Green orthodontics: From clinical innovation to climate responsibility

Climate change has transitioned from an abstract global concern to a defining determinant of health, healthcare delivery, and professional responsibility. The healthcare sector is estimated to contribute nearly 5% of global greenhouse gas emissions,^[1] yet dentistry and orthodontics in particular remain underrepresented in sustainability discourse. Orthodontic care is uniquely resource-intensive, characterized by extensive plastic use, including aligners, energy-dependent technologies, outsourced laboratory workflows, and repeated patient visits over prolonged treatment durations.^[2,3] As a specialty rooted in prevention and long-term outcomes, orthodontics cannot remain detached from the environmental consequences of routine clinical practice.

Although recent literature has acknowledged the environmental burden of dentistry,^[4] most discussions remain descriptive and fragmented. Sustainability is frequently framed as an ethical aspiration rather than an operational responsibility embedded within everyday orthodontic workflows. There remains a clear gap between awareness and actionable, specialty-specific implementation models. This editorial argues that orthodontics requires a paradigm shift-from isolated “green” initiatives to structured, system-level integration of sustainability principles.

We propose green orthodontics as an emerging discipline and introduce the Eco-Ortho Framework [Figure 1] as a conceptual model to guide sustainable orthodontic practice. Rather than functioning as a rigid protocol, the Eco-Ortho Framework is designed as a flexible overlay that integrates sustainability into existing clinical systems – similar to infection control or quality assurance frameworks. It brings together material stewardship, digital workflows, intelligent scheduling, and environmental risk awareness into a unified clinical philosophy.

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Figure 1:

Schematic overview of the suggested Eco-Ortho framework.

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A central pillar of the framework is green chain orthodontics, which re-examines the orthodontic supply chain from procurement to disposal. Orthodontic materials are traditionally evaluated based on cost, convenience, and clinical performance, with limited attention to environmental impact. Digital intraoral scanning^[5] exemplifies how sustainability and clinical efficiency can align by eliminating disposable impression materials, reducing physical storage demands, and minimizing transport-related emissions. Parallel developments in biodegradable and plant-based 3D printing materials further support a transition toward environmentally responsible laboratory practices.^[6] While such measures alone cannot neutralize the environmental footprint of orthodontics, they represent meaningful steps toward responsible material governance.

However, sustainability in digital orthodontics must be approached with nuance. Digital workflows depend on energy-intensive infrastructure, including scanners, 3D printers, cloud-based storage, and AI platforms. These systems rely on continuous electricity supply and water-intensive cooling mechanisms within data centers, introducing indirect carbon and water costs.^[7] The Eco-Ortho Framework, therefore, advocates a digital trade-off axis that is a selective, efficiency-driven digitalization, ensuring that reductions in material waste, laboratory logistics, and patient travel outweigh the environmental costs of digital infrastructure [Figure 2].

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Figure 2:

Digital trade-off axis.

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Another core component is bio-adaptive scheduling, which reframes appointment planning as both a clinical and environmental decision. Frequent in-person visits contribute significantly to travel-related emissions and clinic energy consumption.^[3] Advances in teleorthodontics, smart appliances, and AI-assisted remote monitoring now permit effective treatment supervision with fewer physical visits.^[8] Strategically clustering appointments into high-efficiency clinical time blocks, often described as “green blocks,” can further optimize energy use related to lighting, Heating, ventilation and air conditioning (HVAC) systems, and chair occupancy. In this model, sustainability becomes an extension of clinical efficiency rather than an additional burden.

The framework also incorporates material life cycle orthodontics, encouraging clinicians to consider the full life span of orthodontic materials: from raw material extraction to end-of-life disposal. Orthodontic plastics, metals, and packaging do not cease to exist after clinical use; instead, they accumulate within broader waste streams with long-term ecological and public health implications. This life-cycle perspective aligns orthodontics with contemporary environmental governance principles increasingly adopted across healthcare systems.^[9]

Importantly, the Eco-Ortho Framework extends beyond routine sustainability to incorporate disaster risk awareness. Plastic pollution is no longer viewed solely as an environmental concern but as a systemic risk. International instruments such as the Basel Convention^[10] have expanded regulatory oversight of plastic waste, while ongoing United Nations negotiations toward a legally binding Global Plastics Treaty reflect growing recognition of plastics as a transboundary hazard. Inadequately managed clinical plastics contribute to environmental vulnerability, exacerbating disaster risks during floods, waste surges, and public health emergencies, as highlighted during the COVID-19 pandemic. Positioning orthodontic waste management within disaster risk reduction frameworks elevates sustainability from an ethical choice to a resilience strategy.

The Eco-Ortho Framework also promotes reflective practice through structured self-assessment. Sustainability scorecards and graded benchmarks are not intended as regulatory tools but as mechanisms for awareness, incremental improvement, and professional accountability. When integrated into routine audits, such approaches can normalize sustainability as a quality indicator alongside treatment outcomes and patient safety.

For sustainability initiatives to achieve meaningful impact, they must extend beyond individual clinics. Professional bodies, accreditation agencies, and educational institutions play a critical role in embedding environmental responsibility into orthodontic identity. Integrating sustainability principles into postgraduate curricula, continuing education, and institutional audits can accelerate cultural change. At a policy level, aligning orthodontic sustainability initiatives with national health strategies and global environmental agreements ensures coherence between clinical practice and planetary health goals.

Green orthodontics is not a peripheral concern but a professional obligation in an era where clinical excellence must coexist with environmental stewardship. The Eco-Ortho Framework offers a pragmatic pathway for this transition - one that does not ask orthodontists to choose between excellence and responsibility, but to recognize that, in a climate-constrained world, the two are inseparable. Green orthodontics is not about doing less; it is about doing better, with foresight, accountability, and respect for both present patients and future generations.