Integration of skeletal anchorage and clear aligners in challenging malocclusions: A case series

Aim: Advances in technology have extended the use of clear aligners (CA) to more complex cases, such as severe crowding, extraction protocols, and distalization movements. However, achieving controlled tooth movement in these cases remains challenging. This case series evaluates the combined use of CA and Temporary anchorage devices (TADs) in managing complex vertical malocclusions, focusing on biomechanical ef cacy, aesthetic out-comes, and clinical efficiency. Materials and Methods: Three clinical complex cases were analyzed: vertical bilateral traction of impacted maxillary canines, intrusion of a supra-erupted molar due to missing antagonists, and simultaneous intrusion and distalization of the upper arch in a hyperdivergent patient. In each case, palatal or interradicular Mini screws were strategically placed to ensure controlled tooth movement while preserving aesthetics to overcome the limitations of CA. Results: The combination of CA and TADs successfully achieved controlled extrusion of impacted canines, precise intrusion of supra-erupted teeth, and reliable intrusion with distalization of the upper arch without compromising biomechanical ef ciency. Enhanced patient compliance further reduced treatment duration and improved clinical outcomes. Conclusion: The integration of TADs with CA enabled effective, predictable tooth movement, signi cantly expanding the applicability of CA to complex malocclusions. This integrated method balances aesthetics and biomechanics, offering a reliable, patient-friendly solution for achieving optimal functional and aesthetic orthodontic outcomes