The Environmental Burden and Sustainability Challenges of Clear Aligners: Implications for Public Health, Practice,...

Malocclusion is a major global oral health concern and has driven the rapid adoption of clear aligner therapy (CAT) as an esthetic and removable alternative to conventional fixed appliances. However, the widespread use of CAT has raised important concerns regarding its environmental footprint and potential public health implications, including waste generation, chemical leaching, and the release of microplastics. This scoping review aimed to systematically synthesize the available evidence on the environmental and public health implications of CAT and identify key areas in practice, research, and policy to advance toward sustainable oral healthcare services in alignment with the World Health Organization's Global Oral Health Action Plan 2023-2030.

This scoping review was conducted in accordance with Arksey and O'Malley's framework and reported in line with PRISMA-ScR guidelines. Eligible sources were identified through a search across four databases, namely, PubMed, Scopus, Web of Science, and Embase, to identify literature addressing environmental or public health aspects of clear aligners, published in English, either in print or online ahead of print, between January 2005 and December 2025. Data charting was conducted, followed by qualitative analysis using ATLAS.ti to identify the key themes emerging from included sources relating to the research question.

A total of 61 sources were included. The major themes which emerged from this scoping review included material toxicity and chemical exposure, microplastic and nanoplastic release, environmental burden of CAT, technological transitions in the form of 3D/4D aligners, strategies toward sustainability and governance, regulation, and research gaps.

CAT must be recognized not only as an orthodontic innovation but also as an emerging public health and sustainability challenge, highlighting the need for stronger evidence, safer materials, improved waste management, and clearer regulations to align future orthodontic care with Sustainable Development Goals 3 (Good Health and Well-being) and 13 (Climate Action).