The evolution and clinical effectiveness of orthodontic appliance designs: A systematic review from pin and tube to ai-guided aligners

• Author Details:   
• Subash Chandra Nayak
• Anshuman Mishra ^*
• Smruti Ranjan Biswal
• Manisha Khandelwal
• Gourav Agarwala

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Background: In the last century, there have been significant changes in orthodontic treatment methods, which have progressed from basic mechanical devices to highly complex, digitally operated systems. Increasing emphasis on digital imaging, material science, biomechanics, and patient-focused care has contributed to innovations in equipment design. Artificial Intelligence (AI)-guided aligner systems are one of the most recent innovations that have the ability to revolutionize conservative accuracy and effectiveness.
Objective: The purpose of this systematic review is to comprehensively evaluate the evolution of orthodontic appliance designs, ranging from early pin-and-tube systems to modern AI-guided aligners, and to assess their treatment efficiency, patient satisfaction, and clinical effectiveness in terms of long-term outcomes.
Methods: Following the PRISMA 2020 guidelines, a comprehensive electronic search was conducted across PubMed, Scopus, Embase, Web of Science, and the Cochrane Library for studies published between 1950 and 2020. Additional manual searches were performed using orthodontic journals and reference lists. Studies focusing on the development, clinical performance, and comparative effectiveness of orthodontic appliances were included. Data extraction and quality assessment were independently performed by two reviewers, with disagreements resolved through consensus. A qualitative synthesis was conducted due to heterogeneity in study designs and outcome reporting.
Results: A total of 68 clinical studies have met the inclusion criteria, including randomized controlled trials, cohort studies, comparative analyses, and systematic reviews. The reviews have highlighted a progressive improvement in aesthetic results with each gradual generation of patient comfort and equipment systems. AI-directed alignment promised initial results in terms of accuracy and low treatment time, although long-term stability data remains limited.
Conclusion: Orthodontic appliance design has evolved to enhance treatment efficiency and patient-centered outcomes. While AI-guided aligner systems represent a significant advancement, traditional fixed appliances continue to play a vital role in managing complex cases. Further high-quality, long-term studies are needed to establish the durability and cost-effectiveness of AI-driven systems compared to conventional methods.