Husain Fatemah, Riccardi Joseph, Alletto Lia, Stellrecht Elizabeth, Bejehmir Arash Poursattar, Al-Jewair Thikriat
Department of Developmental and Preventive Sciences, College of Dentistry, Kuwait University, P.O. Box 24923, Safat, 13110, Kuwait.
Department of Orthodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY, USA.
Clin Oral Investig. 2025 May 21;29(6):306. doi: 10.1007/s00784-025-06381-7.
This systematic review evaluated the effectiveness and accuracy of clear aligners (CA) for dental and skeletal deep bite correction.
Searches in PubMed, Embase, Cochrane, and grey literature were conducted from inception to May 2024. Studies included all age groups with dental and/or skeletal deep bite treated with CA, with or without control groups, using prospective or retrospective designs. Risk of bias was assessed through Risk Of Bias In Non-randomised Studies-of Interventions ("ROBIN-I").
Out of 829 studies screened, 18 were included. Eight studies assessed CA's effectiveness, eight evaluated CA accuracy, and two examined both. The effectiveness in bite opening ranged from 0.4 mm to 3.8 mm, while the accuracy in deep bite correction varied between 33% and 48.88% across all studies. According to GRADE, the evidence for both CA accuracy and effectiveness in deep bite treatment was rated as low quality due to high risk of bias, indirectness, and imprecision, despite consistent findings across studies.
CA can effectively correct mild to moderate dentoalveolar deep bites; however, its efficacy in skeletal cases compared to full-fixed appliance (FFA) remains uncertain. Planned correction of deep bites with CA often falls short of the actual achieved correction, making overcorrection or refinements necessary for achieving the desired treatment outcomes. Due to the limited quality and methodological variability among the studies, recommending CA as a superior modality for deep bite correction remains premature.
CA may be effective for dentoalveolar deep bites but often needs adjustments for accuracy and is less effective than FFA for skeletal cases.
The review protocol was registered in PROSPERO (#CRD42022334078).
本系统评价评估了透明矫治器（CA）矫正牙性和骨性深覆合的有效性和准确性。
从创刊至2024年5月，在PubMed、Embase、Cochrane及灰色文献中进行检索。纳入所有年龄组采用CA治疗牙性和/或骨性深覆合的研究，有无对照组均可，采用前瞻性或回顾性设计。通过非随机干预性研究的偏倚风险（“ROBIN-I”）评估偏倚风险。
在筛选的829项研究中，纳入了18项。8项研究评估了CA的有效性，8项评估了CA的准确性，2项同时考察了两者。所有研究中，咬打开的有效性范围为0.4毫米至3.8毫米，而深覆合矫正的准确性在33%至48.88%之间。根据GRADE，尽管各研究结果一致，但由于偏倚风险高、间接性和不精确性，CA矫正深覆合的准确性和有效性证据均被评为低质量。
CA可有效矫正轻至中度牙牙槽骨深覆合；然而，与全固定矫治器（FFA）相比，其在骨性病例中的疗效仍不确定。用CA计划矫正深覆合往往达不到实际实现的矫正效果，因此需要过度矫正或细化以实现理想的治疗效果。由于研究质量有限且方法存在差异，推荐CA作为深覆合矫正的优越方式仍为时过早。
CA可能对牙牙槽骨深覆合有效，但通常需要调整以提高准确性，且在骨性病例中比FFA效果差。
该综述方案已在PROSPERO注册（#CRD42022334078）。
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