## 4 Results and Discussion
### Macro-Staging and Micro-Staging
#### 4.3.1 Macro-Staging
Establish the Distribution and Sources of Anchorage  
Clear aligner orthodontics has three possible sources of anchorage that can be combined or used individually: (1) differential intra-arch anchorage, (2) inter-arch anchorage with elastics, and (3) skeletal anchorage. The selection of anchorage at this point defines the strategy. The same staging of movements is not programmed for a patient planning upper arch disletalization using only intra-arch anchorage compared to combining it with the use of skeletal anchorage. In the first situation, the orthodontis should be more careful with the anchorage balance, moving at most two teeth at a time per hemirarch [22; 41], whereas if skeletal anchorage is strategically employed, more teeth can be moved simultaneously, compensating for the lack of intra-arch anchorage [42; 43]. Among the possibilities that can be planned during the macro-staging, there are three mechanics that are especially dependent on a structured staging: (1) distalizations or mesializations, (2) absolute vertical movements of anterior teeth, and (3) closing extraction spaces [21]. The standard staging for the distalization of upper molars was described by [PERSON] [44] as follows: _\"The distalization starts with the upper second molars, and once the second molars are \({}^{2}\!/_{3}\) of the way, then the upper first molars move back, then premolars, and so on. For the anterior teeth, distalize the amines, and then distalize/retrocline the upper incisors\"_. With slight modifications, this proposal evolved into the sequential distalization \({}^{1}\!/_{2}\) pattern, where at most two teeth are moved per hemirach, except for the incisors, which are treated as a single block. This staging has been used by several authors, achieving bodily movement of upper molars of up to 3 mm without appreciable vertical changes [22; 40]. Figure 2: Creating the necessary conditions to maximize predictability. Teen patient with crowding, increased overbite, and pronounced lower Spee curve (**A**,**B**). During the macro-staging, it was established to reduce the overbite through relative and absolute intrusion of the lower anterior teeth due to their mid-line smile (**C**). From aligner #1 to #27, the alignment and leveling of premolars and molars were programmed to reinforce the posterior anchorage segments, simultaneously derotating the canines and aligning the incisors by tipping the crowns labially (**D**). Intraoral situation at aligner #28 (**E**). Optimized rotation and optimized root control attachments for the lower premolars were replaced with optimized deep bite attachments to increase posterior retention (**F**). From aligner #28 to the end, absolute intrusion of lower incisors was performed (**G**). Intraoral situation at the end of the first set of aligners, with a flat lower Spee curve (**H**). Patient’s smile at the end of treatment (**I**). It is crucial to note that no more than two teeth per quadrant are moved simultaneously, as sometimes simultaneous displacement of the first premolars, amines, and incisors can occur because the algorithm tries to avoid opening spaces between the upper lateral incisors and canines when a standard sequential distalization pattern is requested with Invisalign [45]. The difference between a real \({}^{1}/_{2}\) pattern and a false \({}^{1}/_{2}\) pattern can be observed in Figure 3. There is a variation of the \({}^{1}/_{2}\) staging that includes buccal crown inclination movements of incisors during molar distalization [45]. This modification does not significantly impact performance, as it benefits from the synergistic mechanics of both movements and allows for the accelerated anterior esthetic improvement of the patient. Despite this, to date, we have not found publications that compare different distalization staging and their efficacy in the clinical setting. Absolute vertical movements are complex and are associated with low predictability [46; 47] or frequent loss of tracking.