{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T05:04:22Z","timestamp":1784264662527,"version":"3.55.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthod Craniofacial Res"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the impact of baseline malocclusion severity on the number of prescribed, used aligners and treatment duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>An unrestricted, independent search was conducted on the Invisalign ClinCheck database of a private practice for patients without any missing anterior teeth and whose treatment was finished between April 2021 and December 2024. Descriptive statistics were generated, and the feature selection Boruta algorithm (random forest algorithm) was implemented to identify important predictors for the number of aligners (prescribed, used) and treatment duration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 404 patients were included (age: 29.57 [10.7] years). Mean numbers of prescribed, used and unused aligners were 72.21 (37.52), 65.63 (30.40) and 6.57 (14.09), respectively. Important predictors of the numbers of the prescribed and used aligners were relatively similar and included molar and canine relationships, maxillary crowding, overjet, presence and number of missing or extracted posterior teeth, overbite, presence and number of teeth in posterior crossbite and midline discrepancies. Treatment duration was associated with baseline maxillary crowding, molar and canine relationships, overjet, overbite, midline discrepancies and the presence and number of missing or extracted posterior teeth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Factors related to the baseline malocclusion severity significantly affect the number of prescribed, used aligners and treatment duration. This information could be used for informed practice and patient communication, including future evaluation of the biological and environmental footprint of aligners.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ocr.70167","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:15:09Z","timestamp":1784261709000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Malocclusion Severity on the Number of Prescribed, Used Aligners and Treatment Duration; A Retrospective, Singe\u2010Centre, Cohort Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6244-1610","authenticated-orcid":false,"given":"Angeliki Anna","family":"Gkinosati","sequence":"first","affiliation":[{"name":"School of Dentistry European University Cyprus  Nicosia Cyprus"},{"name":"Division of Orthodontics, University Clinics of Dental Medicine University of Geneva  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Candice","family":"Durgnat","sequence":"additional","affiliation":[{"name":"Division of Orthodontics, University Clinics of Dental Medicine University of Geneva  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0057-5544","authenticated-orcid":false,"given":"Effimia","family":"Koumpia","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dentistry, Faculty of Health Sciences Aristotle University of Thessaloniki  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0258-468X","authenticated-orcid":false,"given":"Nikolaos","family":"Pandis","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2549-1079","authenticated-orcid":false,"given":"Christodoulos","family":"Laspos","sequence":"additional","affiliation":[{"name":"School of Dentistry European University Cyprus  Nicosia Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5981-0479","authenticated-orcid":false,"given":"Alexandra K.","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Division of Orthodontics, University Clinics of Dental Medicine University of Geneva  Geneva Switzerland"},{"name":"Department of Orthodontics, School of Dentistry, Faculty of Health Sciences Aristotle University of Thessaloniki  Thessaloniki Greece"},{"name":"Discipline of Orthodontics, School of Dentistry, Faculty of Medicine and Health University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"issue":"2","key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.4041\/kjod.2021.51.2.115","article-title":"Reasons Influencing the Preferences of Prospective Patients and Orthodontists for Different Orthodontic Appliances","volume":"51","author":"Mara\u00f1\u00f3n\u2010V\u00e1squez G. A.","year":"2021","journal-title":"Korean Journal of Orthodontics"},{"key":"e_1_2_13_3_1","unstructured":"Align Technology Inc. \u201cQ2 2024 Corp Fact Sheet \u201d 2026 https:\/\/investor.aligntech.com\/static\u2010files\/a15fadce\u2010cc2f\u20104435\u20109754\u2010b1f560f3baa2."},{"issue":"3","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"280","DOI":"10.2319\/102223-712.1","article-title":"Invisalign Lite: A Cross\u2010Sectional Investigation of Orthodontist Treatment\u2010Planning Practices","volume":"94","author":"Meade M. J.","year":"2024","journal-title":"Angle Orthodontist"},{"issue":"3","key":"e_1_2_13_5_1","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1177\/14653125211027266","article-title":"Predictability of Rotational Tooth Movement With Orthodontic Aligners Comparing Software\u2010Based and Achieved Data: A Systematic Review and Meta\u2010Analysis of Observational Studies","volume":"48","author":"Koletsi D.","year":"2021","journal-title":"Journal of Orthodontics"},{"issue":"3","key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.ajodo.2019.12.015","article-title":"Has Invisalign Improved? A Prospective Follow\u2010Up Study on the Efficacy of Tooth Movement With Invisalign","volume":"158","author":"Haouili N.","year":"2020","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"issue":"5","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.ajodo.2023.11.008","article-title":"Clinical Efficacy of the Invisalign Mandibular Advancement Appliance: A Retrospective Investigation","volume":"165","author":"Meade M. J.","year":"2024","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"e41","DOI":"10.1016\/j.ajodo.2020.08.016","article-title":"Class II Malocclusion Correction With Invisalign: Is It Possible?","volume":"159","author":"Patterson B. D.","year":"2021","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"issue":"9596","key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"Von Elm E.","year":"2007","journal-title":"Lancet"},{"issue":"11","key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v036.i11","article-title":"Feature Selection With the Boruta Package","volume":"36","author":"Kursa M. B.","year":"2010","journal-title":"Journal of Statistical Software"},{"issue":"1","key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1097\/PRS.0000000000010786","article-title":"Comparative Assessment of Orthodontic and Aesthetic Outcomes After Orthognathic Surgery With Clear Aligner or Fixed Appliance Therapy","volume":"154","author":"Liou Y. J.","year":"2024","journal-title":"Plastic and Reconstructive Surgery"},{"issue":"3","key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1177\/14653125241229456","article-title":"Assessment of Patients' Knowledge and Preferences for the Use of Orthodontic Aligners","volume":"51","author":"Paim J.","year":"2024","journal-title":"Journal of Orthodontics"},{"key":"e_1_2_13_13_1","doi-asserted-by":"crossref","DOI":"10.1155\/2022\/2754051","article-title":"Motivation, Perception, and Behavior of the Adult Orthodontic Patient: A Survey Analysis","volume":"2022","author":"Saccomanno S.","year":"2022","journal-title":"BioMed Research International"},{"key":"e_1_2_13_14_1","doi-asserted-by":"crossref","first-page":"e141","DOI":"10.1016\/j.ajodo.2022.06.017","article-title":"Association Between Initial Complexity, Frequency of Refinements, Treatment Duration, and Outcome in Invisalign Orthodontic Treatment","volume":"162","author":"Arqub S. A.","year":"2022","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"issue":"1","key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/03015742231210424","article-title":"Factors Affecting the Seeking of Orthodontic Treatment of Turkish Adults","volume":"58","author":"Uslu A. U.","year":"2024","journal-title":"Journal of the Indian Orthodontic Society"},{"issue":"4","key":"e_1_2_13_16_1","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.ajodo.2022.03.016","article-title":"What Percentage of Patients Switch From Invisalign to Braces? A Retrospective Study Evaluating the Conversion Rate, Number of Refinement Scans, and Length of Treatment","volume":"163","author":"Kravitz N. D.","year":"2023","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"issue":"1","key":"e_1_2_13_17_1","doi-asserted-by":"crossref","DOI":"10.1186\/s40510-022-00438-z","article-title":"Predictability of Crowding Resolution in Clear Aligner Treatment","volume":"23","author":"Fiori A.","year":"2022","journal-title":"Progress in Orthodontics"},{"issue":"1","key":"e_1_2_13_18_1","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1111\/jerd.12708","article-title":"Smile Projection\u2013A New Concept in Smile Design","volume":"33","author":"Sarver D.","year":"2021","journal-title":"Journal of Esthetic and Restorative Dentistry"},{"issue":"6","key":"e_1_2_13_19_1","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1016\/j.prosdent.2021.03.019","article-title":"Comparative Analysis of Smile Esthetics Between Top Celebrity Smile and a Southern European Population","volume":"128","author":"Arroyo\u2010Cruz G.","year":"2022","journal-title":"Journal of Prosthetic Dentistry"},{"issue":"4","key":"e_1_2_13_20_1","first-page":"359","article-title":"The Effect of Axial Midline Angulation on Dental Esthetics","volume":"73","author":"Thomas J. L.","year":"2003","journal-title":"Angle Orthodontist"},{"key":"e_1_2_13_21_1","doi-asserted-by":"crossref","DOI":"10.1155\/2016\/7815274","article-title":"Perceptions of Altered Smile Esthetics: A Comparative Evaluation in Orthodontists, Dentists, and Laypersons","volume":"2016","author":"Al Taki A.","year":"2016","journal-title":"International Journal of Dentistry"},{"issue":"6","key":"e_1_2_13_22_1","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1111\/jerd.12054","article-title":"Influence of the Vertical Position of Maxillary Central Incisors on the Perception of Smile Esthetics Among Orthodontists and Laypersons","volume":"25","author":"Machado A. W.","year":"2013","journal-title":"Journal of Esthetic and Restorative Dentistry"},{"issue":"1","key":"e_1_2_13_23_1","doi-asserted-by":"crossref","DOI":"10.1186\/s40510-023-00479-y","article-title":"Does Different Vertical Position of Maxillary Central Incisors in Women With Different Facial Vertical Height Affect Smile Esthetics Perception?","volume":"24","author":"Atik E.","year":"2023","journal-title":"Progress in Orthodontics"},{"issue":"2","key":"e_1_2_13_24_1","doi-asserted-by":"crossref","first-page":"150","DOI":"10.4041\/kjod.2022.52.2.150","article-title":"Customized Maxillary Incisor Position Relative to Dentoskeletal and Soft Tissue Patterns in Chinese Women: A Retrospective Study","volume":"52","author":"Zhou X.","year":"2022","journal-title":"Korean Journal of Orthodontics"},{"issue":"1","key":"e_1_2_13_25_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.4041\/kjod24.152","article-title":"The Effects of Maxillary Incisor Positions and Chin Prominences on the Perception of Lateral Smiling Profile Attractiveness Among Orthodontists and Laypersons","volume":"55","author":"Yongwongsoontorn P.","year":"2025","journal-title":"Korean Journal of Orthodontics"},{"issue":"1","key":"e_1_2_13_26_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.2319\/040710-195.1","article-title":"Influence of Orthodontic Treatment, Midline Position, Buccal Corridor and Smile Arc on Smile Attractiveness","volume":"81","author":"Janson G.","year":"2011","journal-title":"Angle Orthodontist"},{"issue":"6","key":"e_1_2_13_27_1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.14219\/jada.archive.2011.0245","article-title":"Laypeople's Preferences Regarding Frontal Dentofacial Esthetics: Tooth\u2010Related Factors","volume":"142","author":"Witt M.","year":"2011","journal-title":"Journal of the American Dental Association (1939)"},{"issue":"5","key":"e_1_2_13_28_1","doi-asserted-by":"crossref","DOI":"10.3390\/ma16051910","article-title":"The Predictability of Transverse Changes in Patients Treated With Clear Aligners","volume":"16","author":"D'Ant\u00f2 V.","year":"2023","journal-title":"Materials"},{"issue":"2","key":"e_1_2_13_29_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ortho.2023.100750","article-title":"Is Maxillary Arch Expansion With Invisalign Efficient and Predictable? A Systematic Review","volume":"21","author":"Bouchant M.","year":"2023","journal-title":"International Orthodontics"},{"issue":"1","key":"e_1_2_13_30_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12903-018-0695-z","article-title":"A Comparison of Treatment Effectiveness Between Clear Aligner and Fixed Appliance Therapies","volume":"19","author":"Ke Y.","year":"2019","journal-title":"BMC Oral Health"},{"issue":"3","key":"e_1_2_13_31_1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/ocr.12177","article-title":"Efficiency, Effectiveness and Treatment Stability of Clear Aligners: A Systematic Review and Meta\u2010Analysis","volume":"20","author":"Zheng M.","year":"2017","journal-title":"Orthodontics & Craniofacial Research"},{"issue":"1","key":"e_1_2_13_32_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ejwf.2021.11.002","article-title":"Biomechanics of Clear Aligners: Hidden Truths & First Principles","volume":"11","author":"Upadhyay M.","year":"2022","journal-title":"Journal of the World Federation of Orthodontists"},{"issue":"4","key":"e_1_2_13_33_1","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1177\/14653125231166015","article-title":"Digital Treatment Planning and Clear Aligner Therapy: A Retrospective Cohort Study","volume":"50","author":"Meade M. J.","year":"2023","journal-title":"Journal of Orthodontics"},{"issue":"15","key":"e_1_2_13_34_1","doi-asserted-by":"crossref","DOI":"10.3390\/ma12152406","article-title":"Changes in Roughness and Mechanical Properties of Invisalign Appliances After One\u2010 and Two\u2010Weeks Use","volume":"12","author":"Papadopoulou A. K.","year":"2019","journal-title":"Materials"},{"issue":"4","key":"e_1_2_13_35_1","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4041\/kjod24.085","article-title":"Intraoral Ageing of Aligners and Attachments: Adverse Effects on Clinical Efficiency and Release of Biologically\u2010Active Compounds","volume":"54","author":"Eliades T.","year":"2024","journal-title":"Korean Journal of Orthodontics"},{"issue":"4","key":"e_1_2_13_36_1","doi-asserted-by":"crossref","DOI":"10.1093\/ejo\/cjae026","article-title":"Surface Alterations and Compound Release From Aligner Attachments In\u00a0Vitro","volume":"46","author":"Iliadi A.","year":"2024","journal-title":"European Journal of Orthodontics"},{"key":"e_1_2_13_37_1","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.ajodo.2025.04.022","article-title":"Absorption and Desorption Dynamics of Thermoformed and 3\u2010Dimensional\u2010Printed Orthodontic Aligners","volume":"14","author":"\u0160imunovi\u0107 L.","year":"2025","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"issue":"6","key":"e_1_2_13_38_1","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.ajodo.2024.02.005","article-title":"Interproximal Reduction in the Refinement Phase of Invisalign Treatment: A Quantitative Analysis","volume":"165","author":"Abasseri T.","year":"2024","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"issue":"1","key":"e_1_2_13_39_1","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ajodo.2017.03.019","article-title":"Compliance With Removable Orthodontic Appliances and Adjuncts: A Systematic Review and Meta\u2010Analysis","volume":"152","author":"Al\u2010Moghrabi D.","year":"2017","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"e_1_2_13_40_1","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.ajodo.2021.12.012","article-title":"Are Clear Aligners Environmentally Friendly?","volume":"161","author":"Peter E.","year":"2022","journal-title":"American Journal of Orthodontics and Dentofacial Orthodontics"},{"issue":"6","key":"e_1_2_13_41_1","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.ejwf.2024.10.001","article-title":"Microplastics and Orthodontic Aligners: The Concerns Arising From the Modernization of Practice Through Polymers and Plastics","volume":"13","author":"Panayi N.","year":"2024","journal-title":"Journal of the World Federation of Orthodontists"}],"container-title":["Orthodontics &amp; Craniofacial Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ocr.70167","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ocr.70167","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ocr.70167","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:15:15Z","timestamp":1784261715000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ocr.70167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":40,"alternative-id":["10.1111\/ocr.70167"],"URL":"https:\/\/doi.org\/10.1111\/ocr.70167","archive":["Portico"],"relation":{},"ISSN":["1601-6335","1601-6343"],"issn-type":[{"value":"1601-6335","type":"print"},{"value":"1601-6343","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"assertion":[{"value":"2025-06-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"ocr.70167"}}