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Distal Upper Molar Force Distribution With Clear Aligners Using Different Anterior Teeth Anchorage Setups: A Finite

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Passive anchorage is more effective for clear aligner molar distalization, minimizing side effects like anterior tooth movement. Active anchorage forces can compromise aligner control and treatment outcomes.

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Area of Science:

  • Orthodontics
  • Biomaterials Engineering
  • Dental Mechanics

Background:

  • Clear aligners are increasingly used for orthodontic treatment, but achieving controlled molar distalization without affecting other teeth remains a challenge.
  • Various strategies, including Class II elastics and attachments, have been explored to improve molar distalization with clear aligners.
  • Temporary anchorage devices (TADs) offer potential for enhanced anchorage during clear aligner therapy.

Purpose of the Study:

  • To evaluate the effectiveness of different clear aligner setups for distalizing upper molars using Finite Element Analysis (FEA).
  • To compare passive anchorage (ligature tie) versus active anchorage (1.66 N force) for molar distalization.
  • To assess the influence of vertical attachments on molar distalization outcomes.

Main Methods:

  • Six FEA models were created to simulate molar distalization with 0.2 mm distal activation.
  • Models differed in premolar/molar attachments and anchorage type: passive (ligature tie) or active (1.66 N force).
  • Anchorage was applied using extra-alveolar screws or canine buttons.

Main Results:

  • All tested setups successfully distalized second molars.
  • Passive anchorage systems were more efficient (over 90% distalization-to-anchorage loss ratio) and had fewer side effects than active systems (65%).
  • Passive anchorage minimized unintended anterior tooth movement and allowed for beneficial distal canine movement, unlike active anchorage which caused significant midline (X-axis) canine movement and anterior intrusion (Z-axis).

Conclusions:

  • Passive anchorage, akin to a ligature wire, provides superior control for clear aligner molar distalization compared to active forces.
  • Active anchorage forces may deform clear aligners, compromising treatment control and biomechanics.
  • Passive anchorage supports planned tooth movements without disrupting the overall biomechanical system.