D'Antò Vincenzo, Oliva Giorgio, Nieri Michele, Clauser Tommaso, Statie Maria Denisa, Nucci Ludovica, Caruso Silvia, Castroflorio Tommaso, Chang Stephen, Graf Simon, Grassia Vincenzo, Haubrich Julia, Henrikson Thor, Huanca Ghislanzoni Luis, Kaku John Kosei, Kristensen Kasper Dahl, Lione Roberta, Lozano Javier, Ludwig Björn, Mah James, Meade Maurice, Monteiro Pedro Costa, Retrouvey Jean-Marc, Sabouni Waddah, Schwarze Jörg, Souki Bernardo, Uribe Flavio, Vaiid Nikhillesh, Weir Tony, Franchi Lorenzo
University of Naples Federico II, Naples, Italy.
University of Florence, Florence, Italy.
Prog Orthod. 2025 Aug 4;26(1):28. doi: 10.1186/s40510-025-00575-1.
The aims of this study were to gather expert agreement about essential aspects of clear aligner therapy (CAT) and to determine what research areas need further investigation.
A steering committee performed literature selection and compiled a list of 25 statements. This study used a modified Delphi method involving a panel of 23 international orthodontic experts. Six essential areas of CAT were investigated: treatment efficacy, quality of life, side effects, management of growing patients, treatment with extraction, and treatment of periodontal patients. A panel of experts assessed 25 statements using a 5-point Likert scale throughout 3 rounds of the study. A steering committee adjusted statements that failed to achieve consensus through either revision, splitting, merging, or complete removal.
After the third round, 22 statements achieved consensus while 3 statements were rejected. The panel agreed that aligners could be used effectively in some types of malocclusions, such as those with mild or moderate crowding or open bite cases. The experts reached a consensus on the biomechanical limits of clear aligners. However, they agreed on the benefits in terms of improved quality of life during treatment and easier maintenance of oral hygiene maneuvers. Regarding specific patient categories, the panelists supported the use of aligners in periodontal patients with tooth migration requiring tipping movements. They also agreed on the advantages of using a rapid palatal expander over aligners in growing patients.
The panel members reached agreement on most topics. However, they acknowledged limitations in the current literature regarding root resorption and orthodontic relapse with CAT compared to fixed appliances. The absence of agreement on treatment duration, effects on skeletal growth, and the management of periodontally compromised patients highlights significant evidence gaps that warrant further research.
本研究的目的是就透明矫治器治疗（CAT）的关键方面达成专家共识，并确定哪些研究领域需要进一步调查。
一个指导委员会进行文献筛选，并编制了一份包含25条陈述的清单。本研究采用了一种改良的德尔菲法，涉及一个由23名国际正畸专家组成的小组。对CAT的六个关键领域进行了调查：治疗效果、生活质量、副作用、生长发育期患者的管理、拔牙治疗以及牙周病患者的治疗。在研究的三轮过程中，专家小组使用5点李克特量表对25条陈述进行了评估。指导委员会对未能达成共识的陈述进行调整，方法包括修订、拆分、合并或完全删除。
在第三轮之后，22条陈述达成了共识，3条陈述被否决。专家小组一致认为，矫治器可有效地用于某些类型的错牙合畸形，如轻度或中度拥挤或开牙合病例。专家们就透明矫治器的生物力学极限达成了共识。然而，他们一致认为，在治疗期间改善生活质量以及更易于保持口腔卫生方面有好处。关于特定患者类别，小组成员支持在需要倾斜移动的牙齿移位的牙周病患者中使用矫治器。他们还一致认为，在生长发育期患者中，使用快速腭扩展器比使用矫治器更具优势。
小组成员在大多数主题上达成了一致。然而，他们承认，与固定矫治器相比，目前关于CAT导致牙根吸收和正畸复发的文献存在局限性。在治疗持续时间、对骨骼生长的影响以及牙周受损患者的管理方面未达成一致，这突出了需要进一步研究的重大证据空白。
