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Systematic Review

Biomechanical Insights into the Variation of Maxillary Arch Dimension with Clear Aligners: A Finite Element Analysis-Based Scoping Review

1
Dentistry Unit, Management Innovations, Diagnostics and Clinical Pathways, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
2
Nuvola Research & Development Division, Gruppo Europeo di Ortodonzia, 00030 San Cesareo, Italy
3
UN-EU International Research Project on Human Health–Oral Health Section, 1200 Geneva, Switzerland
*
Authors to whom correspondence should be addressed.
Appl. Sci. 2025, 15(17), 9514; https://doi.org/10.3390/app15179514 (registering DOI)
Submission received: 27 July 2025 / Revised: 22 August 2025 / Accepted: 27 August 2025 / Published: 29 August 2025
(This article belongs to the Special Issue Advances in Orthodontic Treatment, 2nd Edition)

Featured Application

Finite element analysis offers a powerful tool for the design and customization of orthodontic devices, especially clear aligners, allowing treatment to be customized to the individual needs of patients and improving the prediction of therapeutic effects.

Abstract

Clear aligners (CAs) have emerged as a widely accepted alternative to conventional fixed orthodontic appliances due to their aesthetic appeal, comfort, and removability. Despite their increasing use, the precise biomechanical behavior of CAs—particularly in relation to maxillary arch expansion and torque control—remains incompletely understood. This scoping review aims to synthesize and critically examine the recent body of evidence derived from finite element analysis (FEA) studies investigating the performance of clear aligners in managing transverse discrepancies and controlling tooth movement. It considered studies published up to April 2025. All included FEA studies assumed dental and bone tissues as linearly elastic, homogeneous, and isotropic, unless otherwise specified. Five in silico studies were included, all employing three-dimensional FEA models to assess the influence of various clinical and design parameters, such as aligner thickness, movement sequence, attachment configuration, and torque compensation. The findings consistently show that movement protocols involving alternating activation patterns and specific attachment designs can significantly improve the efficiency of maxillary expansion, while reducing undesired tipping or anchorage loss. Additionally, greater aligner thicknesses were generally associated with increased force delivery and more pronounced tooth displacement. Although FEA provides a powerful tool for visualizing stress distribution and predicting mechanical responses under controlled conditions, the lack of standardized force application and limited clinical validation remain important limitations. These findings underscore the potential of optimized aligner protocols to enhance treatment outcomes, but they also highlight the need for complementary in vivo studies to confirm their clinical relevance and guide evidence-based practice.
Keywords: clear aligners; palatal expansion; maxillary arch; transversal dimensions; tooth movement; finite element analysis; biomechanics; torque regulation; attachments; materials clear aligners; palatal expansion; maxillary arch; transversal dimensions; tooth movement; finite element analysis; biomechanics; torque regulation; attachments; materials

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MDPI and ACS Style

Putrino, A.; Bompiani, G.; Aristei, F.; Fornari, V.; Massafra, L.; Uomo, R.; Galeotti, A. Biomechanical Insights into the Variation of Maxillary Arch Dimension with Clear Aligners: A Finite Element Analysis-Based Scoping Review. Appl. Sci. 2025, 15, 9514. https://doi.org/10.3390/app15179514

AMA Style

Putrino A, Bompiani G, Aristei F, Fornari V, Massafra L, Uomo R, Galeotti A. Biomechanical Insights into the Variation of Maxillary Arch Dimension with Clear Aligners: A Finite Element Analysis-Based Scoping Review. Applied Sciences. 2025; 15(17):9514. https://doi.org/10.3390/app15179514

Chicago/Turabian Style

Putrino, Alessandra, Gaia Bompiani, Francesco Aristei, Valerio Fornari, Ludovico Massafra, Roberto Uomo, and Angela Galeotti. 2025. "Biomechanical Insights into the Variation of Maxillary Arch Dimension with Clear Aligners: A Finite Element Analysis-Based Scoping Review" Applied Sciences 15, no. 17: 9514. https://doi.org/10.3390/app15179514

APA Style

Putrino, A., Bompiani, G., Aristei, F., Fornari, V., Massafra, L., Uomo, R., & Galeotti, A. (2025). Biomechanical Insights into the Variation of Maxillary Arch Dimension with Clear Aligners: A Finite Element Analysis-Based Scoping Review. Applied Sciences, 15(17), 9514. https://doi.org/10.3390/app15179514

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