Sayali Athawale, Nikita Mohelay, Puneet Batra, Aditya Talwar, Ashish Kumar Singh
RME demonstrated significantly greater increases in intermolar width compared to CAT, while intercanine width changes were comparable between treatments. Although both modalities effectively address transverse deficiencies in mixed dentition, they differ in expansion patterns and dental effects, with CAT offering more controlled dentoalveolar expansion and minimal molar tipping.
OBJECTIVE: To systematically evaluate and compare the effects of clear aligner therapy (CAT) vs conventional maxillary expanders [rapid maxillary expansion (RME) and slow maxillary expansion (SME)] in treating maxillary arch constriction during mixed dentition with a focus on transverse arch parameters, including intercanine and intermolar widths, molar inclination, arch perimeter, and palatal depth.
MATERIALS AND METHODS: Electronic searches of PubMed, Embase, Scopus, and Medline upto August 2025 identified 341 records. Studies included randomized controlled trials (RCTs) and prospective and retrospective cohorts assessing ME outcomes with clear aligners and conventional RME/SME expanders in mixed dentition patients. Outcomes included intercanine width, intermolar width, arch perimeter, arch width and depth, molar inclination, and palatal volume. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for RCTs and the Methodological Index for Nonrandomized Studies (MINORS) for nonrandomized studies.
RESULTS: Eight studies met inclusion criteria, comprising a total of 412 patients aged 8.4 ± 1.3 years. Meta-analysis showed a significant trend favoring maxillary expanders over CAT for both intercanine width expansion [-0.54; 95% confidence interval (CI): -1.17, 0.09; p = 0.09] and intermolar width [-1.01 (95% CI: -1.59, -0.43; p = 0.0006)]. CAT demonstrated superior control over molar inclination with reduced buccal tipping. Heterogeneity varied across outcomes, largely owing to differences in study designs and protocols. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment revealed overall very low quality of evidence with moderate risk of bias.
CONCLUSION: RME demonstrated significantly greater increases in intermolar width compared to CAT, while intercanine width changes were comparable between treatments. Although both modalities effectively address transverse deficiencies in mixed dentition, they differ in expansion patterns and dental effects, with CAT offering more controlled dentoalveolar expansion and minimal molar tipping.
HOW TO CITE THIS ARTICLE: Athawale S, Mohelay N, Batra P, et al. Comparative Evaluation of Transverse Maxillary Arch Changes in Mixed Dentition with Clear Aligners vs Conventional Maxillary Expanders: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2026;19(8):1067-1077.