Sustainable clear aligner practice in esthetic and prosthetic dentistry: a scoping review for practical...

The purpose of this scoping review is to systematically map and synthesize the available evidence on sustainable practices in Clear Aligner Therapy (CAT), including materials, workflows, and end-of-life management with specific focus on material properties and clinical applications relevant to prosthodontic practice. It aims to systematically map the available evidence on sustainable practices in clear aligner therapy (CAT), including materials, workflows, and end-of-life management, with a specific focus on practical implementation and implications for pre-restorative and prosthodontic care.

Following PRISMA-ScR guidelines, databases including PubMed, Scopus, Web of Science, and Google Scholar were searched. In vitro, observational and clinical studies on sustainability and environmental impact of CAT were included. Extracted data included study characteristics, types of environmentally sustainable practices reported, key outcomes, and identified knowledge gaps.

Out of 419 records, 21 studies met the inclusion criteria. The field is emerging, with the majority (57.1%) published in 2024. Study designs included reviews (52.4%) and in-vitro studies (23.8%). Geographically, (38.1%) of the included studies were originated from India. Key sustainability drivers were environmental impact reduction and public health/well-being (each 61.9%). Reported environmental dimensions primarily focused on material/instrument use (57.1%) and chemical use (47.6%). However, significant knowledge gaps were identified, including a lack of standardized sustainability metrics, unproven clinical feasibility of biodegradable materials and recycling protocols, and an absence of validated frameworks connecting environmental practices to prosthodontic treatment planning.

Sustainable CAT can reduce material and chemical burdens through digital workflows, the evidence base, largely comprising recent narrative and in-vitro studies, lacks the clinical data necessary to validate "environmentally sustainable" protocols, life-cycle impacts, and end-of-life recycling. Because significant knowledge gaps persist regarding standardized metrics and practical feasibility, direct clinical translation remains limited. Orthodontists can best advance sustainability by optimizing digital treatment planning to minimize aligner volume and utilizing structured clinical frameworks to guide responsible, minimally invasive pre-restorative care.

Orthodontists should consider both material properties and environmental impact when selecting clear aligners for pre-restorative tooth positioning, occlusal therapy, or interdisciplinary treatment. The "ProSustain-P" framework provides practical guidance for implementing sustainable material practices in prosthodontic workflows, potentially reducing costs while addressing growing patient demand for environmentally responsible treatment options.