{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:28:14Z","timestamp":1792787294592,"version":"4.5.0"},"reference-count":74,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2019,11,23]],"date-time":"2019-11-23T00:00:00Z","timestamp":1574467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,23]]},"abstract":"Summary<\/jats:title>Background<\/jats:title>The use of orthodontic aligners to treat a variety of malocclusions has seen considerable increase in the last years, yet evidence about their efficacy and adverse effects relative to conventional fixed orthodontic appliances remains unclear.<\/jats:p><\/jats:sec>Objective<\/jats:title>This systematic review assesses the efficacy of aligners and fixed appliances for comprehensive orthodontic treatment.<\/jats:p><\/jats:sec>Search methods<\/jats:title>Eight databases were searched without limitations in April 2019.<\/jats:p><\/jats:sec>Selection criteria<\/jats:title>Randomized or matched non-randomized studies.<\/jats:p><\/jats:sec>Data collection and analysis<\/jats:title>Study selection, data extraction, and risk of bias assessment was done independently in triplicate. Random-effects meta-analyses of mean differences (MDs) or relative risks (RRs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity analyses, and the GRADE analysis of the evidence quality.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 11 studies (4 randomized\/7 non-randomized) were included comparing aligners with braces (887 patients; mean age 28.0 years; 33% male). Moderate quality evidence indicated that treatment with orthodontic aligners is associated with worse occlusal outcome with the American Board of Orthodontics Objective Grading System (3 studies; MD = 9.9; 95% CI = 3.6\u201316.2) and more patients with unacceptable results (3 studies; RR = 1.6; 95% CI = 1.2\u20132.0). No significant differences were seen for treatment duration. The main limitations of existing evidence pertained to risk of bias, inconsistency, and imprecision of included studies.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Orthodontic treatment with aligners is associated with worse treatment outcome compared to fixed appliances in adult patients. Current evidence does not support the clinical use of aligners as a treatment modality that is equally effective to the gold standard of braces.<\/jats:p><\/jats:sec>Registration<\/jats:title>PROSPERO (CRD42019131589).<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejo\/cjz094","type":"journal-article","created":{"date-parts":[[2019,10,30]],"date-time":"2019-10-30T12:11:22Z","timestamp":1572437482000},"page":"331-343","source":"Crossref","is-referenced-by-count":193,"title":["Treatment outcome with orthodontic aligners and fixed appliances: a systematic review with meta-analyses"],"prefix":"10.1093","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1968-3326","authenticated-orcid":false,"given":"Spyridon N","family":"Papageorgiou","sequence":"first","affiliation":[{"name":"Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Despina","family":"Koletsi","sequence":"first","affiliation":[{"name":"Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Iliadi","sequence":"first","affiliation":[{"name":"Department of Biomaterials, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7938-1701","authenticated-orcid":false,"given":"Timo","family":"Peltomaki","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"},{"name":"Department of Ear and Oral Diseases, Tampere University Hospital, Tampere, Finland"},{"name":"Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2313-4979","authenticated-orcid":false,"given":"Theodore","family":"Eliades","sequence":"first","affiliation":[{"name":"Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,23]]},"reference":[{"key":"2020062315034901400_CIT0001","first-page":"203","article-title":"The Invisalign system in adult orthodontics: mild crowding and space closure cases","volume":"34","author":"Boyd","year":"2000","journal-title":"Journal of Clinical Orthodontics"},{"key":"2020062315034901400_CIT0002","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1179\/1465313315Y.0000000004","article-title":"Clear aligners generations and orthodontic tooth movement","volume":"43","author":"Hennessy","year":"2016","journal-title":"Journal of Orthodontics"},{"key":"2020062315034901400_CIT0003","doi-asserted-by":"crossref","first-page":"170","DOI":"10.2478\/aoj-2013-0020","article-title":"2013 survey of Australian orthodontists\u2019 procedures","volume":"29","author":"Miles","year":"2013","journal-title":"Australian Orthodontic Journal"},{"key":"2020062315034901400_CIT0004","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1080\/14653125.2017.1403144","article-title":"Adult orthodontics in the Republic of Ireland: specialist orthodontists\u2019 opinions","volume":"44","author":"McMorrow","year":"2017","journal-title":"Journal of Orthodontics"},{"key":"2020062315034901400_CIT0005","first-page":"607","article-title":"2014 JCO study of orthodontic diagnosis and treatment procedures, Part 1: results and trends","volume":"48","author":"Keim","year":"2014","journal-title":"Journal of Clinical Orthodontics"},{"key":"2020062315034901400_CIT0006","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s40510-019-0263-3","article-title":"Clear aligner treatment: different perspectives between orthodontists and general dentists","volume":"20","author":"d\u2019Apuzzo","year":"2019","journal-title":"Progress in Orthodontics"},{"key":"2020062315034901400_CIT0007","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.ajodo.2010.06.010","article-title":"In the land of no evidence, is the salesman king?","volume":"138","author":"O\u2019Brien","year":"2010","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2020062315034901400_CIT0008","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/s40510-017-0168-y","article-title":"Clinical evaluation of marketed orthodontic products: are researchers behind the times? 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