{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T04:53:18Z","timestamp":1792903998826,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthod Craniofacial Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to assess the loss rate of attachments and investigate its probable influencing factors in patients during orthodontic therapy with clear aligners.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>A total of 55 patients treated with clear aligners were enrolled in this prospective clinical study. The loss rate of attachments was evaluated after a 6\u2010month follow\u2010up since the initial bonding was finished. The attachment survival curves were gone through Kaplan\u2013Meier estimates. The Cox regression model with shared frailty was conducted to evaluate the hazard ratios (HRs) for the following factors, including sex, age, dental malocclusion, vertical skeletal pattern, anterior overbite, operators, tooth extraction, attachment amount, arch, tooth position and attachment type.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were a total of 47 patients (14 males and 33 females; and mean age: 26.77\u2009\u00b1\u20098.45) in which 722 attachments were involved in the final analysis. During the 6\u2010month follow\u2010up, 99 attachments were lost by 40 participants. The overall loss rate was 13.7%. The loss of attachments was more common in the early months of therapy. During the first 2\u2009months, 71 attachments were lost. The loss rate of attachments was not significantly affected by sex, age, dental malocclusion, vertical skeletal pattern, anterior overbite, operators, tooth extraction, attachment amount and attachment type (<jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05). The loss rate of mandibular attachments was 1.8 times that of maxillary attachments (HR\u2009=\u20091.8; 95% CI: 1.2\u20132.8; <jats:italic>P<\/jats:italic>\u2009=\u20090.009). The loss rate of molar attachments was 5.5 times that of incisor attachments (HR\u2009=\u20095.5; 95% CI: 1.6\u201319; <jats:italic>P<\/jats:italic>\u2009=\u20090.007).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>During the first 6\u2009months, the overall loss rate of attachments was 13.7%. In the early months of therapy, loss of attachments was more common. The loss rate decreased as treatment time increased. Loss of attachments was significantly affected by arch and tooth position, with higher loss rates in the mandibular arch and molars. Besides, loss of attachments was not affected by sex, age, dental malocclusion, vertical skeletal pattern, anterior overbite, operators, tooth extraction, attachment amount and attachment type.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ocr.12710","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T05:55:38Z","timestamp":1693806938000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Loss of attachments in patients during orthodontic therapy with clear aligners: A prospective clinical study"],"prefix":"10.1111","author":[{"given":"Qiuying","family":"Li","sequence":"first","affiliation":[{"name":"Department of Orthodontics, School of Stomatology Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Stomatology Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"issue":"2","key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1179\/14653121141362","article-title":"Northcroft lecture: how has the spectrum of orthodontics changed over the past decades?","volume":"38","author":"Melsen B","year":"2011","journal-title":"J Orthod"},{"issue":"3","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ajodo.2008.07.011","article-title":"Attractiveness, acceptability, and value of orthodontic appliances","volume":"135","author":"Rosvall MD","year":"2009","journal-title":"Am J Orthod Dentofacial Orthop"},{"issue":"3","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"140","DOI":"10.4041\/kjod.2019.49.3.140","article-title":"A systematic review of the accuracy and efficiency of dental movements with Invisalign\u00ae","volume":"49","author":"Galan\u2010Lopez L","year":"2019","journal-title":"Korean J Orthod"},{"issue":"3","key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"302.e1\u20109","DOI":"10.1016\/j.ajodo.2006.05.031","article-title":"A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment","volume":"131","author":"Miller KB","year":"2007","journal-title":"Am J Orthod Dentofacial Orthop"},{"issue":"1","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.2319\/031212-217.1","article-title":"Periodontal status of adult patients treated with fixed buccal appliances and removable aligners over one year of active orthodontic therapy","volume":"83","author":"Karkhanechi M","year":"2013","journal-title":"Angle Orthod"},{"issue":"1","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ajodo.2007.05.018","article-title":"How well does Invisalign work? 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