Predictability of Rotational Tooth Movement with Clear Aligners and Its Determining Factors: Exploratory Systematic Review
DOI:
https://doi.org/10.59334/ROV.v2i45.742Keywords:
clear aligners, tooth rotation, orthodontic movement, biomechanicsAbstract
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.
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