Optimal positions of clear aligner attachments to achieve lower canine tipping and bodily movement using finite element analysis

Background/purpose; Clear aligners are popular orthodontic tools because of their relatively aesthetic appearance and convenience of use. Nevertheless, bodily tooth movements still present challenges. This study evaluated various configurations of attachments placed on the mandibular canine in terms of the efficiency of canine bodily movement and correction of tipping. Materials and methods: A finite element model of the mandible was constructed to investigate the effects of various attachment configurations on the overall bodily movement and undesirable tipping of a mandibular canine. Canine movements were categorized into four types, namely tipping and bodily movements in the mesial and distal directions. The size and shape of the attachments were fixed, but their placement and orientation were varied. Five and seven attachment configurations were evaluated for their influence on tipping and bodily movements, respectively. Results: Attachment configuration significantly influenced mandibular canine tipping. The mesial occlusal-distal cervical and mesial occlusal-mesial cervical configurations had notable effects on mesial tipping, and the mesial occlusal-mesial cervical configuration excelled in distal tipping by increasing strain by 33.1%. The mesial occlusal-mesial cervical attachment configuration consistently had superior efficiency in facilitating both mesial and distal bodily movements of the canine. Conclusion: The mesial occlusal-mesial cervical attachment configuration excelled in all four types of canine movement. Irrespective of the attachment configuration, canines tend to move overall with slight tipping due to skeletal resistance and their center of rotation. The attachment configuration is crucial to the success of clear aligner treatment and must be carefully considered in clinical practice.