Q1. Fixed appliances or clear aligners — which is better?

The literature so far gives no one-sided answer. The conclusion of the systematic review is that, relative to conventional fixed appliances, clear aligners are better on dental aesthetics and periodontal health and carry a potential benefit in treatment length and comfort [F23]; but 13 of the 15 studies that review included were of non-randomised design and 7 were at high risk of bias, and the review itself is not indexed by PubMed as a Systematic Review, so this article downgrades it accordingly [F22]. On root resorption, the clear aligner group was significantly lower, though the absolute difference is modest, and the subjects included in that analysis were limited to patients older than 14 years with fully developed anterior roots [F26][F27]. Which one suits you depends on the classification, the aetiology and your individual conditions, and has to be assessed by a dentist [F11][F41].

Q2. Should a child be treated early, and at what age should an assessment be made?

It depends on the classification, not on a single cut-off by age. What the guideline writes is that most malocclusions can be effectively treated in the early mixed, the late mixed and the permanent dentition alike [F3]; but a pronounced class II anomaly can be started on early in order to reduce the risk of anterior tooth trauma, while a moderate class II one is preferably handled before or during the pubertal growth peak [F4]; a class III anomaly should be started early [F5]; and a pronounced transverse anomaly should be started on early in the upper jaw [F6]. The meta-analysis on anterior crossbite in children likewise shows that early treatment is effective, but that the outcome is influenced by aetiology and by the type of appliance [F11].

Q3. Can adults still have orthodontic treatment — can bone still move?

The analysis of miniscrew-assisted rapid palatal expansion in late adolescents and adults shows that, although the sagittal changes were statistically significant (SNA increased by 0.79 degrees, ANB by 1.18 degrees), the authors assess them as clinically modest; the vertical changes did not reach statistical significance [F28][F29]. That paper is an ahead-of-print online publication and is not yet indexed by PubMed as a Systematic Review or Meta-Analysis, so this article downgrades it accordingly [F29]. What an individual adult case can achieve has to be assessed by a dentist against the imaging and the clinical conditions [F41].

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The Complete Guide to Orthodontics: the classification map, the decision framework for treatment timing, and the retention phase｜證據鏈

km 編輯部2026-08-13About 33 min read

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