New consensus on clear aligner treatment aims to improve orthodontic outcomes

Malocclusion affects nearly half of the global population, impacting oral function and aesthetics. Clear aligners have gained popularity due to their discreet appearance and ease of use, but their effectiveness varies depending on the type of tooth movement required. Unlike fixed appliances, clear aligners rely on elastic forces, which can complicate complex corrections like intrusion or torque control. Additionally, patient compliance and anatomical limitations further influence outcomes. These challenges underscore the need for standardized protocols to ensure predictable results. Based on these challenges, a thorough investigation into the clinical strategies for clear aligner therapy (CAT) was essential to bridge the gap between patient expectations and treatment efficacy.

Published (DOI: 10.1038/s41368-025-00350-2) on March 13, 2025, in the International Journal of Oral Science, a study by experts from leading institutions in China presents a consensus on clear aligner treatment (CAT). The research outlines evidence-based strategies for case selection, biomechanical principles, and clinical procedures, supported by a novel difficulty-assessment tool (CAT-CAT). By analyzing predictability across different tooth movements and proposing solutions for common complications, the study aims to standardize CAT practices and improve patient outcomes.

The consensus highlights the biomechanical nuances of clear aligners, emphasizing their strength in predictable movements like molar distalization (86% success) and expansion (80%), while noting limitations in torque control (52%) and extrusion (30%). A key innovation is the CAT-CAT tool, which grades cases into four difficulty levels-easy, moderate, difficult, and challenging-guiding clinicians in treatment planning. For complex cases, the study recommends staged movements, auxiliary devices like mini-implants, and overcorrection designs to counteract aligner limitations. Notably, the research introduces the BEPT-CAT philosophy (Biomechanics-guided, Esthetics-driven, Periodontium-supported, TMJ-compatible), integrating multidisciplinary approaches for optimal results. For example, arch expansion requires careful CBCT analysis to avoid alveolar bone damage, while molar distalization benefits from "V-pattern" staging and intermaxillary elastics. The study also addresses challenges like off-tracking, suggesting elastic traction or attachment adjustments.

Patient-specific considerations, such as adolescent growth potential or periodontal health, are underscored, alongside strategies to mitigate risks like root resorption and relapse. The consensus advocates for digital tools, including 3D modeling, to enhance precision and personalize treatment.

Prof. Wenli Lai, corresponding author of the study, states: "Clear aligners represent a paradigm shift in orthodontics, but their success hinges on understanding their unique biomechanics. Our consensus provides a roadmap for clinicians to navigate complexities, from case selection to retention, ensuring predictable and efficient outcomes. By integrating advanced digital planning and patient-specific strategies, we can unlock the full potential of this transformative technology."

This consensus has far-reaching implications for orthodontic practice, offering a framework to standardize CAT globally. Clinicians can leverage the CAT-CAT tool to tailor treatments, reducing trial-and-error approaches. For patients, the guidelines promise improved aesthetics, comfort, and shorter treatment times, particularly for complex cases. The emphasis on digital workflows and interdisciplinary collaboration aligns with trends toward personalized medicine. Future advancements, such as attachment-free designs and AI-driven planning, could further refine CAT. By addressing current limitations-like predictability in extrusion or torque-this research paves the way for innovations that may gradually shift clear aligners toward becoming the mainstream approach in orthodontics, potentially replacing traditional fixed appliances.