Advanced CAT (clear aligner therapy) Anchorage - Part I : Evolution of CAT, understanding limitations and sagittal considerations

Abstract

Orthodontic treatment with clear aligner therapy (CAT) faces challenges in real-time adjustments compared to fixed appliances. CAT limitations, such as predictability and efficacy, are well-documented, raising questions about treatment outcomes and defining "ideal" results in a commercialized context. If we condone inadequate standards in Orthodontics, we undermine the integrity of our profession, jeopardizing patient outcomes and potentially driving them towards unqualified alternatives. Challenges can be addressed by utilizing skeletal anchorage methods like Temporary Anchorage Devices (TADs), and integrating CAT with complementary treatments for improved efficacy. Miniscrew skeletal anchorage complements aligners by providing additional support for tooth movement. However, excessive forces from mini-screws can disrupt aligner guidance, requiring caution during treatment. Part I of the paper focuses on limiting factors and sagittal corrections elaborated with CAT, while Part II of this series covers vertical and transverse applications with a special focus on interdisciplinary treatment modalities. Ample cases for each scenario were included.