Fracchia David Emilio, Bignotti Denis, Lai Stefano, Battista Eric, Verdecchia Alessio, Spinas Enrico
Department of Surgical Sciences, Postgraduate School in Orthodontics, University of Cagliari, 09124 Cagliari, Italy.
Private Practice, London SE5 9PU, UK.
J Clin Med. 2025 Sep 8;14(17):6339. doi: 10.3390/jcm14176339.
This systematic review aimed to evaluate the effectiveness and predictability of lower incisor intrusion with clear aligners in permanent dentition, addressing one of the most challenging aspects of vertical tooth movement control in the mandibular anterior region. A comprehensive literature search was conducted across five databases (PubMed, Scopus, Embase, and Cochrane) according to PRISMA guidelines. Eight clinical studies fulfilled the eligibility criteria. Risk of bias was assessed using ROBINS-I, and certainty of evidence was graded with GRADE. Key outcomes included the amount of achieved versus planned intrusion, predictability, treatment protocols, use of auxiliaries, and patient-related factors such as age and compliance. Reported mean intrusion values ranged from 0.4 to 1.5 mm, with predictability between 35% and 65%. The effectiveness of intrusion was influenced by the magnitude of planned movement, auxiliaries (e.g., attachments, elastics), refinement strategies, and patient-specific factors. Substantial heterogeneity was present in measurement methods (CBCT, cephalometry, digital models) and clinical protocols (aligner change intervals, refinement frequency), preventing meta-analysis. Seven of the eight studies were rated as having a serious risk of bias, and the overall certainty of evidence was moderate to low. Long-term outcomes and patient-centered measures were not adequately assessed. Within the limitations of the available evidence, lower incisor intrusion with clear aligners may be considered a feasible orthodontic option when supported by biomechanically informed clinical management. However, conclusions should be interpreted with caution due to heterogeneity, high risk of bias, and lack of long-term data. Further standardized studies with longer follow-up are required to strengthen reliability and clinical applicability.
本系统评价旨在评估恒牙列中使用透明矫治器压低下颌切牙的有效性和可预测性，该问题是下颌前部垂直向牙齿移动控制中最具挑战性的方面之一。根据PRISMA指南，在五个数据库（PubMed、Scopus、Embase和Cochrane）中进行了全面的文献检索。八项临床研究符合纳入标准。使用ROBINS-I评估偏倚风险，并采用GRADE对证据的确定性进行分级。主要结局包括实际压低量与计划压低量、可预测性、治疗方案、辅助装置的使用以及年龄和依从性等患者相关因素。报告的平均压低值范围为0.4至1.5毫米，可预测性在35%至65%之间。压低的有效性受计划移动量、辅助装置（如附件、弹力牵引）、精细调整策略和患者个体因素的影响。测量方法（CBCT、头影测量、数字模型）和临床方案（矫治器更换间隔、精细调整频率）存在显著异质性，无法进行荟萃分析。八项研究中有七项被评为存在严重偏倚风险，证据的总体确定性为中到低。长期结局和以患者为中心的指标未得到充分评估。在现有证据的局限性内，在生物力学指导的临床管理支持下，使用透明矫治器压低下颌切牙可被视为一种可行的正畸治疗选择。然而，由于存在异质性、高偏倚风险和缺乏长期数据，结论应谨慎解读。需要进一步进行标准化研究并延长随访时间，以提高可靠性和临床适用性。
