Mechanical and geometric properties of thermoformed and 3D printed clear dental aligners

Validation of a double-semicircular notched configuration for mechanical testing of orthodontic thermoplastic aligner materials

The potential of using specimens with a double-semicircular-notched configuration for performing tensile tests of orthodontic thermoplastic aligner materials was explored. Unnotched and double-semicircular-notched specimens were loaded in tension using a universal testing machine to determine their tensile strength, while finite element analysis (FEA) and digital image correlation (DIC) were used to estimate stress and strain, respectively. The shape did affect the tensile strength, demonstrating the importance of unifying the form of the specimen. During the elastic phase under tension, double-semicircular-notched specimens showed similar behavior to unnotched specimens. However, great variance was observed in the strain patterns of the unnotched specimens, which exhibited greater chance of end-failure, while the strain patterns of the double-semicircular-notched specimens showed uniformity. Considerable agreement between the theoretical (FEA) and practical models (DIC) further confirmed the validity of the double-semicircular-notched models.

The Influence of Thickness on the Mechanical Behaviors of 3D Printing Resins for Orthodontic Retainers

This study aimed to evaluate the mechanical behaviors of thermoformed and 3D-printed retainers with different thicknesses. Thermoformed retainers (Duran) and 3D-printed retainers (Dental LT Clear V2 and NextDent Ortho Flex) were fabricated at thicknesses of 0.5, 0.75, and 1 mm. Five samples of each material were subjected to compression, tensile, and flexural testing with the universal testing machine (Instron Ltd., Buckinghamshire, England). The results revealed that the mechanical behaviors were significantly influenced by thickness in each type of material. The increased thickness tended to increase strength and modulus in all three tests. However, Dental LT Clear V2 and Duran showed that flexural strength and modulus were inversely related to thickness. The compressive test revealed significantly greater compressive resistance in 3D-printed groups, except for the NextDent Ortho Flex at 0.5 mm. The tensile test showed that Dental LT Clear V2 at all thicknesses demonstrated significantly higher tensile strength and modulus, while NextDent Ortho Flex was significantly lowest at any thickness in tensile and flexural properties. In conclusion, the thickness significantly influenced the mechanical behaviors of the 3D-printed retainers. The 0.75 mm thickness of Dental LT Clear V2 could be considered as an alternative to fabricated retainers due to its similar mechanical properties compared with the thermoformed material.

Evaluation of thickness of 3D printed versus thermoformed aligners: A prospective in vivo ageing experiment

BACKGROUND

To compare and investigate the effects of intraoral ageing on the thickness of one group of directly printed and two groups of thermoformed aligners on the labial surface of maxillary central incisors.

MATERIALS AND METHODS

Six groups (12 samples per group) were included in this prospective in vivo experiment. Groups DP-Clin, INV-Clin and CA-Clin consisted of directly printed (Tera Harz TC-85 DAC resin), thermoformed (Invisalign, PU based polymer) and in house thermoformed (CA-Pro, PET-G based polymer) aligners, retrieved after 1 week of intraoral service. Groups DP-Ctr, INV-Ctr and CA-Ctr included unused aligners samples. Thickness measurements were conducted using confocal laser scanning microscopy (CLSM). Data that underwent log-10 transformation was analysed by multiple linear regression analysis (p < .05).

RESULTS

Statistically significant differences were found between the materials in both Clin and Ctr categories (p < .001). Group DP had the highest thickness among the groups and the least thickness was observed in the CA group (p < .001). However, intraoral ageing did not significantly affect the aligner thickness of any groups.

CONCLUSIONS

Both thermoforming and direct printing of clear aligners led to thickness deviations in terms of increase for printed aligners and decrease for thermoformed aligners. Intraoral ageing did not affect the aligner thickness in any of the groups.

Effect of post-printing curing time on cytotoxicity of direct printed aligners: A pilot study

INTRODUCTION

The aim of this in vitro study was to examine the potential impact of different curing times of 3D-printed orthodontic aligners on their cytotoxicity.

METHOD

Some 60 samples of aligner material were directly 3D printed using Tera Harz TC-85 DAC resin and randomly allocated to three different curing time groups (14, 24 and 50 min). Zendura FLX samples were used as control. The samples were incubated in saliva for 14 days, and then the supernatant was collected. Human gingival fibroblasts (HGF-1)-CRL2014 were used to evaluate potential cytotoxicity. Furthermore, HGF-1 cells were plated on the samples as well as on a glass control sample. After 72 h of growth, their viability was tested.

RESULTS

Compared with the glass, only the 50-min curing time markedly reduced fibroblast cell growth. Additionally, a negative linear trend was observed between curing time and fibroblast growth. In comparison with the aligner control group, all samples, including the aligner control samples, exhibited a significant reduction in the viability of human fibroblasts when exposed to saliva.

CONCLUSIONS

3D directly printed aligners showed a cytotoxic effect similar to that of thermoformed conventional aligners in terms of fibroblasts growth. A linear trend was found between curing time and cells growth, indicating that directly printed aligners could exhibit higher cytotoxicity if exposed to a longer curing time. This dependence on curing time underscores the importance of following a strict manufacturing process.

Color and Chemical Stability of 3D-Printed and Thermoformed Polyurethane-Based Aligners

The significant rise in the use of clear aligners for orthodontic treatment is attributed to their aesthetic appeal, enhancing patient appearance and self-confidence. The aim of this study is to evaluate the aligners' response to common staining agents (coffee, black tea, Coca-Cola, and Red Bull) in color and chemical stability. Polyurethane-based thermoformed and 3D-printed aligners from four brands were exposed to common beverages to assess color change using a VITA Easyshade compact colorimeter after 24 h, 48 h, 72 h, and 7 days, as well as chemical stability using ATR-FTIR spectroscopy. The brand, beverage, and manufacturing method significantly influence color stability. ATR-FTIR analysis revealed compositional differences, with variations in response to beverage exposure affecting the integrity of polymer bonds. Color change analysis showed coffee as the most potent staining agent, particularly affecting Tera Harz TC85 aligners, while ClearCorrect aligners exhibited the least susceptibility. 3D-printed aligners showed a greater color change compared to thermoformed ones. Aligners with a PETG outer layer are more resistant to stains and chemical alterations than those made of polyurethane. Additionally, 3D-printed polyurethane aligners stain more than thermoformed ones. Therefore, PETG-layered aligners are a more reliable choice for maintaining the aesthetic integrity of aligners.

Recent advances in additive manufacturing of patient-specific devices for dental and maxillofacial rehabilitation

OBJECTIVES

Customization and the production of patient-specific devices, tailoring the unique anatomy of each patient's jaw and facial structures, are the new frontiers in dentistry and maxillofacial surgery. As a technological advancement, additive manufacturing has been applied to produce customized objects based on 3D computerized models. Therefore, this paper presents advances in additive manufacturing strategies for patient-specific devices in diverse dental specialties.

METHODS

This paper overviews current 3D printing techniques to fabricate dental and maxillofacial devices. Then, the most recent literature (2018-2023) available in scientific databases reporting advances in 3D-printed patient-specific devices for dental and maxillofacial applications is critically discussed, focusing on the major outcomes, material-related details, and potential clinical advantages.

RESULTS

The recent application of 3D-printed customized devices in oral prosthodontics, implantology and maxillofacial surgery, periodontics, orthodontics, and endodontics are presented. Moreover, the potential application of 4D printing as an advanced manufacturing technology and the challenges and future perspectives for additive manufacturing in the dental and maxillofacial area are reported.

SIGNIFICANCE

Additive manufacturing techniques have been designed to benefit several areas of dentistry, and the technologies, materials, and devices continue to be optimized. Image-based and accurately printed patient-specific devices to replace, repair, and regenerate dental and maxillofacial structures hold significant potential to maximize the standard of care in dentistry.

Mechanical Properties of 3D Printed Orthodontic Aligners Produced by Different Commercially Available Printers - An In-Vitro Study

The aim of this study was to compare the mechanical properties of orthodontic aligners among different commercially available 3D printing devices. Three different 3D printers were included in this study (Formlabs Form 2 3D printer; Moonray S100 printer (Sprintray, Los Angeles, CA, USA); Eden500V Stratasys 3D Printers were used to prepare orthodontic aligners with dental. The central incisors of each aligner were cut, prepared, and evaluated in terms of Martens-Hardness (HM), indentation-modulus (EIT), and elastic-index (ηIT) as per ISO14577-1:2002. Post hoc pairwise comparisons indicated no significant difference in Martens-Hardness (HM), indentation-modulus (EIT), and elastic-index (ηIT) properties in any group. Under the limitations of this study, it may be concluded that the mechanical properties of 3D-printed orthodontic aligners are dependent on the 3D printer used, and thus, differences in their clinical efficacy are anticipated.

Experimental study on dimensional variations of 3D printed dental models based on printing orientation

This research investigates the trueness and precision of 3D printing technology in dental applications, specifically focusing on dimensional variations observed in models printed at different angles. The methodology involved importing a dental model into slicing software, adjusting its orientation, and implementing support structures for stability. Subsequently, the model underwent 3D printing five times for each orientation using appropriate equipment and underwent post-processing steps, including cleaning, washing, and UV-light post-curing. The printed models were then scanned using a specialized desktop scanner for further analysis. Accuracy assessment was carried out using dedicated software, employing an algorithm for precise alignment by comparing the scanned files. Color deviation maps were utilized to visually represent variations, aiming to evaluate how positioning during printing influences the trueness and precision of 3D-printed dental models. Trueness and precision analyses involved the Shapiro-Wilk test for normality and a one-way ANOVA to compare means of three independent groups, with statistical analyses conducted using IBM SPSS Statistics software. The color maps derived from 3D comparisons revealed positive and negative deviations, represented by distinct colors. Comparative results indicated that models positioned at 0° exhibited the least dimensional deviation, whereas those at 90° showed the highest. Regarding precision, models printed at 0° demonstrated the highest reproducibility, while those at 15° exhibited the lowest. Based on the desired level of precision, it is recommended that printed models be produced at an inclination angle of 0°.

Fully digital workflow for the fabrication of occlusal stabilization splints based on individual mandibular movement

OBJECTIVE

This study was conducted to present a completely digital workflow for the fabrication of occlusal stabilization splints using CAD/CAM systems and a digital face bow based on optical sensor technology.

METHODS

Digital scans of the maxillary and mandibular arches of 20 volunteers were obtained using an intraoral scanner. Jaw relation and mandibular movements were recorded with a digital face bow via optical sensors. The virtual increase of the vertical dimension of occlusion (VDO) was then performed, after which computer-aided design (CAD) of the occlusal stabilization splints was carried out. The corresponding splints were then manufactured using digitally controlled technology.

RESULTS

A completely digital workflow for the manufacturing of occlusal stabilization splints was found to be clinically feasible. The corresponding data analysis revealed high congruence between virtual and physical occlusal contacts on the occlusal splint. Moreover, the appropriate guidance of the anterior teeth area was easily obtainable, and the time for adjusting the occlusion was less.

CONCLUSIONS

This study demonstrated that the fabrication of occlusal stabilization splints using a fully digital workflow is feasible. Compared to traditional impression-based manufacturing, several advantages of digital manufacturing include easy accessibility, time-efficient manufacturing, high-level accuracy in splint quality, and potential to manufacture duplicate splints.

CLINICAL SIGNIFICANCE

The proposed fully digital approach may help young dentists fabricating stable occlusal splints with beneficial curative effects. Meanwhile, it could also improve the production efficiency of stable occlusal splints, saving time for both doctors and patients while reducing labor costs.

Degree of cure of orthodontic composite attachments underneath aligners

The aim of this study was to assess the percentage degree of cure (DC%) of 2-mm-thick resin composite attachments used for aligner treatment. Three types of aligner - two thermoformed aligners (Clear Aligner [CLA], polyethylene terephthalate glycol modified; and Invisalign [INV], polyester urethane) and a three-dimensional-printed aligner (Graphy TC-85DAC [GRP], an acrylate-methacrylate copolymer) - were selected, along with two universal resin composites (3M Filtek Universal [FTU] and Charisma Topaz ONE [CTO]). Samples of each composite were placed under each aligner, and the degree of cure of each composite was evaluated on the top (facing the aligner) and the bottom (facing the substrate) attachment surfaces after curing. Five specimens were used per combination of aligner and composite, and an additional group of composites irradiated without aligners served as the control. The DC% measurements were performed using attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy. The DC% across the aligners were (median values) 33.8%-44.8% for CLA, 33.6%-40.8% for INV, 32.8%-40.6% for GRP, and 40.0%-51.7% for the control group. The DC% values of the attachments cured under any aligner were significantly lower than that of the corresponding control, with the values recorded on the top surfaces being 6% higher than those on the bottom surfaces after adjusting for aligner group and composite type.

Physiochemical and mechanical characterisation of orthodontic 3D printed aligner material made of shape memory polymers (4D aligner material)

OBJECTIVES

To conduct a physiochemical and mechanical material analysis on 3D printed shape-memory aligners in comparison to thermoformed aligners.

MATERIALS AND METHODS

Four materials were examined, including three thermoformed materials: CA Pro (CP), Zendura A (ZA), Zendura FLX (ZF), and one 3D printed material: Tera Harz (TC-85). Rectangular strips measuring 50 × 10 × 0.5 mm were produced from each material. Five tests were conducted, including differential scanning calorimetry (DSC), dynamic mechanical analysis (DMA), shape recovery tests, three-points bending (3 PB), and Vickers surface microhardness (VH).

RESULTS

DSC recorded glass transition temperatures (Tg) at 79.9 °C for CP, 92.2 °C for ZA, 107.1 °C for ZF, and 42.3 °C for TC-85. In DMA analysis at 20-45 °C, a prominent decrease in storage modulus was observed, exclusively for TC-85, as the temperature increased. Notably, within the temperature range of 30-45 °C, TC-85 exhibited substantial shape recovery after 10 min, reaching up to 86.1 %, while thermoformed materials showed minimal recovery (1.5-2.9 %). In 3 PB test (at 30, 37, 45 °C), ZA demonstrated the highest force at 2 mm bending, while TC-85 exhibited the lowest. Regarding VH at room temperature, there was a significant decrease for both ZA and ZF after thermoforming. ZA had the highest hardness, followed by ZF and TC-85, with CP showing the lowest values.

CONCLUSIONS

TC-85 demonstrates exceptional shape memory at oral temperature, improving adaptation, reducing force decay, and enabling, together with its higher flexibility, extensive tooth movement per step. Additionally, it maintains microhardness similar to thermoformed sheets, ensuring the durability and effectiveness of dental aligners.

CLINICAL RELEVANCE

The 3D printed aligner material with shape memory characteristics (4D aligner) has revolutionized the orthodontic aligner field. It showed mechanical properties more suitable for orthodontic treatment than thermoforming materials. Additionally, it offers enhanced control over aligner design and thickness, while optimizing the overall workflow. It also minimizes material wastage, and reduces production expenses.

Chemical-Physical Characterization of PET-G-Based Material for Orthodontic Use: Preliminary Evaluation of micro-Raman Analysis

OBJECTIVES

 Orthodontic treatment with clear thermoplastic aligners is in great demand by patients especially for aesthetics. Any alterations in the chemical composition of the thermoplastic material for aligners, subjected to the oral environment and exposure to various commonly used substances, could influence the desired orthodontic movement decreasing the predictability of the treatment. The objective of this study was to determine the chemical-physical characterization by micro-Raman spectroscopy of a thermoplastic material based on polyethylene terephthalate glycol (PET-G) used for the manufacture of Lineo aligners (Micerium Lab, Avegno, Italy) subjected to different staining beverages and cleaning agents.

MATERIALS AND METHODS

 Twenty-two thermoformed PET-G samples were immersed to various substances of daily use for 10 and 15 days (coffee, tea, Coca-Cola, red wine, colloidal silver disinfectant, nicotine, artificial saliva, cigarette smoke, and different combinations of saliva with some of the previous solutions). Subsequently, the chemical-physical characterization was investigated by micro-Raman spectroscopy.

RESULTS

 The analysis of the spectra acquired for all the specimens showed no difference in the exposure to the different solvents at 10 and 15 days. Furthermore, having ascertained the heterogeneous surface morphology of the PET-G material due to thermoforming, various deposits were present on all the samples whose consistency and concentration depended on the substance used.

CONCLUSION

 The spectroscopic investigations have provided a precise and detailed analysis of the qualitative and structural data of the PET-G material under examination. No significant structural modifications of the thermoplastic polymer were found after immersion in different solutions in the exposure times adopted.

Design, Stereolithographic 3D Printing, and Characterization of TPMS Scaffolds

Anatomical and functional tissue loss is one of the most debilitating problems and involves a great cost to the international health-care sector. In the field of bone tissue, the use of scaffolds to promote tissue regeneration is a topic of great interest. In this study, a combination of additive manufacturing and computational methods led to creating porous scaffolds with complex microstructure and mechanical behavior comparable to those of cancellous bone. Specifically, some representative models of triply periodic minimal surfaces (TPMSs) were 3D-printed through a stereolithographic technique using a dental resin. Schwarz primitive and gyroid surfaces were created computationally: they are characterized by a complex geometry and a high pore interconnectivity, which play a key role in the mechanism of cell proliferation. Several design parameters can be varied in these structures that can affect the performance of the scaffold: for example, the larger the wall thickness, the lower the elastic modulus and compressive strength. Morphological and mechanical analyses were performed to experimentally assess the properties of the scaffolds. The relationship between relative density and elastic modulus has been analyzed by applying different models, and a power-law equation was found suitable to describe the trend in both structures.

Advancements in Clear Aligner Fabrication: A Comprehensive Review of Direct-3D Printing Technologies

Clear aligners have revolutionized orthodontic treatment by offering an esthetically driven treatment modality to patients of all ages. Over the past two decades, aligners have been used to treat malocclusions in millions of patients worldwide. The inception of aligner therapy goes back to the 1940s, yet the protocols to fabricate aligners have been continuously evolved. CAD/CAM driven protocol was the latest approach which drastically changed the scalability of aligner fabrication-i.e., aligner mass production manufacturing. 3D printing technology has been adopted in various sectors including dentistry mostly because of the ability to create complex geometric structures at high accuracy while reducing labor and material costs-for the most part. The integration of 3D printing in dentistry has been across, starting in orthodontics and oral surgery and expanding in periodontics, prosthodontics, and oral implantology. Continuous progress in material development has led to improved mechanical properties, biocompatibility, and overall quality of aligners. Consequently, aligners have become less invasive, more cost-effective, and deliver outcomes comparable to existing treatment options. The promise of 3D printed aligners lies in their ability to treat malocclusions effectively while providing esthetic benefits to patients by remaining virtually invisible throughout the treatment process. Herein, this review aims to provide a comprehensive summary of studies regarding direct-3D printing of clear aligners up to the present, outlining all essential properties required in 3D-printed clear aligners and the challenges that need to be addressed. Additionally, the review proposes implementation methods to further enhance the effectiveness of the treatment outcome.

Effect of printing orientation on mechanical properties of 3D-printed orthodontic aligners

PURPOSE

The purpose of this study was to assess differences in the fundamental mechanical properties of resin-made three-dimensional (3D) printed orthodontic aligners according to the printing orientation.

METHODS

Twenty resin 3D-printed dumbbell-shaped specimens and 20 orthodontic aligners were fabricated and postcured in nitrogen. Half of the specimens and aligners were built in horizontal (H), the other half in vertical (V) directions. The dumbbell-shaped specimens were loaded in a tensile testing machine, while parts of the aligners were embedded in acrylic resin, ground, polished, and then underwent instrumented indentation testing (IIT). Mechanical properties that were assessed included the yield strength (YS), breaking strength (BS), plastic strain (ε), Martens hardness (HM), indentation modulus (EIT), elastic index (ηIT), and indentation relaxation (RIT). Data were analyzed statistically with independent t‑tests or Mann-Whitney tests at α = 5%.

RESULTS

No significant differences were found between specimens or aligners printed either in a horizontal or a vertical direction (P > 0.05 in all instances). Overall, the 3D-printed aligners showed acceptable mechanical propertied in terms of YS (mean 19.2 MPa; standard deviation [SD] 1.7 MPa), BS (mean 19.6 MPa; SD 1.2 MPa), ε (mean 77%; SD 11%), HM (median 89.0 N/mm2; interquartile range [IQR] 84.5-90.0 NN/m2), EIT (median 2670.5 MPa; IQR 2645.0-2726.0 MPa), ηIT (median 27.5%; IQR 25.9-28.1%), and RIT (mean 65.1%; SD 3.5%).

CONCLUSION

Printing direction seemed to have no effect on the mechanical properties of 3D-printed resin aligners, which are promising for orthodontic use.

Comparative assessment of orthodontic clear aligner versus fixed appliance for anterior retraction: a finite element study

BACKGROUND

The aim of this study is to conduct a comparative evaluation of different designs of clear aligners and examine the disparities between clear aligners and fixed appliances.

METHODS

3D digital models were created, consisting of a maxillary dentition without first premolars, maxilla, periodontal ligaments, attachments, micro-implant, 3D printed lingual retractor, brackets, archwire and clear aligner. The study involved the creation of five design models for clear aligner maxillary anterior internal retraction and one design model for fixed appliance maxillary anterior internal retraction, which were subsequently subjected to finite element analysis. These design models included: (1) Model C0 Control, (2) Model C1 Posterior Micro-implant, (3) Model C2 Anterior Micro-implant, (4) Model C3 Palatal Plate, (5) Model C4 Lingual Retractor, and (6) Model F0 Fixed Appliance.

RESULTS

In the clear aligner models, a consistent pattern of tooth movement was observed. Notably, among all tested models, the modified clear aligner Model C3 exhibited the smallest differences in sagittal displacement of the crown-root of the central incisor, vertical displacement of the central incisor, sagittal displacement of the second premolar and second molar, as well as vertical displacement of posterior teeth. However, distinct variations in tooth movement trends were observed between the clear aligner models and the fixed appliance model. Furthermore, compared to the fixed appliance model, significant increases in tooth displacement were achieved with the use of clear aligner models.

CONCLUSIONS

In the clear aligner models, the movement trend of the teeth remained consistent, but there were variations in the amount of tooth displacement. Overall, the Model C3 exhibited better torque control and provided greater protection for posterior anchorage teeth compared to the other four clear aligner models. On the other hand, the fixed appliance model provides superior anterior torque control and better protection of the posterior anchorage teeth compared to clear aligner models. The clear aligner approach and the fixed appliance approach still exhibit a disparity; nevertheless, this study offers a developmental direction and establishes a theoretical foundation for future non-invasive, aesthetically pleasing, comfortable, and efficient modalities of clear aligner treatment.

Alterations in the surface roughness and porosity parameters of directly printed and Invisalign aligners after 1 week of intraoral usage: An in vivo prospective investigation

INTRODUCTION

Direct printing of clear aligners could be the next paradigm shift in modern orthodontics and can potentially overcome the limitation of the indirect production method. This study investigated the effects of 1 week of intraoral usage on the surface roughness parameters of directly printed aligners (DPAs) and commercially produced Invisalign aligners compared with their unused control counterparts using confocal laser scanning microscopy.

METHODS

The study consisted of 4 groups with 34 samples per group. Unused control aligners were allocated to the control groups (DP-Ctr and INV-Ctr). Sixty-eight patients undergoing clear aligner therapy were allocated to group DP-Clin (patients in therapy using DPAs made from TC-85 DAC resin) and group INV-Clin (patients provided with Invisalign aligners). After 1 week of intraoral usage, the aligners were retrieved from the patients in groups DP-Clin and INV-Clin. Samples were made from the buccal surface of the maxillary right central incisor of each aligner and underwent surface roughness and porosity measuring using confocal laser scanning microscopy. The arithmetic mean deviation of the profile, root mean square deviation, maximum peak height, maximum valley depth, maximum height difference among the highest peak and deepest valley, void volume, and void count were measured. Descriptive analysis and median (quantile) regression models were used for data analysis of this experiment.

RESULTS

One week of intraoral usage significantly increased the surface roughness and porosity of DPAs. In contrast, a significant reduction in the surface roughness and porosity parameters of Invisalign aligners was recorded after intraoral service.

CONCLUSIONS

This study suggests an increase in the surface roughness and surface porosity of DPAs following 1 week of intraoral usage, which might lead to an increase in bacterial adhesion and biofilm formation in these aligners.

Mechanical properties of materials for 3D printed orthodontic retainers

AIM

The purpose of this study was to compare the mechanical properties of materials used for orthodontic retainers made by direct 3D printing and thermoforming.

The effect of crowding on the accuracy of 3-dimensional printing

INTRODUCTION

The purpose of this study was to evaluate the accuracy of 3-dimensional (3D) printed aligners compared to conventional vacuum-formed thermoplastic aligners with varying levels of dental crowding.

METHODS

Digital intraoral scans of 10 cases were assigned to their respective groups (n = 10, each, 30 total) as follows: no crowding (control), moderate crowding, and severe crowding. Digital images of these models were created in standard tessellation language (STL) file format using 3Shape software and randomly 3D printed. The STL files of each case were also sent to a dental laboratory to fabricate vacuum-formed samples, the current technology used for manufacturing aligners. The intaglio surfaces of fabricated aligners in both groups were scanned using cone beam computed tomography to create STL files, which were then compared to the original STL files of the cases using Geomagic Control X software. Absolute deviations from the original file and root mean square values were recorded. A Kruskal-Wallis test was conducted to analyze the difference in average deviation, and a t-test was repeated for the RMS measure. The significance level was set at 0.05.

RESULTS

The crowding did not affect the trueness of aligners manufactured using 3D printing or conventional vacuum-forming techniques (P = 0.79). 3D-printed aligners showed less deviation than the vacuum-formed samples (0.1125 mm vs 0.1312 mm; P <0.01). Aligners manufactured with the vacuum-forming technique had significantly higher variation than those with the 3D printing process (P = 0.04).

CONCLUSIONS

3D aligners printed directly from an STL file exhibited better precision and trueness than those fabricated using the conventional vacuum-forming technique. Since accuracy is defined as a combination of precision and trueness, it is concluded that direct printing from an STL file can be used to manufacture aligners.

Literature Review of an Anterior Deprogrammer to Determine the Centric Relation and Presentation of Cases

The increasing demand for dental aesthetics, articulation corrections, and solutions for pain and frequent bruxism demands quick and effective restorative dental management. The biomedical research aimed to create a beneficial, ecological, and readily available anterior deprogrammer to determine the centric relation (CR) of cases. This medical device is additively manufactured from a biocompatible material. Size is customizable based on the width of the patient's anterior central incisors. This is a pilot study with two subjects. The task was to develop a complete data protocol for the production process, computer-aided design (CAD), and three-dimensional (3D) printing of the anterior deprogrammers. The research focused on creating simple and practically applicable tools for the dentist's prescription (anterior deprogrammer in three sizes), and secondly for the communication between the dentist and the patient (computer application). The tested hypothesis was whether, according to these novel tools, it is possible to produce functional occlusal splints, which could be manufactured using current technologies. This study compared a traditional splint with a digitally designed and 3D-printed one. The tested hypothesis was whether manufactured occlusal splints differ in patients' subjective perception of comfort. Each conservative treatment was monitored for ten weeks. Initial results are promising; no statistically significant difference was found between the productive technologies.

The effect of aging on the mechanical properties of 3-dimensional printed biocompatible resin materials used in dental applications: An in vitro study

INTRODUCTION

The mechanical properties of biocompatible printable resin materials in an intraoral environment is still being investigated. This study aimed to assess the effect of the aging process on the mechanical properties of resin samples produced by stereolithography appearance (SLA) and digital light processing (DLP) 3-dimensional printer systems.

METHODS

The cylindrical sample (4.00 × 20.00 mm) was designed by software, and the data were transformed into digital format. A DLP printer (n = 40) and an SLA printer (n = 40) carried out the printing process. The aging procedure was applied to 20 samples from each group using a thermocycling device. After the aging procedure, the samples were placed in the universal testing device for the 3-point bending test.

RESULTS

This study showed that the aging procedure decreased maximum load, bending stress, and Young's modulus values and increased maximum deflection values of the DLP group (P <0.01). However, no statistical difference was detected in the parameters compared with the SLA group except for the maximum deflection values. Furthermore, statistically significant differences were found between maximum deflection and Young's module values of SLA and DLP control and study groups (P <0.05).

CONCLUSIONS

This in vitro study revealed that the biocompatible printable resin materials produced by DLP and SLA printers had the mechanical strength to resist the values resembling the physiological occlusal forces even after the aging procedure and could produce intraoral appliances.

Comparison of translucency, thickness, and gap width of thermoformed and 3D-printed clear aligners using micro-CT and spectrophotometer

The present study compared the thickness and gap width of thermoformed and 3D-printed clear aligners (CAs) using micro-computed tomography (micro-CT) and evaluated their translucency using spectrophotometer. Four groups of CAs were tested: thermoformed with polyethylene terephthalate glycol (TS) or copolyester-elastomer combination (TM), and 3D-printed TC-85 cleaned with alcohol (PA) or with centrifuge (PC). CIELab coordinates were measured (n = 10) to evaluate translucency. CAs (n = 10) were fitted onto respective models and micro-CT was performed to evaluate the thickness and gap width. Thickness and gap width were measured for different tooth type and location in sagittal sections on all sides. The PC group showed significantly higher translucency than the PA group, which was similar to the TS and TM groups (p < 0.01). After the manufacturing process, thickness reduction was observed in the thermoformed groups, whereas thickness increase was observed in the 3D printed-groups. The TM group showed the least gap width amongst the groups (p < 0.01). Thermoformed and 3D-printed CAs had significantly varied thicknesses and regions of best fit depending on the tooth type and location. Differences in the translucency and thickness of the 3D-printed CAs were observed depending on the cleaning methods.

Accuracy (trueness and precision) of 3D printed orthodontic models finalized to clear aligners production, testing crowded and spaced dentition

BACKGROUND

The study's objective was to assess the accuracy (trueness and precision) of orthodontic models obtained from crowded and spaced dentition finalized for the production of clear aligners. Four 3D printers featuring different technologies and market segments were used for this purpose.

METHODS

Two digital master models were obtained from two patients featuring respectively crowded dentition (CM group) and diastema/edentulous spaces (DEM group). The 3D printers tested were: Form 3B (SLA technology, medium-professional segment), Vector 3SP (SLA technology, industrial segment), Asiga Pro 4K65 (DLP technology, high-professional segment), and Anycubic Photon M3 (LCD technology, entry-level segment). Each 3D printed model was scanned and superimposed onto the reference master model and digital deviation analysis was performed to assess the trueness and precision calculated as root mean square (RMS). All data were statistically examined to obtain intra-group and inter-groups comparisons(p 0.05).

RESULTS

In both CM and DEM groups, SLA 3D printers (Vector 3SP and Form 3B) showed lower trueness error compared to DLP/LCD technologies (Asiga Pro 4K65, Anycubic Photon M3) (p < 0.001). In general, the entry-level printer (Anycubic Photon M3) showed the greatest trueness error (p < 0.001). Comparing CM and DEM models generated with the same 3D printer, statistically significant differences were found only for Asiga Pro 4k65 and Anycubic Photon M3 printers (p > 0.05). Concerning data of precision, the DLP technology (Asiga Pro 4k65) showed lower error compared to the other 3D printers tested. The trueness and precision errors were within the accepted clinical error for clear aligner manufacturing (< 0.25 mm), with the entry-level 3D printer nearly reaching this value.

CONCLUSIONS

The accuracy of orthodontic models generated for clear aligners can be affected by different 3D printer technologies and anatomical characteristics of dental arches.

The state of additive manufacturing in dental research - A systematic scoping review of 2012-2022

Background/purpose

Additive manufacturing (AM), also known as 3D printing, has the potential to transform the industry. While there have been advancements in using AM for dental restorations, there is still a need for further research to develop functional biomedical and dental materials. It's crucial to understand the current status of AM technology and research trends to advance dental research in this field. The aim of this study is to reveal the current status of international scientific publications in the field of dental research related to AM technologies.

Materials and methods

In this study, a systematic scoping review was conducted using appropriate keywords within the scope of international scientific publishing databases (PubMed and Web of Science). The review included related clinical and laboratory research, including both human and animal studies, case reports, review articles, and questionnaire studies. A total of 187 research studies were evaluated for quantitative synthesis in this review.

Results

The findings highlighted a rising trend in research numbers over the years (From 2012 to 2022). The most publications were produced in 2020 and 2021, with annual percentage increases of 25.7% and 26.2%, respectively. The majority of AM-related publications in dentistry research originate from Korea. The pioneer dental sub-fields with the ost publications in its category are prosthodontics and implantology, respectively.

Conclusion

The final review result clearly stated an expectation for the future that the research in dentistry would concentrate on AM technologies in order to increase the new product and process development in dental materials, tools, implants and new generation modelling strategy related to AM. The results of this work can be used as indicators of trends related to AM research in dentistry and/or as prospects for future publication expectations in this field.

Coffee Staining and Simulated Brushing Induced Color Changes and Surface Roughness of 3D-Printed Orthodontic Retainer Material

This in vitro study evaluated the influence of combined coffee staining and simulated brushing-induced color changes and surface roughness on 3D-printed orthodontic retainers. Specimens measuring 10 × 10 × 0.75 mm³ were obtained either by conventional vacuum forming or 3D printing at four print angulations (0°, 15°, 30°, and 45°) (n = 10). The prepared specimens were immersed in a coffee beverage and then mechanically brushed using a simulating device. The specimen's color difference (ΔE) and surface roughness (Ra) were quantified using a spectrophotometer and a non-contact profilometer, respectively. The highest and lowest mean ΔE values were recorded for the 3D-printed-45° (4.68 ± 2.07) and conventional (2.18 ± 0.87) groups, respectively. The overall mean comparison of ΔE between the conventional and 3D-printed groups was statistically significant (p < 0.01). After simulated brushing, all groups showed a statistically significant increase in the Ra values (p < 0.01). The highest Ra was in the 3D-printed-45° (1.009 ± 0.13 µm) and conventional (0.743 ± 0.12 µm) groups, respectively. The overall ΔE of 3D-printed orthodontic retainers was not comparable to conventional VFRs. Among the different angulations used to print the retainers, 15° angulations were the most efficient in terms of color changes and surface roughness and were comparable to conventional VFRs.

Comparison of mechanical properties of 3-dimensional printed and thermoformed orthodontic aligners

INTRODUCTION

Orthodontic treatment using clear aligners has experienced exponential growth since its introduction in the late 1990s. Three-dimensional (3D) printing has also grown in popularity among orthodontists, and companies have begun to produce resins to directly print clear aligners. This study aimed to examine the mechanical properties of commercially available thermoformed aligners and direct 3D-printed aligners under laboratory conditions and a simulated oral environment.

METHODS

Samples were prepared (approximately 2.5 × 20 mm) from 2 thermoformed materials, EX30 and LD30 (Align Technology Inc, San Jose, Calif), as well as 2 direct 3D-printing resins, Material X (Envisiontec, Inc; Dearborn, Mich) and OD-Clear TF (3DResyns, Barcelona, Spain). Wet samples were subjected to phosphate-buffered saline at 37°C for 7 days, whereas dry samples were stored at 25°C. Tensile and stress relaxation tests were carried out on an RSA3 Dynamic Mechanical Analyzer (Texas Instruments, Dallas, Tex) and Instron Universal Testing System (Instron, Norwood, Mass) to calculate elastic modulus, ultimate tensile strength, and stress relaxation.

RESULTS

The elastic modulus of dry and wet samples was 103.2 ± 17.3 MPa and 114.4 ± 17.9 MPa (EX30), 61.3 ± 9.18 MPa and 103.5 ± 11.4 MPa (LD30), 431.2 ± 16.0 MPa and 139.9 ± 34.6 MPa (Material X), and 38.4 ± 14.7 MPa and 38.3 ± 8.4 MPa (OD-Clear TF), respectively. The ultimate tensile strength of dry and wet samples was 64.41 ± 7.25 MPa and 61.43 ± 7.41MPa (EX30), 40.04 ± 5.00 MPa and 30.09 ± 1.50 MPa (LD30), 28.11 ± 3.75 MPa and 27.57 ± 4.09 MPa (Material X), and 9.34 ± 1.96 MPa and 8.27 ± 0.93 MPa (OD-Clear TF), respectively. Residual stress of wet samples at 2% strain for 2 hours was 59.99 ± 3.02% (EX30), 52.57 ± 12.28% (LD30), 6.98 ± 2.64% (Material X), and 4.39 ± 0.84% (OD-Clear TF).

CONCLUSIONS

There was a significant difference in elastic modulus, ultimate tensile strength, and stress relaxation among the samples tested. Moisture, specifically a simulated oral environment, appears to have a greater effect on the mechanical properties of direct 3D-printed aligners when compared with thermoformed aligners. This is likely to impact the ability of 3D-printed aligners to generate and maintain adequate force levels for tooth movement.

Mechanical Properties, Fractal Dimension, and Texture Analysis of Selected 3D-Printed Resins Used in Dentistry That Underwent the Compression Test

Three-dimensional printing is finding increasing applications in today’s world. Due to the accuracy and the possibility of rapid production, the CAD/CAM (computer-aided design/computer-aided manufacturing) technology has become the most desired approach in the preparation of elements, especially in medicine and dentistry. This study aimed to compare the biomechanical properties, fractal dimension (FD), and texture of three selected materials used for 3D printing in dentistry. Three biomaterials used in 3D printing were evaluated. The materials were subjected to the compression test. Then, their mechanical features, FD, and texture were analyzed. All the tested materials showed different values for the studied properties. The only statistically insignificant difference was observed for the force used in the compression test. All three materials showed differences in width and height measurements. The difference in the decrease between the compression plates was also significant. For Dental LT Clear, the mean value was 0.098 mm (SD = 0.010), while for BioMed Amber it was 0.059 mm (SD = 0.019), and for IBT it was 0.356 mm (SD = 0.015). The nominal strain also differed between the materials. IBT had the highest mean value (7.98), while BioMed Amber had the smallest (1.31). FD analysis revealed that Dental LT Clear did not show differences in the structure of the material. The other two materials showed significant changes after the compression test. Texture analysis (TA) revealed similar results: BioMed Amber resin showed significantly less pronounced texture changes compared to the other two materials. BioMed Amber also showed the most stable mechanical properties, whereas those of IBT changed the most. Fractal analysis revealed that IBT showed significant differences from the other two materials, whereas TA showed that only Dental LT Clear did not show changes in its texture after the compression test. Before the compression, however, BioMed Amber differed the most when bone index was taken into account.

Clinically Relevant Properties of 3D Printable Materials for Intraoral Use in Orthodontics: A Critical Review of the Literature

The review aimed at analyzing the evidence available on 3D printable materials and techniques used for the fabrication of orthodontic appliances, focusing on materials properties that are clinically relevant. MEDLINE/PubMed, Scopus, and Cochrane Library databases were searched. Starting from an initial retrieval of 669 citations, 47 articles were finally included in the qualitative review. Several articles presented proof-of-concept clinical cases describing the digital workflow to manufacture a variety of appliances. Clinical studies other than these case reports are not available. The fabrication of aligners is the most investigated application of 3D printing in orthodontics, and, among materials, Dental LT Clear Resin (Formlabs) has been tested in several studies, although Tera Harz TC-85 (Graphy) is currently the only material specifically marketed for direct printing of aligners. Tests of the mechanical properties of aligners materials lacked homogeneity in the protocols, while biocompatibility tests failed to assess the influence of intraoral conditions on eluents release. The aesthetic properties of 3D-printed appliances are largely unexplored. The evidence on 3D-printed metallic appliances is also limited. The scientific evidence on 3D printable orthodontic materials and techniques should be strengthened by defining international standards for laboratory testing and by starting the necessary clinical trials.

3D Printing of Dental Prostheses: Current and Emerging Applications

Revolutionary fabrication technologies such as three-dimensional (3D) printing to develop dental structures are expected to replace traditional methods due to their ability to establish constructs with the required mechanical properties and detailed structures. Three-dimensional printing, as an additive manufacturing approach, has the potential to rapidly fabricate complex dental prostheses by employing a bottom-up strategy in a layer-by-layer fashion. This new technology allows dentists to extend their degree of freedom in selecting, creating, and performing the required treatments. Three-dimensional printing has been narrowly employed in the fabrication of various kinds of prostheses and implants. There is still an on-demand production procedure that offers a reasonable method with superior efficiency to engineer multifaceted dental constructs. This review article aims to cover the most recent applications of 3D printing techniques in the manufacturing of dental prosthetics. More specifically, after describing various 3D printing techniques and their advantages/disadvantages, the applications of 3D printing in dental prostheses are elaborated in various examples in the literature. Different 3D printing techniques have the capability to use different materials, including thermoplastic polymers, ceramics, and metals with distinctive suitability for dental applications, which are discussed in this article. The relevant limitations and challenges that currently limit the efficacy of 3D printing in this field are also reviewed. This review article has employed five major scientific databases, including Google Scholar, PubMed, ScienceDirect, Web of Science, and Scopus, with appropriate keywords to find the most relevant literature in the subject of dental prostheses 3D printing.

Integrated manufacturing of direct 3D-printed clear aligners

The inception of the laboratory work for a removable tooth moving appliance construction by sectioning the teeth from the malocclusion model to align them with wax and achieve minor dental correction has evolved into a state of digital planning and appliance manufacturing for a wide spectrum of malocclusion. The disruptive technology of directly printing clear aligners has drawn the clinician and researcher's interest in the orthodontic fraternity contemporarily. This workflow enables to the development of an in-house aligner system with complete control over desired aligner thickness, extent, and attachments; also technically resource-efficient with greater accuracy by excluding all the intermediate steps involved in the thermoforming method of manufacturing. This promising exploratory subject demands to be well-received with further research-based improvements. This article intends to summarize the digital orthodontic workflow and the literature evidence.

Color stability of aligner materials on exposure to indigenous food products: An in-vitro study

Background

In the recent day, there has been an exponential growth in the usage of clear aligners for orthodontic treatment. As with any removable appliance, the compliance of patients to remove it during ingestion of food is, at times, poor. Thus, the stability of the clear aligner to be "clear" becomes questionable. This in-vitro study examined how the clear aligners changed colour on exposure to various indigenous food products used in everyday life.

Methods

Aligners from 5 different companies (K Line, Clearbite Aligners, The Aligner Company, iAligners and MaxDent CA Digital) were exposed for 12 hours and 24 hours to various indigenous substances (tea, green tea, coffee, turmeric, saffron and Kashmiri red chili powder) and a control solution (distilled water) in-vitro. The color change was assessed with the help of VITA Easyshade compact colorimeter based on Commission Internationale de I'Eclairage L*a*b* color system. Values were then modified to NBS units for clinical relevance.

Results

The hue of the transparent aligners was noticed to change in a statistically meaningful way when exposed to turmeric, saffron, Kashmiri red chili powder and coffee in decreasing order and mild color change in tea and green tea at both 12 hours and 24 hours intervals.

Conclusion

Aligners are prone to color change when exposed to indigenous foods that contain staining properties.

Comparison of the Compression and Tensile Modulus of Two Chosen Resins Used in Dentistry for 3D Printing

(1) The CAD/CAM technique exploiting 3D printing is becoming more and more popular in dentistry. The resins are used in all the dental specialties, including conservative dentistry, prosthodontics, surgery, and orthodontics. The interest in investigating the different properties of dental materials has been an aim of researchers. The purpose of the presented study was to compare the properties of two 3D-printable dental resins (both rigid, used for medical purposes). (2) Methods: Ten blocks of two-type shapes were printed on a printer designed for medical use. The tensile modulus and compression were investigated and compared. The axial compression test was performed according to the PN-EN ISO 604:2003 norm, while the tensile test was performed according to the PN-En ISO 527-1-2019 (E) norm. In the first test, the sample size of the perpendicular shape was 10 ± 0.2 mm × 10 ± 0.2 mm × 4 ± 0.2 mm and in the second it was 75 mm, the end width 10 mm, and the thickness 2 mm. (3) Results: The statistical analysis based on ANOVA tests showed that all the obtained results were statistically significant. Both of the examined materials had similar properties and were resistant and stable in shape. The tensile modulus and compression tests performed on them gave similar results. They also showed high durability to compression and tensility. (4) Conclusions: Both of the examined materials were durable and rigid materials. BioMed Amber was more resistant to compression, while Dental LT clear was more resistant in the tensility test. Although both resins had similar physical properties, it is still disputable whether the chosen materials could be used interchangeably.

In-house three-dimensional printing within the digital orthodontic workflow

Intraoral scanning techniques, and the associated software, have revolutionized model acquisition, analysis, and virtual planning in orthodontics. Three-dimensional printing is the final aspect of this digital workflow, converting these virtual models and simulations of the tooth and occlusal movements into physical reality. This article provides an insight into how in-house three-dimensional printing is now a feasible and transformative reality for many orthodontic settings and how this empowers orthodontists to optimize their patient care.

Force profile assessment of direct-printed aligners versus thermoformed aligners and the effects of non-engaged surface patterns

Background

The purpose of the study was to measure the forces delivered by direct-printed aligners (DPA) in the vertical dimension and compare the force profile with traditional thermoformed aligners (TFA) and to investigate the impact of non-engaged surface patterns to the properties of DPA and TFA.

Methods

A force-measuring appliance was fabricated capable of displacing the aligner in 0.10 mm increments and measuring the resultant force. Polyethylene terephthalate glycol (ATMOS 0.030″ American Orthodontics) and TC-85DAC resin (Graphy Inc) were used to create TFA and DPA, respectively. Aligners were temperature-controlled prior to and during testing to simulate the oral environment. The resultant forces from displacements ranging from 0.10 to 0.30 mm were measured.

Results

At intraoral temperatures, DPA demonstrated significantly less force than TFA. TFA demonstrated a substantial statistically significant increase in force with each 0.10 mm increase in vertical displacement. DPA demonstrated a much more consistent force profile across the range of displacements. The effects of surface patterns in both DPA and TFA were generally a decrease in force. Statistical significance of surface patterns was detected for TFA at displacements of 0.30 mm and greater and significant for DPA only at a displacement of 0.10 mm. Surface patterns in both DPA and the TFA did not show any statistical difference when assessing force proprieties.

Conclusions

Forces delivered by aligners in the vertical dimension by DPA are more consistent and of lower magnitude than those of TFA aligners. Surface patterns were not capable of altering the force properties of both DPA and TFA.

Contemporary management of complex craniofacial trauma: virtual planning, navigation and the novel thermoformed cage splints in a strategic, sequential, computer-guided protocol

INTRODUCTION

It was the aim of the study to assess if computerized simulation and the use of thermoformed cage splints are useful to plan cases of complex craniofacial trauma.

MATERIALS AND METHODS

patients with fractures in any of the thirds of the craniofacial skeleton and occlusion impairment. Virtual surgical planning with digital reduction of fractures, navigated planning, thermoformed cage splints were used in all cases. Surgical outcomes were evaluated by computing the surface deviation and occlusograms between planned and postoperative models.

RESULTS

13 patients were enrolled in this study. Accuracy of bone repositioning was evaluated compared with the surgical planning. For the mandible, mean Root Mean Square Error (RMSE) was of 1.67 with a standard deviation (SD) of ±0.75 mm (p < 0.001); for the maxilla, average RMSE was of 0.88 with SD of ±0.52 mm (p < 0.001); and for midfacial and upper third bone segments, average RMSE was of 0.59 with SD of ±0.47 mm (p < 0.001) CONCLUSIONS: Within the limitations of the study it seems that thermoformed cage splints might be a promising alternative to other well-established approaches for accurate occlusal restoration and can be fully integrated within the digital workflow.

Advances in orthodontic clear aligner materials

Rapid technological improvements in biomaterials, computer-aided design (CAD) and manufacturing (CAM) have endorsed clear aligner therapy (CAT) as a mainstay of orthodontic treatment, and the materials employed for aligner fabrication play an all-important role in determining the clinical performance of clear aligners. This narrative review has attempted to comprehensively encompass the entire gamut of materials currently used for the fabrication of clear aligners and elucidate their characteristics that are crucial in determining their performance in an oral environment. Historical developments and current protocols in aligner fabrication, features of contemporary bioactive materials, and emerging trends related to CAT are discussed. Advances in aligner material chemistry and engineering possess the potential to bring about radical transformations in the therapeutic applications of CAT; in the absence of which, clear aligners would continue to underperform clinically, due to their inherent biomechanical constraints. Finally, while innovations in aligner materials such as shape memory polymers, direct three-dimensional (3D) printed clear aligners and bioactive materials combined with clear aligner materials are essential to further advance the applications of CAT; increased awareness of environmental responsibilities among aligner manufacturers, aligner prescribing clinicians and aligner users is essential for better alignment of our climate change goals towards a sustainable planet.

Accuracy of additive manufacturing in stomatology

With the rapid development of the three-dimensional (3D) printing technology in recent decades, precise and personalized manufacturing has been achieved gradually, bringing benefit to biomedical application, especially stomatology clinical practice. So far, 3D printing has been widely applied to prosthodontics, orthodontics, and maxillofacial surgery procedures, realizing accurate, efficient operation processes and promising treatment outcomes. Although the printing accuracy has improved, further exploration is still needed. Herein, we summarized the various additive manufacturing techniques and their applications in dentistry while highlighting the importance of accuracy (precision and trueness).

Three-Dimensional-Printed Customized Orthodontic and Pedodontic Appliances: A Critical Review of a New Era for Treatment

Three-dimensional (3D) designing and manufacturing technology is a direct derivative of digital technology. Three-dimensional volume and surface acquisition, CAD software, and 3D manufacturing are major changes included in daily practice in many orthodontic and pedodontic offices. Customized appliances can be designed using dental CAD software or general-purpose CAD software in the office or a laboratory. Materials that can be used are resins, alloys, or zirconia. Methods: The search strategy of this critical review included keywords in combination with MeSH terms in Medline, Scopus, and Cochrane Library up to June 2022 in the English language without any limit to the publication period. Results: According to our search, 12 articles were selected for our study. All the articles were in vitro prospective studies. Conclusions: The results suggested that almost all the known appliances can be designed and printed in a tailor-made fashion in contrast to the traditional one-size-fits-all approach. Customized appliances should be manufactured according to the patient’s needs, and this is justified by the certainty that this approach will be beneficial for the patient’s treatment. There is a need for more research on all direct 3D-printed appliances.

A full-field DIC analysis of the mechanical-deformation behavior of polyethylene terephthalate glycol (PET-G) aligners

OBJECTIVES

The aim was to investigate the full-field mechanical-deformation behavior of clear aligners made by polyethylene terephthalate glycol (PET-G) subjected to cyclic compression tests.

METHODS

Digital Image Correlation (DIC) (Chu et al., 1985; Schreier et al., 2009), a contactless full-field measurement technique, and Optical Microscope (OM) analysis were applied to study two PET-G aligners thermoformed from discs of a thickness of 0.75 mm and 0.88 mm. The clear aligners were placed on dental shape resin casts and were subjected to cyclic compression up to 13000 load cycles from 0 to 50 N at room temperature. The chosen number of load cycles simulates the average load history to which an aligner is subjected for one week. Local displacements and strains were measured for each test at 2, 6, 10, 20, 1000, 5000 and 13000 loading cycles.

RESULTS

Both aligners showed greater displacements in the early stages of loading, more pronounced for the 0.88 mm one. Local displacement and strain maps are derived both along the load direction and to the transverse one (never done from other researchers). Load-displacement cyclic curves allowed to evaluate the evolution of the stored energy and the stiffness during the test. The OM analyses showed significant morphological variations on the aligners' surface, such as wear and tear, high depressions and cracks, especially for the 0.75 mm specimen.

SIGNIFICANCE

Full-field analysis allowed to understand the mechanical behavior of device with complex geometry and complex load distribution, like invisible aligners. The knowledge of the stiffness and the direction of the total displacement helps the orthodontist to implement the best strategy to improve the patient's comfort and the treatment time.

Digital Technologies: From Scientific to Clinical Applications in Orthodontic and Dental Communities

The significant progress made in our sector since the introduction of digital technologies has now made it possible to easily obtain all the information necessary to diagnose, design and perform interdisciplinary and complex therapies in a simpler and more reproducible way [...]

Treatment of Class III Malocclusion and Anterior Crossbite with Aligners: A Case Report

The article describes the orthodontically treated case of a 25-year-old patient with skeletal and dental class III malocclusion, anterior crossbite, which caused functional and aesthetic problems, occlusal trauma, and incisor wear. Treatment with transparent aligners was proposed to meet the patient's needs, using the sequential distalization protocol. While sequential distalization is well documented for class II malocclusion treatment in maxillary arch teeth, further investigations are necessary for class III malocclusions. In fact, lower teeth movements are more complex due to mandibular bone density and the presence of the third molars, which are often extracted to perform distalization. In addition, the use of intermaxillary elastics helps control the proclination of the anterior teeth as a reaction to distalizing forces. At the end of the treatment, the patient reached molar and canine class I and positive overjet and overbite. The inclination of lower incisors and the interincisal angle have improved, resulting in aesthetic and functional enhancement.

Comparison of dimensional accuracy between direct-printed and thermoformed aligners

Objective

The purpose of this study was to evaluate and compare the dimensional accuracy between thermoformed and direct-printed aligners.

Methods

Three types of aligners were manufactured from the same reference standard tessellation language (STL) file thermoformed aligners were manufactured using Zendura FLX^TM (n = 12) and Essix ACE^TM (n = 12), and direct-printed aligners were printed using Tera Harz^TM TC-85DAP 3D Printer UV Resin (n = 12). The teeth were not manipulated with any tooth-moving software in this study. The samples were sprayed with an opaque scanning spray, scanned, imported to Geomagic^® Control X^TM metrology software, and superimposed on the reference STL file by using the best-fit alignment algorithm. Distances between the aligner meshes and the reference STL file were measured at nine anatomical landmarks.

Results

Mean absolute discrepancies in the Zendura FLX^TM aligners ranged from 0.076 ± 0.057 mm to 0.260 ± 0.089 mm and those in the Essix ACE^TM aligners ranged from 0.188 ± 0.271 mm to 0.457 ± 0.350 mm, while in the direct-printed aligners, they ranged from 0.079 ± 0.054 mm to 0.224 ± 0.041 mm. Root mean square values, representing the overall trueness, ranged from 0.209 ± 0.094 mm for Essix ACE^TM, 0.188 ± 0.074 mm for Zendura FLX^TM, and 0.140 ± 0.020 mm for the direct-printed aligners.

Conclusions

This study showed greater trueness and precision of direct-printed aligners than thermoformed aligners.

Thermo-mechanical properties of 3D printed photocurable shape memory resin for clear aligners

To overcome the limitations of the conventional vacuum thermoforming manufacturing method, direct 3D printing of clear aligners has been developed. The present study investigated the thermo-mechanical and viscoelastic properties of a photocurable resin TC-85, which is a new material for the direct 3D printed clear aligners, comparing to a conventional thermoplastic material polyethylene terephthalate glycol. Dynamic mechanical analysis was performed to analyse the mechanical behaviours of the two materials at 37 °C and 80 °C, respectively. Furthermore, the shape memory property of the two materials was evaluated using a U-shape bending test, and the shape recovery ratio for 60 min at 37 °C was calculated. The results indicate that TC-85 can constantly apply a light force to the teeth when used for the 3D printed clear aligners, owing to its flexibility and viscoelastic properties. In addition, it is expected that the force decay induced by repeated insertion of the clear aligners will be reduced and a constant orthodontic force will be maintained. Furthermore, its geometric stability at high temperatures and the shape memory properties provide advantages for the clinical application.

Accuracy evaluation of orthodontic movements with aligners: a prospective observational study

Background

Since their introduction in orthodontics, clear aligners have been appreciated by patients, including adults, for their comfort and low aesthetic impact. Despite the enormous mobilization of financial resources all over the world aimed at producing new product lines, few clinical studies or high-quality evidence have been produced regarding the real effectiveness of such treatment. Given the few limited kinds of research on the subject, this study aims to produce and critically evaluate other data, to establish the concrete reliability of clear aligners in orthodontic therapy.

Results

Significant sample sizes were obtained for intrusion, vestibulo/lingual (V/L) crown tipping, and rotation. The overall accuracy for rotation resulted in 86%, ranging from 96% for maxillary central incisors to 70.4% for mandibular first premolars. The intrusion was registered only for anterior teeth; mean predictability was 92%, with the worst result being 86.7% for mandibular canines and the best being 98% for mandibular central incisors. V/L tipping was the most accurate movement: 93.1% of the prescribed movement was completed. Maxillary central incisors showed the lowest accuracy (80.7%), while mandibular central incisors were the highest (97.5%).

Conclusions

The present study provided reassuring data in support of the accuracy of the Invisalign^® system. Vestibulo/lingual tipping was the most predictable movement, while rotation of canines, premolars, and lateral incisors were the least predictable. Intrusion resulted highly predictable up to 2 mm. When careful treatment planning follows a correct diagnosis, together with the use of auxiliary features and refinements, the planned results can be achieved in a clinically successful way. Authors believe that there is a major need for greater samples to overcome bias related to variables if we want to answer the unsolved questions, such as the predictability of severe malocclusions treatment.