Root resorption in orthodontic treatment with clear aligners: A systematic review

Abstract

The use of clear aligners in orthodontic treatment has grown in popularity because of its visual appeal and patient-friendly nature. In contrast to fixed appliance treatments (FAT), the relationship between external apical root resorption (ERR) and clear aligners is still unknown. The objective of this systematic review was to evaluate the frequency and severity of root resorption in clear aligner orthodontic treatment, compare it to fixed multi-bracket appliances, and determine the factors that contribute to this phenomenon. The review was conducted without regard to linguistic constraints, using PRISMA criteria and examining studies from 2000 to 2023. MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were among the databases that were searched. MeSH words about root resorption, aligners, and orthodontics were utilized. Cohort studies, case-control studies, randomized clinical trials, and comparative clinical studies assessing root resorption during clear aligner orthodontic therapy. Out of the 116 studies that were first found, 11 studies were included in the final analysis. While several trials revealed equal results or no significant differences, six reported decreased incidence and severity of ERR in clear aligner therapies (CAT) compared to FAT. A meta-analysis revealed that CAT had less severe ERRs than FAT. In both treatments, ERR frequently affected the maxillary lateral incisors. Potential significant factors included the mechanical distinctions between CAT and FAT, length of therapy, tooth movement velocity, degree of malocclusion, and extraction instances.The review indicates that there may be differences in the frequency and intensity of ERR between CAT and FAT. In multiple investigations, CAT demonstrated reduced ERR severity, although it did not completely eradicate its recurrence. Mechanical characteristics, length of therapy, degree of malocclusion, and number of extraction instances were factors affecting ERR. The included studies' quality assessment indicated a moderate to substantial risk of bias, highlighting the need for more thorough research using reliable measuring techniques, especially when utilizing CBCT imaging.