Enhancing the predictability of tooth movements with clear aligners-Part 2: Clinical strategies.

Abstract

Despite rapid advances in clear aligner therapy, the low predictability of aligner tooth movements remains a clinical challenge. This article (part 2) translates the conceptual biomechanical triad of anchorage, stress continuity, and aligner-tooth contact, along with the related determinant factors, described in part 1 into practical strategies to enhance the predictability of tooth movements with clear aligners. This paper features 3 interrelated strategic domains: patient-centered, aligner-mediated, and practitioner-directed strategies. Patient-centered strategies emphasize appropriate aligner case selection, aligner-favored treatment planning, and difficulty-based patient management. Aligner-mediated strategies focus on choosing optimal aligner materials, reducing aligner stress concentration, and optimizing aligner designs. Furthermore, practitioner-directed strategies highlight the practitioner's active role in managing the fundamental prerequisites of tooth movements (ie, force, space, and time). This is achieved through deliberate overtreatment with aligners, biomechanical augmentation with attachments and auxiliaries, judicious staging sequences that prioritize predictable movements, and dynamic monitoring and troubleshooting protocols. Collectively, in clinical practice, the 3 strategic domains should not be isolated but rather be integrated to achieve predictable tooth movements with clear aligners.