Search Results (77)

Background/Objectives: The effectiveness of clear aligner therapy depends significantly on the precision of force delivery through the aligner–attachment interface. This study aimed to evaluate the microscopic compatibility between different orthodontic clear aligner materials (Duran+ and Zendura FLX) and attachment designs (rectangular and optimized) using scanning electron microscopy (SEM). Methods: Fifty-six samples were divided into four groups: rectangular attachments with Duran+ aligners (n = 14), rectangular attachments with Zendura FLX aligners (n = 14), optimized attachments with Duran+ aligners (n = 14), and optimized attachments with Zendura FLX aligners (n = 14). Attachments were bonded to bovine incisors using standardized protocols. Clear aligners were thermoformed at 220 °C for 40 s. Cross-sectional samples were analyzed using SEM at 250× magnification. Gap measurements were taken at seven points for rectangular attachments and five points for optimized attachments. Results: Gap measurements ranged from 14.75 ± 1.41 µm to 91.07 ± 3.11 µm. Zendura FLX demonstrated significantly better adaptation than Duran+ with rectangular attachments (42.10 ± 1.07 µm vs. 44.52 ± 1.51 µm, p < 0.001). Optimized attachments showed better overall adaptation than rectangular attachments. All combinations showed regional variation with the largest gaps at gingival borders (67.18–91.07 µm) and the smallest at flat buccal surfaces (14.75–20.98 µm). Conclusions: Perfect adaptation was not achieved with any material–attachment combination tested. Material selection and attachment design significantly influence microscopic adaptation, with multi-layer materials and optimized geometries showing superior performance. These findings provide mechanical explanations for clinical limitations in clear aligner therapy. Full article

This study explores the clinical, behavioural, and environmental risks of chronic proton pump inhibitor (PPI) use in older adults through a One Health perspective. Among 246 participants, 32.5% were receiving PPI therapy, with 91.3% on long-term treatment, frequently lacking clear clinical justification. Polypharmacy, drug interactions, and risky lifestyle behaviours were common. Environmental review highlighted the potential persistence of PPI transformation products in water systems, raising concerns about ecological impact and antimicrobial resistance. These findings underscore the urgency of implementing deprescribing strategies, enhancing patient education, and adopting sustainable prescribing practices that align human and environmental health. Full article

Background: Attachments are essential components in clear aligner therapy, enhancing retention and improving the predictability of tooth movements. Mechanical and wear properties of the composite resins used for attachment reproduction are critical to maintaining their integrity and shape over time. This study aimed to evaluate and compare the mechanical properties, thermal behavior, and wear performance of the hybrid composite Aligner Connect (AC) and the flowable resin (Connect Flow, CF). Methods: Twenty samples (ten AC and ten CF) were reproduced. All specimens underwent differential scanning calorimetry (DSC), combustion analysis, flat instrumented indentation, compression stress relaxation tests, and tribological analysis. A 3D wear profile reconstruction was performed to assess wear surfaces. Results: DSC and combustion analyses revealed distinct thermal transitions, with CF showing significantly lower Tg values (103.8 °C/81.4 °C) than AC (110.8 °C/89.6 °C) and lower residual mass after combustion (23% vs. 61%), reflecting reduced filler content and greater polymer mobility. AC exhibited superior mechanical properties, with higher maximum load (585.9 ± 22.36 N) and elastic modulus (231.5 ± 9.1 MPa) than CF (290.2 ± 5.52 N; 156 ± 10.5 MPa). Stress relaxation decrease was less pronounced in AC (18 ± 4%) than in CF (20 ± 4%). AC also showed a significantly higher friction coefficient (0.62 ± 0.060) than CF (0.55 ± 0.095), along with greater wear volume (0.012 ± 0.0055 mm³ vs. 0.0070 ± 0.0083 mm³) and maximum depth (36.88 ± 3.642 µm vs. 17.91 ± 3.387 µm). Surface roughness before wear was higher for AC (Ra, 0.577 ± 0.035 µm; Rt, 4.369 ± 0.521 µm) than for CF (Ra, 0.337 ± 0.070 µm; Rt, 2.862 ± 0.549 µm). After wear tests, roughness values converged (Ra, 0.247 ± 0.036 µm for AC; Ra, 0.236 ± 0.019 µm for CF) indicating smoothened and similar surfaces for both composites. Conclusions: The hybrid nanocomposite demonstrated greater properties in terms of stiffness, load-bearing capacity, and structural integrity when compared with flowable resin. Its use may ensure more durable attachment integrity and improved aligner–tooth interface performance over time. Full article

Objective: The present review aims to compare the oral microbial profile (OMP) of patients undergoing fixed orthodontic therapy (OT) versus clear aligner therapy (CAT) for the treatment of malocclusions. Methods: Clinical studies were included. Case-reports/-series, letters to the editor, reviews, perspectives, and expert opinions were excluded. Indexed databases (MEDLINE/PubMed, Embase, Scopus, and Web of Science) were searched up to the end point of May 2025, without time and language barriers. The study was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias (RoB) and quality of evidence were assessed. Results: Three randomized clinical trials (RCTs) and seven non-RCTs were included. In all RCTs and five non-RCTs, OMP was assessed using subgingival plaque samples. Periodontopathogenic bacteria and Gram-negative anaerobic microbes were more often identified in patients undergoing fixed OT than CAT. The biofilm mass was higher in patients undergoing fixed OT than CAT. In two RCTs, periodontopathogenic bacteria were dominant among patients undergoing fixed OT than CAT. All RCTs and two non-RCTs had a high RoB. The certainty of evidence was “moderate” in 70% of the studies. Conclusions: Due to a high RoB, variability in study designs, and lack of power analysis, direct comparisons remain limited. Full article

Background: Clear aligner therapy (CAT) has become increasingly popular for treating mild to moderate malocclusions. However, discrepancies between predicted and achieved tooth movement remain a concern, partly due to the limited understanding of aligner material behavior under clinical conditions. Since these materials must deliver controlled and sustained forces, their flexural properties are critical for treatment efficacy. Objective: To identify and analyze in vitro studies investigating the flexural properties of thermoplastic clear aligner materials, summarize their testing methodologies, and examine the factors that may influence their clinical performance. Methods: A scoping review was conducted following the PRISMA-ScR guidelines. Three electronic databases (PubMed, Scopus, and Web of Science) were systematically searched. Studies were screened based on predefined eligibility criteria, and data extraction included testing methods, materials, and clinically relevant variables. Risk of bias was assessed using the QUIN tool. Results: Seventeen studies published between 2008 and 2024 were included. All studies used three-point bending to assess mechanical properties. Common influencing factors included thermoforming, liquid absorption, temperature changes, loading conditions, and material thickness. Most studies reported that these factors negatively affected force delivery. The most frequently tested material was Duran (PET-G). Polyurethane-based materials, such as Zendura, showed comparatively better stress relaxation properties. Conclusions: Thermoforming, intraoral temperature changes, liquid exposure, and prolonged or repeated loading can compromise the mechanical properties and force delivery capacity of aligner materials. Standardized testing methods and further investigation of newer materials are essential to enhance the predictability and performance of clear aligner therapy. Full article

Background: The use of aligner therapy for open bite and deep bite correction has increased in contemporary society. There is no evidence that unify the results present the in literature regarding a real comparison between clinical outcomes and the results predicted by the ClinCheck software 3.0 (Align Technology, Santa Clara, CA, USA). Furthermore, the literature shows conflicting data about the protocols and not all authors compare the programmed movements and the clinical results obtained for the overbite correction. Therefore, the aim of this systematic review is to assess the predictability of ClinCheck in the correction of vertical discrepancies by comparing the planned outcomes with the actual clinical results performed with clear aligners. Methods: The research question focused on the effectiveness of ClinCheck in predicting the actual correction of deep bite AND open bite in adult patients. Five electronic databases (PubMed, Scopus, Embase, Web of Science and Cochrane Library) were investigated, with the following keywords: overbite AND aligners. A quality assessment was performed using the Newcastle-Ottawa scale, while the risk of bias was evaluated using the ROBINS-I tool 2.0. PROSPERO ID: CRD420251078610. Results: Out of a total of 838 records initially screened, seven studies fulfilled the inclusion criteria and were ultimately selected for this systematic review. The analysis focused on assessing the divergence between the overbite correction predicted by ClinCheck and the outcomes observed in clinical practice. Conclusions: ClinCheck demonstrated a predictability of 62.1% for overbite correction in open bite cases and 41.5% in deep bite cases. However, not all studies report the planned tooth movements. Among the studies that addressed this aspect, the majority reported no significant association between the overbite correction predicted during treatment planning and the results ultimately achieved—except for one study, which demonstrated significant accuracy in achieving absolute extrusion in the correction of open bite. Full article

Background and Objectives: To systematically map and evaluate the current literature on the application of artificial intelligence (AI) in teleorthodontics, focusing on clinical use, technological approaches, outcomes, and limitations. Materials and Methods: A scoping review was conducted following a formal and recognized methodological framework. Three databases (PubMed, Scopus, Web of Science) were searched until 30 April 2025. Studies were included if they reported original data on AI applications in orthodontic remote monitoring or virtual care. Data extraction focused on study design, type of AI, clinical setting, reported outcomes, and main findings. Results: Nine studies met the inclusion criteria. Most research focused on the use of the Dental Monitoring™ (DM) system, which employs deep learning algorithms to analyze intraoral scans captured via smartphones. Reported benefits included reduced in-office visits (up to 33%), accurate 3D tracking of tooth movement, improved hygiene compliance, and high patient engagement. However, significant variability was observed in the repeatability and precision of AI decisions, especially in GO/NO-GO aligner progression instructions. One study explored an alternative system, StrojCHECK™, based on a decision tree algorithm, showing improved compliance with personalized feedback. Conclusions: AI-powered teleorthodontic systems show potential to enhance treatment efficiency and patient engagement, particularly in aligner therapy. However, their current clinical application remains narrowly focused on commercial monitoring platforms, with limited validation and transparency. This review highlights the early stage of real-world AI integration in orthodontics, underlining the need for independent validation, broader applications beyond monitoring, and robust ethical frameworks. In this context, AI should be used as a complementary tool, never a substitute, for clinical judgment. Full article

Background/Objectives: Previous studies on clear aligner therapy (CAT) in mixed dentition primarily focused on the predictability of maxillary arch expansion. However, limited evidence is available regarding mandibular arch changes, particularly in relation to inter-arch coordination. This study aims to evaluate the effectiveness and predictability of dental expansion in both the upper and lower arches using Invisalign First^® aligners. Methods: A retrospective analysis was conducted with 15 participants. Dental expansions were assessed before and after treatment using iTero intraoral scans processed with 3D analysis software. Measurements were compared to the predicted movements planned in ClinCheck^®. Data normality was verified (Shapiro–Wilk test), descriptive statistics were calculated, and paired t-tests were performed to compare clinical and predicted expansions, with significance set at 0.05. Results: Clear aligners achieved effective dento-alveolar expansion in both arches. Predictability was higher at the cusp level than at the gingival level, indicating a tendency toward tipping movements rather than bodily expansion. The study also highlighted mandibular expansion outcomes and gingival-level discrepancies, providing new insights compared to the previous literature. Minor differences between predicted and achieved movements were observed, partly attributable to natural growth and deciduous tooth exfoliation. Conclusions: Clear aligners are effective in achieving maxillary and mandibular arch expansion in mixed dentition, with good predictability at the coronal level. Overengineering buccal root torque may help promote bodily expansion and reduce cuspal–gingival discrepancies. Further studies with larger sample sizes are needed to optimize treatment planning and predictability. Full article

Background/Objectives: Currently, clear aligners are preferred to conventional appliances, especially among adult patients. However, the use of aligners for treating maxillary constriction is still debated in the literature. Therefore, the purpose of this study was to assess maxillary dentoalveolar expansion following clear aligner therapy in adults using CBCT scans. Methods: The study sample encompassed 50 non-growing patients (27 females and 23 males) aged 20 to 42 undergoing clear aligner orthodontics without dental extractions or auxiliaries. Transverse linear distances were measured on initial and final CBCTs and, subsequently, analysed through paired t-test and ANOVA. We considered alveolar bone measurements and interdental widths measured at the buccal apices and cusps from canines to second molars. Results: The buccal alveolar ridge width showed the greatest expansion (1.01 ± 0.38 mm), followed by the palatal alveolar ridge and maxillary alveolar bone. Statistically significant improvements were observed for all interdental measurements. The most considerable changes occurred in the interpremolar cusp distances, while the least changes were seen in the intermolar apex distances. At the cusp level, the average interpremolar widths increased by 3.44 ± 0.22 mm for the first premolars and 3.14 ± 0.27 mm for the second ones. Conclusions: Clear aligner treatment can effectively manage a constricted maxillary arch. We found significant changes in the maxillary alveolar bone. Both inter-apex and inter-cusp widths increased in all teeth, with the highest values in the premolars. Moreover, the increases in interdental distances at both apex and cusp levels were related to tooth position. Full article

Background: Aesthetic dentistry increasingly demands minimally invasive, predictable, and patient-centered solutions. Digital technologies and AI-driven planning tools are now integral to interdisciplinary treatments. Aim: To evaluate, by means of a 16-item questionnaire, patients’ perceptions of smile aesthetics and oral function before and after receiving clear aligner therapy followed by minimally invasive ceramic veneers, using digital planning and Smile Creator software. Materials and Methods: Five adult patients underwent digital smile design, clear aligner therapy, and feldspathic veneer placement. Pre- and post-treatment perceptions of smile aesthetics and function were assessed using a structured questionnaire. AI-based simulation tools (2D and 4 K TruSmile video previews) were incorporated. Paired t-tests were used to compare outcomes before and after treatment. Results: Mean pre-treatment scores were 4.8 for smile aesthetics and 6.6 for function. Post-treatment scores significantly improved to 9.8 (p = 0.001) and 9.4 (p = 0.002), respectively. Patients rated AI-generated smile previews more favorably than 2D designs and acknowledged the value of digital tools in understanding and accepting treatment. Conclusions: The integration of digital and AI-based tools in aesthetic dentistry enhances patient communication, improves predictability, and enables minimally invasive treatment. Patient satisfaction was high, underscoring the effectiveness of the combined orthodontic and prosthetic approach. Full article

This study investigated the biomechanical effects of varying buccolingual beam widths in maxillary first premolar extraction spaces on canine distal bodily movement during clear aligner treatment. Using finite element analysis, four distinct models were constructed, incorporating beam designs with widths of 0 (edentulous), 1, 2, and 3 mm within the extraction space. Each model underwent a comprehensive 50-stage iterative simulation to evaluate canine displacement patterns, tipping, rotational movements, aligner deformation characteristics, and magnitudes of forces and moments applied to the canines throughout long-term tooth movement. Group 0 (no beam, 0 mm beam width) exhibited the greatest crown displacement and tipping angle. In contrast, Group 2 (2 mm beam width) most effectively reduced the final angulation of the canine, whereas Group 3 (3 mm beam width) was most effective in controlling unwanted rotation and minimizing deformation of the clear aligner. Furthermore, an increase in the beam width was associated with a trend of higher initial force and lower initial moment. Notably, relatively high levels of both force and moment were maintained during the later stages of the simulation, which is advantageous for sustained control of tooth movement. In conclusion, incorporating a beam of 2–3 mm width into the maxillary first premolar extraction space appears to be optimal for managing canine tipping and rotation while promoting bodily movement of the tooth. Full article

Background and Objectives: Anterior open-bite malocclusion remains a challenging orthodontic condition where achieving a positive overbite necessitates precise control of incisor extrusion and molar intrusion. With recent advances in clear aligner therapy—improved materials, attachment techniques and digital treatment planning—the potential for non-invasive treatment has increased. This scoping review systematically maps the evidence on the efficacy of clear aligners in treating anterior open bite among adult patients, outlines treatment protocols and highlights gaps in the literature. Materials and Methods: A systematic search was conducted in PubMed/Medline, Embase/ScienceDirect and Clarivate/Web of Science for literature published in English between January 2000 and December 2024. Studies involving adult patients treated with clear aligners (predominantly Invisalign^®) were included. A two-step screening process was applied, and data were charted according to pre-specified criteria. The review adheres to the PRISMA-ScR checklist guidelines. Results: From an initial pool of 802 articles, 30 met the inclusion criteria following duplicate removal and full-text screening. The evidence suggests that clear aligners can achieve measurable incisor extrusion and posterior intrusion when appropriate auxiliary techniques (e.g., attachments and mini screws) are used. However, digital treatment planning software may overestimate movement predictions, necessitating iterative refinement phases. Patient compliance, clinician expertise and technological limitations are key factors influencing outcomes. Conclusions: Clear aligner therapy represents a promising alternative to fixed appliances for anterior open-bite correction in adults, although challenges remain in achieving precise vertical control. Further high-quality randomized controlled trials and standardized outcome measures are needed to confirm long-term stability and efficacy. Full article

This study evaluated the effects of different clear aligner (CA) designs on forces and moments during maxillary second molar distalization. Four designs were tested: attachment only (group 1), neither attachment nor enhanced structure (group 2), a combination of attachment and enhanced structure (group 3), and enhanced structure only (group 4). CAs were fabricated from thermoformed polyethylene terephthalate glycol with 30 CAs per group. Forces and moments were measured using a multi-axis transducer as the molars were distally displaced by 0.25 mm. All groups experienced buccodistal and intrusive forces. Group 3 showed the highest distalizing force (Fy = 2.51 ± 0.37 N) and intrusive force (Fz = −2.04 ± 0.48 N) and also the largest rotational moment (Mz = 3.89 ± 0.71 Nmm). Groups 3 and 4 (with enhanced structures) demonstrated significant intrusive forces (p < 0.05). Most groups exhibited mesiodistal angulation, lingual inclination, and distal rotational moments. Group 2 had the lowest moment-to-force ratio (Mx/Fy = 3.27 ± 0.44 mm), indicating inefficient bodily movement. Group 3 demonstrated significantly greater moments across all axes compared to other groups. The results indicate that designs incorporating enhanced structures with attachments increase CA stiffness and applied forces/moments, enhancing distalization efficiency while minimizing vertical side effects. This suggests that, clinically, reinforced CAs can serve as a simple yet effective modification to existing protocols in Class II orthodontic cases, enabling more efficient molar distalization without requiring complete appliance redesign or additional fabrication and allowing easy adaptation to individual treatment needs. Full article

This systematic review aims to further current knowledge on the effects of microplastics from orthodontic clear aligners, identifying potential implications for human health and providing a basis for further research and development of alternative materials. A literature search to find all peer-reviewed citations relevant to the review topic was conducted in the following databases: PubMed, Scopus, Web of Science, and Cochrane Library on 31 December 2024. A manual search of grey literature was also performed. There were 62 citations retrieved by the search query, and 11 were selected for inclusion in the review. Four selected studies were in vitro, while seven were in vitro following intraoral material aging studies. Ten studies evaluated the surface morphology of the material after aging, among the mechanical characteristics assessed, while only one article evaluated the chemical characteristics and size of the microplastic particles released from the aligners after simulated in vitro use. Discussion: From the evaluation of the studies included in this review, it is possible to state that there is a gradual increase over time in the surface roughness of the material, and modifications occurred in the morphology and surface topography of the aligners. Furthermore, it emerged that dispersion of microplastics occurs during the use of different types of aligners, with microplastic particle sizes ranging from 5 to 20 μm The findings suggest that clear aligners may cause microplastic dispersion in saliva during therapy, and this could cause a problem for the general health of patients, due to the absorption or ingestion of these released molecules. Further research is needed to fully understand the extent of microplastics released from aligners and to find alternative materials that can reduce this occurrence. Full article

(1) The aim was to evaluate the predictability of treatment outcomes using clear aligner therapy (CAT) and ClinCheck Web 1.4 (Align Technology, Inc., San Jose, CA, USA) software in mandibular incisor intrusion in both children and adults with deep bite malocclusion. (2) This study included healthy children and adults with skeletal Class I or mild to moderate Class II/III malocclusions, mild to moderate dental crowding (<5 mm), and deep overbite (OB) who underwent CAT. Pre-treatment (T1) and post-treatment (T2) orthodontic treatment records were assessed and compared to initial planned ClinCheck movements. The cephalometric parameters evaluated included bodily intrusion (Centroid-C point), IMPA, L1-NB, and L1-A-Po. Clinical expression of CAT was compared to ClinCheck predictions using paired sample t-tests, and differences between growing and non-growing groups were assessed using a repeated measures ANOVA with Tukey post hoc analysis. (3) The sample included 48 patients (mean age 19.79 ± 11.78 years), including 18 adults (mean age 30.28 ± 13.79 years) and 30 children (mean age 13.5 ± 2.05 years). The predicted vertical mandibular incisor movement (intrusion) was significantly higher using ClinCheck (2.32 mm) compared to clinical treatment (0.22 mm). The angular movements of IMPA, L1-NB, and L1-APo were all significantly higher using ClinCheck (4.6°) compared to clinical expression of 0.79°, 0.55°, and 1.21°, respectively. There were no significant differences between children and adults with respect to vertical or angular tooth movements. (4) CAT and ClinCheck software significantly overpredicts orthodontic tooth movements related to mandibular incisor intrusion in both adults and children with no statistical difference between the groups. Full article