Clinical outcomes of clear aligners in growing children: An umbrella review

Clear aligners are increasingly used in growing patients, but their effectiveness remains uncertain. This umbrella review aims to evaluate the effectiveness, safety, and limitations of clear aligner therapy in growing children.

This umbrella review followed Joanna Briggs Institute methodology, was registered in PROSPERO (CRD420251054252), and adhered to the Preferred Reporting Items for Overviews of Reviews checklist. Systematic reviews with or without meta-analysis assessing clinical outcomes of clear aligner therapy in children under 18 years were included. PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Epistemonikos were searched without year or language restrictions on December 5, 2025, alongside Gray literature and registries. Methodological quality of included reviews was assessed using AMSTAR-2. A qualitative assessment was conducted; pooled estimates were reported where available. Overlap among primary studies was assessed using the corrected covered area.

Of 1609 records identified, six systematic reviews were included Methodological quality was critically low in five reviews and low in one, with a high degree of overlap. All six reviews reported dentoalveolar improvements, including alignment, overjet reduction and arch development. Skeletal outcomes varied across reviews, with two reporting possible mandibular changes, three reporting minimal or no skeletal effects and one reporting insufficient evidence. Periodontal and patient-reported outcomes were each reported in two reviews. Meta-analyses assessed ANB, SNA, SNB, overjet, and overbite, demonstrating low heterogeneity for sagittal skeletal measures and variable heterogeneity for dental outcomes.

Clear aligner therapy in growing patients is associated with predictable dentoalveolar correction. Evidence for skeletal effects remains limited, and periodontal and patient-reported outcomes are insufficiently reported. These findings should be interpreted with caution due to the low methodological quality of the included reviews and overlap of primary studies.