Available evidence, predominantly retrospective Level III–IV studies, supports over-correction strategies of 50%–100% for intrusions, 5°–15° for rotations and torque, and 1–2 mm for arch expansions; however, these estimates derive from heterogeneous, Invisalign-focused research and should not be applied as universal benchmarks.
Abstract
Background Clear aligner therapy (CAT) has significant predictability limitations, particularly in complex malocclusions. This scoping review maps discrepancies between digitally predicted and clinically achieved tooth movements across a broad evidence base. Objectives To map the available evidence on the accuracy of CAT tooth movements and identify gaps in the current literature to guide future research. Eligibility criteria Studies evaluating the accuracy or predictability of CAT tooth movements using quantitative methods (intraoral scanning with 3D metrology, cone-beam computed tomography, or cephalometric analysis) were eligible. Eligible designs included retrospective and prospective cohort studies, randomised controlled trials, and systematic reviews, published from 2001 up to June 2026 with no language restriction. In-office aligner systems and non-proprietary aligner systems were excluded from this review. Sources of evidence PubMed and Scopus were searched in April 2026 and updated in June 2026, supplemented by manual reference list searching. Charting methods Data were extracted onto a pre-piloted standardised form. A descriptive narrative synthesis was performed, organised thematically by movement type. Results Of 6,865 records retrieved after removal of duplicates, 764 were selected after screening, 356 underwent full-text review, and 119 studies met inclusion criteria, including 70 retrospective studies, 12 prospective studies, and 4 RCTs. Early-generation Invisalign studies report approximately 50% mean accuracy. Rotational shortfalls averaged approximately 5°; torque was under-expressed at 35%–58%; overbite reduction achieved 28%–55% accuracy; arch expansion (73%–88%) predominantly produced tipping rather than bodily movement. Anterior open bite correction reached 58%–90% accuracy, while incisor intrusion was limited to 33%–53%. Based on limited studies, refinements were required in over 50% of cases and 17.2% necessitated conversion to fixed appliances. Conclusions Available evidence, predominantly retrospective Level III–IV studies, supports over-correction strategies of 50%–100% for intrusions, 5°–15° for rotations and torque, and 1–2 mm for arch expansions; however, these estimates derive from heterogeneous, Invisalign-focused research and should not be applied as universal benchmarks. CAT is most reliable for anterior open bite correction under 3 mm. Hybrid approaches and informed consent regarding potential fixed appliance conversion are advisable for complex malocclusions. Adequately powered RCTs are needed to validate current clinical protocols.
The results of individual studies suggest that aligners could be a viable technique for the correction of mild to moderate open bite with good vertical control in contrast to deep bite malocclusions where treatment efficacy is still limited.
Hajar Ben Mohimd, Houda Neani, F. Zaoui et al.· Journal of Orofacial Orthope...· 0 citations
Clear aligner therapy is increasingly used for adult anterior open-bite correction, but the certainty of evidence, reported dentoskeletal changes, and clinical boundaries of this approach remain unclear. This systematic review aimed to summarize overbite change and descriptively map the dentoskeletal findings reported in the current clinical literature. This systematic review was conducted according to PRISMA. PubMed, EMBASE, Scopus, and the Cochrane Library were searched. Reference lists of included studies and relevant reviews were also checked, but no additional eligible records were identified. Eligible studies evaluated adult or predominantly adult cohorts with anterior open bite treated with clear aligners and reported overbite change or dentoskeletal outcomes. Risk of bias was assessed using ROBINS-I and RoB 2. Reported dentoskeletal findings were classified as direct, indirect, or insufficient evidence for mechanistic interpretation. Exploratory single-arm random-effects meta-analyses were performed when extractable completed-treatment data were available. Certainty of evidence was appraised using GRADE principles. Ten clinical studies involving 421 aligner-treated participants were included. Most studies were retrospective and nonrandomized, and nine had serious overall risk of bias. The primary exploratory synthesis of five completed-treatment cohorts showed a pooled overbite increase of 3.07 mm, while an extended sensitivity analysis of seven studies yielded 2.89 mm. Heterogeneity was substantial. Reported dentoskeletal changes most commonly involved anterior dentoalveolar changes, variable posterior vertical change, and limited mandibular plane change. Most studies were not designed to test mechanisms directly; therefore, the dentoskeletal findings were interpreted cautiously. The certainty of evidence was very low. Very low-certainty evidence suggests that selected adult anterior open-bite cases treated with clear aligners may show overbite improvement. However, the available evidence is insufficient to confirm predictable skeletal correction or to validate a single mechanism of bite closure. Future studies should use prospective comparative designs, standardized anterior open-bite phenotyping, direct component-level outcome assessment, blinded evaluation, and long-term retention endpoints. CRD420261376480
Background: Transverse maxillary discrepancies during mixed dentition can negatively affect occlusal development and facial harmony. Clear aligners have been increasingly proposed as an interceptive alternative to traditional expansion approaches, but the extent and nature of the transverse dentoalveolar changes associated with their use in growing patients remain incompletely defined. While previous reviews have qualitatively explored this topic, no prior meta-analysis has been conducted to provide a quantitative synthesis of these changes in mixed dentition. Methods: A comprehensive electronic search was conducted for English-language studies published from January 2019 to April 2026 using the PubMed, Ovid MEDLINE, Web of Science, Embase, and Cochrane Library databases. The final database search was performed on 30 April 2026. Randomized controlled trials, prospective studies, and retrospective studies evaluating transverse maxillary changes in growing patients treated with clear aligners were included. Case reports, reviews, and studies involving syndromic patients or surgical interventions were excluded. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Furthermore, a meta-analysis of quantitative outcomes with sufficient comparability across studies was performed. Effect sizes were reported as standardized mean differences (SMDs). Results: From 40 screened records, a total of 7 studies were included in this review. The meta-analysis revealed a reasonably consistent trend toward increased transverse dimensions. The pooled SMDs were 0.685 (distal intermolar), 1.141 (mesial intermolar), 0.828 (transpalatal), 2.052 (intercanine transpalatal), and 1.541 (intercanine width). However, the magnitude of the effect remains uncertain because of the small number of included studies, methodological variability, heterogeneous outcome definitions, limited long-term follow-up, and substantial statistical heterogeneity observed for selected outcomes. Conclusions: The current evidence base reveals a reasonably consistent direction toward favorable transverse dentoalveolar changes with clear aligner therapy. However, the exact magnitude of the benefit remains uncertain due to methodological heterogeneity and the lack of robust long-term data. Due to the qualitative limitations of the included studies, the meta-analysis was intended to provide exploratory insights rather than definitive conclusions. Further high-quality studies with 3D imaging, standardized 3D outcomes, and long-term follow-up are needed to corroborate these results and guide clinical protocols.
O. Di Fede, Maria Zappia, F. Canepa et al.· Applied Sciences· 0 citations
Introduction: Clear aligner treatment has gained popularity in recent years. Accurate torque expression of the upper incisors is crucial for orthodontic treatment outcomes but remains challenging in invisible orthodontic treatment.
Objectives: This systematic review aims to evaluate the existing literature and critically assess the clinical effectiveness of aligners in controlling anterior torque or bucco-lingual root inclination, in both extraction and non-extraction cases.
Methods: A systematic search of Scopus, PubMed, Web of Science, Ebsco, and the Cochrane Library was conducted for peer-reviewed articles published between 2014 and March 2025. A total of 257 records were identified (Scopus: 32; Web of Science: 87; PubMed: 96; Cochrane: 23; Ebsco: 19). After screening and eligibility assessment, 10 studies were included. Inclusion criteria comprised clinical studies evaluating anterior torque or bucco-lingual inclination achieved with clear aligners. Study selection and data extraction were performed according to predefined criteria.
Results: Ten studies involving a total of 412 patients were included. In non-extraction cases, planned torque movements greater than 10° showed moderate predictability, ranging from 35.21% to 42%, whereas movements below 10° exhibited low predictability, reaching only 21.2%. Notably, one study using the Novela system reported an accuracy range of 48% to 98% across all anterior teeth. In premolar extraction cases, treatment with aligners was associated with increased lingual crown inclination and a tendency toward greater overbite.
Conclusion: Torque changes _10° show only moderate predictability in non-extraction cases, and even less for smaller planned changes. In extraction cases, torque control is further reduced, often resulting in increased lingual crown inclination and deeper overbite. These findings should be interpreted with caution due to the heterogeneity of study designs, measurement methods, and patient characteristics in the included studies.
Houda Ousli, Kawtar Chadli, F. Zaoui et al.· International Arab Journal o...· 0 citations
Objective: To systematically review and appraise the available evidence regarding the clinical effectiveness, digital workflows, manufacturing processes and cost-efficiency of in-office clear aligner therapy compared with commercially outsourced aligner systems and conventional fixed orthodontic appliances.
Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar for publications up to March 2026. Studies evaluating in-office or in-house clear aligner fabrication, digital orthodontic workflows, clinical outcomes and cost analyses were included. Reporting followed the PRISMA 2020 statement. Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials, the ROBINS-I tool for non-randomized studies and the AMSTAR 2 checklist for systematic reviews. Because of substantial clinical and methodological heterogeneity across studies, data were synthesized narratively; a formal quantitative meta-analysis was not undertaken.
Results: Twenty-eight studies met the inclusion criteria. In-office aligner fabrication was associated with enhanced clinician control, reduced turnaround times and lower per-case costs compared with outsourced commercial systems. Digital workflows integrating intraoral scanning, computer-aided design software and three-dimensional printing produced clinical results comparable to those of commercial aligner systems for mild-to-moderate malocclusions. Directly three-dimensional-printed aligners demonstrated promising dimensional accuracy and reduced manufacturing steps, although clinical evidence remains limited. The overall quality of available evidence ranged from low to moderate.
Conclusion: In-office clear aligner therapy represents a viable and cost-effective alternative to commercially outsourced systems, offering increased practitioner autonomy and faster treatment delivery. However, the evidence base remains limited and further high-quality randomized controlled trials are necessary to establish standardized protocols and confirm long-term clinical outcomes.
Amilkar Cárdenas· Journal of Dental Health and...· 0 citations
Background/Objectives: Vestibular socket therapy (VST) is a minimally invasive technique for immediate implant placement (IIP) in compromised extraction sockets that reconstructs the deficient buccal plate while preserving the crestal soft tissue. Despite growing clinical adoption, the randomized evidence on its predictability and biological performance remains limited. Methods: Following PRISMA 2020 and prospectively registered in PROSPERO (CRD420261288724), PubMed/MEDLINE and EMBASE were searched to January 2026 for randomized controlled trials (RCTs) evaluating VST with IIP. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed. Final follow-up buccal bone plate thickness was pooled using a random-effects model; trials comparing variations within VST were reported narratively but not pooled. Results: Seven RCTs (186 participants) were included; implant survival was 99.5%, with no shield exposure, peri-implantitis, or dehiscence. Meta-analysis of the three trials comparing VST against a distinct alternative technique showed no significant between-group difference in final buccal bone plate thickness at any level: crestal +0.24 mm (95% CI−0.13 to 0.61; I2 = 45%), mid-root +0.32 mm (−0.45 to 1.09; I2 = 82%), or apical +0.19 mm (−0.48 to 0.87; I2 = 67%). VST showed minimal mid-facial recession, stable papillae, and Pink Esthetic Scores of 10.29–13.17. Certainty was very low for all outcomes. Conclusions: VST achieved high implant survival and favorable soft tissue and esthetic outcomes but did not significantly outperform comparator techniques in buccal bone plate thickness, with very low certainty. Adequately powered, independent trials with longer follow-up are needed.
Y. Soliman, Nadine Gräfin von Krockow, F. E. Hassanein et al.· Dental journal· 0 citations
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