Aug 2026· Journal of Orofacial Orthopedics-fortschritte Der Kieferorthopadie· 0 citations· 24 references
Medicine
TL;DR
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.
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
BACKGROUND
Deep bite, defined as excessive vertical overlap of the lower incisors, remains a challenging malocclusion in adults. The existing literature largely focuses on growing patients, with limited high-quality evidence on treatment outcomes in skeletally mature individuals.
OBJECTIVES
To systematically evaluate randomised controlled trials (RCTs) assessing anterior intrusion mechanics for deep-bite correction in adults (≥ 18 years), focusing on measurable dentoalveolar outcomes, specifically the magnitude of overbite reduction, the extent of incisor intrusion, and treatment duration.
METHODS
This systematic review was conducted in accordance with the PRISMA 2020 guidelines. Comprehensive searches of six electronic databases and grey literature sources were conducted up to 10 March 2025, with no language restrictions. Only RCTs involving adults were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Cochrane RoB 2.0 tool. Certainty of evidence for each outcome was assessed using the GRADE framework. Due to substantial clinical and methodological heterogeneity, a quantitative synthesis was not undertaken, and findings were narratively synthesised.
RESULTS
Six randomised controlled trials (RCTs) met the inclusion criteria. The included studies were few in number, generally small in sample size, and clinically heterogeneous with respect to treatment indication, imaging modality, reference planes, and follow-up duration. Across individual studies, miniscrew-assisted intrusion mechanics were associated with slightly greater overbite reduction and greater incisor intrusion than conventional approaches; however, the observed differences were modest and inconsistent across studies. Dual miniscrew configurations generally resulted in greater incisor intrusion (up to 3.81 ± 0.55 mm) than single miniscrew systems (up to 2.62 ± 0.40 mm). Treatment duration ranged from approximately 4.8 to 5.9 months, with minimal differences between intervention groups. None of the included trials evaluated post-treatment stability, patient-reported outcomes, anchorage loss, or temporomandibular joint outcomes. The overall certainty of the evidence varied from low to very low across the assessed outcomes, primarily due to high risk of bias and imprecision.
CONCLUSIONS
Current adult RCT evidence suggests that miniscrew-supported approaches may provide slight benefits in anterior intrusion for deep bite correction. However, the magnitude and consistency of these benefits are limited. Changes in overbite reduction are typically small, and any decrease in treatment time is minimal and probably not clinically significant. Secondary outcomes, such as root resorption and periodontal health, are reported inconsistently but tend to be mild. No trials have assessed long-term stability or patient-reported outcomes. The reliability of these findings is further reduced by the limited number of studies, brief follow-up periods, varied outcome measures, and significant clinical differences. Consequently, the current evidence does not allow for definitive clinical recommendations.
TRIAL REGISTRATION
Registration: Registration number: PROSPERO CRD420250654373.
Wan Ying Lee, S. Othman, Saritha Sivarajan· BMC Oral Health· 0 citations
Protrusion of the maxillary incisors represents a frequent clinical challenge in orthodontic treatment. Current systematic reviews are limited in range and methods employed, while individual trials lack consensus on the most effective mechanics for retraction. This systematic review aimed to evaluate the effectiveness of various approaches used to control anterior tooth inclination during non‑accelerated retraction with buccal fixed appliances. A search of databases was conducted in September (2025) to identify randomized controlled trials using various methods and techniques to retract the upper anterior teeth. Eligible RCTs enrolling patients aged 12–35 years who underwent extraction of upper first premolars were included. Meta‑analyses used random‑effects models (RevMan 5.3). Certainty of evidence was appraised with GRADE. Twenty RCTs with 568 patients in total were included. Risk‑of‑bias was low in 11 trials, some concerns in 4, and high in 5. Pooled analyses showed that retraction produced clinically and statistically significant palatal crown inclination of the upper incisors across techniques: sliding en‑masse (MD ≈ − 9.8°; moderate certainty), loop‑based en‑masse (MD ≈ − 13.3°; moderate certainty), and two‑step retraction (MD ≈ − 8.9°; moderate certainty). Loop‑based mechanics were associated with slightly greater retroclination than sliding (MD = 2.49°; statistically significant but not clinically meaningful; moderate certainty). Comparisons of en‑masse versus two‑step retraction showed no significant difference (very low certainty). Vertical incisal changes were inconsistently reported and supported by very low‑certainty evidence. Heterogeneity varied from low to considerable across analyses. Anterior teeth retraction is generally associated with clinically meaningful incisor retroclination. Loop-based mechanics appear to produce slightly greater retroclination than sliding, but the clinical relevance is limited. Evidence quality ranges from moderate to very low, and heterogeneity could not be avoided; high‑quality RCTs with standardized inclination measurements are needed to define optimal inclination‑control strategies. The review protocol was prospectively registered with PROSPERO (CRD420251167359) during the early stages of the review process.
Majd Abdullah Kalloumeh, M. Y. Hajeer, A. Burhan et al.· BMC Oral Health· 0 citations
OBJECTIVE
To assess the impact of baseline malocclusion severity on the number of prescribed, used aligners and treatment duration.
MATERIALS AND METHODS
An unrestricted, independent search was conducted on the Invisalign ClinCheck database of a private practice for patients without any missing anterior teeth and whose treatment was finished between April 2021 and December 2024. Descriptive statistics were generated, and the feature selection Boruta algorithm (random forest algorithm) was implemented to identify important predictors for the number of aligners (prescribed, used) and treatment duration.
RESULTS
A total of 404 patients were included (age: 29.57 [10.7] years). Mean numbers of prescribed, used and unused aligners were 72.21 (37.52), 65.63 (30.40) and 6.57 (14.09), respectively. Important predictors of the numbers of the prescribed and used aligners were relatively similar and included molar and canine relationships, maxillary crowding, overjet, presence and number of missing or extracted posterior teeth, overbite, presence and number of teeth in posterior crossbite and midline discrepancies. Treatment duration was associated with baseline maxillary crowding, molar and canine relationships, overjet, overbite, midline discrepancies and the presence and number of missing or extracted posterior teeth.
CONCLUSIONS
Factors related to the baseline malocclusion severity significantly affect the number of prescribed, used aligners and treatment duration. This information could be used for informed practice and patient communication, including future evaluation of the biological and environmental footprint of aligners.
A. Gkinosati, Candice Durgnat, Effimia Koumpia et al.· Orthodontics & craniofacial...· 0 citations
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
PURPOSE
The objective of this systematic review was to identify and evaluate the quality of the available evidence on the orthodontic aspects and implications when treating patients with MIH, before, during and after orthodontic treatment.
METHODS
Six electronic bibliographic databases were searched up to 26.05.2026. All studies assessing orthodontic interventions and outcomes in 5-18-year old patients with MIH were considered as eligible for inclusion. Qualitative and quantitative synthesis of results were performed and reported according to the PRISMA guidelines.
RESULTS
Out of 243 records identified, 5 studies were included: a prospective, split-mouth trial, a prospective cohort, a cross-sectional study, and 2 retrospective studies. The included studies evaluated the relationship between MIH, extraction timing, space closure outcomes, adjacent teeth eruption and angulation, and orthodontic outcomes in paediatric populations. The relationship between MIH and orthodontic treatment was primarily therapeutic, rather than aetiological. Maxillary extractions yielded more favourable spontaneous space closure compared to mandibular extractions. This was confirmed after pooling the estimates for complete space closure after first molar extraction of 3 studies (no orthodontic treatment need versus orthodontic treatment need) in the maxilla: RR 4.12, 95% CIs: 1.44,11.80 and no orthodontic treatment need versus orthodontic treatment need in the mandible: RR 1.36, 95% CIs: 0.63, 2.91.
CONCLUSION
Management of severely affected first permanent molars through extraction creates orthodontic considerations that should be addressed through appropriate timing, patient selection, and interdisciplinary collaboration. The literature presents notable gaps; no reliable data on the optimal timing to extract severely affected FPMs could be identified.
D. Kloukos, K. Seremidi, N. Krämer et al.· European Archives of Paediat...· 0 citations
