Evaluation of predictability of tooth movement using different aligner brand: A prospective clinical study

Abstract

To evaluate the predictability of orthodontic tooth movement using different clear aligner brands through a secondary-data synthesis of published clinical evidence available up to 2025. A secondary-data-based comparative clinical evidence study was conducted using published clinical studies and systematic reviews that evaluated planned versus achieved orthodontic tooth movement with clear aligners. The main multi-brand dataset was extracted from a 2025 longitudinal clinical study comparing Angel Aligners, Invisalign, Spark, and HeySmile in adult patients requiring dentoalveolar expansion. Additional movement-specific data were extracted from published studies on Invisalign and other clear aligner systems. Predictability was defined as the percentage of clinically achieved movement relative to planned digital movement. In the 2025 multi-brand adult expansion study, Angel Aligner showed the highest overall predictability at 60.002%, followed by HeySmile 59.895%, Spark 59.275%, and Invisalign 57.153%. Lower-arch expansion was more predictable than upper-arch expansion. Tooth-group analysis showed the highest predictability for second bicuspids, followed by first bicuspids, first molars, and canines. Earlier Invisalign evidence reported mean overall tooth movement accuracy of 41% in 2009 and approximately 50% in 2020. Extrusion, canine rotation, premolar derotation, torque, and mandibular incisor intrusion were among the least predictable movements, whereas molar distalization and selected transverse expansion movements showed comparatively higher predictability. Clear aligner predictability remains moderate and varies according to aligner brand, arch, tooth group, and movement type. Brand-level differences were observed for dentoalveolar expansion, although the evidence is stronger for Invisalign than for newer aligner systems. Clinicians should apply overcorrection, optimized attachments, careful staging, auxiliaries, and refinement planning for less predictable movements.