Understanding the effectiveness of attachments in clear aligner therapy: navigating design, placement, material selection and biomechanics

Abstract Background Clear aligner treatments have gained popularity due to their aesthetic advantages over traditional metal brackets. Attachments play a crucial role in enhancing the efficacy of treatment by addressing challenges posed by the flexibility of aligner materials. This comprehensive review aims to clarify the significance of attachments used during clear aligner therapy and explore the nuances of their design, placement, and material selection. Methods A systematic search of literature databases including Web of Science, PubMed, Scopus, Google Scholar, and Cochrane was conducted. Twelve sets of keywords related to clear aligner therapy and attachments were applied for the search. Results A total of 24 studies that met the inclusion criteria and focused on the biomechanics of attachments, attachment shape, attachment placement and materials used in attachment production were included in the analysis. Conclusions Within the limits of the review, the use of attachments in clear aligner therapy can enhance the efficacy of treatment by facilitating complex tooth movements. The selection of materials, as well as the design and positioning strategies of attachments, should be customised for each patient to optimise treatment success. By the use of clinical studies, future research should focus on the long-term performance of attachments to confirm their effectiveness in achieving planned tooth movements, particularly regarding design, positioning, and the materials used.