Canine substitution using clear aligners—a case report and literature review

This case report describes a 16-year-old male patient who presented with bilateral peg-shaped lateral incisors, Class II Division 1 incisors and a Class II buccal occlusion. The patient chose to remove the peg-shaped lateral incisors and have the anterior spaces closed using clear aligners. The treatment involved 11 mm of space closure gained by retracting the central incisors and mesialisation of the posterior teeth. A satisfactory aligner result was achieved after 20 months. Following space closure, canine enameloplasty was performed using the central incisors as a reference. The colour of the canines will be improved through whitening after the completion of orthodontic treatment. The present study describes the successful closure of an 11 mm space using clear aligners to allow for canine substitution, thereby demonstrating the effectiveness of aligners in complex cases requiring large space closure and precise root movement control. It provides an insight into an alternative approach for managing similar cases. The present report highlights the importance of individualised treatment planning, optimal design of the aligner attachments, good control of root movements, and the regional acceleratory phenomenon (RAP) in the success of canine substitution. The treatment strategy could serve as a useful reference for practitioners dealing with similar orthodontic challenges.