REGISTRO DOI: 10.69849/revistaft/fa10202001081603
Waldir Martineli Filho
ABSTRACT
The evolution of clear aligners has significantly transformed orthodontics, providing an aesthetic and comfortable alternative to traditional fixed braces. Since the introduction of these devices in the 1990s, continuous technological advancements have expanded aligners’ ability to address an increasing variety of orthodontic cases. Initially, aligners were limited to minor dental corrections due to restricted biomechanical control. However, advances in 3D modeling, 3D printing, intraoral scanning, and artificial intelligence have enabled greater personalization, enhancing the precision and effectiveness of treatments. Recent algorithm developments allow orthodontists to simulate the entire tooth movement process, adjusting each treatment stage. This increases control and reduces the overall treatment time. Flexible and durable materials have also improved aligners’ ability to perform complex movements, which previously required fixed braces. Additionally, technologies like augmented reality provide patients with a preview of the final result, fostering greater adherence to treatment. The growing popularity of clear aligners requires orthodontists to acquire skills in digital tools and detailed planning. This new digital approach transforms clinical practice and makes treatment more accessible, driving acceptance of these devices among adults seeking less invasive options. Although challenges remain in expanding the predictability of certain movements, ongoing technological progress continues to broaden aligners’ applicability, benefiting both patients and professionals and setting a new standard for personalization and efficiency in orthodontics.
Keywords: Clear aligners; Digital orthodontics; 3D technology; Artificial intelligence in orthodontics; Treatment personalization.
The evolution of clear aligners represents one of the most remarkable advancements in modern orthodontics, significantly transforming both patient experience and the work of professionals in the field. Since their introduction in the 1990s, aligners have undergone constant technological improvements, changing the approach to dental alignment treatment. Initially, they were recommended only for mild cases of tooth movement due to limited precision and restricted biomechanical control. However, with advances in digital technology — including 3D modeling software, 3D printing, and intraoral scanning — it has become possible to plan and produce customized aligners for each patient, increasing the accuracy of results.
Among the most significant advances is the development of algorithms and software that simulate tooth movement throughout the treatment, enabling orthodontists to predict outcomes and adjust each stage of movement with precision, ensuring greater process control and reducing total treatment time. Additionally, the use of more flexible and durable materials has improved the effectiveness and comfort of aligners, allowing for more complex movements that previously were only possible with traditional fixed braces.
Another noteworthy advancement is the integration of aligners with digital technologies, such as artificial intelligence (AI) and augmented reality, optimizing the experience for both the patient and the orthodontist. AI enables the automatic analysis of thousands of clinical cases, facilitating more accurate predictions of tooth movements. Meanwhile, augmented reality allows patients to visualize the final outcome before starting treatment, increasing their motivation and adherence to the process.
Figure 1: Advances in orthodontic clear aligner materials.
Source: Causey (2018)
Clear aligners offer aesthetic and functional advantages, as they are nearly invisible and removable, providing a discreet solution that does not compromise appearance and facilitates oral hygiene. These factors are particularly appealing to adult patients, who often seek alternatives to metal braces. For orthodontic professionals, the popularity of clear aligners has expanded treatment options, offering less invasive alternatives adaptable to patients’ lifestyles. However, this technology requires new skills and knowledge, especially in digital tools and 3D planning, prompting many orthodontists to invest in training to maximize the innovations that aligners bring.
The evolution of clear aligners points to a promising future in orthodontics, with treatments becoming increasingly personalized, faster, and more comfortable. Technology continues to advance, expanding treatment possibilities for more complex cases. As digital orthodontics progresses, clear aligners are expected to become a viable option for an increasing number of patients, revolutionizing orthodontic practice and delivering more aligned and healthier smiles worldwide.
Since the introduction of the “Tooth Positioner” by TP Orthodontics in 1944, removable devices similar to aligners have been used for mild to moderate tooth movements. According to Dreyer and Weir (2017), clear aligner therapy has been part of orthodontic practice for decades, gaining prominence with the launch of Invisalign by Align Technology in 1998, becoming an increasingly common tool in the orthodontic arsenal. Currently, an internet search reveals at least 27 different aligner products available for orthodontic treatment, highlighting the growing popularity of these devices and exploring the differences among the types available on the market. Kundal’s (2020) study examines treatment with clear aligners, addressing its benefits and limitations, the principles and biomechanics involved, the materials used, manufacturing methods, and usage time. The growing demand from patients interested in this type of treatment has led to the emergence of various manufacturers, with this number increasing annually.
The study by Rossini et al. (2015) evaluated the effectiveness of clear aligners (CAT) in controlling orthodontic movements, reviewing peer-reviewed articles from 2000 to 2014 in databases like PubMed, Cochrane, and Scopus. The results indicated aligners’ effectiveness in movement and leveling of arches and anterior intrusion control, though with lower precision for anterior extrusion and rounded tooth rotation. The distalization of upper molars showed high predictability (88%) with a minimal bodily movement of 1.5 mm. However, Rossini et al. recommend caution in interpreting the results, considering the quantity and heterogeneity of studies.
Zheng et al. (2017) conducted a systematic review on the efficiency and stability of aligners compared to conventional brackets. Four controlled clinical studies were included, totaling 252 participants, with evidence pointing to a significant advantage of aligners in treatment time and chair time for mild to moderate cases. Gao et al. (2020) analyzed the effects of aligners and fixed appliances on pain perception, anxiety, and oral health-related quality of life, observing that patients with aligners reported lower levels of pain and anxiety and better quality of life.
Finally, Robertson et al. (2020) reviewed the efficacy of clear aligners regarding the predictability of movements and compared the results with fixed appliance therapy, finding “low to moderate certainty” in aligners’ efficiency for some tooth movements. While aligners may offer clinically acceptable results comparable to fixed appliances for buccolingual inclinations of incisors, the predictability of many movements is still limited, requiring further advancements to expand their clinical application.
In summary, the evolution of clear aligners has revolutionized orthodontic practice, offering patients an aesthetic, comfortable, and effective alternative compared to traditional fixed braces. With the support of technological innovations, such as 3D modeling, artificial intelligence, and advanced materials, aligners can now address a broader range of needs, from mild cases to complex tooth movements. Although challenges remain in expanding the predictability of certain movements, ongoing research and development continue to overcome limitations and enhance the clinical viability of aligners.
The popularization of aligners is also redefining the skills required for orthodontic professionals, necessitating expertise in digital tools and detailed treatment planning. With the steady advancement of digital orthodontics, clear aligners are expected to become an increasingly accessible and efficient option, benefiting both patients and professionals, and setting a new standard of excellence and personalization in orthodontic treatments.
REFERENCES
Causey, M. (2018). Clear aligners: Technology versus physiology. Available in: https://www.dentaleconomics.com/science-tech/article/16384915/clear-aligners-technology-versus-physiology. Acess in: October 2020.
Dreyer, C., & Weir, T. (2017). Clear aligners in orthodontic treatment. Australian Dental Journal, 62, 58–62. https://doi.org/10.1111/adj.12480.
Gao, M., Yan, X., Zhao, R., Shan, Y., Chen, Y., Jian, F., Long, H., & Lai, W. (2020). Comparison of pain perception, anxiety, and impacts on oral health-related quality of life between patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatment.. European journal of orthodontics. https://doi.org/10.1093/ejo/cjaa037.
Kundal, S. (2020). Aligners: The Science of Clear Orthodontics. International Journal of Dental and Medical Specialty. https://doi.org/10.30954/ijdms.1.2020.9.
Robertson, L., Kaur, H., Fagundes, N., Romanyk, D., Major, P., & Mir, C. (2020). Effectiveness of clear aligner therapy for orthodontic treatment: A systematic review.. Orthodontics & craniofacial research. https://doi.org/10.1111/ocr.12353.
Rossini, G., Parrini, S., Castroflorio, T., Deregibus, A., & Debernardi, C. (2015). Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review.. The Angle orthodontist, 85 5, 881-9 . https://doi.org/10.2319/061614-436.1.
Zheng, M., Liu, R., Ni, Z., & Yu, Z. (2017). Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta-analysis.. Orthodontics & craniofacial research, 20 3, 127-133 . https://doi.org/10.1111/ocr.12177.