Biomechanical effect of combined use of mini-screws and aligners in preventing uncontrolled tipping of the incisor and mesial tipping of the molar: a three-dimensional finite element study

Abstract Background This study aimed to evaluate the effect of external force applied from mini-screws to the aligner during space closure in extraction cases, and to determine the optimal loading conditions to prevent lingual crown tipping of the incisor and mesial tipping of the molar using the finite element (FE) method. Methodology A three-dimensional FE model of the maxillary dentition with extraction of first premolars was constructed, and three different loading conditions were designed. The aligner was activated for 0.25 mm of incisor retraction without using mini-screws, with application of 0, 100, 200, or 300 cN of distal force through mini-screws placed in the posterior region, or with application of 0, 100, 200, 300, or 400 cN of intrusive force through mini-screws placed in the anterior region, in addition to the application of 300 cN of distal force. Results As the magnitude of distal force increased, the degree of mesial tipping of the first molar gradually decreased, becoming almost zero with nearly 300 cN of distal force. As the magnitude of intrusive force increased in addition to the application of 300 cN of distal force, the degree of lingual crown tipping of the central incisor gradually decreased, becoming almost zero with nearly 400 cN of intrusive force. Conclusion Application of 300 cN of distal force to the aligner from mini-screws placed in the posterior region could completely prevent mesial tipping of the molar and anchorage loss during anterior retraction. Application of 400 cN of intrusive force from mini-screws placed in the anterior region could prevent lingual crown tipping of the incisor, thus providing better torque control for the incisors.