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The Accuracy of Maxillary Canines' Rotation with Different Attachment Designs: A Retrospective Study.

Edoardo Staderini1,2,3, Marianna Balacco1, Federica Guglielmi1,2,3

  • 1Department of Head and Neck and Sense Organs, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, 00168 Rome, Italy.

Journal of Clinical Medicine
|January 28, 2026
PubMed
Summary

Clear aligner treatment for significant maxillary canine rotations is challenging. Oblique crescent-shaped attachments showed a trend toward improved rotational control compared to vertical and horizontal designs in this study.

Keywords:
accuracyattachment designclear alignersmaxillary caninerotational accuracy

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Area of Science:

  • Orthodontics
  • Biomaterials Engineering

Background:

  • Maxillary canine rotation exceeding 10° with clear aligners presents predictability challenges.
  • Rounded crown morphology and limited aligner grip contribute to difficulties in achieving precise canine rotations.

Purpose of the Study:

  • To compare the effectiveness of three crescent-shaped attachment designs (vertical, horizontal, oblique) for clear aligner therapy.
  • To evaluate rotational accuracy for maxillary canines requiring rotations greater than 10°.

Main Methods:

  • Retrospective analysis of 78 maxillary canines treated with clear aligners.
  • Categorization into three groups based on attachment orientation: vertical, horizontal, or oblique.
  • Assessment of rotational accuracy using digital models and 3D software by comparing planned vs. achieved rotations.

Main Results:

  • Mean rotational accuracy was 55.10% (vertical), 62.40% (horizontal), and 64.60% (oblique).
  • No overall statistically significant difference was found among the three groups (p=0.09).
  • Pairwise comparison indicated a statistically significant difference favoring oblique attachments over vertical ones (p=0.05).

Conclusions:

  • Attachment orientation may impact the accuracy of maxillary canine rotation using clear aligners.
  • Oblique crescent-shaped attachments demonstrated a potential trend towards enhanced rotational control for significant canine rotations.