Total arch distalisation using clear aligners and micro-implant anchorage for treating crowding and lip protrusion in an adult

This case report presents a treatment approach which combines clear aligners and skeletal anchorage, mainly micro-implants, to address crowding and lip protrusion in a middle-aged adult who presented with multiple prosthetic restorations. Tooth movements were strategically staged in a virtual setup, beginning with canine retraction using micro-implants to resolve anterior crowding, followed by en-masse distalisation of the dentition. For refinement, additional in-house aligners were employed alongside fixed auxiliaries. The total treatment duration was 9 months, demonstrating high time efficiency. Cone beam computed tomography superimposition indicated posterior tooth distalisation, slight dental arch expansion, and predominantly tipping movements of the distalised teeth. This approach of total arch distalisation rather than conventional sequential distalisation, proved to be temporally efficient against equivalent treatment results. Further research is warranted to improve biomechanical predictability and develop standardised treatment protocols.