External Apical Root Resorption with Clear Aligners Versus Fixed Appliances: A Scoping Review of Comparative Evidence, Treatment-Related Factors, Imaging Modalities and Consistency of Reported Data
8 affiliations
- 1Doctoral School, Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania
- 2Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
- 3Department of Orthodontics, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139 Targu Mures, Romania
- 4Department of Orthodontics, Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania
- 5Department of Surgery, Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania
- 6Clinical Medical Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania
- 7Department of Dental Medicine and Nursing, Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania
- 8Clinical Surgical Department, Faculty of Medicine, Lucian Blaga University of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania
Abstract
Most meta-analyses report less external apical root resorption (EARR) with clear aligners (CAs) than fixed appliances (FAs), but pooled differences are sub-millimetric and rest on few recurring studies. This scoping review (PRISMA-ScR) mapped how 2020–2026 evidence on CA–FA comparisons, treatment-related factors and imaging modalities was generated, and checked data consistency, without pooling. Its unregistered protocol (version 1.0) was reconstructed during manuscript preparation. PubMed, Scopus and Web of Science were searched; paired reviewers screened 1688 records and 263 full texts and included 176 reports (174 studies). Fifteen reports, including eight of 32 direct-comparison reports, were excluded because outcome data were not attributable to a distinct sample or not identifiable; in one, pooled by six syntheses, aligner values equal another study’s fixed-appliance values. Of 21 included comparisons, 17 had serious or high risk of bias, one accounted for clustering and three reported measurement error in millimetres; differences were 0.01–1.12 mm except in one. Fifteen of 17 studies not described as randomised reported less EARR with CAs; the only concealed-allocation trial of appliances alone found no difference. Two imaging comparisons disagreed on whether panoramic radiography under- or overestimates EARR. Differences should be judged against measurement error and design, and data consistency should be checked before pooling.
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BibTeX
@article{groza2026external,
title = {{External Apical Root Resorption with Clear Aligners Versus Fixed Appliances: A Scoping Review of Comparative Evidence, Treatment-Related Factors, Imaging Modalities and Consistency of Reported Data}},
author = {Bianca Luminița (Erhan) Groza and Emilia (Prodea) Rusu and Mariana Păcurar and Maria Popa and Mihai Dan Roman and Adrian-Gheorghe Boicean and Gabriela Bota and Laura Stef and Anca Maria Fratila and Denisa Elena Redean and Sorin Radu Fleacă},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218219},
url = {https://www.mdpi.com/2077-0383/15/21/8219},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - External Apical Root Resorption with Clear Aligners Versus Fixed Appliances: A Scoping Review of Comparative Evidence, Treatment-Related Factors, Imaging Modalities and Consistency of Reported Data
AU - Bianca Luminița (Erhan) Groza
AU - Emilia (Prodea) Rusu
AU - Mariana Păcurar
AU - Maria Popa
AU - Mihai Dan Roman
AU - Adrian-Gheorghe Boicean
AU - Gabriela Bota
AU - Laura Stef
AU - Anca Maria Fratila
AU - Denisa Elena Redean
AU - Sorin Radu Fleacă
PY - 2026
DA - 2026/10/22
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218219
UR - https://www.mdpi.com/2077-0383/15/21/8219
AB - Most meta-analyses report less external apical root resorption (EARR) with clear aligners (CAs) than fixed appliances (FAs), but pooled differences are sub-millimetric and rest on few recurring studies. This scoping review (PRISMA-ScR) mapped how 2020–2026 evidence on CA–FA comparisons, treatment-related factors and imaging modalities was generated, and checked data consistency, without pooling. Its unregistered protocol (version 1.0) was reconstructed during manuscript preparation. PubMed, Scopus and Web of Science were searched; paired reviewers screened 1688 records and 263 full texts and included 176 reports (174 studies). Fifteen reports, including eight of 32 direct-comparison reports, were excluded because outcome data were not attributable to a distinct sample or not identifiable; in one, pooled by six syntheses, aligner values equal another study’s fixed-appliance values. Of 21 included comparisons, 17 had serious or high risk of bias, one accounted for clustering and three reported measurement error in millimetres; differences were 0.01–1.12 mm except in one. Fifteen of 17 studies not described as randomised reported less EARR with CAs; the only concealed-allocation trial of appliances alone found no difference. Two imaging comparisons disagreed on whether panoramic radiography under- or overestimates EARR. Differences should be judged against measurement error and design, and data consistency should be checked before pooling.
SN - 2077-0383
ER -