Clinical trends and utilization of clear aligner therapy among specialist orthodontists in Iran

Clear aligner therapy (CAT) has transformed contemporary orthodontic practice; however, evidence regarding its adoption and clinical use among specialist orthodontists remains scarce. This study investigated CAT practices among Iranian specialist orthodontists.

This study forms part of the Cardiff University International Aligner Survey: Orthodontists" Practices and Perceptions. A web-based cross-sectional survey of specialist orthodontists in Iran was conducted from October 2025 to January 2026. A voluntary, anonymous English-language questionnaire assessed demographics, CAT usage patterns, adjuncts, training, preferred malocclusions and patient age groups, monitoring and retention protocols, and perceived advantages and limitations.

A total of 142 specialists (16%-20% estimated response rate) responded (83 male, 59 female). Most were aged 30-39 years (47.2%), had 11-20 years of experience (40.8%), and worked in private practice (59.9%). CAT was used by 69% of respondents; 35.9% treated <10 new CAT cases annually, while 7.7% treated >50. For 51.4%, CAT comprised about 10% of their caseload; only 2.8% reported CAT use in >50% of cases. CAT was used mainly in adults and least in mixed dentition/adolescents (P < 0.001). Preferred indications were mild crowding (<4 mm; 81.6%), spacing/diastema (63.1%), anterior crossbite (44.3%), and mild open bite (1-2 mm; 38.6%). CAT was favoured for single-extraction or space-opening cases rather than complex extractions or orthognathic surgery. About 8.5% reported using a hybrid approach, consisting of CAT in one arch combined with fixed appliance therapy in the opposing arch. Elastics were the most common adjunct. Intraoral 3D scanners were the most common method (68.1%) for taking records among respndents (n = 141). Approximately, 49.3% and 19% of aligners were provided by local manufacturers or produced in-office, respectively. Most orthodontists recognised biomechanical limitations of CAT (agree and strongly agree), with 73.3% reporting limited control of tooth movement, 77.5% inadequate torque expression, 88.7% difficulty achieving certain tooth movements, and 88.8% a limited scope for complex cases. Furthermore, 68.1% believed CAT may require longer treatment times than fixed appliances, and 83.1% agreed that CAT often necessitates greater interproximal reduction than fixed appliance therapy.

CAT was mainly used for mild malocclusions, supported by expanding local aligner manufacturers and in-office aligner production.