上顎側切歯の移動が「遅れている（計画より進まない／傾斜・挙上が不十分）」場合、クリアアライナー特有の限界に合わせたリカバリーが有効です。以下はエビデンスに基づく選択肢です。
**原因と評価（なぜ遅れるか）**
– クリアアライナーでは前歯の牽引で「舌側傾斜（根が前方へ倒れない）」「挙上不足」「犬歯の遠心傾斜」「臼歯の近心傾斜」が起こりやすく、設計予測よりも達成度が低下します（回転・垂直移動の達成率が特に低い） [1][2][3]。
– 側切歯は抜歯症例や群牽引で「遠心傾斜」「根の後方移動不足」「過挙上」などの不一致が出やすい部位です [1][4][5]。
**リカバリー設計（計画の見直し）**
– **アタッチメントの再設計・追加**：犬歯への縦長矩形や最適化アタッチメントは前歯トルクと挙上の予測性を改善します（犬歯・前歯の身体移動に有利） [6][7][8]。側切歯自体にも適切なアタッチメントを付与すると遠心傾斜の軽減に寄与します [4]。
– **オーバートリートメント（過補正）**：インシサルのトルク・挙上は過補正が必要（例：犬歯アタッチ併用で約1.2°の過補正で中切歯の身体牽引を得る、歯種ごとの過補正比を高める） [9][10]。厚めアライナー＋パワーリッジで根の口蓋側トルクと挙上を増やせます [11]。
– **ステージング調整**：犬歯を「先行牽引（canine‑first）」にすると前歯の不正傾斜が減り、側切歯の遠心傾斜を抑制できます [4][12][13]。
– **IPR（ディスク法など）精度改善**：スペース確保が不十分ならIPRの実行精度を高める（モータ駆動法が精度良好）ことで計画通りの並進を支援します [14][15][16]。
**補助装置の併用（ハイブリッド）**
– **ミニスクリュー＋エラスティック**：前歯群牽引で「根の口蓋側トルク」「挙上」を得やすく、舌側傾斜を是正できます（唇側より舌側エラスティックが有利） [17]。ただし後方アンカレッジ管理が必要です [1][10]。
– **部分舌側装置の併用**：回転や難移動で、アライナー単独より回転精度が大幅に向上します（平均精度約88% vs 56%） [18]。
**安全性とリスク管理**
– 根吸収はアライナーで平均0.13–0.55 mm程度と軽微で、固定装置より少ない傾向ですが、過度の挙上・トルク設計や皮質骨近接はリスクを上げます [19][20][21]。
– 開放空隙（ブラックトライアングル）はアタッチメント数やIPR量の分布と関連し得るため設計を慎重に [22]。
まとめると、側切歯の遅れには、アタッチメント再設計・過補正・犬歯先行牽引・精度の高いIPR、さらに必要に応じてミニスクリューや部分舌側装置の併用を組み合わせるのが効果的です。これらは前歯の「根のコントロール（トルク）」と「垂直管理（挙上）」を強化し、計画達成率を高めます [2][4][7][8][9][10][11][17][18]。
[1] Jiang et al., “Clear aligners for maxillary anterior en masse retraction: a 3D finite element study.”,
Scientific reports (2020).
https://pubmed.ncbi.nlm.nih.gov/32576935/
[2] Vicioni-Marques et al., “Space closure after premolar extraction using clear aligners: a systematic review with meta-analysis.”,
Clinical oral investigations (2025).
https://pubmed.ncbi.nlm.nih.gov/40892106/
[3] Harandi et al., “Assessment of clear aligner accuracy of 2 clear aligners systems.”,
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (2023).
https://pubmed.ncbi.nlm.nih.gov/37498253/
[4] Yan et al., “Mesiodistal angulation change of the maxillary lateral incisor in the extraction treatment by clear aligner- a retrospective cone-beam computed tomography study.”,
BMC oral health (2025).
https://pubmed.ncbi.nlm.nih.gov/40604817/
[5] Wang et al., “Tridimensional Analysis of Maxillary Teeth Movements in Premolar-Extraction Cases Treated With Clear Aligners.”,
International dental journal (2025).
https://pubmed.ncbi.nlm.nih.gov/41317686/
[6] Ahmed et al., “Effects of varying attachment positions on palatal displacement of maxillary incisors with clear aligner therapy : A three-dimensional finite element analysis.”,
Surgery (2022).
https://pubmed.ncbi.nlm.nih.gov/35061060/
[7] Ren et al., “The predictability of orthodontic tooth movements through clear aligner among first-premolar extraction patients: a multivariate analysis.”,
Progress in orthodontics (2022).
https://pubmed.ncbi.nlm.nih.gov/36581703/
[8] Chanduka et al., “Optimization of the effectiveness of lower canine retraction: A FEM comparison of different attachment systems with no attachments in clear aligners.”,
International orthodontics (2025).
https://pubmed.ncbi.nlm.nih.gov/41270426/
[9] Wen et al., “Predictability of curve of Spee levelling and vertical tooth movements in the lower arch with clear aligners based on cone-beam computed tomography.”,
Clinical oral investigations (2025).
https://pubmed.ncbi.nlm.nih.gov/40481966/
[10] Liu et al., “The effects of aligner overtreatment on torque control and intrusion of incisors for anterior retraction with clear aligners: A finite-element study.”,
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (2022).
https://pubmed.ncbi.nlm.nih.gov/35219555/
[11] Cheng et al., “The three-dimensional displacement tendency of teeth depending on incisor torque compensation with clear aligners of different thicknesses in cases of extraction: a finite element study.”,
BMC oral health (2022).
https://pubmed.ncbi.nlm.nih.gov/36384512/
[12] Tang et al., “Effects of canine movement on maxillary anterior en-masse retraction with clear aligners: a finite element study.”,
BMC oral health (2025).
https://pubmed.ncbi.nlm.nih.gov/40038618/
[13] Bocchino et al., “Maxillary Impacted Canine and Upper Lateral Incisor Agenesis Treatment with “Canine First Technique” and Clear Aligners: A Case Report.”,
Healthcare (Basel, Switzerland) (2023).
https://pubmed.ncbi.nlm.nih.gov/37628542/
[14] Güleç-Ergün et al., “Comparison of the accuracy of three interproximal reduction methods used in clear aligner treatment.”,
Clinical oral investigations (2024).
https://pubmed.ncbi.nlm.nih.gov/38221544/
[15] Har-Zion, “A new bur for interproximal reduction of anterior teeth.”,
Journal of orthodontics (2025).
https://pubmed.ncbi.nlm.nih.gov/40735797/
[16] Ergün et al., “Evaluation of the Consistency of Two Interproximal Reduction Methods in Clear Aligner Therapy: A Preliminary Study.”,
Turkish journal of orthodontics (2024).
https://pubmed.ncbi.nlm.nih.gov/38556946/
[17] Liu et al., “Effectiveness of an anterior mini-screw in achieving incisor intrusion and palatal root torque for anterior retraction with clear aligners.”,
The Angle orthodontist (2021).
https://pubmed.ncbi.nlm.nih.gov/34061964/
[18] Cremonini et al., “Accuracy of a clear aligner hybrid approach in managing severe rotations of rounded teeth : A retrospective cohort study.”,
Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie (2026).
https://pubmed.ncbi.nlm.nih.gov/41609796/
[19] Song et al., “Factors influencing fenestration and dehiscence in the anterior teeth after clear aligner treatment: a multicenter retrospective study.”,
Progress in orthodontics (2025).
https://pubmed.ncbi.nlm.nih.gov/41091392/
[20] Li et al., “Prevalence and severity of apical root resorption during orthodontic treatment with clear aligners and fixed appliances: a cone beam computed tomography study.”,
Progress in orthodontics (2020).
https://pubmed.ncbi.nlm.nih.gov/31903505/
[21] Aman et al., “Apical root resorption during orthodontic treatment with clear aligners: A retrospective study using cone-beam computed tomography.”,
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (2018).
https://pubmed.ncbi.nlm.nih.gov/29853242/
[22] Zhang et al., “IPR treatment and attachments design in clear aligner therapy and risk of open gingival embrasures in adults.”,
Progress in orthodontics (2023).
https://pubmed.ncbi.nlm.nih.gov/36617584/
ボタンの使用は？
ボタン（コンポジット製のボタン／精密切り込み＋ボタン併用）は、インビザラインで側切歯の「遅れ（特に挙上・トルク不足）」を補うための補助として有効です。適応と限界を踏まえて設計します。
**ボタンの役割（エラスティック併用）**
– **牽引力の伝達効率**：フックよりボタンの方が牽引力の伝達損失が少なく、約96%を歯列へ分配できるため（フックは約84%）、前歯挙上や群牽引で有利です [1]。
– **トルク・挙上の補助**：前歯の一括牽引で、ミニスクリューとボタンを用いたラビアル／リンガル方向のエラスティックは、根の口蓋側トルクと切歯の侵入（挙上方向の制御）を生じさせ、アライナー単独の舌側傾斜・押し出しを是正します。リンガル側エラスティックの方が副作用（頬側開咬など）が少ない傾向です [2]。
**側切歯の挙上・トラッキング改善**
– **水平アタッチ＋ボタンの併用**：側切歯の挙上は達成率が低く（平均約62–79%達成、最適化より水平アタッチが有利）、ボタンや補助牽引の追加で不足分を補います [3]。
– **アタッチ形状との組み合わせ**：水平矩形や半楕円アタッチは挙上力を高め、不要なモーメントを抑えます（例：中帯の矩形で最大Fz、不要モーメント少） [4][5][6][7]。アタッチなしでは挙上力がほぼ得られません [8]。
**設計上の注意（力の方向・副作用）**
– **力の配分とアンカレッジ**：ボタン牽引だけではアライナー由来の反作用力を完全に相殺できないため、強めのエラスティック、装着時間延長、あるいは骨性アンカレッジの併用を検討します [1][9]。
– **トルク損失への対策**：上顎切歯トルクは予測通りに出にくく（平均効率約47%）、過補正やパワーリッジ・厚めトリムラインの併用が推奨されます [10][11][12][13]。
– **臨床達成率の現実値**：回転・挙上は平均達成率が約47–63%で、過補正や再スキャン（リファイン）を前提に計画します [14][15]。
**まとめ**
– ボタンはエラスティック牽引の効率を高め、側切歯の挙上・トルク補助に有用です。水平系アタッチと組み合わせ、必要ならミニスクリュー併用でアンカレッジを補強し、過補正を設計してください [1][2][3][7][9][10][12]。
[1] Song et al., “Force distributions associated with different elastic traction methods for maxillary dentition distalization by clear aligners: an in-vitro study.”,
BMC oral health (2025).
https://pubmed.ncbi.nlm.nih.gov/40251540/
[2] Liu et al., “Effectiveness of an anterior mini-screw in achieving incisor intrusion and palatal root torque for anterior retraction with clear aligners.”,
The Angle orthodontist (2021).
https://pubmed.ncbi.nlm.nih.gov/34061964/
[3] Groody et al., “Effect of clear aligner attachment design on extrusion of maxillary lateral incisors: A multicenter, single-blind randomized clinical trial.”,
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (2023).
https://pubmed.ncbi.nlm.nih.gov/37610383/
[4] Costa et al., “Effect of three different attachment designs in the extrusive forces generated by thermoplastic aligners in the maxillary central incisor.”,
Dental press journal of orthodontics (2020).
https://pubmed.ncbi.nlm.nih.gov/32844975/
[5] Bojrab et al., “In Vitro Comparison of the Effectiveness of Different Attachment Shapes and Locations on Extrusion of the Upper Left Lateral Incisor Using Thermoplastic Aligners.”,
Orthodontics & craniofacial research (2024).
https://pubmed.ncbi.nlm.nih.gov/39706801/
[6] Laohachaiaroon et al., “Initial Displacement and Stress Distribution of Upper Central Incisor Extrusion with Clear Aligners and Various Shapes of Composite Attachments Using the Finite Element Method.”,
Dentistry journal (2022).
https://pubmed.ncbi.nlm.nih.gov/35735656/
[7] Elshazly et al., “Effect of attachment configuration and trim line design on the force system of orthodontic aligners: A finite element study on the upper central incisor.”,
Orthodontics & craniofacial research (2024).
https://pubmed.ncbi.nlm.nih.gov/38459802/
[8] Kaur et al., “In Vitro Biomechanics of Attachment Use and Their Placement for Extrusive Tooth Movement by Aligner Mechanotherapy.”,
Orthodontics & craniofacial research (2025).
https://pubmed.ncbi.nlm.nih.gov/39912367/
[9] Marinelli et al., “Temporary Anchorage Devices in Clear Aligner Therapy: A Systematic Review.”,
Bioengineering (Basel, Switzerland) (2025).
https://pubmed.ncbi.nlm.nih.gov/40428150/
[10] Hong et al., “Efficacy of upper-incisor torque control with clear aligners: a retrospective study using cone-beam computed tomography.”,
Clinical oral investigations (2023).
https://pubmed.ncbi.nlm.nih.gov/37036513/
[11] Tang et al., “Upper incisal torque movement with clear aligners: A three‑dimensional finite element analysis.”,
Journal of the World federation of orthodontists (2025).
https://pubmed.ncbi.nlm.nih.gov/40442002/
[12] Cheng et al., “The three-dimensional displacement tendency of teeth depending on incisor torque compensation with clear aligners of different thicknesses in cases of extraction: a finite element study.”,
BMC oral health (2022).
https://pubmed.ncbi.nlm.nih.gov/36384512/
[13] Hong et al., “Effect of varying auxiliaries on maxillary incisor torque control with clear aligners: A finite element analysis.”,
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (2024).
https://pubmed.ncbi.nlm.nih.gov/38639703/
[14] Bates et al., “Perceived efficacy of extrusion of maxillary lateral incisors with aligners.”,
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (2022).
https://pubmed.ncbi.nlm.nih.gov/36376173/
[15] Karras et al., “Efficacy of Invisalign attachments: A retrospective study.”,
American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (2021).
https://pubmed.ncbi.nlm.nih.gov/34217574/
