A novel hybrid method for orthodontic leveling and aligning using custom tunnel attachments paired with clear aligners

This study aims to develop and formally describe a novel hybrid method which incorporates a wire into computer-designed tunnel attachments used in conjunction with clear aligners to overcome certain limitations in orthodontic tooth movements using clear aligner therapy. The method was demonstrated on a patient with a non-tracking tipped lower second premolar. The geometry and size of tunnel attachments, transfer method, and archwires used in this hybrid system are described. Virtual planning was utilized to find the orientation of the tunnel attachments. The method was effective in improving non-tracking tipped teeth. This method can be used in correcting rotations of conical teeth, vertical movements, correcting angulation and inclination. This novel hybrid method can be used to address limitations with stand-alone clear aligner therapy and customize approaches to treat malocclusions.