Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical Outcomes

<b>Background:</b> Distalization is a fundamental orthodontic strategy for correcting Class II and Class III malocclusions, particularly in cases where specific dental or skeletal conditions favor its application. Recent technological advances have enabled complex dental movements to be...

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Main Authors: Teresa Pinho, Diana Melo, Sofia Ferreira, Maria Gonçalves
Format: Article
Language:English
Published: MDPI AG 2025-07-01
Series:Dentistry Journal
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Online Access:https://www.mdpi.com/2304-6767/13/7/316
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author Teresa Pinho
Diana Melo
Sofia Ferreira
Maria Gonçalves
author_facet Teresa Pinho
Diana Melo
Sofia Ferreira
Maria Gonçalves
author_sort Teresa Pinho
collection DOAJ
description <b>Background:</b> Distalization is a fundamental orthodontic strategy for correcting Class II and Class III malocclusions, particularly in cases where specific dental or skeletal conditions favor its application. Recent technological advances have enabled complex dental movements to be performed using clear aligners, aided by digital planning platforms such as ClinCheck<sup>®</sup>. <b>Methods:</b> This retrospective study aimed to evaluate the accuracy of ClinCheck<sup>®</sup> in predicting molar and canine distalization outcomes with the Invisalign<sup>®</sup> system and to identify clinical factors influencing treatment predictability. Thirty patients with complete permanent dentition and at least 2 mm of programmed distalization were selected. Planned movements were extracted from the Invisalign<sup>®</sup> Doctor Site and compared to achieved outcomes using Geomagic<sup>®</sup> Control X™ software. Occlusal improvements were assessed using the <i>Peer Assessment Rating (PAR) index</i>. <b>Results:</b> The results revealed significant discrepancies between the programmed and achieved distalization, with mean deviations greater than 1 mm in both arches. Skeletal anchorage with <i>mini-screws</i> significantly improved distalization outcomes in the maxillary arch; however, no significant effect was observed in the mandibular arch. Additionally, no significant associations were found between distalization outcomes and skeletal pattern (<i>ANB angle</i>) or <i>facial biotype</i>. <b>Conclusions:</b> Clear aligners are effective in achieving substantial occlusal improvements, particularly when combined with personalized digital planning and supplementary strategies such as skeletal anchorage. Mandibular cases demonstrated greater reductions in PAR scores, emphasizing the potential of aligners in complex distalization treatments.
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spelling doaj-art-375a5fb7abca44b7a2e85ee4188ac95e2025-08-20T03:08:05ZengMDPI AGDentistry Journal2304-67672025-07-0113731610.3390/dj13070316Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical OutcomesTeresa Pinho0Diana Melo1Sofia Ferreira2Maria Gonçalves3UNIPRO—Oral Pathology and Rehabilitation Research Unit, University Institute of Health Science (IUCS—CESPU), 4585-116 Gandra, PortugalUNIPRO—Oral Pathology and Rehabilitation Research Unit, University Institute of Health Science (IUCS—CESPU), 4585-116 Gandra, PortugalUNIPRO—Oral Pathology and Rehabilitation Research Unit, University Institute of Health Science (IUCS—CESPU), 4585-116 Gandra, PortugalAssociate Laboratory I4HB, Institute for Health and Bioeconomy, University Institute of Health Sciences (IUCS—CESPU), 4585-116 Gandra, Portugal<b>Background:</b> Distalization is a fundamental orthodontic strategy for correcting Class II and Class III malocclusions, particularly in cases where specific dental or skeletal conditions favor its application. Recent technological advances have enabled complex dental movements to be performed using clear aligners, aided by digital planning platforms such as ClinCheck<sup>®</sup>. <b>Methods:</b> This retrospective study aimed to evaluate the accuracy of ClinCheck<sup>®</sup> in predicting molar and canine distalization outcomes with the Invisalign<sup>®</sup> system and to identify clinical factors influencing treatment predictability. Thirty patients with complete permanent dentition and at least 2 mm of programmed distalization were selected. Planned movements were extracted from the Invisalign<sup>®</sup> Doctor Site and compared to achieved outcomes using Geomagic<sup>®</sup> Control X™ software. Occlusal improvements were assessed using the <i>Peer Assessment Rating (PAR) index</i>. <b>Results:</b> The results revealed significant discrepancies between the programmed and achieved distalization, with mean deviations greater than 1 mm in both arches. Skeletal anchorage with <i>mini-screws</i> significantly improved distalization outcomes in the maxillary arch; however, no significant effect was observed in the mandibular arch. Additionally, no significant associations were found between distalization outcomes and skeletal pattern (<i>ANB angle</i>) or <i>facial biotype</i>. <b>Conclusions:</b> Clear aligners are effective in achieving substantial occlusal improvements, particularly when combined with personalized digital planning and supplementary strategies such as skeletal anchorage. Mandibular cases demonstrated greater reductions in PAR scores, emphasizing the potential of aligners in complex distalization treatments.https://www.mdpi.com/2304-6767/13/7/316distalizationInvisalignclear alignersmini-screwsPAR index
spellingShingle Teresa Pinho
Diana Melo
Sofia Ferreira
Maria Gonçalves
Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical Outcomes
Dentistry Journal
distalization
Invisalign
clear aligners
mini-screws
PAR index
title Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical Outcomes
title_full Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical Outcomes
title_fullStr Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical Outcomes
title_full_unstemmed Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical Outcomes
title_short Distalization with Clear Aligners: Accuracy, Impact of Mini-Screws, and Clinical Outcomes
title_sort distalization with clear aligners accuracy impact of mini screws and clinical outcomes
topic distalization
Invisalign
clear aligners
mini-screws
PAR index
url https://www.mdpi.com/2304-6767/13/7/316
work_keys_str_mv AT teresapinho distalizationwithclearalignersaccuracyimpactofminiscrewsandclinicaloutcomes
AT dianamelo distalizationwithclearalignersaccuracyimpactofminiscrewsandclinicaloutcomes
AT sofiaferreira distalizationwithclearalignersaccuracyimpactofminiscrewsandclinicaloutcomes
AT mariagoncalves distalizationwithclearalignersaccuracyimpactofminiscrewsandclinicaloutcomes