ArticleBMC oral health2026
Biomechanical analysis of implant anchorage versus class II elastics in maxillary anterior retraction with clear aligners: a three-dimensional iterative finite element study.
Article in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundClear aligners are widely used for their esthetic advantages, yet anchorage control in extraction cases remains challenging, often leading to the "roller-coaster effect"-characterized by anterior tipping, extrusion, and posterior mesial drift. Evidence comparing anchorage strategies to mitigate this effect is limited. This study used iterative finite element analysis to evaluate two anchorage modalities during maxillary anterior retraction with clear aligners.
methodsThree-dimensional models of maxillary teeth, periodontal ligaments, alveolar bone, and aligners were constructed from cone-beam CT data. An improved displacement-driven iterative simulation (10 iterations, 2 mm total retraction post-first premolar extraction) compared three conditions: control (M1), implant anchorage (M2), and Class II elastics (M3). Tooth displacement, inclination, occlusal plane rotation, and periodontal ligament stress were analyzed.
resultsBoth implant anchorage and Class II elastics effectively reduced posterior mesial movement, yet vertical control differed markedly between them. Implant anchorage minimized anterior extrusion and produced canine intrusion, whereas Class II elastics aggravated the roller-coaster effect through greater anterior extrusion and more pronounced lingual tipping. It also limited clockwise rotation of the anterior occlusal plane most effectively, while the control group exhibited the largest counterclockwise rotation of the posterior occlusal plane. Periodontal ligament stress distribution in the anterior region further highlighted these differences: it showed higher tensile stress peaks with Class II elastics but greater compressive stress at the palatal mid-root areas with implant anchorage.
conclusionsImplant anchorage is biomechanically preferable for hyperdivergent or deep-bite patients requiring strong vertical control. Class II elastics necessitate overcorrection to offset adverse effects. The iterative approach effectively reveals long-term biomechanical trends and supports personalized treatment planning, pending clinical validation.
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