Fixed Orthodontic Mechanotherapy Beyond MBT: A Review from Origins to Future Perspectives

Fixed orthodontic mechanotherapy has become a cornerstone in achieving predictable tooth movement and functional occlusion. The MBT system, although widely adopted, presents limitations due to its standardized bracket prescriptions that may not accommodate individual anatomical variations. Challenges such as incomplete torque expression, reliance on precise bracket placement, and increased friction with conventional ligatures often necessitate additional adjustments, thereby extending treatment time and compromising efficiency. These drawbacks have driven the exploration of alternative strategies that extend beyond MBT. Contemporary approaches emphasize reduced friction mechanics, digital customization, and patient-centered treatment planning. Advances in computer-aided design and manufacturing enable custom brackets and archwires tailored to specific tooth morphology, while integration of three- dimensional imaging improves diagnostic accuracy and precision in appliance placement. Innovations such as self-ligating systems, digitally guided workflows, and bioadaptive force concepts are reshaping clinical practice by enhancing comfort, efficiency, and treatment predictability. Looking forward, the incorporation of artificial intelligence, smart materials, and real-time monitoring technologies is expected to further individualize orthodontic care. This review critically evaluates the shortcomings of MBT mechanotherapy and highlights the transition toward innovative, technology-driven systems that promise to redefine fixed orthodontics in the future.