Background/Objectives: This systematic review aimed to evaluate the effectiveness and predictability of lower incisor intrusion with clear aligners in permanent dentition, addressing one of the most challenging aspects of vertical tooth movement control in the mandibular anterior region. Methods: A comprehensive literature search was conducted across five databases (PubMed, Scopus, Embase, and Cochrane) according to PRISMA guidelines. Eight clinical studies fulfilled the eligibility criteria. Risk of bias was assessed using ROBINS-I, and certainty of evidence was graded with GRADE. Key outcomes included the amount of achieved versus planned intrusion, predictability, treatment protocols, use of auxiliaries, and patient-related factors such as age and compliance. Results: Reported mean intrusion values ranged from 0.4 to 1.5 mm, with predictability between 35% and 65%. The effectiveness of intrusion was influenced by the magnitude of planned movement, auxiliaries (e.g., attachments, elastics), refinement strategies, and patient-specific factors. Substantial heterogeneity was present in measurement methods (CBCT, cephalometry, digital models) and clinical protocols (aligner change intervals, refinement frequency), preventing meta-analysis. Seven of the eight studies were rated as having a serious risk of bias, and the overall certainty of evidence was moderate to low. Long-term outcomes and patient-centered measures were not adequately assessed. Conclusions: Within the limitations of the available evidence, lower incisor intrusion with clear aligners may be considered a feasible orthodontic option when supported by biomechanically informed clinical management. However, conclusions should be interpreted with caution due to heterogeneity, high risk of bias, and lack of long-term data. Further standardized studies with longer follow-up are required to strengthen reliability and clinical applicability.

Objectives: This study aimed to evaluate the reproducibility of artificial intelligence (AI) in identifying cephalometric landmarks, comparing its performance with manual tracing by an experienced orthodontist. Methods: A high-quality lateral cephalogram of a 26-year-old female patient, meeting strict inclusion criteria, was selected. Eighteen cephalometric landmarks were identified using the WebCeph software (version 1500) in three experimental settings: AI tracing without image modification (AInocut), AI tracing with image modification (AI-cut), and manual tracing by an orthodontic expert. Each evaluator repeated the procedure 10 times on the same image. X and Y coordinates were recorded, and reproducibility was assessed using the coefficient of variation (CV) and centroid distance analysis. Statistical comparisons were performed using one-way ANOVA and Bonferroni post hoc tests, with significance set at p < 0.05. Results: AInocut achieved the highest reproducibility, showing the lowest mean CV values. Both AI methods demonstrated greater consistency than manual tracing, particularly for landmarks such as Menton (Me) and Pogonion (Pog). Gonion (Go) showed the highest variability across all groups. Significant differences were found for the Posterior Nasal Spine (PNS) point (p = 0.001), where AI outperformed manual tracing. Variability was generally higher along the X-axis than the Y-axis. Conclusions: AI demonstrated superior reproducibility in cephalometric landmark identification compared to manual tracing by an experienced operator. While certain points showed high consistency, others—particularly PNS and Go—remained challenging. These findings support AI as a reliable adjunct in digital cephalometry, although the use of a single radiograph limits generalizability. Broader, multi-image studies are needed to confirm clinical applicability.

Background/Objectives: Class II malocclusion treatment in patients at the end of skeletal growth represents a significant clinical challenge. Traditional sequential distalization with clear aligners often requires prolonged treatment duration, carrying the risk of patient compliance burnout. This article describes a clinical technique combining a “Distalizing Bar Appliance” (DBA) with active lower clear aligners and Class II elastics for the management of dentoalveolar Class II malocclusion, and illustrates its application through a case series of three end-of-growth adolescent patients. Methods: Proposed inclusion criteria and a standardized three-phase workflow are presented: (1) distalization using a DBA supported by Class II elastics, with active lower clear aligners providing anchorage and concurrent crowding resolution; (2) alignment and arch coordination with clear aligners; and (3) finishing for occlusal settling. Results: In all three cases, a Class I molar and canine relationship was achieved, with cephalometric changes consistent with the dentoalveolar mechanisms previously reported for similar appliances and no clinically apparent mandibular skeletal changes. The concurrent use of active lower aligners allowed early crowding resolution, although careful monitoring of lower incisor and molar inclination was required to limit unwanted mesial tipping induced by Class II elastics. Conclusions: Within the limits of a case series, the technique appears clinically feasible and reproducible in carefully selected patients; comparative, controlled studies are needed before any claim of superior efficiency or effectiveness over established Class II treatment modalities can be made.

The authors would like to include an acknowledgment in the original publication