{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:23:55Z","timestamp":1787772235429,"version":"build-2784847793"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Maxillary transverse deficiency, affecting approximately 21% of patients in the mixed dentition stage, represents a common skeletal discrepancy in orthodontics. Clear aligners have demonstrated efficacy in achieving maxillary arch expansion, alleviating crowding, and meeting orthodontic treatment objectives. This review aims to systematically evaluate and synthesize the available evidence on the clinical outcomes of maxillary arch expansion using clear aligners in the mixed dentition period. The protocol was registered in PROSPERO (CRD42024542510) and the review followed Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. A comprehensive literature search was conducted using the electronic databases PubMed, Cochrane Library, Web of Science, Embase, and Scopus. A gray literature search was also done to identify unpublished or ongoing studies. An additional manual search was conducted up to October 15, 2025. The risks of bias (quality) assessment was done by the Cochrane book for ROBINS-I tool. The visualization of the risk of bias assessment was generated using the risk of bias visualization tool. The initial search yielded 659 studies, with 470 remaining after removing duplicates. After screening, 457 studies that were not relevant were removed. Out of 13 full-text articles assessed, 2 were excluded based on selection criteria, resulting in 11 studies included in the qualitative synthesis. Clear aligner therapy is effective in maxillary arch expansion in the mixed dentition period and is a reasonable alternative to traditional maxillary expanders for limited transverse maxillary deficiency.<\/jats:p>","DOI":"10.4103\/jisppd.jisppd_421_25","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T07:00:52Z","timestamp":1772175652000},"page":"24-35","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Clinical outcome of maxillary arch expansion with clear aligners in mixed dentition: A systematic review"],"prefix":"10.4103","volume":"44","author":[{"given":"Devendra I.","family":"Nagpal","sequence":"first","affiliation":[{"name":"Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juili Rajendra","family":"Dorlikar","sequence":"additional","affiliation":[{"name":"Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Rathi","sequence":"additional","affiliation":[{"name":"Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayushi","family":"Gurharikar","sequence":"additional","affiliation":[{"name":"Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samrudhi","family":"Khondalay","sequence":"additional","affiliation":[{"name":"Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gagandeep","family":"Lamba","sequence":"additional","affiliation":[{"name":"Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"key":"R1-20260227","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1186\/s12903-023-03312-4","article-title":"Treatment effects after maxillary expansion using invisalign first system versus acrylic splint expander in mixed dentition:A prospective cohort study","volume":"23","author":"Lu","year":"2023","journal-title":"BMC Oral Health"},{"key":"R2-20260227","first-page":"384","article-title":"Advances in orthodontic clear aligner materials","volume":"22","author":"Bichu","year":"2023","journal-title":"Bioact Mater"},{"key":"R3-20260227","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1186\/s12903-023-03302-6","article-title":"Clinical outcomes of arch expansion with invisalign:A systematic review","volume":"23","author":"Ma","year":"2023","journal-title":"BMC Oral Health"},{"key":"R4-20260227","doi-asserted-by":"crossref","first-page":"738","DOI":"10.3390\/diagnostics15060738","article-title":"A retrospective study regarding the efficacy of Nuvola(\u00ae) OP clear aligners in maxillary arch expansion in adult patients","volume":"15","author":"Bucur","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"R5-20260227","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1186\/s12903-023-03655-y","article-title":"Effects of upper arch expansion using clear aligners on different stride and torque:A three-dimensional finite element analysis","volume":"23","author":"Zhang","year":"2023","journal-title":"BMC Oral Health"},{"key":"R6-20260227","first-page":"125","article-title":"Maxillary expansion with clear aligners in the mixed dentition:A preliminary study with invisalign\u00ae first system","volume":"22","author":"Levrini","year":"2021","journal-title":"Eur J Paediatr Dent"},{"key":"R7-20260227","first-page":"208","article-title":"Mixed-dentition treatment with clear aligners and vibratory technology","volume":"54","author":"Gorton","year":"2020","journal-title":"J Clin Orthod"},{"key":"R8-20260227","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement:An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"R9-20260227","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I:A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"R10-20260227","doi-asserted-by":"crossref","first-page":"91","DOI":"10.22514\/jocpd.2024.012","article-title":"The predictability of arch expansion with the invisalign first system in children with mixed dentition:A retrospective study","volume":"48","author":"Kim","year":"2024","journal-title":"J Clin Pediatr Dent"},{"key":"R11-20260227","doi-asserted-by":"crossref","first-page":"392","DOI":"10.2319\/121523-833.1","article-title":"Evaluation of maxillary dimensional changes in the mixed dentition:Clear aligners versus acrylic expanders","volume":"94","author":"Pamuk\u00e7u","year":"2024","journal-title":"Angle Orthod"},{"key":"R12-20260227","first-page":"20","article-title":"Comparison of Maxillary Expansion between Clear Aligners and Removable Expansion Appliance in the Mixed Dentition [Thesis","author":"Zaverdinos","year":"2021","journal-title":"Orthodontics and Endodontics Theses"},{"key":"R13-20260227","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s00056-021-00332-z","article-title":"Upper arch dimensional changes with clear aligners in the early mixed dentition:A prospective study","volume":"84","author":"Lione","year":"2023","journal-title":"J Orofac Orthop"},{"key":"R14-20260227","first-page":"408","article-title":"Comparison between two different expansion protocols in early mixed dentition:Clear aligners versus rapid maxillary expansion","volume":"29","author":"Lombardo","year":"2023","journal-title":"Semin Orthod"},{"key":"R15-20260227","first-page":"1323","article-title":"Evaluation of the upper arch morphological changes after two different protocols of expansion in early mixed dentition:Rapid maxillary expansion and invisalign(\u00ae) first system","volume":"12","author":"Cretella","year":"2022","journal-title":"Life (Basel)"},{"key":"R16-20260227","doi-asserted-by":"crossref","first-page":"8675","DOI":"10.3390\/app13158675","article-title":"Maxillary response induced by rapid palatal expansion versus clear aligners:A short-term retrospective evaluation of the dento-alveolar effects in mixed dentition","volume":"13","author":"Cretella","year":"2023","journal-title":"Appl Sci"},{"key":"R17-20260227","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1186\/s12903-024-04435-y","article-title":"Predictability of expansion movements performed by clear aligners in mixed dentition in both arches:A retrospective study on digital casts","volume":"24","author":"Loberto","year":"2024","journal-title":"BMC Oral Health"},{"key":"R18-20260227","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.3390\/healthcare13131508","article-title":"Efficacy and predictability of maxillary and mandibular dental arch expansion with clear aligners in prepuberal subjects:A digital retrospective analysis","volume":"13","author":"Caruso","year":"2025","journal-title":"Healthcare (Basel)"}],"container-title":["Journal of Indian Society of Pedodontics and Preventive Dentistry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jisppd.jisppd_421_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:34:31Z","timestamp":1787769271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jisppd.jisppd_421_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jisppd.jisppd_421_25","relation":{},"ISSN":["0970-4388","1998-3905"],"issn-type":[{"value":"0970-4388","type":"print"},{"value":"1998-3905","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2025-09-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}