Vicioni-Marques Fernanda, Reis Caio Luiz Bitencourt, de Almeida Ana Paula Valladares, de Melo Letícia Pinho Maia Paixão, Romano Fábio Lourenço, Matsumoto Mirian Aiko Nakane, Stuani Maria Bernadete Sasso
School of Dentistry of Ribeirão Preto, Department of Pediatric Dentistry, University of São Paulo, Avenida do café, s/n, São Paulo, 14040-904, Ribeirão Preto, Brazil.
Department of Pediatric and Social Dentistry, School of Dentistry of Araçatuba, São Paulo State University "Júlio de Mesquita Filho", Rua José Bonifácio, 1193, SP, 16015-050, Araçatuba, Brazil.
Clin Oral Investig. 2025 Sep 2;29(9):435. doi: 10.1007/s00784-025-06475-2.
The efficacy of clear aligner treatment (CAT) in space closure following premolar extraction (SCaPE) and its resistance to unwanted tooth movement remain uncertain. This systematic review aims to evaluate the efficacy, predictability, and resistance to unwanted tooth movement by CAT for SCaPE.
Pre-post studies, randomized, and non-randomized clinical trials were included. A comprehensive search was conducted in PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases up to November 12, 2024. Study quality was assessed using ROB-2 and ROBINS-I tools. Three independent reviewers performed data extraction. A meta-analysis compared predicted versus achieved maxillary tooth movements in similar studies using the Invisalign system. Standardized Paired Difference (SPD) with 95% Prediction Interval (95% PI) and Confidence Interval (95% CI) were used for effect size estimation. The GRADE tool evaluated the certainty of evidence.
Fourteen studies encompassing 510 participants were included. Four studies had a low risk of bias, while ten had a high risk of bias. The results from pre-post studies indicated that CAT was significantly less effective than predicted in achieving Anterior Teeth Retraction (SPD= -0.87; 95% CI = -1.15 to -0.60; 95% PI= -1.14 to -0.59; p < 0.001; number of studies = 4), resulting in more lingual tipping (SPD = 1.09; 95% CI = 0.46 to 1.73; 95% PI= -1.01 to 3.19; p = 0.001; number of studies = 3) and extrusion of anterior teeth (SPD = 0.88, 95% CI = 0.47 to 1.29; 95% PI= -0.16 to 1.92; p < 0.001; number of studies = 4) than predicted. The achieved distal tipping of canine (SPD = 1.42; 95% CI = 0.35 to 2.51; 95% PI= -2.5 to 5.40; p = 0.009; number of studies = 3) and mesial tipping of first molars (SPD = 1.68; 95% CI = 1.17 to 2.20; 95% PI = 0.34 to 3.01; p < 0.001; number of studies = 3;) were also greater than predicted. Clinical trials comparing CAT and fixed appliances provide limited evidence.
The findings suggest that CAT may not be effective or predictable for SCaPE due to its limited capacity to promote the bodily movement of the teeth and control anchorage. Evidence indicates that fixed appliances might be superior to CAT. Limitations of the evidence include bias across studies, with the certainty of evidence ranging from low to very low. Future research should focus on improving prediction models and exploring the potential benefits of accessories to enhance CAT's effectiveness.
Not registered.
在拔除前磨牙后的间隙关闭（SCaPE）中，透明矫治器治疗（CAT）的疗效及其对不必要牙齿移动的抵抗性仍不确定。本系统评价旨在评估CAT用于SCaPE的疗效、可预测性以及对不必要牙齿移动的抵抗性。
纳入前后对照研究、随机和非随机临床试验。截至2024年11月12日，在PubMed、Scopus、Embase、Web of Science和Cochrane图书馆数据库中进行了全面检索。使用ROB-2和ROBINS-I工具评估研究质量。由三名独立 reviewers 进行数据提取。一项荟萃分析比较了使用隐适美系统的类似研究中预测的与实际实现的上颌牙齿移动情况。采用标准化配对差异（SPD）及95%预测区间（95%PI）和置信区间（95%CI）进行效应量估计。使用GRADE工具评估证据的确定性。
纳入了14项研究，共510名参与者。4项研究的偏倚风险较低，而10项研究的偏倚风险较高。前后对照研究的结果表明，在实现前牙后移方面，CAT的效果明显低于预期（SPD = -0.87；95%CI = -1.15至-0.60；95%PI = -1.14至-0.59；p < 0.001；研究数量 = 4），导致更多的舌倾（SPD = 1.09；95%CI = 0.46至1.73；95%PI = -1.01至3.19；p = 0.001；研究数量 = 3）和前牙的伸长（SPD = 0.88，95%CI = 0.47至1.29；95%PI = -0.16至1.92；p < 0.001；研究数量 = 4），均高于预期。实际实现的尖牙远中倾斜（SPD = 1.42；95%CI = 0.35至2.51；95%PI = -2.5至5.40；p = 0.009；研究数量 = 3）和第一磨牙近中倾斜（SPD = 1.68；95%CI = 1.17至2.20；95%PI = 0.34至3.01；p < 0.001；研究数量 = 3）也高于预期。比较CAT和固定矫治器的临床试验提供的证据有限。
研究结果表明，由于CAT促进牙齿整体移动和控制支抗的能力有限，其在SCaPE中可能无效或不可预测。有证据表明固定矫治器可能优于CAT。证据的局限性包括各研究存在偏倚，证据的确定性从低到极低。未来的研究应侧重于改进预测模型，并探索附件的潜在益处以提高CAT的有效性。
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