Temporary Anchorage Devices and Clear Aligner Therapy: A Systematic Review

Area of Science:

• Orthodontics
• Biomaterials in Dentistry
• Dental Mechanics

Background:

• Clear aligner therapy (CAT) has biomechanical limitations for complex tooth movements.
• Temporary anchorage devices (TADs) offer skeletal anchorage to potentially overcome CAT limitations.
• Clinical evidence on the combined use of TADs and CAT is limited.

Purpose of the Study:

• To systematically review and critically appraise clinical evidence on TADs used with CAT.
• To synthesize findings by clinical indication and evaluate study quality.
• To identify evidence gaps for future research.

Main Methods:

• Systematic review of four databases (PubMed, Cochrane, Web of Science, Scopus) from inception to April 2026.
• Inclusion of human clinical studies on combined TAD and CAT treatment; exclusion of in vitro and surgical studies.
• Quality assessment using JBI Critical Appraisal Checklists and MINORS instrument.

Main Results:

• Fourteen studies (109 patients) met inclusion criteria; no randomized controlled trials identified.
• Applications included molar distalization, vertical correction, and impacted canine management.
• TADs reduced side effects but distalization efficiency was below planned values (32-71%).

Conclusions:

• Combined TAD and CAT is technically feasible with improved tooth movement control, not magnitude.
• Evidence certainty is low, precluding definitive recommendations.
• Well-designed RCTs with 3D outcome measures are needed to establish effectiveness.