Temporary skeletal anchorage devices to correct challenging malocclusions with clear aligners

Clear aligners are esthetical mechanics that provide good pushing (compressive) loads when they are well-fitted to the surfaces of teeth. They were considered excellent for a pushing (compression)–type movement but poor for pulling (tension) to close large molar spaces and were inappropriate for short clinical crowns with few if any undercuts. However, temporary skeletal anchorage devices such as miniscrews can provide strong anchorage for pull (tensile) loads. In this article, the extraalveolar miniscrews were placed in the mandibular buccal shelf or mandibular ramus in the mandible and infrazygomatic crest in the maxilla to integrate with clear aligners for retraction, uprighting, and erupting impactions or correcting the severe posterior lingual crossbite. By demonstrating these challenging patients, the authors wish to raise clinicians’ awareness of the importance of extending treatment possibilities.