Muthuswamy Pandian Srirengalakshmi, Subramanian Aravind Kumar, Vaiid Nikhillesh
Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, India.
J Oral Biol Craniofac Res. 2025 Sep-Oct;15(5):1123-1133. doi: 10.1016/j.jobcr.2025.07.019. Epub 2025 Jul 29.
This systematic review and meta-analysis aimed to compare the efficacy and accuracy of optimized versus conventional attachments in clear aligner treatment using Invisalign.
Adhering to the 'Preferred Reporting Items for Systematic Review and Meta-analysis' (PRISMA) 2020 guidelines, the review obtained 6 retrospective cohort studies and one randomized controlled trial, sourced from databases such as PubMed, SCOPUS, Web of Science, Cochrane Library, Google Scholar, and clinical trial registries. Four studies were included for meta-analysis. Data was pooled for mean percentage accuracy of various tooth movements and corresponding Forest plots were generated.
Most of the studies included showed a good methodological quality with a low risk of bias. No significant differences in the accuracy of tooth movement between conventional attachments and optimized attachments were noted for canine derotation, anterior extrusion, and root angulation changes in canine, premolar, and molar (p > 0.05). The studies however exhibited high heterogeneity (I = 75 %). The pooled accuracy for canine derotation was 61.2 % and 71.5 % for conventional and optimized rotations respectively. Similarly, 57.5 % and 62.4 % were the pooled accuracy for conventional and optimized attachments in anterior extrusion. None of the attachments produced the expected tooth movement as predicted by the ClinCheck program.
There was a non-significant difference in accuracy between optimized and conventional attachments for most orthodontic movements. While optimized attachments may offer improved control for specific movements like upper lateral incisor rotation, and conventional attachments potentially enhance anterior extrusion, their overall superiority remains inconclusive. Further high-quality research is needed to validate the hypothesized biomechanical advantages of optimized attachments.
本系统评价和荟萃分析旨在比较使用隐适美进行隐形矫治时，优化附件与传统附件在疗效和准确性方面的差异。
本评价遵循2020年“系统评价和荟萃分析的首选报告项目”（PRISMA）指南，从PubMed、SCOPUS、科学网、考克兰图书馆、谷歌学术等数据库以及临床试验注册库中获取了6项回顾性队列研究和1项随机对照试验。纳入4项研究进行荟萃分析。汇总各类牙齿移动的平均百分比准确性数据，并生成相应的森林图。
纳入的大多数研究显示出良好的方法学质量，偏倚风险较低。在尖牙扭转、前牙前突以及尖牙、前磨牙和磨牙的牙根角度变化方面，传统附件与优化附件在牙齿移动准确性上无显著差异（p>0.05）。然而，这些研究显示出高度的异质性（I=75%）。传统旋转和优化旋转时尖牙扭转的汇总准确性分别为61.2%和71.5%。同样，前牙前突时传统附件和优化附件的汇总准确性分别为57.5%和62.4%。没有一种附件能产生ClinCheck程序预测的预期牙齿移动。
对于大多数正畸移动，优化附件和传统附件在准确性上无显著差异。虽然优化附件可能在控制特定移动（如上颌侧切牙旋转）方面表现更好，而传统附件可能增强前牙前突，但它们的总体优越性仍无定论。需要进一步的高质量研究来验证优化附件假设的生物力学优势。
