How clinical experience shapes Turkish orthodontists' approaches to clear aligner treatment: a cross-sectional survey

This study aimed to investigate how orthodontists' clinical experience influences their treatment preferences and clinical strategies in clear aligner therapy (CAT). CAT has become increasingly widespread in contemporary orthodontic practice, largely due to its aesthetic appeal and the enhanced comfort it offers to patients, making it a preferred option among both orthodontists and patients. The reasons for the preference of CAT and the manner in which it is applied can vary significantly between orthodontists, especially in complex cases. The study was designed based on the assumption that one possible reason for these differences is the varying levels of clinical expertise among orthodontists.

A cross-sectional original, validated questionnaire was distributed to orthodontists in Türkiye. The questionnaire consisted of four main sections: (1) demographic information, (2) management of CAT, including clinical experience and clinical protocols, (3) types of patients treated and/or managed with CAT, and (4) perspectives of orthodontists who do not use CAT. Responses were analyzed using descriptive statistics and chi-square tests with effect sizes to explore associations between clinical experience and treatment-related variables.

A total of 338 orthodontists completed the survey (response rate: 14.1%). Mild-to-moderate crowding was the most frequently treated condition. More experienced orthodontists reported significantly greater use of CAT in complex cases, including extractions and skeletal discrepancies. Clinical experience was also significantly associated with the use of adjunctive techniques, refinement frequency, and awareness of CAT limitations. Distalization was perceived as the most predictable advantage of CAT over fixed appliances, regardless of experience. Patient compliance was considered the most critical factor for success, whereas aligner brand had minimal impact.

Clinical experience appears to play a critical role in shaping orthodontists' treatment decisions regarding CAT. Greater clinical exposure and structured training may expand orthodontists' ability to manage complex malocclusions effectively with CAT, underscoring the importance of continued education and experience-based proficiency in achieving predictable and optimal outcomes.