To analyze the effects of maxillary tooth distalization by clear aligner (CA) treatment with variations in the angular direction of the distalization force, presence of attachments, and force-application method used.

Materials and Methods

A finite element model containing alveolar bone, dentition, and periodontal ligament was constructed. Analytical model groups were as follows: (1) distalization with buttons (without attachments), (2) buttons on canines (with attachments), (3) precision cuts on the canines (without attachments), and (4) precision cuts on the canines (with attachments). A distalization force of 1.5 N was applied to the button or precision cut at −30°, −20°, −10°, 0°, 10°, 20°, and 30° to the occlusal plane.


As the direction of force approached +30°, the dentition inclined posteriorly. The posterior movement pattern was significantly influenced by the presence of an attachment and the direction of force, rather than the area where the force was applied. Distal inclination was dramatically reduced with attachments. A disengagement or deformation of the CA may reduce the distalization efficiency of the dentition or move the dentition in an inappropriate direction.


Attachments for efficient distalization by the CA are necessary. The use of miniscrews in the direction of force parallel to the occlusal plane is more advantageous than the use of Class II elastics. Due to CA deformation, distalization with the button on the canines can be more effective for distal movement of the maxillary dentition.

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Author notes


Adjunct Assistant Professor, Department of Orthodontics, Pusan National University, and private practice, Busan, South Korea.


Resident, Dental Research Institute, Pusan National University Dental Hospital, Yangsan, South Korea.


Clinical Associate Professor, Department of Orthodontics, Pusan National University Hospital, Busan, South Korea.


Professor, Department of Orthodontics, School of Dentistry, Pusan National University; Dental Research Institute, Yangsan, South Korea.


Professor, Department of Orthodontics; and Dental Life and Science Institute, Pusan National University, and Dental Research Institute, Yangsan, South Korea.

The first two authors contributed equally to this work.