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In recent years, there has been a growing demand for aesthetic orthodontic treatments, leading to the rise in popularity of clear aligners. These aligners offer a discreet and convenient alternative to traditional braces, but certain tooth movements, such as extrusion, remain challenging. Extrusion requires precise and stable force application, which clear aligners alone may struggle to achieve. To address this, attachments-small, tooth-colored composite resin pieces-are strategically placed on teeth to enhance aligner grip and improve force transmission. Various attachment designs exist, each with unique benefits for specific movements like extrusion. This systematic review aims to analyze the efficacy of different attachment designs in generating extrusive forces. By examining studies such as randomized controlled trials and FEM studies, the review seeks to provide evidence-based guidance for orthodontists. The goal is to enhance treatment outcomes, improve patient satisfaction, and offer clinicians valuable insights into optimizing clear aligner therapy through effective attachment selection.