A Survey of Orthodontic Clear Aligner Practices among Orthodontists in Croatia

The aim of this cross-sectional survey was to investigate clear aligner therapy (CAT) practices and protocols among orthodontic specialists in the Republic of Croatia.

The modified version of a previously published questionnaire s was distributed online to 180 orthodontists. It included 46 open- and closed-ended questions across 11 sections, covering demographics, clinical use of CAT, aligner preferences, digital treatment planning (DTP), indications, protocols, interproximal reduction (IPR), refinements, retention, patient-reported issues, and overall perceptions. Respondents not using CAT were directed to a separate section on non-use.

The majority of respondents (88%) reported using CAT in clinical practice, although only 10% of their annual cases involved CAT. Adults were more common patient group (57.9%), and the main indication was mild to moderate crowding. Invisalign was the most frequently used aligner system (58.7%), primarily chosen for the quality of digital treatment planning (DTP) and sophistication of product features. Two-thirds of the respondents reported modifying the digital treatment plan, particularly by adjusting the final tooth position. Refinement was performed in 50% of the cases. IPR was included in 80% of the initial treatment plans and only 20% of the refinement phases. Finally, 52.6% of orthodontists considered CAT to be superior to conventional fixed appliance therapy.

CAT is widely used by orthodontists in Croatia, primarily for mild cases. Nevertheless, aligners are still not perceived as producing superior outcomes compared with fixed appliances.