Clear aligner therapy has become increasingly widespread in contemporary orthodontics, relying on composite resin attachments to enhance force transmission and improve the predictability of tooth movement. The physicochemical and mechanical properties of these biomaterials play a crucial role in attachment durability, dimensional stability, and esthetic performance during treatment. This systematic review aimed to evaluate how different composite resin types influence the mechanical, optical, and functional performances of orthodontic attachments used in clear aligner therapy. A systematic literature search was conducted in the PubMed, Scopus, and Cochrane databases for studies published between 2015 and 2025, following PRISMA guidelines. In vitro studies and clinical trials evaluating composite resins used for attachment fabrication were included. Fifteen studies met the eligibility criteria, including eleven laboratory investigations and four clinical studies. The evaluated outcomes comprised shear bond strength, wear resistance, surface roughness, microhardness, color stability, and accuracy of attachment reproduction. Overall, all evaluated composite resins demonstrated shear bond strength values within clinically acceptable ranges. However, significant differences were observed in the material performances depending on the resin composition and viscosity. Nanohybrid and high-viscosity composite resins were generally associated with improved mechanical resistance, reduced wear, and greater dimensional stability, although SBS outcomes should be interpreted in light of the bonding protocols used. In contrast, flowable composite resins showed improved handling and adaptation to attachment molds but presented higher susceptibility to surface degradation and discoloration. The findings suggest that the composition and properties of composite resins significantly influence the mechanical and optical behavior of orthodontic attachments. Optimizing material selection according to biomechanical demands and esthetic requirements may improve attachment longevity and treatment predictability in clear aligner therapy. Clinicians should prioritize nanohybrid or high-viscosity composite resins for high-load attachments and use flowable composite resins materials when adaptation and esthetics are critical.
Frias et al. (Tue,) studied this question.