Abstract

Customised Planning of Extraction Cases with Aligners: towards safer orthodontics

by Molinari Camilla

Over the past two decades, clear aligners have emerged as an increasingly popular alternative to fixed appliances in the management of mild to moderate malocclusions. However, tooth movement achieved with aligners is inherently more complex compared to that obtained with conventional fixed appliances. This complexity may be attributed to the lack of specific points of force application, the anatomical characteristics of individual teeth, the intrinsic properties of the aligner material, the geometric mismatch between aligners and dental structures, as well as other biomechanical factors. A thorough understanding of the biomechanical components of this technique—namely material properties, attachments, and staging protocols—has therefore become essential when addressing malocclusions, particularly in complex scenarios such as extraction cases. Given these critical challenges, it is not only necessary to master the underlying biomechanics but also to appropriately select cases in which an extraction-based treatment protocol may be indicated. In recent years, the evidence-based integration of mandibular repositioning technologies in combination with aligners has reduced the reliance on camouflage extractions in the management of Class II malocclusions. This lecture will examine the clinical challenges associated with aligner therapy, with a focus on the biomechanical considerations that can enhance the predictability of orthodontic outcomes. Emphasis will be placed on appropriate case selection and meticulous treatment planning tailored to the specific type of malocclusion presented by each patient.

Learning Objectives

After this lecture, you will be able to identify the potential and limitations of treatment objectives in the management of challenging tooth movements.
After this lecture, you will be able to understand the role of attachments and staging protocols in addressing complex malocclusions.
After this lecture, you will be able to select the most suitable cases for extraction therapy with aligners, while also appreciating the alternative potential of emerging mandibular advancement technologies in the treatment of Class II malocclusions.