Retinoids, derivatives of vitamin A, play a crucial role in various physiological processes, including vision, immune function, bone mineralization and cellular differentiation. Isotretinoin (13-cis-retinoic acid), a powerful retinoid is widely used in treating severe acne, particularly in adolescents and young adults. As the patient population experiencing the onset of severe acne coincides with the largest patient age group requesting orthodontic treatment, the impact of isotretinoin on bone metabolism raises concerns. This manuscript reviews the mechanism of action of isotretinoin and its effects on bone and the implications for orthodontic tooth movement in clinical practice.