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A scoping review of sustainable orthodontic supply chains: innovations and waste management in clear aligner therapy.
Summary
A scoping review found that clear aligner orthodontic therapy generates over 1,000 tons of plastic waste annually and produces microplastic contamination, raising significant sustainability concerns. Despite digital advances, the orthodontic supply chain has been slow to adopt effective waste reduction strategies.
BACKGROUND: Clear aligner therapy has become a popular orthodontic treatment, with over 14 million users globally. However, its environmental impact is significant, generating over 1000 tons of plastic waste annually, alongside microplastic contamination and high carbon emissions. Despite digital advancements, recycling rates remain low, ranging from only 12% in Asian clinics to 29% in the EU, underscoring the urgent need for sustainable practices in orthodontics. AIMS: This scoping review aimed to synthesize current evidence on the environmental impact of clear aligner therapy and evaluate sustainable strategies and implementation challenges, guided by the United Nations Sustainable Development Goals (SDGs). METHODS: This review followed PRISMA-ScR guidelines and was registered in the Open Science Framework (Registration ID: pnjd4). Twenty-seven studies from eight countries (2017-25) were analyzed, focusing on sustainability strategies, waste management, and innovations. Data were synthesized thematically using the 4R framework (Reduce, Reuse, Recycle, Rethink) and aligned with relevant sustainable development goals. RESULTS: Key findings revealed that (i) staged aligner production and digital workflows reduce waste by 30%-41% and lower carbon emissions by 58%; (ii) bioplastics (e.g. silk fibroin) and 4D-printed shape-memory aligners show promise but face cost and material scalability challenges, and (iii) stakeholder collaboration across manufacturing, clinics, and policy is essential. Barriers include inadequate infrastructure and a lack of lifecycle data. CONCLUSION: This review fills a critical gap by linking clinical orthodontic innovations to broader environmental and public health goals. Future research must prioritize lifecycle analyses, enzymatic recycling, and AI-driven planning to bridge evidence gaps. By integrating these strategies, orthodontics can balance ecological responsibility with clinical efficacy.