Attachment geometry and clinical predictability in aligner treatment: A systematic review

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Abstract
Objectives: The aim of this systematic review was to assess attachment efficiency in the improvement of movement predictability in aligner treatment and to determine the impact of their type (conventional or optimized) on movement accuracy. Material and Methods: Three electronic databases (PubMed, ScienceDirect, and Cochrane Library) were screened from initiation to December 2023 for studies assessing attachment efficacy using this search equation (Aligners OR Invisalign OR [clear aligners] OR [transparent aligners]) AND (attachments) AND (efficacy OR efficiency OR effectiveness) AND (orthodontics). Quality assessment of the included studies was performed using the JBI tool to assess cohort and case-control studies and Risk of Bias 2 (RoB 2) in randomized trials. Results: A total of 970 publications were found as search results in the screened databases. Nineteen were included in this systematic review based on pre-determined inclusion criteria. The studies were published between 2009 and 2023. The analysis of the results was realized by examining all types of movements. RoB assessment in this systematic review was moderate in the majority of the studies. Conclusion: The current systematic review showed that the use of attachments could improve movement accuracy. However, more interventional studies are necessary with control groups to support and confirm the results of the included studies.

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