Dipalma Gianna, Marinelli Grazia, Inchingolo Francesco, Longo Marialuisa, Di Giulio Cesare Maral, Di Serio Sharon, Palermo Andrea, Del Fabbro Massimo, Inchingolo Alessio Danilo, Inchingolo Angelo Michele
Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy.
Department of Biomedical, Surgical and Dental Sciences, Milan University, 20122 Milan, Italy.
J Funct Biomater. 2025 Sep 19;16(9):354. doi: 10.3390/jfb16090354.
Class II malocclusion is one of the most common and challenging orthodontic problems, often requiring complex, lengthy treatment and sometimes involving extractions or surgery. While conventional fixed appliances have been the gold standard, the increasing demand for aesthetic and comfortable treatment alternatives has made clear aligners a prevalent choice. Understanding the specific biomechanics, limitations, and successful clinical strategies for using aligners-especially in managing vertical dimension and achieving skeletal correction (mandibular advancement)-is crucial for expanding non-invasive treatment options and improving outcomes for a broad range of Class II patients.
The objective of this review is to examine the effectiveness and clinical approaches of clear aligners in Class II correction across different age groups, with particular attention to vertical control, mandibular advancement methods, and the predictability of tooth movements in both growing and fully mature patients.
This review narratively discusses the most relevant clinical findings and practical strategies for managing Class II malocclusions with clear aligners. Particular attention is given to the integration of auxiliary devices, such as elastics, attachments, and temporary anchorage devices (TADs), which can enhance biomechanical control.
The combination of aligners with mini-implants and attachments resulted in a consequent decrease in excessive overjet, improvement in facial profile, and long-term stability supported by fixed retention. In growing patients, correction benefited from mandibular advancement protocols and control of molar extrusion, allowing for preservation of the mandibular plane angle. Movement predictability showed higher reliability in anterior torque movements, whereas maxillary incisor intrusion remained less predictable.
Clear aligners, especially when supported by auxiliary device, such as mini-implants and attachments, offer a reliable and aesthetic alternative to conventional orthodontic treatment for Class II malocclusions. However, certain tooth movements may still be less predictable, highlighting the need for careful planning, individualized biomechanics, and ongoing technological improvements.
Ⅱ类错颌是最常见且具挑战性的正畸问题之一，通常需要复杂、漫长的治疗，有时还涉及拔牙或手术。虽然传统固定矫治器一直是金标准，但对美观且舒适的治疗选择的需求不断增加，使得透明矫治器成为一种普遍的选择。了解使用透明矫治器的特定生物力学、局限性和成功的临床策略，尤其是在控制垂直维度和实现骨骼矫正（下颌前突）方面，对于扩大非侵入性治疗选择和改善广泛的Ⅱ类患者的治疗效果至关重要。
本综述的目的是研究透明矫治器在不同年龄组Ⅱ类错颌矫治中的有效性和临床方法，特别关注垂直控制、下颌前突方法以及生长发育期和完全成熟患者牙齿移动的可预测性。
本综述以叙述方式讨论了使用透明矫治器治疗Ⅱ类错颌的最相关临床发现和实用策略。特别关注弹性牵引、附件和临时支抗装置（TADs）等辅助装置的整合，这些装置可增强生物力学控制。
透明矫治器与微型种植体和附件的结合导致覆盖过大明显减小，面部轮廓改善，并且通过固定保持获得长期稳定性。在生长发育期患者中，矫治受益于下颌前突方案和磨牙垂直萌出控制，从而保留了下颌平面角。移动可预测性在前牙转矩移动中显示出更高的可靠性，而上颌切牙压低的可预测性仍然较低。
透明矫治器，尤其是在微型种植体和附件等辅助装置的支持下，为Ⅱ类错颌的传统正畸治疗提供了一种可靠且美观的替代方案。然而，某些牙齿移动可能仍然较难预测，这凸显了精心规划、个性化生物力学以及持续技术改进的必要性。
