Abstract

Treatment with Aligners: what can we really expect? A summary of the Consensus paper

by D'Antò Vincenzo

This international study, published in Progress in Orthodontics (2025), used a modified Delphi method to reach consensus among experts on the indications and limitations of clear aligner therapy (CAT). A scientific steering committee selected relevant literature and formulated 25 statements, which were evaluated by 23 internationally recognized orthodontists over three rounds of anonymous voting. Six main areas were investigated: treatment efficacy, quality of life, side effects, management of growing patients, treatment with extractions, and management of periodontal patients. After three rounds, 22 statements reached consensus while 3 were rejected. The experts agreed that aligners are effective in Class I non-extraction cases with mild to moderate crowding and in open bite cases, though they primarily produce crown tipping movements and show biomechanical limitations for complex rotations and root control. It was recognized that expansion with aligners occurs mainly through dental tipping, whereas a rapid palatal expander provides more predictable skeletal outcomes in growing patients. In extraction cases with severe crowding, aligners were considered less effective than fixed appliances in achieving proper occlusal contacts, torque control, and complex tooth movements. From the patient’s perspective, the panel highlighted the benefits of CAT in terms of reduced pain, improved quality of life during treatment, and better maintenance of oral hygiene, with lower incidence of carious lesions and root resorption compared to fixed appliances. For periodontal patients, aligners were deemed suitable in cases of minor tooth migration that can be managed with tipping or relative extrusion, while no consensus was reached on their use in situations requiring complex bodily movements. In conclusion, the study clarified many clinical indications of clear aligners but also identified significant gaps in the literature: treatment duration, skeletal effects in growing patients, and management of periodontally compromised individuals remain areas of uncertainty that require further high-quality research.

Learning Objectives

After this lecture, you will be able to understand the clinical indications and limitations of clear aligner therapy (CAT):
After this lecture, you will be able to evaluate patient-centered outcomes and side effects of CAT
After this lecture, you will be able to recognize evidence gaps and future research needs in CAT