In recent decades, there has been an increase in the number of patients, predominantly adults, who present with complex dental problems & seek orthodontic treatment. These patients typically present with complex problems & specific characteristics, including their periodontal condition, the presence or necessity of prosthetic reconstructions & further issues. Consequently, these patients frequently exhibit increased anchorage requirements that cannot be met by conventional anchorage methods, such as transpalatal arches. Furthermore, treatment with clear aligners is generally indicated for simple to moderate non-skeletal malocclusions. Nevertheless, this treatment modality is also subject to certain limitations, including cases necessitating tooth extractions, skeletal anterior-posterior discrepancies exceeding 2 mm, severely rotated teeth, & teeth with short clinical crowns. Moreover, the restricted capacity for manipulation of root movement, in conjunction with the constrained potential for intermaxillary correction, may be regarded as inherent constraints of this methodology. However, the utilization of clear aligners in conjunction with TADs has been demonstrated to facilitate the management of these issues with a high degree of efficacy. This approach enables the provision of support during the process of orthodontic tooth movement, thereby ensuring optimal outcomes. Orthodontic TADs have been employed with great efficiency in the field of orthodontics for the purpose of anchorage reinforcement. However, depending on the biomechanical factors & the specific conditions of the individual patient, orthodontic biomechanics should be carefully considered & utilized during treatment as well. It is imperative that all these issues are given due consideration when orthodontic management is being planned for these patients. This lecture will present & discuss several conditions highlighting the proper use of orthodontic miniscrew implants & aligners in practice.

Learning Objective 1:
Understanding Treatment Limitations Across Orthodontic Modalities
Participants will be able to explain why conventional orthodontic anchorage methods are insufficient for certain patient populations with complex problems (missing teeth, severe periodontal conditions, short clinical crowns). They will understand that clear aligners are generally indicated for simple to moderate non- skeletal problems, but are subject to certain limitations including cases requiring tooth extractions, skeletal discrepancies exceeding 2 mm, and severely rotated teeth. Learners will recognize how TADs provide skeletal anchorage to overcome these constraints and address the restricted capacity for root movement manipulation inherent in both conventional and clear aligner approaches.

Learning Objective 2:
Clinical Decision-Making for Appropriate Treatment Selection
Participants will be able to identify specific clinical conditions where clear aligners, conventional orthodontics, or TADs are appropriately indicated versus contraindicated. They will understand that treatment modality selection must consider the complexity of the case, with clear aligners suited for simple to moderate cases, while TADs facilitate management of complex cases requiring skeletal anchorage. They will recognize that proper patient selection and understanding of each modality's limitations are critical for successful outcomes.

Learning Objective 3:
Integration of Biomechanical Principles Across Treatment Modalities
Participants will be able to apply orthodontic biomechanical principles when planning treatment with clear aligners, conventional appliances, and TADs for anchorage reinforcement. They will understand that successful implementation of any orthodontic approach requires careful consideration of biomechanical factors and homeostatic conditions of individual patients, ensuring optimal treatment outcomes through evidence-based clinical practice.