Comparison of efficacy and accuracy of tooth movements in optimized and conventional attachments of clear aligners - A systematic review and meta-analysis

Srirengalakshmi Muthuswamy Pandian, Aravind Kumar Subramanian, Nikhillesh Vaiid · 2025 · 9 citationsRead the paper

Aim This systematic review and meta-analysis aimed to compare the efficacy and accuracy of optimized versus conventional attachments in clear aligner treatment using Invisalign. Materials and methods Adhering to the ‘Preferred Reporting Items for Systematic Review and Meta-analysis’ (PRISMA) 2020 guidelines 12 , the review obtained 6 retrospective cohort studies and one randomized controlled trial, sourced from databases such as PubMed, SCOPUS, Web of Science, Cochrane Library, Google Scholar, and clinical trial registries. Four studies were included for meta-analysis. Data was pooled for mean percentage accuracy of various tooth movements and corresponding Forest plots were generated. Results Most of the studies included showed a good methodological quality with a low risk of bias. No significant differences in the accuracy of tooth movement between conventional attachments and optimized attachments were noted for canine derotation, anterior extrusion, and root angulation changes in canine, premolar, and molar (p > 0.05). The studies however exhibited high heterogeneity (I 2 = 75 %). The pooled accuracy for canine derotation was 61.2 % and 71.5 % for conventional and optimized rotations respectively. Similarly, 57.5 % and 62.4 % were the pooled accuracy for conventional and optimized attachments in anterior extrusion. None of the attachments produced the expected tooth movement as predicted by the ClinCheck program. Conclusion There was a non-significant difference in accuracy between optimized and conventional attachments for most orthodontic movements. While optimized attachments may offer improved control for specific movements like upper lateral incisor rotation, and conventional attachments potentially enhance anterior extrusion, their overall superiority remains inconclusive. Further high-quality research is needed to validate the hypothesized biomechanical advantages of optimized attachments.

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