To analyse the biomechanics of molar protraction through clear aligner therapy (CAT) with and without a buccal cantilever.

Models were composed of mandible, lower dentition, periodontal ligaments, attachments, a buccal cantilever, and clear aligner. Four groups were designed: (1) control (aligner only), (2) aligner+buccal cantilever with buccal class II traction, (3) aligner+buccal cantilever with buccal class II and lingual class II tractions, (4) aligner+buccal cantilever with buccal horizontal traction named buccal class I, buccal class II, and lingual class II tractions.

CAT alone caused mesial tipping, lingual tipping, and intrusion of mandibular second molar. Adding the buccal cantilever on the mandibular second molar with 100-g buccal class II traction was effective in preventing the mesial tipping of mandibular second molar, but resulted in a greater lingual tipping tendency. Further addition of lingual class II traction prevented aforementioned lingual tipping and bodily protraction was achieved in sagittal dimension, while buccal tipping was present. Bodily protraction without buccolingual tipping was achieved through clear aligner, buccal class II, lingual class II, and buccal class I tractions, and the stress concentrated on the alveolar bone was reduced.

CAT produced mesial tipping, lingual tipping, and intrusion of mandibular molar during protraction. The incorporation of the buccal cantilever into the clear aligner improves the biomechanical effect of molar protraction. Bodily molar protraction can be achieved with a judicious combination of buccal class II, lingual class II and buccal class I tractions with clear aligner and buccal cantilever.