Nearly half of the world’s population suffers from malocclusion, which affects oral function and aesthetics. Clear aligners are popular for their discreet appearance and ease of use, but their effectiveness varies depending on the type of tooth movement required. Unlike fixed aligners, clear aligners rely on elastic forces, which may complicate complex corrections such as intrusion or torque control.
In addition, patient compliance and anatomical limitations further affect treatment outcomes. These challenges highlight the need for standardized protocols to ensure predictable results. Based on these challenges, a thorough investigation of clinical strategies for clear aligner treatment (CAT) is essential to bridge the gap between patient expectations and treatment outcomes.
A study conducted by experts from leading institutions in China and published in the International Journal of Oral Science on March 13, 2025 (DOI: 10.1038/s41368-025-00350-2) proposed a consensus on clear aligner treatment (CAT). The study outlines evidence-based case selection strategies, biomechanical principles, and clinical procedures, supported by a novel difficulty assessment tool (CAT-CAT).
By analyzing the predictability of different tooth movements and proposing solutions to common complications, the study aims to standardize CAT practice and improve patient outcomes. The consensus emphasizes the biomechanical nuances of clear aligners, highlighting their advantages in predictable movements such as molar distalization (86% success rate) and expansion (80% success rate), while also noting their limitations in torque control (52% success rate) and extrusion (30% success rate).
The CAT-CAT tool is a key innovation that categorizes cases into four difficulty levels—easy, moderate, difficult, and challenging—to guide clinicians in treatment planning. For complex cases, the study recommends staged movements, the use of adjuncts such as mini-implants, and overcorrection designs to offset appliance limitations.
Notably, the study introduced the BEPT-CAT concept (biomechanically guided, aesthetically driven, periodontal tissue supported, temporomandibular joint compatible), integrating a multidisciplinary approach to achieve optimal efficacy. For example, arch expansion requires careful CBCT analysis to avoid alveolar bone damage, while molar distalization benefits from “V-shaped” staging and intermaxillary traction.
The study also explored challenges such as dentition deviation and recommended traction or adjustment of attachments. The study emphasized individual patient factors, such as adolescent growth potential or periodontal health, and strategies to reduce the risk of root resorption and recurrence. The consensus advocates the use of digital tools including 3D modeling to improve precision and achieve personalized treatment. Professor Lai Wenli, the corresponding author of the study, pointed out:
Transparent aligners represent a paradigm shift in orthodontics, but their success depends on an understanding of their unique biomechanics. Our consensus provides clinicians with a roadmap to help them navigate the complex process from case selection to retention, ensuring predictable and efficient treatment outcomes. By integrating advanced digital planning and personalized strategies for patients, we can fully unleash the potential of this transformative technology.
This consensus has far-reaching implications for orthodontic practice, providing a framework for standardization of clear aligners (CATs) worldwide. Clinicians can use the CAT-CAT tool to customize treatment plans and reduce trial and error.
For patients, the guidelines promise improved aesthetics, improved comfort, and reduced treatment time, especially in complex cases. The emphasis on digital workflows and interdisciplinary collaboration fits in with the trend toward personalized medicine.
Future advances, such as attachment-free designs and AI-driven planning, could further refine CATs. By addressing current limitations, such as predictability of extrusion or torque, this study paves the way for innovations that could gradually make clear aligners a mainstream approach in orthodontics, potentially replacing traditional fixed appliances.
Related topics:
