From Italy, the signs of the demand boom for invisible aligners in Europe

Problems of malocclusion for two out of three Italians

Almost two out of three Italian adults affirm to have dental malocclusion or misalignment problems. The demand for clear aligners in dental clinics is already booming.

This is demonstrated by an extensive market study carried out by Key-Stone Research Institute, which integrated data both from industry and dental practices.

Key-Stone analyzed the phenomenon thanks to an extensive survey, carried out on a representative sample of 2,878 Italians, aged between 20 and 50 years, representing more than half of the national population.

The study shows that 55% declare problems of malocclusion, already corrected in adulthood with orthodontic braces in 19% of cases. For that matter, this is a share also confirmed by plenty of international literature.

Malocclusion: the Italians’ perception

The Italians’ perception about this problem is very interesting, as well as the great desire to solve it. These aspects were investigated on over 1,000 individuals, that is 36% of the sample who reported a malocclusion yet untreated (at least 8 million people in the age group investigated).

Among them:

  • 60% complain of dental misalignment, considering it to be minor
  • 34% consider the problem as moderately severe
  • 6% consider the misalignment as very evident

The age group between 25 and 35 years is the most sensitive to the issue, judging the imperfection generally to be more evident.

Impact on the aesthetic and functional levels

Malocclusion mainly concerns aesthetics and, according to the interviewees, it worsens their appearance in 90% of cases, albeit with different levels of perceived severity.

Anyway, the problems mentioned by the sample are not only aesthetic. The survey provided for the possibility of reporting different symptoms (multiple choice):

  • in 28% of cases, difficulties in chewing were mentioned
  • in 28% of cases, gum problems emerge
  • difficult oral hygiene, as disclosed by about one third of the sample
  • orthopedic and postural issues, albeit to a lesser extent
  • only 20% do not report any functional problems related to malocclusion

The propensity to solve the problem

Although with different degrees of motivation, 72% of the sample affirmed to be interested in correcting their malocclusion or misalignment. In particular, half of them (36% of total respondents) show a high motivation. Translating this into numbers, it deals with over 3 million Italians, mostly women – twice as many as men – with a significant greater interest as the evidence of the defect increases.
The strong propensity to correct their smile exceeds 50% for those who complain of a very evident misalignment and, more generally, it is over 40% among those who have both aesthetic and functional problems.

Restoring a perfect smile with the aligners

Among those wishing to correct their smile, 62% would prefer to use a transparent aligner system. For another 30%, the type of device does not matter, but it would be very important to them to solve the problem of dental misalignment. It is above all those who present more serious dental conditions who want to solve the problem, regardless of the type of medical device the orthodontist will suggest.

Limits and forecasts

Slightly more than 70% of the interviewees have already considered the possibility to consult a dentist to solve the problem, but the economic barrier is the most named brake in accepting orthodontic treatments in the short term, particularly during this time of uncertainty due to the pandemic. Nowadays, part of the population is, in fact, more cautious when taking into consideration expenses likely impacting on the family budget.

In any case, 6% have already decided to go to the dental office to solve the problem and, if the doctor evaluates positively the need to carry out the alignment orthodontic treatment, it can be estimated that almost half a million people could undergo corrective treatments soon.

Over 150,000 treatments with aligners in 2021

According to Key-Stone researchers, this figure is consistent with the measurements carried out by the research institute itself, specialized in the dental sector at international level. In fact, data coming from industry and dental practices indicate that in 2019 over 80,000 treatments with aligners were carried out (in the vast majority of cases on adults). In 2021, over 150,000 treatments will be carried out, which is twice the previous figure, after having experienced an evident slowdown in growth in 2020, due to the pandemic.

According to Key-Stone’s estimates, this is an investment for Italians which will exceed 300 million Euros by 2021 and will continue its double-digit growth in the next few years.

Patients treated with aligners

Motivation for treatment

Within the starting sample, 200 cases involving subjects who recently underwent orthodontic treatment with transparent aligners were also studied. The goal is to evaluate the reasons leading them to the treatment and the overall perceived experience.

Considering the 200 patients treated, it emerged that the psychological component is absolutely dominant in the motivation for treatment:

  • 44% in fact stated that they wanted to solve the discomfort first of all with themselves
  • 35% claimed that they wanted to improve the relationship with others, showing a social discomfort as well.


In general, the experience and perception of the treatment outcome are very positive, with 34% of treated patients affirming to have achieved a better result than expected and, undoubtedly, beyond the initial expectations. The main factors causing satisfaction are:

  • first of all, the competence and interpersonal skills of the clinician and of the clinic staff in general
  • the final result, on average very satisfactory
  • comfort and transparency as distinctive elements of the treatment.

Overall, over 85% would re-undergo the treatment and recommend it to friends and family. This means that, in addition to the strong interest of a part of the population in solving their misalignment, the positive experience of friends and relatives generates a driving force in the sector, fostering positive references and organically stimulating the demand.

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