Introduction Temporary anchorage devices (TADs) have been introduced to overcome the biomechanical limitations of clear aligner therapy (CAT), yet the evidence remains fragmented. An overview of the integration of TADs into CAT is therefore warranted to inform aligner practice and identify research gaps. Methods PubMed, Web of Science, Scopus, Embase, and the Cochrane Library were searched. All study types reporting TADs in clear aligner–based treatment were eligible. Two independent reviewers screened studies and extracted data. Results A total of 133 publications were included. Publications have increased rapidly since 2021, with case and in vitro studies accounting for most evidence (82.0%). Publications varied across countries, while international collaboration remained limited (22.6%). Most studies focused on tooth movement and anchorage design (92.3%). Among clinical studies, Class II was the most common malocclusion (63.4%), and non-extraction protocols outnumbered premolar-extraction protocols (68.5% vs 31.5%). TADs were predominantly applied as direct anchorage (87.4%), mainly for distalization (40.7%), intrusion (22.1%), and anterior retraction (18.6%). The most common insertion sites were the maxillary buccal region (41.3%), palatal side (23.4%), and mandibular buccal region (15.0%). Elastics on the TAD side and precision cuts on the aligner side were the most frequent connection strategies. Conclusions Studies on the use of TADs to expand the biomechanical capacity of clear aligner therapy have increased substantially in recent years. However, the literature remains dominated by low-level study designs (case reports and in vitro studies), with limited reporting of clinical and patient-centered outcomes. Future well-designed clinical studies with standardized reporting are needed for higher-quality evidence on TADs in CAT.
Background Open bite Class III malocclusions pose a complex orthodontic challenge because sagittal discrepancy often coexists with vertical imbalance and transverse disharmony. Orthodontic management in such cases has traditionally focused on sagittal correction; however, vertical factors, particularly posterior dentoalveolar height, may exert a more decisive influence on mandibular posture and occlusal relationships. Case Presentation This case series describes three patients with open bite Class III malocclusion treated with a non-surgical, vertically oriented approach. Treatment plans were individualized but followed a shared biomechanical concept centered on vertical control, transverse correction, occlusal deprogramming, and camouflage mechanics where appropriate. Results Across the three cases, management of posterior dentoalveolar height was associated with improvement in mandibular position, closure of anterior open bite, and establishment of positive overjet. In one patient, removal of occlusal interferences allowed spontaneous mandibular repositioning. In the second patient, controlled management of posterior dentoalveolar height was associated with sagittal improvement. In the third, coordinated vertical and transverse correction improved intercuspation and occlusal stability. Conclusion These cases suggest that vertical control should be considered a primary therapeutic axis in open bite Class III malocclusion. By addressing posterior dentoalveolar height and associated transverse or functional constraints, meaningful non-surgical correction may be achieved in carefully selected patients.
Objective To systematically review and meta-analyze randomized controlled trials (RCTs) comparing clear aligner therapy (CAT) and lingual appliances (LA) with conventional labial fixed appliances (FA) regarding enamel demineralization and patient-reported outcomes (PROs). Materials and methods A systematic search of PubMed/MEDLINE, CENTRAL, Embase, and Scopus was conducted without date restrictions up to January 22, 2026. Additional searches included trial registries, citation tracking, and contact with experts. Only RCTs including adolescents and adults treated with CAT or LA compared with FA were eligible. The primary outcome was enamel demineralization, including white spot lesions (WSLs), manifest caries, and quantitative measures of mineral loss. Secondary outcomes were PROs, including oral health-related quality of life (OHRQoL), pain, oral function, and treatment satisfaction. Study selection, data extraction, risk of bias assessment (RoB 2), and GRADE evaluation were performed according to Cochrane and PRISMA guidance. Random-effects meta-analyses were conducted where appropriate. The protocol for this systematic review was prospectively submitted to PROSPERO prior to study initiation (submitted December 18, 2025) PROSPERO registration: CRD420251269067. Results Twelve RCTs involving 558 participants were included. Only one RCT assessed enamel demineralization and reported mixed findings: greater fluorescence loss in the FA group but larger lesion area in the CAT group after 3 months. Four RCTs were pooled for OHRQoL (OHIP-14), showing significantly lower scores in the CAT group than in the FA group (mean difference = -5.92; 95% CI, -7.91 to -3.94; I² = 76%), particularly during the first week and first month of treatment. Meta-regression showed that this advantage decreased over time by 0.21 OHIP-14 units per week (P < 0.01). Three RCTs were pooled for pain and showed no statistically significant difference between CAT and FA (SMD = -0.59; 95% CI, -3.17 to 2.00; I² = 93%). Limited evidence from 2 RCTs suggested that LA may be associated with greater early impairment in speech, mastication, and OHRQoL than FA. Overall risk of bias was high in most studies, and the certainty of evidence was low to very low. Conclusions Clear aligners may provide a short-term benefit in OHRQoL compared with conventional labial fixed appliances, but this advantage appears to diminish over time. Evidence regarding pain remains inconsistent, and randomized evidence on enamel demineralization is very limited. For lingual appliances, available evidence is sparse and mainly indicates greater early functional impairment. More high-quality RCTs with standardized outcomes and longer follow-up are needed.
Background Developmental defects of enamel (DDE) give rise to hypoplastic and/or hypomineralised enamel. The affected enamel responds differently to etch and bonding. There is a need of an overview how to best handle DDE in orthodontic treatment, aspects of shear bond strength and treatment failure. Objectives The objective was to comprehensively map existing literature on DDE and shear bond strength and treatment failure in orthodontics. Methods Reports of primary studies addressing orthodontic treated patients having DDE of treatment failure, treatment time, shear bond-strength (SBS), and bond failure, published in the period 2000–2025, written in English were considered for inclusion in this scoping review. PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. The protocol was registered with the PROSPERO International prospective register under registration number PROSPERO 2026 CRD420261283906. Results Sixteen studies were included, 14 (88%) of them being in vitro studies. Dental fluorosis (DF) was the developmental defect of enamel described. All in vitro papers referred to SBS, and there were also reports of ARI (79%). A variety of procedures increased the SBS of teeth with DF; concerning cleaning methods prior etching (43%), etching (50%), or bonding (29%). Most studies (86%) reported SBS above critical threshold of 8 MPa. Mean SBS in DF is approximately 2 MPa lower than normal enamel. Conclusions The current evidence base is limited, with a dominance of studies on dental fluorosis, methodological heterogeneity, and in-vitro shear bond strength. Several pretreatments achieve acceptable SBS in enamel with dental fluorosis, but enamel damage and clinical failure rates remain under-researched.
Insight into relevant orthodontist preferences and opinions regarding orthodontic retention and retainers is a key component of relevant evidence-based healthcare. The aim of this review was to collate and synthesize the evidence related to orthodontist preferences regarding orthodontic retainers and retention protocols. The review methodology aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Systematic searching of four databases and independent screening of publications by two reviewers resulted in 30 cross-sectional questionnaire studies for inclusion. A total of 8258 orthodontists in at least 23 countries were surveyed. The number and nature of questions within each study varied considerably. The clear plastic retainer (n = 11 studies; 36.7%) was reportedly the most prescribed retainer in the maxilla followed by the Hawley retainer (n = 7 studies; 23.3%). The bonded retainer was the most preferred retainer in the mandible in 18 studies (60%) followed by the clear plastic retainer in five (16.7%) studies. Indefinite retainer wear was recommended by between 5.4–100% of respondents. There was wide variance in preferred clear plastic retainer and bonded retainer wear full-time and part-time wear protocols, material, design and fabrication characteristics reported by orthodontists. Adjunctive procedures appeared to be infrequently employed, and the pre-treatment malocclusion was the factor that most influenced orthodontists’ choice of retainer. Future investigations should consider qualitative research methodologies to help provide insights and deeper understanding into orthodontists’ retainer and retention preferences.
Tooth autotransplantation is a biologically based and cost-effective surgical procedure in which a tooth is repositioned within the same individual, offering a valuable alternative to prosthetics or implants, particularly in growing patients. Modern protocols, developed through advances in surgical techniques, imaging, and case selection, have significantly improved predictability and success rates. This narrative review aims to synthesize current knowledge on periodontal and pulpal healing following autotransplantation, with emphasis on biological mechanisms and factors influencing clinical outcomes. Periodontal healing depends largely on preservation of periodontal ligament vitality and stem cells, enabling regeneration and functional integration. Revascularization, increased dentin formation and obliteration of the pulp are favourable for survival of the transplant, although complete histological restoration is rare. In general, immature teeth demonstrate superior regenerative capacity compared to mature teeth, but complications such as root resorption and ankylosis remain challenges in both instances. Radiographic evaluation provides limited insight during early healing stages, highlighting discrepancies with histological findings. In conclusion, successful autotransplantation relies on careful case selection, atraumatic technique, and biological preservation, though further human-based research is needed to clarify healing mechanisms and optimize long-term results.
Despite existing regulations and training opportunities, there is a need to systematically identify the competencies orthodontic assistants should possess to perform their duties and responsibilities in providing patient-centered care under the orthodontist’s supervision. This scoping review maps the literature on competencies for professionals in orthodontic assisting roles.A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR). Five databases (Embase, MEDLINE, Scopus, Web of Science, and ProQuest Dissertations & Theses) were searched up to April 2026 without language or study design restrictions. Two reviewers independently screened studies and extracted data using a pilot-tested form. Descriptive statistics and content analysis were used to summarize findings.Twenty-two articles that aimed to determine, describe, and assess competencies were included. Frequently reported competencies included chairside clinical support, orthodontic appliance maintenance, impression taking, radiographic imaging, oral hygiene instruction, and management of orthodontic emergencies. Training strategies involved lectures, simulation-based learning, and supervised clinical practice, with training ranging from 3 to 35 weeks. Differences in task delegations were observed across jurisdictions: complex procedures were more commonly delegated in North America than in Europe. While most studies reported satisfactory trainee performance, they lacked standardized frameworks and assessment tools.Orthodontic assistant competencies are mostly reported at the task level, with limited attention to the underlying knowledge, attitudes, and standardized assessment methods. Further research is needed to develop comprehensive competency frameworks to support consistent training.
Background: Mandibular advancement appliances (MAAs) are an effective treatment for obstructive sleep apnea (OSA), but concerns remain about their long-term effects on dental movements and masticatory function. Objective: To evaluate dental movement and masticatory efficiency after one year of treatment with a customized 3D-printed MAA in adults with OSA. Methods: In this prospective longitudinal study, 20 adults with OSA (5<AHI<50) and 20 controls were assessed. Customized MAAs were digitally designed, 3D-printed, and titrated to achieve optimal mandibular advancement. Home sleep testing was performed under three conditions: no device, MAA, and CPAP. Dental movements were measured by superimposing maxillary and mandibular digital models, and masticatory efficiency was evaluated using a two-color chewing-gum test analyzed by colorimetry. Statistical analyses included repeated-measures/ Friedman and paired t/ Wilcoxon tests (α = 0.05). Results: The oxygen desaturation index (ODI) decreased from 13.5 events/h (no device) to 6.0 (MAA) and 5.3 (CPAP). Both MAA and CPAP produced significant reductions in ODI and snoring compared with no device, with no significant difference between them. Snoring scores fell from 28.2 (no device) to 5.9 (MAA) and 0.7 (CPAP). Mean dental displacement after 12 months was about 0.2 mm, with no intergroup variation. Masticatory efficiency remained stable in both OSA and control groups, and the chewing-gum test showed moderate reliability (ICC [2,1] = 0.683). Conclusions: Customized 3D-printed MAAs significantly reduced desaturation and snoring versus no device, showing similar efficacy to CPAP without inducing occlusal changes or impairing masticatory efficiency after one year.Statement Of Significance: This study is the first to integrate objective assessment of masticatory efficiency with three-dimensional digital quantification of dental movement in patients undergoing long-term mandibular advancement appliance (MAA) therapy for Obstructive Sleep Apnea (OSA). By combining functional and morphological analyses, it provides a comprehensive understanding of the dental and functional consequences of this treatment. The findings demonstrate that customized, 3D-printed MAAs can achieve clinical efficacy comparable to CPAP in improving oxygen desaturation and snoring, without inducing significant occlusal alterations or impairing masticatory performance over one year. These results highlight the potential of digital workflows to enhance the safety and precision of oral appliance therapy, with implications for patient adherence, long-term oral health, and cost-effective management of OSA within sleep medicine.
Aims The objective was to comprehensively map existing literature on maxillary expansion in the early mixed dentition as an interceptive measure to treat anterior maxillary crowding in the absence of posterior crowding. Methods This scoping review was conducted according to the PRISMA-ScR guidelines and registered at the PROSPERO-register. Medline, Cochrane, Embase, and Web of Science were searched. Randomized, prospective and retrospective controlled trials were included if the maxilla was expanded and a change in arch perimeter was reported. Two reviewers screened and retrieved papers independently for eligibility and charted the data. Results The literature search identified 2176 studies, with 1241 abstracts screened. This process led to 30 studies undergoing full-text review, of which five were included. The included studies comprised one RCT, one prospective cohort study, and three retrospective cohort studies. All patients in these studies exhibited dental crowding and/or narrow dental arches. Various expansion modalities and protocols were employed. The studies reported changes in arch perimeter ranging from 0.9 to 6.15 millimetres. No harm or adverse effects were reported. Conclusions The existing body of evidence is limited by significant methodological heterogeneity. Given the inherent limitations of predominantly retrospective studies, maxillary expansion appears to increase the arch perimeter, thereby alleviating anterior crowding. Patient-reported outcomes were seldom evaluated. Future studies should consider utilizing qualitative research methodologies that incorporate an untreated control group in order to provide valuable insights and promote a more profound understanding of interceptive expansion in cases characterized by maxillary anterior crowding.
Tooth cryopreservation enables long-term storage of extracted teeth by arresting biological activity at ultra-low temperatures and has been proposed to extend the clinical applicability of tooth autotransplantation. In orthodontics, this approach is particularly attractive when immediate transplantation is not feasible or when teeth are preserved for future therapeutic or regenerative purposes. However, teeth represent a complex biological unit composed of multiple soft and hard tissues harvested from a microbiologically contaminated environment, making successful cryopreservation technically challenging. This narrative review synthesizes current experimental, preclinical, and limited clinical evidence on the effects of cryopreservation on dental soft and hard tissues. Attention is given to periodontal ligament viability, pulpal responses and root development, but also on enamel and dentin integrity and the mechanical behaviour of these structures. Available data indicate that periodontal healing after transplantation of cryopreserved teeth is largely preserved when appropriate protocols are used, whereas pulpal outcomes remain variable and strongly dependent on anatomical and procedural factors. Continued root development after cryopreservation is insufficiently supported by current evidence. Importantly, cryopreservation does not appear to compromise the structural integrity, mechanical performance, or orthodontic bonding capacity of enamel and dentin. Despite encouraging experimental findings, clinical evidence remains scarce, and the application of tooth cryopreservation is limited by logistical complexity, regulatory constraints, and high costs. Moreover, the traditional concept of an optimal developmental stage for autotransplantation within a narrow time frame has become less absolute, as successful transplantation of mature teeth with fully developed roots has been increasingly reported. Recent advances in regenerative dentistry and dental pulp stem cell (DPSC) cryopreservation suggest that future clinical relevance may lie less in whole-tooth banking and more in integration with biologically based regenerative strategies.
Tooth size discrepancy (TSD) represents a critical challenge during orthodontic finishing, as occlusal stability depends on precise inter-arch proportional size relationships and adequate interdigitation between maxillary and mandibular teeth. Alterations in these proportions may compromise overjet, overbite, midline coincidence, canine relationships, posterior intercuspation, quality and stability of treatment outcomes. Despite its clinical relevance, the management of TSD remains insufficiently systematized, and treatment decisions are often based on numerical ratios without adequate integration of functional and esthetic considerations. This narrative review synthesizes current concepts and clinical applications of scenarios with anterior and posterior tooth size discrepancies, with particular emphasis on their implications for orthodontic finishing. Classical analyses, including Bolton ratios and their limitations, are discussed. Related treatment decisions are part of a dynamic, continuous occlusal assessment as orthodontic treatment progresses. Orthodontic and restorative strategies are explored through clinical scenarios managed with an interdisciplinary approach. A broad spectrum of situations is analyzed, including mixed dentition, extraction and non-extraction treatments, tooth size asymmetries and orthognathic surgery. Emphasis is placed in ortho-restorative coordination before, during, and after treatment, as well as on the selection of materials and the extent of restorative intervention. Clinical management of TSD should not rely solely on numerical ratios but rather on their clinical expression, functional requirements, and esthetic demands. The integration of orthodontic and restorative strategies is essential to achieve optimal finishing outcomes. This narrative review aims to provide clinically focused framework to support decision-making and improve the predictability of orthodontic finishing in patients with tooth size discrepancies.
Bibliometric analysis can help identify areas within research domains where potentially impactful research has been carried out and can inform future relevant scholarly activity.Analysis of this kind has not yet been conducted in the domain of orthodontic retention and retainers. The aim of this investigation was to undertake a bibliometric analysis of the 100 most-cited articles on orthodontic retention and retainers. The study was carried out in accordance with the bibliometric reviews of the biomedical literature (BIBLIO) preliminary guidelines. A search of the Web of Science Core Collection (Clarivate Analytics, Philadelphia, Pa) [WoS] database, via a customised keyword-based search string using Boolean logic developed in collaboration with a university librarian was undertaken. Two reviewers independently screened articles for inclusion and recorded relevant data from the WoS and Journal Citation Reports (Clarivate Analytics) databases. Additional analysis was via VOSviewer (Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands). The 100 included articles published in 21 journals or other sources and recorded a total of 9613 citations. The 2016 iteration of the relevant Cochrane review was the most cited article with 220 citations. The 100 articles were authored by 329 individuals, and more than half of the included articles were published in the American Journal of Orthodontics and Dentofacial Orthopedics (43%) and the European Journal of Orthodontics (16%). The United States (23%) was the country to which first named authors were most affiliated. Almost one in six (n=1449; 15.1%) of the total citations were associated with RCT articles, with 9.1% (n=872) of the citations related to systematic review articles and 875 (9.1%) citations allied with narrative review articles. The bonded retainer was the retainer type upon which most focus was applied in the 100 most cited articles. The relatively small number of connected authors suggested that there is room for increased collaboration between centres concerning orthodontic retention research.
Mandibular canine transmigration represents a severe form of eruption disturbance that may preclude conventional orthodontic repositioning. In selected cases, autotransplantation may provide a tooth-preserving alternative, particularly when conventional orthodontic repositioning is unlikely to be successful. This article describes the interdisciplinary management of a female aged 12 years and 6 months who presented with bilateral mandibular canine eruption disturbances. The right mandibular canine showed mesial ectopic eruption and was managed by orthodontic repositioning, whereas the left mandibular canine had transmigrated across the mandibular midline and was treated by autotransplantation as a nearly mature tooth with limited residual apical opening. A nonextraction treatment approach was selected. Preoperative forced eruption of the donor canine, cone-beam computed tomography-based three-dimensional analysis, and a three-dimensional printed donor tooth replica were used to facilitate atraumatic extraction and recipient site preparation. Planned postoperative endodontic treatment was incorporated into the treatment protocol, and orthodontic tooth movement of the transplanted tooth was initiated 5 months after transplantation. At the completion of active treatment, both mandibular canines were aligned within the dental arch, and mandibular arch continuity was restored without extraction of the permanent teeth. The transplanted canine remained stable, showed no evidence of root resorption, and responded to subsequent orthodontic force. This case demonstrates that autotransplantation of a nearly mature mandibular canine may be compatible with orthodontic tooth movement and may serve as a useful interdisciplinary option in selected patients with severe canine displacement.
This case report describes the autotransplantation of two mandibular premolars in a young boy following the traumatic loss of all maxillary incisors. Successful treatment outcome required careful interdisciplinary planning and close collaboration among the oral surgeon/periodontist, orthodontist, and restorative dentist. Autotransplantation of premolars provided a functional and esthetic solution during growth and development, while preserving the alveolar process and supporting continued dentoalveolar development. In addition to achieving favorable clinical outcomes, management of the psychosocial consequences of trauma was an important aspect of treatment. This case report highlights the value of autotransplantation of premolars as a predictable treatment option for growing patients with traumatic loss of maxillary incisors.
Immersive technologies, including virtual reality (VR), augmented reality (AR), mixed reality (MR), and extended reality (XR) are increasingly being integrated into orthodontic education, yet the breadth, quality, and educational impact of the available evidence remain unclear. The aim of this scoping review was to comprehensively map the existing literature on immersive technologies in orthodontic education, characterize their educational applications and learner-related outcomes, and evaluate educational effectiveness using the Kirkpatrick framework. A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted through March 2026 in accordance with Joanna Briggs Institute guidance and PRISMA-ScR reporting. Twelve studies published between 2019 and 2025 met the eligibility criteria, encompassing VR (n = 7), MR (n = 3), AR (n = 2), and one haptic-enhanced VR platform. Educational applications included bracket placement and bonding, wire bending, miniscrew insertion, orthognathic surgical planning, CBCT interpretation, and visualization of impacted teeth. Across studies, learner perceptions (Kirkpatrick Level 1) were consistently favorable, with high ratings for engagement, three-dimensional visualization, and perceived educational value. Learning outcomes (Level 2) were broadly comparable to conventional instruction for knowledge-based tasks, while some studies reported improvements in procedural and psychomotor outcomes, particularly for AR-guided wire bending, bracket placement, and haptic-enhanced VR bracket bonding. No study evaluated behavioral (Level 3) outcomes. The current evidence positions immersive technologies as promising adjuncts rather than replacements for traditional orthodontic instruction. Multicenter, longitudinal studies with standardized outcome measures and assessment of behavioral and clinical endpoints are needed to support their evidence-based curriculum integration.
The aim of this narrative review is to provide an evidence-based overview of fixed and removable orthodontic retainers, with particular emphasis on their effects on stability, oral health, patient satisfaction, and cost considerations to support clinical decision-making. Current evidence indicates that, in the maxillary arch, fixed and removable retainers are similarly effective in maintaining post-treatment alignment. In contrast, the mandibular anterior segment demonstrates a greater susceptibility to relapse, with fixed retainers providing superior long-term stability due to their independence from patient adherence. Fixed retainers are associated with increased plaque accumulation and gingival inflammation compared with removable appliances. However, consistent evidence of clinically significant periodontal destruction is lacking. Removable retainers are generally more favourable for oral hygiene but rely heavily on patient compliance, which tends to decline over time and may compromise treatment outcomes. Patient satisfaction is often higher with fixed retainers due to their convenience, minimal impact on speech, and reduced reliance on adherence. Evidence regarding cost-effectiveness remains limited, although available data suggest that economic outcomes are influenced by relapse risk and maintenance requirements. Overall, no single retention modality is universally superior. Fixed retainers appear advantageous in the mandible, whereas both fixed and removable approaches may be appropriate in the maxilla. Retainer selection should be individualized based on patient-specific factors, oral hygiene, and expected compliance.
This article provides a critical review of the currently available literature dealing with torque side effects of fixed retainers, followed by an evidence-based synopsis of the clinically relevant information. Despite intact fixed retainers, changes in crown or root torque of single or multiple teeth within the retained segment have been reported. Although the number of affected patients seems to be small, this kind of side effects may lead to extensive dental and periodontal problems. In moderate to severe cases, orthodontic retreatment is required, often accompanied by the need for periodontal surgery. This narrative review was based on a targeted literature search. Relevant publications were identified through PubMed using broad topic-specific search terms. Following deduplication, records were screened for relevance, and additional studies were identified through manual screening of reference lists of eligible articles. The final selection of publications was guided by their relevance to the scope and objectives of the review and by the authors' expertise in the field. After addressing terminology and definitions, the available literature is categorized according to its level of evidence, with key sources of bias highlighted where relevant. Subsequently, a clinical synthesis of the pertinent findings is provided, encompassing the prevalence of torque-related side effects, the wire types involved, and their clinical presentation in terms of onset and characteristic movement patterns. Current etiological hypotheses are reviewed, and particular emphasis is placed on early diagnosis and clinical management. Finally, potential protective factors and directions for future research are discussed.
