Efficacy and accuracy of Invisalign attachments: an updated systematic review

Background: The primary purposes of Invisalign® technology are to treat minor to moderate crowding problems and patch up minute cracks. But more recent research and development have made it possible to cure more complex malocclusions. Although the accuracy of Invisalign-assisted orthodontic tooth movements has been researched, the effectiveness of various attachment methods and other aligner factors has not been thoroughly assessed. This study aimed at assessing the accuracy and efficacy of the Invisalign attachment mechanism as described in the most recent publications. Method: A systematic assessment of research examining the precision and efficacy of Invisalign attachments between 2019 and 2022 was performed employing Google Scholar and PubMed databases. The keywords were "efficacy, accuracy, Invisalign attachments, clear aligners, Invisalign®, invisible orthodontics, treatment results," which were used in various combinations. Original research describing the precision and effectiveness of the Invisalign attachments and full-text papers met the criteria for inclusion. Results: Only 8 articles out of 14 met the requirements for inclusion. Six studies were retrospective, one was prospective observational research, and one was a case-series investigation. Together, they involved 621 people. Even though Invisalign® orthodontic treatment is widely used, aside from the non-extraction treatment of mild to moderate malocclusions in non-growing patients, there are presently no definitive recommendations on additional indications of the system based on trustworthy scientific evidence. Invisalign attachments, transparent aligners, and full-text studies demonstrated its efficacy in the non-extraction correction of mild to moderate malocclusions in patients who were not growing. Conclusion: Despite the large number of studies examined in this study, evaluations of treatment results need to be cautious due to the significant heterogeneity. For a broad spectrum of malocclusions and expanding patient populations, further research involving parallel arm RCTs or carefully planned prospective trials is necessary to develop solid clinical recommendations.