Kesling HD. Coordinating the predetermined pattern and tooth positioner with conventional treatment. Am J Orthod Oral Surg. 1946; 32:285-293
Hennessy J, Al-Awadhi EA. Clear aligners generations and orthodontic tooth movement. J Orthod. 2016; 43:68-76
Chhibber A, Agarwal S, Yadav S Which orthodontic appliance is best for oral hygiene? A randomized clinical trial. Am J Orthod Dentofacial Orthop. 2018; 153:175-183
Zhao R, Huang R, Long H The dynamics of the oral microbiome and oral health among patients receiving clear aligner orthodontic treatment. Oral Dis. 2020; 26:473-483
Rossini G, Parrini S, Castroflorio T Periodontal health during clear aligners treatment: a systematic review. Eur J Orthod. 2015; 37:539-543
Jiang Q, Li J, Mei L Periodontal health during orthodontic treatment with clear aligners and fixed appliances: a meta-analysis. J Am Dent Assoc. 2018; 149:712-720.e12
Levrini L, Mangano A, Montanari P Periodontal health status in patients treated with the Invisalign(®) system and fixed orthodontic appliances: a 3 months clinical and microbiological evaluation. Eur J Dent. 2015; 9:404-410
Pango Madariaga AC, Bucci R, Rongo R Impact of fixed orthodontic appliance and clear aligners on the periodontal health: a prospective clinical study. Dent J. 2020;
Bishara SE, Ostby AW. White spot lesions: formation, prevention, and treatment. Semin Orthod. 2008; 14:174-182
Buschang PH, Chastain D, Keylor CL Incidence of white spot lesions among patients treated with clear aligners and traditional braces. Angle Orthod. 2019; 89:359-364
Chapman JA, Roberts WE, Eckert GJ Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. 2010; 138:188-194
Moshiri M, Eckhart JE, McShane P, German DS. Consequences of poor oral hygiene during aligner therapy. J Clin Orthod. 2013; 47:494-498
Julien KC, Buschang PH, Campbell PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013; 83:641-647
Albhaisi Z, Al-Khateeb SN, Abu Alhaija ES. Enamel demineralization during clear aligner orthodontic treatment compared with fixed appliance therapy, evaluated with quantitative light-induced fluorescence: a randomized clinical trial. Am J Orthod Dentofacial Orthop. 2020; 157:594-601
d'Apuzzo F, Perillo L, Carrico CK Clear aligner treatment: different perspectives between orthodontists and general dentists. Prog Orthod. 2019; 20
Haouili N, Kravitz ND, Vaid NR Has Invisalign improved? A prospective follow-up study on the efficacy of tooth movement with Invisalign. Am J Orthod Dentofacial Orthop. 2020; 158:420-425
Kravitz ND, Kusnoto B, BeGole E How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign. Am J Orthod Dentofacial Orthop. 2009; 135:27-35
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Aligner orthodontics: a literature review

From Volume 16, Issue 1, January 2023 | Pages 33-38


Nikhil Gogna

BDS (Hons), MFDS RCS (Glasg), DClinDent, MOrth (Eng), FDS (Eng)

Locum Consultant Orthodontist, Bristol Dental Hospital, University Hospitals Bristol and Weston NHS Foundation Trust

Articles by Nikhil Gogna

Email Nikhil Gogna

Murray Irving

BDS, MFDS RCS (Eng), Dental Core Trainee (Restorative Dentistry)

Restorative DCT, Cardiff

Articles by Murray Irving

Email Murray Irving

Kieran Nandhra


Dental Core Trainee (Oral and Maxillofacial Surgery), Luton and Dunstable University Hospital, Bedfordshire NHS Trust

Articles by Kieran Nandhra


Many studies have been undertaken to understand the limitations and benefits of aligners, including systematic reviews with meta-analyses. However, there are very few comprehensive reviews of the current evidence. This literature review provides an up-to-date summary of various aspects of clear aligner therapy, including patient compliance, clinical effectiveness, social interactions and iatrogenic effects.

CPD/Clinical Relevance: Clear aligners are a popular choice and the article provides an up-to-date summary of various aspects of clear aligner therapy.


Clear aligners are an aesthetic alternative to fixed appliances and have come a long way since their conception as a ‘tooth positioner,’ in the 1940s. In 1946, Kesling stated that a series of these positioners could be used to achieve more ambitious tooth movements when used as an adjunct to conventional treatment.1 Many aligner systems were created, but often their scope was limited and required clinicians to take multiple impressions throughout the course of treatment. In 1999, Align technology introduced Invisalign, which used computer aided manufacturing and design principles to mitigate the need for multiple impressions.2 This encouraged more clinicians to engage with this mode of orthodontics, thus resulting in its increase in popularity. Currently, Invisalign and other major clear aligner systems can use specific force delivery via composite precision attachments, generating force vectors to permit a range of specific tooth movements. Once thought to be limited to tipping only, aligners have developed into a system that can attempt most movements achieved with fixed appliances.

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