Abstract
• Attachments improve fit, retention and favorable force distribution.
• 10–14 day change interval supports better torque and posterior movement control.
• Extraction closure is difficult, leading to uncontrolled tipping (roller coaster effect).
• Aligner seaters improve fit but increase risk of attachment loss.
• Predictability is high for distalisation, alignment and premolar expansion; low for torque, intrusion, and extrusion.
• Weekly microplastic release (10²–10³/aligner).
• Cytotoxicity due to residual monomers; no clinical adverse effects reported as of yet.
Clear Aligner Therapy (CAT) continues its significant global expansion, currently treating an estimated 4.7 million patients annually. This narrative roadmap summarizes current evidence concerning CAT efficacy, attachment design, clinical protocols, movement predictability and biocompatibility. CAT offers favourable clinical advantages, including reduced chairside time, fewer appointments, and improved short-term oral hygiene outcomes. Nevertheless, significant limitations exist concerning predictability for complex movements such as extrusion, bodily translation, and precise torque control. To address these deficiencies, composite attachments and clinical protocols have been investigated to improve movement predictability. Although concerns regarding micro- and nanoplastic release have emerged, no directly related clinical adverse effects have been reported thus far. CAT is an evolving orthodontic modality, but further rigorous research is necessary to establishing robust evidence-based protocols for predictability and explore the scientific nature of CAT biocompatibility.