Predictability of Lower Incisor Intrusion with Clear Aligners: A Systematic Review of Efficacy and Influencing Factors
Abstract
1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
- -
- Studies involving patients with mixed or deciduous dentition.
- -
- Studies that did not directly analyze lower incisor intrusion.
- -
- Studies lacking quantitative data.
- -
- Studies involving orthodontic treatments with extractions.
2.2. Information Sources and Search Strategy
2.3. Selection Process
2.4. Data Collection
- (a)
- Author and Year of Publication
- (b)
- Country
- (c)
- Study Design
- (d)
- Number of Patients
- (e)
- Mean Age of Patients
- (f)
- Gender (M/F)
- (g)
- Treatment Duration
- (h)
- Main Conclusions
- (1)
- Aligner Brand
- (2)
- Intrusion Measurement System
- (3)
- Refinement
- (4)
- Aligner Change Frequency
- (5)
- Predictability of Movement (%)
- (6)
- Intrusion Amount (mm)
- (7)
- Auxiliary Elements and Attachments
2.5. Quality Assessment
3. Results
3.1. Study Selection
3.2. Study Characteristics
3.3. Primary Outcomes
3.3.1. Predictability of Movement (%)
3.3.2. Intrusion Amount (mm)
3.4. Secondary Outcomes: Influencing Factors
3.4.1. Intrusion Measurement System
3.4.2. Refinement
3.4.3. Aligner Change Frequency
3.4.4. Auxiliary Elements and Attachments
3.5. Risk of Bias Assessment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Certainty of Assessment | Certainty | |||||
---|---|---|---|---|---|---|
Study | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | |
M. Al-balaa et al. (2021) [26] | Moderate | Low | Moderate | Moderate | None | Moderate |
G. Bilello et al. (2022) [27] | Low | Low | Low | Low | None | High |
G. Fiorillo et al. (2024) [28] | Moderate | Moderate | Moderate | Moderate | None | Moderate |
K. Fujiyama et al. (2022) [29] | Moderate | Low | Moderate | Moderate | None | Moderate |
J. Kang et al. (2024) [30] | Moderate | Moderate | Moderate | Moderate | None | Moderate |
N. Kravitz et al. (2024) [31] | Low | Low | Low | Low | None | High |
M. Sadek et al. (2024) [32] | Moderate | Moderate | Moderate | Moderate | None | Moderate |
N. Shahabuddin et al. (2023) [33] | Moderate | Moderate | Moderate | Moderate | None | Moderate |
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PICOS | Inclusion Criteria | Exclusion Criteria |
---|---|---|
Participant | Adult and adolescent patients with permanent dentition | Patients with mixed or deciduous dentition |
Intervention | Use of clear aligners for the intrusion of lower incisors without extractions | Treatments with clear aligners without lower incisor intrusion, treatments with extractions. |
Comparison | Studies analyzing the effectiveness of clear aligners in lower incisors intrusion, with or without comparison to other orthodontic methodologies | Studies that do not include any analysis of the effectiveness of lower incisor intrusion with clear aligners. |
Outcome | Effectiveness of lower incisor intrusion measured through CBCT, setup software, or cephalometric analysis. | Studies without measurable quantitative data. |
Study design | R&PCTs | Case–control, cohort, cross-sectional, Nr-RCTs 2; reviews; case reports; case series; in vitro; and animal studies |
Database | Search Strategy |
---|---|
PubMed | (“Tooth Movement Techniques”[MeSH Terms] OR “Orthodontic Anchorage Procedures”[MeSH Terms]) AND (“Clear Aligners”[All Fields] OR “Invisalign”[All Fields]) |
Scopus | (TITLE-ABS-KEY (“tooth movement techniques” OR “orthodontic anchorage procedures”) AND TITLE-ABS-KEY (“clear aligners” OR “Invisalign” OR “removable aligners”)) |
Embase | (‘Tooth movement’/exp OR ‘orthodontic anchorage’/exp) AND (‘clear aligner’/exp OR ‘invisalign’ OR ‘removable orthodontic appliance’) |
Cochrane Central Register of Controlled Trials | (“Tooth movement” OR “orthodontic anchorage”) AND (“clear aligner” OR “Invisalign” OR “removable orthodontic appliance”) |
Web of Science | (((TS = (“Tooth Movement Techniques”)) OR TS = (“Orthodontic Anchorage Procedures”)) AND TS = (“Clear Aligners”)) OR TS = (“Invisalign”) |
Author (Year) | Country | Study Design | Number of Patients | Mean Age (Years) | Gender (M/F) | Treatment Duration (Months) | Main Conclusions |
---|---|---|---|---|---|---|---|
Al-balaa et al. (2021) [26] | China | RCT | 22 | 23.74 | 10/12 | Average 19.27 | The mandibular incisors exhibited the least precise tooth movement, with an intrusion predictability of 44.71%. |
Bilello et al. (2022) [27] | Italy | PCT | 10 | 34.8 ± 14 | 3/7 | Not specified | The mandibular incisors demonstrated a high predictability of intrusion (92.2%), but accuracy decreased for movements exceeding 2 mm. |
Fiorillo et al. (2024) [28] | Italy | RCT | 25 | 32.28 | 12/13 | Not specified | Larger vertical changes were correlated with larger errors. |
Fujiyama et al. (2022) [29] | Japan | RCT | 25 Invisalign 23 fixed appliances | 23.3 ± 8.5 | 7/18 | 31.9 ± 8.6 | Deep overbite correction was primarily achieved through 2.0 mm mandibular incisor intrusion, along with 1.0 mm maxillary incisor intrusion. Treatment duration was comparable to fixed appliances. |
Kang et al. (2024) [30] | USA | RCT | 20 | 32.63 ± 11.88 | 7/13 | 22.96 ± 12.34 | The vertical movement of lower incisors has moderate predictability in the first set of aligners but decreases in refinements. |
Kravitz et al. (2024) [31] | USA | PCT | 58 (29 adolescents, 29 adults) | -Adolescents: 15.1 -Adults: 40.7 | 16/42 | Not specified | Mandibular incisor intrusion was more accurate in adolescents (63.5%) than adults (45.3%), with greater intrusion (1.7 mm vs. 0.9 mm). Accuracy decreased with age. |
Sadek et al. (2024) [32] | UAE | RCT | 34 | 30.65 ± 11.80 | Not specified | 16.14 ± 6.42 | Lower incisor intrusion with aligners shows limited predictability, with unplanned vertical movements being more pronounced in anterior teeth compared to posterior teeth. |
Shahabuddin et al. (2023) [33] | USA | RCT | 24 | 32.8 ± 11.9 | 10/14 | 11.04 ± 4.14 | Intrusion success increased slightly with bite ramps and elastics, but not significantly. Planned vs. achieved movements showed significant discrepancies. Overcorrection and refinements are needed. |
Study | Planned (mm) | Achieved (mm) | Predictability (%) |
---|---|---|---|
Al-balaa et al. (2021) [26] | 1.8 | 0.82 | 51.2 |
Bilello et al. (2022) [27] | ≤2.0 | NR | 92 |
Fiorillo et al. (2024) [28] | NR | 1.15–2.11 diff. | 41–51 |
Fujiyama et al. (2022) [29] | NR | ~2.0 | NR |
Kang et al. (2024) [30] | NR | 1.48–1.59 | 27–42 |
Kravitz et al. (2024) [31] | NR | 0.9–1.7 | 45–64 |
Sadek et al. (2024) [32] | NR | NR | NR |
Shahabuddin et al. (2023) [33] | NR | 1.02–1.09 | 42.5 |
Author (Year) | Aligner Brand | Intrusion Measurement System | Refinement | Aligner Change Frequency | Auxiliary Elements and Attachments |
---|---|---|---|---|---|
Al-balaa et al. (2021) [26] | Invisalign | CBCT | No | 14 days | Pressure areas, no bite ramps |
Bilello et al. (2022) [27] | Invisalign | Rhinoceros® software (Robert McNeel & Associates, USA) | Yes | 7 days | Bite ramps, power ridges, elastics, optimized root control attachments |
Fiorillo et al. (2024) [28] | Invisalign | Geomagic Control X software (Rock Hill, SC, USA). | No | Not specified | Standardized horizontal attachments on premolars and molars, no bite ramps or elastics used |
Fujiyama et al. (2022) [29] | Invisalign | Cephalometric radiographs | Not specified | Not specified | No auxiliary appliances other than elastics were used |
Kang et al. (2024) [30] | Invisalign | 3D Slicer software via the SlicerCMF project (cmf.slicer.org, open-source, version 4.11.2). | Yes | 7–14 days | Bite ramps, optimized rotation attachments, optimized deep bite attachments, and conventional rectangular attachments |
Kravitz et al. (2024) [31] | Invisalign Teen (Adolescents), Invisalign Full (Adults) | Compare (version 8.1; GeoDigm, Falcon Heights, Minn) | No | 7 days | Maxillary incisor bite ramps, G5 attachments on mandibular premolars and first molars, 4.0 mm beveled attachments on mandibular lateral incisors and canines. Mandibular premolars and first molars extruded 0.5 mm, canines and incisors intruded progressively. Final: 0.0 mm overbite, heavy posterior contacts, no interproximal reduction. |
Sadek et al. (2024) [32] | Invisalign | eModel 9.0 software (GeoDigm Corporation, Falcon Heights, MN) | Not specified | 14 days | Optimized deep bite attachments, precision bite ramps, pressure areas |
Shahabuddin et al. (2023) [33] | Invisalign | 3D Slicer via the SlicerCMF project (version 4.9.0; cmf.slicer.org)) | No | 7–14 days | Precision bite ramps, optimized deepbite attachments, new pressure areas on lingual surfaces |
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Fracchia, D.E.; Bignotti, D.; Lai, S.; Battista, E.; Verdecchia, A.; Spinas, E. Predictability of Lower Incisor Intrusion with Clear Aligners: A Systematic Review of Efficacy and Influencing Factors. J. Clin. Med. 2025, 14, 6339. https://doi.org/10.3390/jcm14176339
Fracchia DE, Bignotti D, Lai S, Battista E, Verdecchia A, Spinas E. Predictability of Lower Incisor Intrusion with Clear Aligners: A Systematic Review of Efficacy and Influencing Factors. Journal of Clinical Medicine. 2025; 14(17):6339. https://doi.org/10.3390/jcm14176339
Chicago/Turabian StyleFracchia, David Emilio, Denis Bignotti, Stefano Lai, Eric Battista, Alessio Verdecchia, and Enrico Spinas. 2025. "Predictability of Lower Incisor Intrusion with Clear Aligners: A Systematic Review of Efficacy and Influencing Factors" Journal of Clinical Medicine 14, no. 17: 6339. https://doi.org/10.3390/jcm14176339
APA StyleFracchia, D. E., Bignotti, D., Lai, S., Battista, E., Verdecchia, A., & Spinas, E. (2025). Predictability of Lower Incisor Intrusion with Clear Aligners: A Systematic Review of Efficacy and Influencing Factors. Journal of Clinical Medicine, 14(17), 6339. https://doi.org/10.3390/jcm14176339