall, there were 233 (19.5%) respondants with the majority (n = 121, 53.1%) being female. Most respondents reported practising in England (n = 171, 74.7%). The majority (n = 177, 77.3%) indicated that they used CAT in their practice, with 48.1% (n = 81) treating 1-20 patients with CAT annually. The most frequently prescribed CAT system was Invisalign (n = 138, 81.2%). One to three changes to the initial digital treatment plan were made by 72.9% (n = 121) with final tooth positions being the most common reason for adjustment (64.4%). Most (n = 97, 60.3%) rarely or never performed premolar extractions with CAT. Of the respondents, 23 12.7%) reported that they always or mostly used a remote monitoring system in conjunction with CAT, with a wide range of aligner change protocols reported. The median number of months required to complete non-extraction CAT reported by the respondents was 12. Most respondents (n = 77, 51.7%) did not feel that CAT provides superior outcomes compared with fixed appliance therapy. CAT practice varied widely among the surveyed orthodontists. A predilection for the use of Invisalign and utility in less severe cases was noted.

Background: Clear aligner therapy (CAT) has rapidly evolved as a preferred orthodontic treatment option due to its aesthetic appeal, comfort, and removability. Despite increasing availability, variability exists in practitioners' knowledge, attitudes, and practical application of CAT.Objective: This study aimed to determine the knowledge and demand for CAT education amongst practitioners so as to offer insights for future tailored curricula on CAT.Methods: A cross-sectional survey was conducted among 112 licensed orthodontists and general dentists. Data were collected using a validated, self-administered questionnaire that focused on CAT-related knowledge, attitudes, practices, and training needs. Descriptive and inferential statistics were analyzed using SPSS Version 26 (IBM Corp., Armonk, NY, USA), with significance set at p < 0.05.Results: Participants had a mean age of 33.97 years, with 73.2% (n = 89) being orthodontists. While 60.7% (n=68) had received CAT training, and 57.1% (n=64) had access to CAT systems within their clinics, 41.1% (n=41) reported no clinical experience with CAT. Major barriers identified included cost (77.7%, n = 87) and patient compliance (46.4%, n = 52). Most respondents recognized CAT as suitable for minor to moderate malocclusions and polyurethane as the standard material used in this context. A majority acknowledged the need for fewer clinical visits with CAT compared to traditional braces. Practitioners expressed a willingness to pursue further CAT training and integrate it into their routine practice. Statistical analyses revealed significant associations between access to CAT systems and confidence in patient education and clinical application.Conclusion: This study highlights the gaps between theoretical knowledge and the clinical application of CAT, with cost and patient compliance being key challenges that must be addressed. The findings underscore the importance of targeted continuing education in enhancing the adoption of CAT and optimizing patient care in modern orthodontics.

Lateral cephalograms have the inherent drawback of superimposition of bilateral structures, while landmarks are more reproducible on CBCT scans. Yet no studies in the literature have utilized 3D imaging to investigate the effects of clear aligners on anterior open bite. Therefore, The aim is to measure the skeletal and dental changes that contribute to anterior open bite closure with clear aligner therapy on CBCT scans. It is a single-arm retrospective study that included 40 cases of anterior open bite who were treated using Invisalign. Pre- and post-treatment CBCT scans were traced to record 13 dental and 3 skeletal measurements. A paired t-test was conducted to compare the mean values of pre- and post-treatment measurements. Combined intrusion of the maxillary right and left molars was statistically significant, meanwhile mandibular molars maintained their vertical position. Maxillary incisors were extruded and retroclined significantly, whereas mandibular incisors were only extruded. While anterior facial height was decreased insignificantly, both lower anterior facial height and mandibular plane angle showed a significant decrease. Clear aligner (Invisalign) therapy is effective in the management of anterior open bite through vertical control, maxillary molars intrusion, maxillary incisors extrusion, maxillary and mandibular incisors retroclination, and mandibular autorotation.

Background: Clear aligner (CA) therapy has been increasingly adopted as an alternative to fixed orthodontic appliances. However, evidence regarding its periodontal effects, including gingival inflammation, biofilm composition, and the potential role of aligner marginal edge design, remains insufficiently mapped. The objective of this scoping review was to map and synthesize available clinical and laboratory evidence on periodontal and biological outcomes associated with CA therapy, with particular attention to the potential influence of aligner marginal edge design. Methods: This scoping review followed PRISMA-ScR and the Population-Concept-Context (PCC) framework. PubMed, Scopus, and Web of Science were searched from 1 January 2015 to 24 October 2025. A total of 1587 records were identified; after deduplication, 770 unique records were screened by title and abstract, followed by full-text assessment of potentially eligible articles. Twenty-five primary studies published between 2020 and 2025 met eligibility criteria and were included in the review. Results: The final synthesis comprised clinical investigations, laboratory studies, and case reports. Clinical periodontal indices and inflammatory biomarkers were assessed using heterogeneous protocols and timepoints. Only three studies specifically addressed aligner marginal edge design; one directly compared margin configurations, reporting differences in local gingival response, with substantial diversity in study design precluding quantitative synthesis. Conclusions: Available evidence on periodontal outcomes during CA therapy is methodologically heterogeneous. Investigations of aligner marginal edge design remain scarce. Standardized assessment protocols and targeted clinical studies are needed to establish the periodontal relevance of trimline configurations.

Digital treatment planning software in clear aligner (CA) therapy incorporates virtual simulations to generate planned tooth movements. While baseline tooth positions constitute one of the geometric inputs to digital setups, limited information is available regarding the association between pre-treatment positional asymmetry and the magnitude of planned movements, and how these associations vary by tooth and movement type. A retrospective analysis was conducted on 65 patients (390 anterior teeth) treated with Invisalign®. Baseline malpositions of anterior teeth were measured using 3D digital models in ClinCheck®, while planned movements-including rotation, angulation, extrusion, and intrusion-were extracted from the corresponding digital treatment plans. Baseline asymmetry between contralateral teeth was calculated to quantify movement complexity. General Linear Model (GLM) regression analyses were employed to assess the relationship between initial asymmetry and the magnitude of planned movements. Descriptive statistics and normality assessments were also performed. In the 11-21 tooth pair, baseline asymmetry was significantly associated with planned extrusion (p = .002) and rotation (p < .001), but not intrusion (p = .190) or angulation (p = .270). For the 12-22 pair, significant associations were observed for intrusion (p = .008), angulation (p < .001), and rotation (p < .001), but not extrusion (p = .493). In the 13-23 pair, only extrusion was significantly associated with baseline differences (p < .001); no significant effects were observed for the other movement types. Baseline positional asymmetry was associated with variation in planned extrusion, intrusion, and rotation movements within digital CA setups. These findings should be interpreted as descriptive associations rather than evidence of software-imposed constraints or internal planning strategies, and underscore the relevance of baseline geometry when interpreting digitally planned tooth movements.

Clear aligner therapy (CAT) has gained popularity as an alternative to Conventional Orthodontic Treatments (COT) for its potential to reduce pain and discomfort. This systematic review and meta-analysis aimed to compare pain perception and surface electromyography (sEMG) in masticatory muscles between CAT and COT groups. A comprehensive search of multiple electronic databases was conducted to identify relevant studies. The PRISMA guidelines were employed to ensure transparency and completeness in reporting and was registered in PROSPERO (CRD42024556800). Nine studies were considered for inclusion. The meta-analysis revealed a nonsignificant difference in Visual Analog Scale scores between CAT and COT groups, with a mean difference (MD) of -2.77 (95% confidence interval [CI]: -7.25, 1.71), P = 0.23. The heterogeneity test revealed significant heterogeneity among studies (I² = 100%). In contrast, the sEMG activity scores showed a nonsignificant difference between CAT and COT groups (MD = -0.80, P = 0.60). In addition, the odds ratio for patients requiring analgesics was 0.23 (95% CI: 0.08, 0.65), P = 0.005, suggesting a significant difference between CAT and COT groups. The results suggest that CAT may be associated with improved patient outcomes, including reduced pain and discomfort, as well as lower analgesic consumption. However, the evidence is not conclusive, and further research is needed to fully understand the differences between CAT and COT.

ObjectivePatients aiming for clear aligner therapy (CAT) have a distinct expectation regarding their orthodontic treatment. The aim of this prospective cohort study was to increase our knowledge on these specific patients’ needs, expectations, and concerns regarding CAT.MethodsPatients, who were about to start CAT, were asked to answer both, a 32-item questionnaire addressing expectations regarding CAT, rated on a 10-point visual analogue scale, and the Oral Health Impact Profile (OHIP-14) questionnaire. In addition, demographic and clinical data were collected.ResultsA total of 82 patients participated (mean age 35 ± 12 years; 74.4% female). Patients strongly expected CAT to treat their malocclusion as effectively as orthodontic brackets (9.5 ± 0.9 points) and they would seek a second opinion if they were told treatment with CAT would not be possible (7.2 ± 3.3 points). In addition, patients appeared not willing to compromise on the planned treatment outcome, even if it would decrease treatment time (2.1 ± 2.3 points) or costs (2.4 ± 2.5 points). Further, they highly expected that the treatment result would endure for their lifetime (8.8 ± 2.1 points), they wanted to avoid visibility of orthodontic brackets (7.9 ± 2.8 points), prevent potential future problems (9.1 ± 1.5 points), and see a simulation of the expected treatment outcome (7.5 ± 2.9 points). The most important limitations with CAT expected by the participants were pain during treatment (7.7 ± 2.7 points) and restricted eating and drinking habits (7.3 ± 2.8 points).ConclusionPatients considering CAT exhibit high expectations, particularly regarding treatment outcomes, aesthetics, and efficiency and they appear not willing to accept any compromise due to choosing CAT.Clinical relevanceKnowledge about these expectations can support our patient communication and thereby improve patients’ satisfaction with the treatment outcome.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00784-026-06903-x.

Clear aligner therapy (CAT) is an aesthetic alternative to fixed appliance therapy (FAT). An understanding of patient experiences with CAT can enable clinicians to educate patients, manage expectations, and identify potential barriers to effective treatment. A scoping review was undertaken to map and synthesise the available evidence on patient experiences with CAT. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed (MEDLINE), Embase, Scopus, Web of Science and Dentistry & Oral Sciences Source databases and grey literature were searched. Data collation and synthesis was presented in descriptive and tabular formats. The initial search yielded 541 articles following removal of duplicate studies. 37 studies met the selection criteria and were scoped in the present review. The studies identified included cross-sectional, longitudinal, prospective, and randomised clinical trials reporting on patient experiences with CAT associated with Oral Health-Related Quality of Life (OHRQOL) and satisfaction. The impacts of CAT on OHRQOL with relevance to pain was the most frequently evaluated aspect, followed by speech, satisfaction, eating, anxiety, and sleep. CAT patients report satisfaction with the aesthetics of the appliance however can expect transient negative effects on OHRQOL, pain, anxiety, and speech after commencing treatment. Further longitudinal research using validated qualitative tools focussing on CAT is required. This review was registered in the Open Science Framework database (DOI: xx).

The purpose of this systematic review was to assess the postoperative facial swelling (FS) and occlusion attained with clear aligner therapy (CAT) and fixed orthodontic therapy (OT) after orthognathic surgery (OS). The focused question was “Is there a difference in postoperative FS and occlusion attained with CAT and fixed OT after OS?” Indexed databases were searched up to and including October 2023 using different keywords. Original clinical studies that compared postoperative FS and occlusion attained with CAT and fixed OT after OS were included. Risk of bias (RoB) and quality of evidence were also assessed. Four retrospective studies were included. One study reported no difference in postoperative FS among patients that underwent CAT or fixed OT after OS. In one study, patients treated with CAT demonstrated less FS in the first post-surgical week than individuals that underwent fixed OT. In one study, postoperative occlusion was comparable among patients that underwent CAT or fixed OT, whereas in another, postoperative occlusion was better in patients that underwent fixed OT than CAT. All studies had a moderate RoB and none of the investigations were based on power-adjusted data. Based upon the sparsity and questionable quality of available evidence, there is a need to render a firm conclusion. However, it seems that CAT and fixed OT are comparable in relation to postoperative occlusion and FS after OS.

The aim of this study was to evaluate and compare the amount of external apical root resorption (EARR) observed during the orthodontic treatment with pre-adjusted edgewise appliance (PEA) or clear aligner therapy (CAT) and with 2D or 3D radiographic methods of measuring the root resorption. A search of PubMed MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, LILACS, Web of Science, Dissertations & Theses Global, ClinicalTrials.gov registry, and the ISRCTN Registry was performed. Studies that have evaluated the amount of root resorption in non-extraction cases using CAT or PEA were selected for the systematic review. A meta-analysis was performed for the amount of root resorption of permanent maxillary incisors using PEA or CAT treatment modalities by either 2D or cone-beam computed tomography radiographic examination. Database research, elimination of duplicate studies, data extraction, and risk of bias were performed by authors independently and in duplication. A random-effect meta-analysis followed by subgroup comparisons were performed to evaluate EARR. A total of 16 studies (4 were prospective and 12 were retrospective) were identified for inclusion in the systematic review. The mean root resorption for the permanent maxillary incisors was in the range from 0.25 to 1.13 mm (overall: 0.49 mm; 95% confidence interval [CI] = 0.24 to 0.75 mm). The mean root resorption difference between CAT and PEA was statistically significant (P < 0.05) for 12 but not for 21, 11, or 22. One of the drawbacks is a lack of good quality prospective studies, specifically randomized clinical trials in the literature. Neither PEA or CAT technique leads to clinically significant root resorption (1 mm) of the maxillary incisors. The amount of EARR of maxillary incisors is not significant in comparing two treatment modalities (PEA and CAT), except for 12, where the PEA group has significantly more EARR when compared to CAT. The protocol for this systematic review was based on the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 and was registered at PROSPERO database (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018113051). This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

A survey of orthodontic clear aligner practices among orthodontists

BackgroundThis study aimed to investigate how orthodontists’ clinical experience influences their treatment preferences and clinical strategies in clear aligner therapy (CAT). CAT has become increasingly widespread in contemporary orthodontic practice, largely due to its aesthetic appeal and the enhanced comfort it offers to patients, making it a preferred option among both orthodontists and patients. The reasons for the preference of CAT and the manner in which it is applied can vary significantly between orthodontists, especially in complex cases. The study was designed based on the assumption that one possible reason for these differences is the varying levels of clinical expertise among orthodontists.MethodsA cross-sectional original, validated questionnaire was distributed to orthodontists in Türkiye. The questionnaire consisted of four main sections: (1) demographic information, (2) management of CAT, including clinical experience and clinical protocols, (3) types of patients treated and/or managed with CAT, and (4) perspectives of orthodontists who do not use CAT. Responses were analyzed using descriptive statistics and chi-square tests with effect sizes to explore associations between clinical experience and treatment-related variables.ResultsA total of 338 orthodontists completed the survey (response rate: 14.1%). Mild-to-moderate crowding was the most frequently treated condition. More experienced orthodontists reported significantly greater use of CAT in complex cases, including extractions and skeletal discrepancies. Clinical experience was also significantly associated with the use of adjunctive techniques, refinement frequency, and awareness of CAT limitations. Distalization was perceived as the most predictable advantage of CAT over fixed appliances, regardless of experience. Patient compliance was considered the most critical factor for success, whereas aligner brand had minimal impact.ConclusionsClinical experience appears to play a critical role in shaping orthodontists’ treatment decisions regarding CAT. Greater clinical exposure and structured training may expand orthodontists’ ability to manage complex malocclusions effectively with CAT, underscoring the importance of continued education and experience-based proficiency in achieving predictable and optimal outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-07405-0.