---
type: Article
title: "Complex Cases: Aligners and Skeletal Anchorage"
description: "Case study by Dr. Steinmaier (née Funke): Aligners combined with skeletal anchorage for complex malocclusions – explained for patients."
resource: https://www.just-kfo.de/en/specialist-publications/complex-cases-aligners-skeletal-anchorage/
language: en
tags: [orthodontics, specialist-publications]
timestamp: 2026-09-04T13:59:37+02:00
---

# Complex Cases: Aligners and Skeletal Anchorage

Approaching complex orthodontic treatment cases using aligners in combination with skeletal anchorage

Some orthodontic starting situations are particularly challenging — for instance, when multiple misalignments occur simultaneously and a tooth must be replaced or a gap closed. The following real treatment case from our Cologne practice demonstrates how even such a complex case can be resolved using clear aligners when combined with stable anchorage in the palate.

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The Initial Situation
An adult patient required extraction of an upper first molar. Rather than replacing the resulting gap with an implant, she preferred the most inconspicuous orthodontic solution possible.1 Additional findings included severe crowding in the lower jaw, an anterior open bite, and a unilateral crossbite. Such a combination requires particularly careful three-dimensional planning.
The treatment approach
Gap closure instead of implant
Instead of artificially filling the gap, the posterior teeth were moved forward in a controlled manner to close it naturally. Moving large teeth over such a distance requires very stable anchorage — provided by a palatal system with small mini-implants.2 You can read more about how this technique is used in classic gap closure in the posterior region on our page about the Mesialslider in the posterior dentition.
Aligners for overall correction
The actual tooth alignment was accomplished with clear aligners. They provided nearly invisible treatment and controlled tooth movements precisely.3 To resolve the severe crowding in the lower jaw, a single lower incisor was additionally removed4 — a proven approach in such cases to create space quickly and gently without compromising the profile. Learn more about treatment with clear aligners on our dedicated page.
The treatment result
In the end, the gap from the extracted molar was completely closed, the open bite corrected5 , and the teeth brought into harmonious, functional occlusion. The patient received a balanced smile and stable bite — without an implant and without visible appliances during treatment.
What this case demonstrates
Even complex initial situations with multiple simultaneous misalignments can now be treated with clear aligners, provided they are combined with suitable skeletal anchorage. While this article presents a particularly challenging case, you will find detailed information on routine space closure in the posterior region on our page about mesialization in the posterior region. In every case, precise planning and good patient compliance remain essential. To read how this case progressed from the patient's perspective, see our case study: Complex Correction in Adults.

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Sources:

Re, S., Cardaropoli, D., Corrente, G., & Abundo, R. (2001). Bodily tooth movement through the maxillary sinus with implant anchorage for single tooth replacement. Clinical Orthodontics and Research, 4(3), 177–181. https://doi.org/10.1034/j.1600-0544.2001.040308.x

Wilmes, B., Nienkemper, M., Nanda, R., Lübberink, G., & Drescher, D. (2013). Palatally anchored maxillary molar mesialization using the mesialslider. Journal of Clinical Orthodontics, 47(3), 172–179.

Rossini, G., Parrini, S., Castroflorio, T., Deregibus, A., & Debernardi, C. L. (2015). Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review. The Angle Orthodontist, 85(5), 881–889. https://doi.org/10.2319/061614-436.1

Palikaraki, G., Karamesinis, K., & Damanakis, G. (2018). Orthodontic treatment in a periodontal patient with incisor extraction using the Invisalign clear aligner system: A case report. Journal of Aligner Orthodontics, 2(4), 317–323.

Dayan, W., Aliaga-Del Castillo, A., & Janson, G. (2019). Open-bite treatment with aligners and selective posterior intrusion. Journal of Clinical Orthodontics, 53, 53–54.