The Effect of Clear Aligners on Root Length in Endodontically Treated Teeth: A Systematic Review of Split-Mouth Studies
Bibliographic record
Abstract
Background/Objectives: Clear aligners are increasingly prescribed for orthodontic treatment, primarily in adult patients; however, concerns have been raised that this treatment approach may negatively impact root length, especially in endodontically treated teeth. The present investigation aims to systematically synthesize available research addressing the potential effects of clear aligner orthodontic treatment on root length changes in endodontically treated teeth. Methods: Four electronic databases were searched until May 2025, and lists of references from relevant publications were screened to identify studies (randomized clinical trials, controlled clinical trials, and observational studies) written in the English language with no date restriction. Clinical studies comparing clear aligner orthodontic treatment in endodontically treated teeth versus vital pulp teeth in humans, using cone beam computed tomography or panoramic radiographs to evaluate root resorption, were assessed. Following study selection and data extraction, the risk-of-bias assessment was evaluated with the Newcastle–Ottawa tool for the observational studies. Results: A total of 173 studies were retrieved, and ultimately 2 observational cohort studies were included in the systematic review, encompassing 135 patients (69.6% female; with an average age of 22.5 years). The present review found an association between endodontic status and root resorption, with vital pulp teeth (VPT) exhibiting a greater degree of resorption compared to root canal treated teeth (RCT). Clear aligner (CA) orthodontic treatment resulted in less root resorption than fixed orthodontic appliances (FAs). Conclusions: Limited evidence indicates that clear aligner orthodontic treatment leads to a lower occurrence of root resorption and fewer cases of severe root resorption in endodontically treated teeth. Based on findings from studies comparing CAs to FAs, there is overall significantly greater resistance to root resorption in RCT than VPT, irrespective of the orthodontic treatment modality (CAs or FAs).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.007 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".