Predictability of Rotational Tooth Movement with Clear Aligners and Its Determining Factors: Exploratory Systematic Review

Resumen

Introduction: Clear aligners have become a widely used therapeutic alternative in  orthodontics due to their aesthetic and comfort advantages. However, despite advances in  thermoplastic materials, three-dimensional digital planning, and attachment design, certain  tooth movements continue to present biomechanical limitations. Among these, tooth rotation  is recognized as one of the least predictable movements, especially in teeth with unfavorable  crown and root morphology, such as canines and premolars. Objective: To analyze the available scientific evidence on the predictability of rotational  tooth movement in patients treated with clear aligners and to identify the main factors that  influence the accuracy of this movement. Methods: An exploratory systematic review was conducted following the PRISMA  guidelines. Searches were performed in the PubMed and ScienceDirect databases in English  and Spanish, using combinations of MeSH terms and keywords related to clear aligners and  tooth rotations. Original, fully accessible studies published between January 2020 and  October 2025 that evaluated the clinical accuracy of rotational movements with aligners were  included. Case reports, previous reviews, and studies that included combined treatments with  fixed appliances, miniscrews, or orthognathic surgery were excluded. Results: After the selection process, 10 studies were included for qualitative analysis. The  evidence showed that the predictability of rotational movement with clear aligners is variable,  with values ranging approximately from 28% to 70%, depending on the tooth type, the  magnitude of rotation, and the treatment design. Incisors showed greater accuracy compared  to canines, premolars, and molars, with rotations greater than 10–15° being the least  predictable. Factors such as the configuration and type of attachments, treatment staging, the  number of aligners, patient compliance, and dental morphology significantly influenced the  clinical outcomes. Conclusions: Tooth rotation remains one of the least predictable movements in clear aligner  therapy. Despite technological advances, the effectiveness of rotational control depends on  multiple biomechanical, biological, and digital planning factors. Individualized planning,  appropriate use of attachments, and the programming of progressive movements can improve  the clinical expression of movement, although the need for refinements remains frequent.