Effect of Material and Pad Abrasion on Shear Bond Strength of 3D-Printed Orthodontic Brackets.

OBJECTIVE: To investigate the effect of printing material and air abrasion of bracket pads on the shear bond strength of 3D-printed plastic orthodontic brackets when bonded to the enamel of extracted human teeth. MATERIALS AND METHODS: Premolar brackets were 3D-printed using the design of a commercially available plastic bracket in two biocompatible resins: Dental LT Resin and Dental SG Resin (n = 40/material). 3D-printed brackets and commercially manufactured plastic brackets were divided into two groups (n = 20/group), one of which was air abraded. All brackets were bonded to extracted human premolars, and shear bond strength tests were performed. The failure types of each sample were classified using a 5-category modified adhesive remnant index (ARI) scoring system. RESULTS: Bracket material and bracket pad surface treatment presented statistically significant effects for shear bond strengths, and a significant interaction effect between bracket material and bracket pad surface treatment was observed. The non-air abraded (NAA) SG group (8.87 ± 0.64 MPa) had a statistically significantly lower shear bond strength than the air abraded (AA) SG group (12.09 ± 1.23 MPa). In the manufactured brackets and LT Resin groups, the NAA and AA groups were not statistically significantly different within each resin. A significant effect of bracket material and bracket pad surface treatment on ARI score was observed, but no significant interaction effect between bracket material and pad treatment was found. CONCLUSION: 3D-printed orthodontic brackets presented clinically sufficient shear bond strengths both with and without AA prior to bonding. The effect of bracket pad AA on shear bond strength depends on the bracket material.

Root Surface Changes in Endodontically Treated Teeth following Orthodontic Movement.

INTRODUCTION: Orthodontically induced external root resorption has been labeled an unavoidable consequence of orthodontic tooth movement (OTM). The objective of this study was to investigate the change in surface area (mm2) and volume (mm3) of endodontically treated teeth (ETT) compared with contralateral teeth with a vital pulp (VPT) after OTM. METHODS: Seventy-six teeth were included in this retrospective analysis: ETT (n = 38) and VPT (n = 38). All teeth were evaluated using cone-beam computed tomographic imaging at 2 time periods: before OTM (T1) and after OTM (T2). Study teeth were segmented to include all areas contained within the lamina dura and then were converted into a mesh model for data calculation. The surface area (mm2) and volume (mm3) of each tooth were calculated at T1 and T2 based on the number of cubic voxels present within the mesh model. Statistical analysis was performed using a linear mixed-effects model. RESULTS: The average change in surface area after OTM in ETT was 13.01 mm2 and 19.95 mm2 in VPT (P < .05). The average percent change in surface area after OTM in ETT was 2.09% and 3.38% in VPT (P < .05). The average change in volume after OTM in ETT was 22.48 mm3 and 32.44 mm3 in VPT (P < .05). The average percent change in volume after OTM in ETT was 2.62% and 4.10% in VPT (P < .05). CONCLUSIONS: The results from this study suggest that ETT are less susceptible to root resorption after OTM than their vital counterparts.

Evaluation of the dimensional accuracy of thermoformed appliances taken from 3D printed models with varied shell thicknesses: An in vitro study.

OBJECTIVE: Clinicians make numerous decisions when 3D printing models for fabrication of thermoformed appliances, including printing solid or hollow models. While hollow models can reduce resin use, models intended for thermoformed appliance fabrication must be printed with sufficient thickness to withstand thermoforming. The aim of the study was to determine for hollow 3D printed orthodontic models if there is an effect of shell thickness on the dimensional accuracy of retainers thermoformed upon them as compared with solid models and, if so, to identify the minimum shell thickness that ensures dimensional accuracy of the thermoformed retainer under the conditions investigated. MATERIAL AND METHODS: Thermoformed appliances were fabricated on 3D printed models of six shell thicknesses: 1.0mm, 1.5mm, 2.0mm, 2.5mm, 3.0mm, and solid (n=10/group). The models were scanned before and after thermoforming. Thermoformed appliances were captured by two methods: scanning a polyvinylsiloxane casting of the appliance and scanning the appliance interior surface (intaglio surface). Each model-appliance pair was compared using superimposition software. A generalized linear model and post-hoc Tukey contrasts (α=0.05) were applied to compare each thickness. RESULTS: Model thickness has a statistically significant effect on dimensional accuracy of thermoformed appliances. Appliances fabricated on 1.0mm and 1.5mm models displayed poor accuracy, with a statistically significantly lower percentage of data points within tolerance (±0.250mm) than appliances fabricated on models printed at 2.0mm thickness and greater. CONCLUSIONS: 3D printed model thickness affects the dimensional accuracy of a thermoformed retainer. To ensure minimal deformation and promote clinical utility of the thermoformed appliance, models should be printed with a minimum shell thickness of 2.0mm for the materials investigated.

Comparison of automated grading of digital orthodontic models and hand grading of 3-dimensionally printed models.

INTRODUCTION: Emerging workflows in orthodontics enable automated analysis of digital models and production of physical study models from digital files for the evaluation of treatment outcomes. The objective of this study was to compare the automated assessment of digital orthodontic models and the hand grading of 3D-printed models with the use of the American Board of Orthodontics cast-radiograph evaluation (ABO CRE) system. METHODS: Plaster models from 15 cases were scanned with the use of a desktop model scanner to create digital models from which physical models were produced with the use of a stereolithography-based 3D printer. All digital models from each case were graded with the use of an automated software tool (SureSmile), and 3D-printed models were scored by hand with the use of the ABO CRE grading system. All hand-graded models were scored a second time at least 2 weeks later. RESULTS: SureSmile gave statistically significantly higher scores to alignment and rotations (P < 0.001), overjet (P < 0.001), occlusal contacts (P < 0.001), and total score (P < 0.001). Hand grading scored higher in buccolingual inclination (P < 0.001). No significant differences were found in marginal ridges, occlusal relationships, and interproximal contacts. CONCLUSIONS: Scores assessed in an automated manner by SureSmile are generally significantly greater than those assessed by hand grading.

Effect of print layer height and printer type on the accuracy of 3-dimensional printed orthodontic models.

INTRODUCTION: Three-dimensional (3D) printing technologies enable production of orthodontic models from digital files; yet a range of variables associated with the process could impact the accuracy and clinical utility of the models. The objective of this study was to investigate the effect of print layer height on the accuracy of orthodontic models printed 3 dimensionally using a stereolithography format printer and to compare the accuracy of orthodontic models fabricated with several commercially available 3D printers. METHODS: Thirty-six identical models were produced with a stereolithography-based 3D printer using 3 layer heights (n = 12 per group): 25, 50, and 100 µm. Forty-eight additional models were printed using 4 commercially available 3D printers (n = 12 per group). Each printed model was digitally scanned and compared with the input file via superimposition analysis using a best-fit algorithm to assess accuracy. RESULTS: Statistically significant differences were found in the average overall deviations of models printed at each layer height, with the 25-µm and 100-µm layer height groups having the greatest and least deviations, respectively. Statistically significant differences were also found in the average overall deviations of models produced using the various 3D printer models, but all values fell within clinically acceptable limits. CONCLUSIONS: The print layer height and printer model can affect the accuracy of a 3D printed orthodontic model, but the impact should be considered with respect to the clinical tolerances associated with the envisioned application.

Accuracy and mechanical properties of orthodontic models printed 3-dimensionally from calcium sulfate before and after various postprinting treatments.

INTRODUCTION: Dental models fabricated with 3-dimensional printing technologies are revolutionizing the practice of orthodontics, but they generally comprise polymeric materials that may not be suitable for certain applications, such as soldering appliances. The objective of this study was to investigate the dimensional accuracy and mechanical properties of 3-dimensional printed ceramic-based models before and after various treatments intended to improve their mechanical properties. METHODS: Thirty identical models were printed 3-dimensionally from a calcium sulfate-based substrate and divided into 3 groups for treatment: high heat (250°C for 30 minutes), low heat (150°C for 30 minutes), and Epsom salt treatment. Each model was scanned before and after treatment with a laser scanner, and dimensional stability was analyzed by digital superimpositions using a best-fit algorithm. The models were weighed before and after treatment to evaluate mass changes. Additionally, 3-dimensional printed cylinders treated as described above and an untreated control group were subjected to compressive mechanical testing (n = 11 per group). RESULTS: The Epsom salt treatment group had statistically significant increases in both peak compressive stress and modulus of elasticity when compared with the other treatment groups. All treatment groups had statistically significant changes in mass, with the Epsom salt group gaining mass and the 2 heat-treatment groups losing mass. The low-temperature treatment group had a statistically significantly lower mean average for dimensional deviations (0.026 ± 0.010 mm) than did the other treatment groups (0.069 ± 0.006 and 0.059 ± 0.010 mm for high temperature and Epsom salt, respectively). CONCLUSIONS: Dental models printed 3-dimensionally with calcium sulfate and treated with Epsom salt showed significant improvement in compressive mechanical properties and retained clinically acceptable dimensional stability.

Diagnostic accuracy of impression-free digital models.

INTRODUCTION: Impression-free techniques might eliminate the potential shortcomings of digital dental models. Chairside scanners offer the advantage of obtaining digital dental models directly from the patient without the need for dental impressions. The aim of this study was to evaluate the accuracy of 3-dimensional digital models acquired from a chairside intraoral scanner compared with both manual and cone-beam computed tomography measurements of the same dental anatomy. METHODS: The study sample comprised 60 dry skulls. Each skull had the maxillary and mandibular arches scanned with a Cadent iTero scanner (Align Technology, San Jose, Calif) and had a cone-beam computed tomography scan taken with a CS 9300 unit (Carestream Health, Atlanta, Ga). Linear measurements in all 3 dimensions of the space in each dental arch together with tooth-size arch-length analysis for both the maxillary and mandibular arches were carried out manually on the dry skulls with calipers and digitally on the scanned 3-dimensional models and cone-beam computed tomography images. Intraclass correlation (ICC) analysis was performed for all variables tested in the study groups, with the manual measurements on the dry skulls as the gold standard. The Bland-Altman analysis was also applied to the data to graphically display the agreement of the diagnostic measurements obtained from these methods. RESULTS: Measurements from the iTero models demonstrated near-perfect agreement (ICC, 0.91-0.99) with the caliper measurements. Cone-beam computed tomography measurements had moderate to high levels of agreement (ICC, 0.65-0.99) compared with the caliper measurements. CONCLUSIONS: Direct digital acquisition of the dental arches with a chairside scanner provided almost 1-to-1 diagnostic information of the investigated anatomy and was superior to the cone-beam computed tomography measurements.