The effects of lingual buttons, precision cuts, and patient-specific attachments during maxillary molar distalization with clear aligners: Comparison of finite element analysis

Introduction: This study aimed to analyze the biomechanical effects of the combined use of clear aligners (CA) and auxiliaries (precision cuts, lingual buttons, and patient-specific attachments) on mesial tipping and extrusion of the premolars during maxillary molars distalization. Methods: Three-dimensional finite element method was employed to simulate clinical scenarios of CA with different auxiliaries for molar distalization. As such, 200 g of distal force was applied to the microimplants from the notches, lingual buttons, and hooks. Orthodontic tooth movement and the hydrostatic pressure in the periodontal ligament were compared. Results: Adding auxiliaries can provide the maxillary arch anchorage and promote the distal tipping of premolars and retroclination of maxillary incisors. In contrast, this effect was more pronounced in patient-specific attachment applications than in other types of auxiliaries. The independent application of the CA caused mesial tipping and extrusion of the premolar and also caused the incisor proclination. Conclusions: The anchorage loss caused by the CA alone could be alleviated with the assistance of auxiliaries. Notably, patient-specific attachments further reinforce the anchorage of the anterior arch by incorporating anchor teeth as 1 anchorage unit.