{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T11:05:41Z","timestamp":1780311941523,"version":"3.54.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,4,3]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n Sustainability is a prominent topic in modern-day society, with a trend toward reducing environmental impact. The growing amount of plastics and the release of greenhouse gases during waste management raise concerns. This study compares the environmental burden of clear aligners- and self-ligating metal brackets (fixed appliances) to identify the production phase where improvements could best reduce impact.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A simplified fast-track life cycle impact assessment (LCIA) was performed for four illustrative patient cases (two aligner, two fixed appliances). Data were derived from the Industrial Design & Engineering Materials open access database (Idemat, 2024) and manufacturer specifications. Environmental indicators were carbon footprint (kg CO2-eq), cumulative energy demand [megajoules (MJ)], and total ReCiPe score [Points (Pt)].<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Clear aligners show a higher environmental impact in all categories. Mean carbon footprint for clear aligners ranged from 20.58 to 24.75\u2005kg CO2 and 0.22\u2005kg CO2 in fixed appliance treatment. The Total ReCiPe ranges 0.54\u20130.66 Pt) for clear aligners compared with 0.01 Pt in treatment with self-ligating metal brackets. These results should be interpreted cautiously, as they may overestimate true magnitudes.<\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n This study used a simplified LCIA, incorporating assumptions substantiated by research whenever possible.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Within the limitations of a small sample size and a simplified model, fixed appliance treatment showed a lower environmental impact than clear aligners. The results are exploratory and require validation through larger, clinically based studies incorporating sensitivity analyses and multi-source datasets. The \u201cmaterials\u201d phase seems a key contributor, stimulating environmentally conscious decision making.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/ejo\/cjag025","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T11:32:59Z","timestamp":1774870379000},"source":"Crossref","is-referenced-by-count":0,"title":["Environmental impact of orthodontic treatment: a simplified fast-track comparative life-cycle impact assessment of self-ligating metal brackets and clear aligners"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0384-2224","authenticated-orcid":false,"given":"Maria Johanna Jacoba","family":"Heezen","sequence":"first","affiliation":[{"name":"Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center , Philips van Leydenlaan 25, Nijmegen 6525 EX ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geer M","family":"van den Dungen","sequence":"additional","affiliation":[{"name":"Orthodontie Amersfoort , Charlotte de Bourbonlaan 2, Amersfoort 3818 DJ ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6462-9789","authenticated-orcid":false,"given":"Mette A R","family":"Kuijpers","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center , Philips van Leydenlaan 25, Nijmegen 6525 EX ,","place":["The Netherlands"]},{"name":"Amalia Cleft and Craniofacial Centre, Radboud University Medical Centre , Philips van Leydenlaan 25, Nijmegen 6525 EX ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9250-027X","authenticated-orcid":false,"given":"Edwin M","family":"Ongkosuwito","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Craniofacial Biology, Radboud University 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