Non-Cochrane · intervention · PM42278800
CBCT-Based Assessment of External Apical Root Resorption in Clear Aligner Versus Fixed Orthodontic Therapy: A Systematic Review and Meta-Analysis.
Yıldırım Ersin, Topbas Celalettin · Healthcare (Basel, Switzerland) · 2026 · PubMed · doi:10.3390/healthcare14111547
Findings
12 findings
| Population | ||||
|---|---|---|---|---|
| Patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Planned subgroup: RCTs only | No randomized controlled trials met the inclusion criteria No studies found 0 studies |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Sensitivity: excluding Chen 2023 | MD -0.60 [-0.88, -0.32] GRADE not reported 5 studies · 333 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Leave-one-out: excluding Chen 2023 | MD -0.60 [-0.88, -0.32] GRADE not reported 5 studies · 333 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Leave-one-out: excluding Almagrami 2023 | MD -0.52 [-0.81, -0.23] GRADE not reported 5 studies · 352 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Sensitivity: excluding Eissa 2018 (serious risk of bias) | MD -0.53 [-0.81, -0.25] GRADE not reported 5 studies · 359 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Leave-one-out: excluding Almagrami 2025 | MD -0.41 [-0.69, -0.13] GRADE not reported 5 studies · 312 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Sensitivity: excluding Almagrami 2025 (extraction-only study) | MD -0.41 [-0.69, -0.13] GRADE not reported 5 studies · 312 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Leave-one-out: excluding Jyotirmay 2021 | MD -0.53 [-0.82, -0.24] GRADE not reported 5 studies · 282 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Overall (all six studies) | MD -0.50 [-0.79, -0.21] Low Downgraded: inconsistency 6 studies · 392 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Leave-one-out: excluding Li 2020 | MD -0.41 [-0.70, -0.12] GRADE not reported 5 studies · 322 participants |
| Human patients undergoing orthodontic treatment | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Leave-one-out: excluding Eissa 2018 | MD -0.53 [-0.81, -0.25] GRADE not reported 5 studies · 359 participants |
| Patients treated with non-extraction or mixed protocols | Clear aligner therapy | Fixed orthodontic appliances | External apical root resorption: CBCT-based linear root length change (mm) Orthodontic treatment, clinical studies · Subgroup: non-extraction/mixed protocol | MD -0.41 [-0.69, -0.13] GRADE not reported 5 studies · 312 participants |
Included primary studies 6
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Almagrami 2023 A quantitative three-dimensional comparative study of alveolar bone changes and apical root resorption between clear aligners and fixed… PMID:36843193 | 2023 | 1 other review | External apical root resorption: CBCT-based linear root length change (mm) | not extracted yet |
| Chen 2023 Changes of maxillary central incisor and alveolar bone in Class II Division 2 nonextraction treatment with a fixed appliance or clear… PMID:37079283 | 2023 | 1 other review | External apical root resorption: CBCT-based linear root length change (mm) | not extracted yet |
| Eissa 2018 Evaluation of root length following treatment with clear aligners and two different fixed orthodontic appliances. A pilot study. PMID:29963506 | 2018 | 1 other review | External apical root resorption: CBCT-based linear root length change (mm) | not extracted yet |
| Jyotirmay 2021 Comparison of Apical Root Resorption in Patients Treated with Fixed Orthodontic Appliance and Clear Aligners: A Cone-beam Computed… PMID:34615781 | 2021 | 1 other review | External apical root resorption: CBCT-based linear root length change (mm) | not extracted yet |
| Li 2020 Prevalence and severity of apical root resorption during orthodontic treatment with clear aligners and fixed appliances: a cone beam… PMID:31903505 | 2020 | 1 other review | External apical root resorption: CBCT-based linear root length change (mm) | not extracted yet |
| Almagrami 2025 Volumetric and tridimensional root resorption and alveolar bone changes in Class II malocclusion extraction protocol treated with clear… PMID:39797866 | 2025 | this review only | External apical root resorption: CBCT-based linear root length change (mm) | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
| Review | Shared studies | Jaccard |
|---|---|---|
| External Apical Root Resorption Following Orthodontic Treatment with Clear Aligners Versus Fixed Appliances: A Systematic Review and… (2025) | 5 | 0.45 |
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Human subjects undergoing orthodontic treatment | Orthodontic patients, 392 in six studies (n=6) |
| Intervention | Clear aligner therapy (Invisalign or other thermoplastic aligners) | Clear aligners (n=179 patients) |
| Comparison | Fixed orthodontic appliances (conventional, self-ligating, passive self-ligating brackets) | Fixed appliances (n=213 patients) |
| Outcomes | External apical root resorption by quantitative CBCT linear root length measurements (mm) | CBCT linear root length change in mm (n=6) |
| Study designs | RCTs or non-randomized clinical studies | Non-randomized comparative clinical studies, no RCTs (n=6) |
| Timing | Not specified | Not specified |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Partial Yes | Partial Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: N/A · NRSI: Yes | NRSI: Yes · RCT: N/A | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: No | NRSI: No · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |