Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls.

INTRODUCTION: Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. METHODS: One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). RESULTS: The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. CONCLUSION: The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.

Evaluation of occlusal force in Class II subdivision malocclusion.

BACKGROUND: Class II subdivision is a malocclusion characterized by dental and functional asymmetry that is difficult to manage. Impaired muscle function can result in asymmetrical growth, leading to occlusal instability. OBJECTIVE(S): The study aimed to assess occlusal force in patients with Class II subdivision malocclusion using Innobyte. Additionally, the discrepancies of force generated at the position of maximum intercuspidation between the left and right sides of the arches were evaluated. METHODS: The occlusal force of 66 patients with Class II subdivision malocclusion (group S) was measured and compared with that of 66 patients with Class I (group I) and 66 patients with Class II malocclusion (group II). The S group patients had a Class I molar on the right side and a Class II molar on the left side. ANOVA test, followed by the Games-Howell post hoc test, was performed to compare the mean of the total force among the groups. To assess the difference in force between the right and left arches, one-way ANOVA test followed by Tukey's post hoc comparison was performed. Finally, a boxplot was created to show the trend of occlusal force recorded in the three groups of patients. RESULTS: The occlusal force differed significantly among the groups (p < .001). Post hoc Games-Howell analysis showed significant differences as follows: the total force in group S was 165.24 N greater than in group II and in group I was 218.06 N greater than in group II. The difference (right-left) in total force between the groups was statistically significant (p < .001). Tukey's post hoc test showed following significant correlation: in group S was 53.51 N greater than in group II and 63.12 N greater than in group I. CONCLUSIONS: Among the analysed groups, patients with Class II malocclusion exhibited the lowest value of occlusal force. In patients with Class II subdivision malocclusion, force asymmetry, characterised by a higher value on the Class I side and a lower value on the Class II side was observed.

Evaluation of the relationship between incisor torque and profile aesthetics in patients having orthodontic extractions compared to non-extractions.

OBJECTIVE: The aim of the present study was to evaluate the relationship between soft tissues aesthetics and incisor torque, as well as the effect of crowding, anchorage, and extraction pattern, in adult patients treated without extraction or with two or four extractions. MATERIALS AND METHODS: Seventy-seven subjects with permanent dentition were selected retrospectively. Among these, 24 patients were treated with four extractions, 24 with two extractions and 29 without extractions. Lateral cephalograms and photographies taken before (T0) and after (T1) treatment were retrieved. The amount of crowding and the type of anchorage were recorded, and a cephalometric analysis was performed. A one-way ANOVA was used to compare the variables within and between groups. Linear regressions were performed to evaluate the effect of different predictors on soft tissues variables at T1. RESULTS: The statistical analysis showed no differences within and between groups for soft tissue aesthetics. A significant reduction of the angle obtained from the intersection of Frankfurt plane and mandibular plane was observed in the four-extractions group, and a significant proclination of the lower incisors was observed in the two-extraction group. Linear regressions revealed that the change in soft tissue profile aesthetics was affected by the type of anchorage and the two-extractions pattern. CONCLUSIONS: Similar soft tissue aesthetics were observed after treatment in the three groups, despite the presence of some skeletal and dental differences. CLINICAL RELEVANCE: A well-controlled incisor torque helps to preserve soft tissues aesthetics. The type of anchorage could influence soft tissues.

Short-term effect of orthodontic clear aligners on muscular activity and occlusal contacts: A cohort study.

INTRODUCTION: The simultaneous presence of maxillary and mandibular clear aligners alters the vertical dimension and the quantity and quality of occlusal contacts. Few data in the literature explain how this occurs and the effects on neuromuscular coordination. This study aimed to evaluate occlusal contacts and muscular balance during treatment with clear aligners over a short follow-up time. METHODS: Twenty-six female adult patients were enrolled in this study. The center of occlusal force (COF) was evaluated using a T-Scan II device, whereas muscular symmetry and balance were determined through surface electromyography using a standardized protocol that reduces anthropometric and electrode variations. Both evaluations were performed in centric occlusion and with aligners worn before treatment, after 3 months, and after 6 months. RESULTS: A statistically significant variation in COF position was reported in the sagittal plane but not in the transverse plane. The shift in the COF position was followed by a change in muscular balance evaluated through surface electromyography. CONCLUSIONS: Treatment with clear aligners resulted in an anterior shift of the COF when biting in centric occlusion and a posterior shift when the aligners were worn in healthy female patients after 6 months of observation. This change in occlusal contact was followed by an improvement in muscular function symmetry in the short term when aligners were worn, compared with the centric occlusion during treatment.

The Correlation between Mandibular Arch Shape and Vertical Skeletal Pattern.

Background and Objectives: The aim of this study was to evaluate the correlation between the mandibular arch shape and the vertical skeletal pattern in growing patients. Materials and Methods: A total of 73 Caucasian patients (33 males and 40 females; mean age 9.4) were retrospectively enrolled from a pool of patients treated in chronological order at the Department of Orthodontics, University of Foggia, Italy, from April 2018 to December 2021. Each patient received a laterolateral radiograph and a digital scan of the dental arch. Eight cephalometric parameters (lower gonial angle, intermaxillary angle, divergence angle, Wits index, Jarabak ratio, OP-MP angle, PP-OP angle, and ANB) and five dental measurements (posterior mandibular arch width, anterior mandibular arch width, mandibular occlusal angle, posterior width on distobuccal molar cusps, and molar angle) were analyzed and then compared. A Spearman's rho correlation test between the cephalometric measurements and the dental measurements was performed. Statistical significance was set at p < 0.05. Results: A negative statistically significant correlation was found between the Jarabak ratio and the intermolar angle; a statistically significant correlation was also observed between the Wits index, the posterior mandibular width, and the occlusal mandibular angle; the ANB angle and the occlusal mandibular angle; the intermaxillary angle (PP-PM) and the mandibular occlusal angle, posterior mandibular width on the disto-vestibular cusp, and the intermolar angle; and the OP-MP angle and mandibular occlusal angle and the posterior mandibular width on the disto-vestibular cusp. Conclusions: The mandibular arch form may be related to certain predisposing features in craniofacial morphology, such as jaw divergence, the Jarabak ratio, and the intermaxillary angle.

Treatment of Mandibular Impacted Canine in a Patient with Class II Division 1 Malocclusion with "Reverse Pin": A Case Report.

This case report presents an orthodontic treatment conducted on a 13-year-old girl with bilateral Class II malocclusion and a mandibular impacted canine. The presence of an impacted tooth necessitates careful consideration of the timing of orthodontic treatment, the appropriate surgical procedure to expose the tooth, the specific orthodontic mechanics involved, and the potential problems that may arise, all of which depend on the type and location of the canine impaction in the jaw. The treatment plan included a surgical procedure to expose the impacted tooth and orthodontic traction to guide it into position. Correction of the Class II Division 1 malocclusion utilized a specialized technique called the "reverse pin", reducing vertical side effects. The revised version maintains clarity and key information about the case report and treatment.

Three-dimensional differences between intraoral scans and conventional impressions of edentulous jaws: A clinical study.

STATEMENT OF PROBLEM: Using intraoral scans for removable dentures has been questioned because of a suggested lack of accuracy. However, data regarding the accuracy of digital intraoral complete-arch scans are sparse, present some methodological issues, and mostly come from in vitro studies on dentate casts, which are very different from edentulous arches. PURPOSE: The purpose of this clinical study was to evaluate 3D differences between intraoral scans (IOS) and conventional impressions of edentulous arches by means of digital analysis. MATERIAL AND METHODS: Ten maxillary and 10 mandibular edentulous arches were investigated. For each of them, IOS was performed, and a custom tray was digitally designed based on these scans. Trays were built by using a 3D printer and used to make a conventional impression with a polysulfide impression material. The conventional impression was scanned immediately by using the same intraoral scanner and by the same dentist. Standard tessellation language (STL) files of IOS and the scans of the corresponding conventional impressions (CIS) were superimposed with a 2-phase best-fit alignment in a reverse engineering software program. The corresponding full-scan, 3D mean distance was measured. This procedure was repeated after trimming the IOS and CIS to eliminate peripheral areas not present in both files, as well as nonmatching areas caused by practical aspects related to obtaining the IOS (mobile tissue stretching) and the conventional impressions (mobile tissue compression and folding at the margin of impression), which could have impaired alignment and, consequently, measurement accuracy. The mean distance between the full and trimmed IOS and CIS was statistically investigated, and subgroup analysis was performed for the maxillary and mandibular arches. The statistical significance of the differences between the 2 impression methods was also investigated. RESULTS: The full-scan mean distance between the IOS and CIS (-0.19 ±0.18 mm) was significantly different from that of the trimmed scan mean distance (-0.02 ±0.05 mm), with no significant differences for maxillary and mandibular arches. The differences between the IOS and CIS were statistically significant for full scans; they were not significant for trimmed scans, except for the maxillary subgroup. CONCLUSIONS: The mean distance between the IOS and CIS may be significantly different if they are not properly superimposed. The mean distance (-0.02 ±0.05 mm) between the IOS and CIS falls within the range of mucosa resilience. Thus, 3D differences between the IOS and CIS can be attributed to the different physics behind the 2 impression methods and not to defects in accuracy of one method compared with the other. The size of the measured difference between the 2 impression methods was not statistically significant and was not clinically significant for removable denture fabrication.

Overexpression of ADAR1 into the cytoplasm correlates with a better prognosis of patients with oral squamous cells carcinoma.

BACKGROUND: ADAR1 is an enzymatic protein, which catalyzes a RNA editing reaction by converting Adenosine to Inosine, and its expression has been found to be dysregulated in many cancer types. The aim of this study was to analyze the expression of ADAR1 in oral squamous cells carcinoma. METHODS: In order to analyze the ADAR1 mRNA expression, data from The Cancer Genome Atlas (TCGA) database were downloaded and analyzed. In addition, immunohistochemistry analysis was performed on an institutional database including 46 samples of oral squamous cell carcinoma in a tissue microarray (TMA). RESULTS: No statistically significant correlation linked the mRNA ADAR1 expression to any clinic-pathological variables in the TCGA database. Immunohistochemistry analysis of ADAR1 showed different expressions between normal mucosa and tumor tissue. Focusing on the subcellular localization, the nuclear expression of ADAR1 correlated with higher grading of differentiation (ρ = 0.442; P-value = 0.002); the general expression of ADAR1 either in cytoplasm or in nuclei, correlated with the Gender of patients (Cytoplasm expression: ρ = -0.295; P-value = 0.049; while for nuclear expression: ρ = +0.374; P = 0.011); cytosol expression resulted to be an independent protective prognostic factor (HR = 0.047; C.I. 95% 0.007-0.321; P-value = 0.002). CONCLUSION: Higher expression of ADAR1 into the cytoplasm resulted to be an independent prognostic factor. In order to understand ADAR1 role in cancer, further studies should be performed, in bigger cohort and under a bio-molecular point of view.

Passive Ultrasonic Irrigation Efficacy in the Vapor Lock Removal: Systematic Review and Meta-Analysis.

Passive Ultrasonic Irrigation (PUI) represents one of the most used systems to improve the endodontic irrigants activity. PUI acts increasing the reaction rate of NaOCl, with an increase of dentinal debris and smear layer removal. There is a stronger shear stress and a vapor lock reduction. Aim of this systematic review was to figure out the effects of the PUI on the vapor lock removal, during irrigation. Literature research has been carried out by two reviewers, consulting online databases such as PubMed, EBSCO, and Google Scholar, using keywords like Vapor Lock, Vapour Lock, and Vapor Lock Endodontic. The articles list has been screened based on titles and abstracts, applying eligibility and inclusion criteria. The three articles were eligible for quantitative and statistical analysis, by using RevManager Software Version 5.3. Results show statistical heterogeneity (P=0.08; I2 index=61%) in the vapor lock elimination between the use of PUI and PPI, with an overall Odds Ratio=0.08, CI=95% [0.03;0.25]. PUI resulted to be a useful technique to improve NaOCl activity for vapor lock removal, despite PPI alone using a needle.

Immunohistochemical Analysis Revealed a Correlation between Musashi-2 and Cyclin-D1 Expression in Patients with Oral Squamous Cells Carcinoma.

AIM: Musashi 2 (MSI2), which is an RNA-binding protein, plays a fundamental role in the oncogenesis of several cancers. The aim of this study is to investigate the expression of MSI2 in Oral Squamous Cell Carcinoma (OSCC) and evaluate its correlation to clinic-pathological variables and prognosis. MATERIALS AND METHODS: A bioinformatic analysis was performed on data downloaded from The Cancer Genome Atlas (TCGA) database. The MSI2 expression data were analysed for their correlation with clinic-pathological and prognostic features. In addition, an immmunohistochemical evaluation of MSI2 expression on 108 OSCC samples included in a tissue microarray and 13 healthy mucosae samples was performed. RESULTS: 241 patients' data from TCGA were included in the final analysis. No DNA mutations were detected for the MSI2 gene, but a hyper methylated condition of the gene emerged. MSI2 mRNA expression correlated with Grading (p = 0.009) and overall survival (p = 0.045), but not with disease free survival (p = 0.549). Males presented a higher MSI2 mRNA expression than females. The immunohistochemical evaluation revealed a weak expression of MSI2 in both OSCC samples and in healthy oral mucosae. In addition, MSI2 expression directly correlated with Cyclin-D1 expression (p = 0.022). However, no correlation has been detected with prognostic outcomes (overall and disease free survival). CONCLUSIONS: The role of MSI2 expression in OSCC seems to be not so closely correlated with prognosis, as in other human neoplasms. The correlation with Cyclin-D1 expression suggests an indirect role that MSI2 might have in the proliferation of OSCC cells, but further studies are needed to confirm such results.

Alignment of intraoral scans and registration of maxillo-mandibular relationships for the edentulous maxillary arch.

One of the main issues in using intraoral scans for the fabrication of removable dentures is that scans need to be aligned to each other. The workflow presented provides aligned intraoral scans of the arches and of the occlusion rim incorporating maxillo-mandibular relationships and information for tooth arrangement in a single procedure. Thus, after intraoral scanning, the clinician can proceed directly with the denture design.

Early and late implant failure of submerged versus non-submerged implant healing: A systematic review, meta-analysis and trial sequential analysis.

INTRODUCTION: The aim of this systematic review was to analyse current evidence regarding differences in early and late implant failure as well as in marginal bone level (MBL) changes between submerged and non-submerged healed dental implants. METHODS: PUBMED, SCOPUS, EMBASE and Web of Science databases were searched for prospective randomized and non-randomized controlled studies addressing direct comparison between submerged and non-submerged implant healing, without performing immediate loading. Early and late implant failure (before or after 6 months from implant placement, respectively) together with MBL were the investigated outcomes. Risk of bias assessment was performed using the Cochrane Collaboration Tool for Randomized clinical trials. Meta-analysis was performed and the power of the meta-analytic findings determined by trial sequential analysis (TSA). RESULTS: Eleven studies met the inclusion criteria and were included in the review. Results of this systematic review revealed a small higher rate (2%) of early implant failure when a non-submerged healing approach is performed. Late implant failure appears not to be different in submerged or non-submerged healing, but the power of evidence, as determined by TSA, is not high. If we consider MBL changes at 1 year from implant load, it seems that non-submerged healing may better preserve marginal bone, although with a small effect size (0.13 mm). CONCLUSIONS: Implants placed with a non-submerged technique have a higher risk (2%) of early failure. The power of the evidence about the effects on MBL is low, but present results seem to favour non-submerged healing, although with a very small effect size.

Correlation between body mass index and obstructive sleep apnea severity indexes - A retrospective study.

PURPOSE: To evaluate if Body Mass Index (BMI) is correlated to Apnea-Hypopnea Index (AHI), mean arterial oxygen saturation (SaO2) and Nadir SaO2, which are all indexes defining the severity of the respiratory stress associated with Obstructive Sleep Apnea (OSA). MATERIALS AND METHODS: Seventy-five adult patients (mean age 51.4) referred for polysomnography were retrospectively recruited. BMI was calculated for each patient, as well as AHI, SaO2, and Nadir SaO2 recorded during polysomnography. Spearman's Rho test was used to evaluate if OSA severity was correlated to BMI values. First type error was set as p < 0.025. RESULTS: No correlation was observed between BMI and AHI, and between BMI and SaO2. A statistically significant negative correlation (r2 = 0.424; p < 0.001) was found between the BMI index and the Nadir SaO2. CONCLUSIONS: Higher BMI values were correlated with lower Nadir SaO2 during overnight polysomnography. Since hypoxia stress is a risk factor for cardiovascular diseases and alters the lipid metabolism, dietary consulting should be recommended in association with other treatment modalities for OSA.

Swallowing and Temporomandibular Disorders in Adults.

INTRODUCTION: Temporomandibular disease (TMD) etiology is multifactorial and is related to many perpetuating, predisposing, and initiating factors. The daytime parafunctions may have an important role in TMD pathogenesis. The most frequent parafunctions analyzed were the static parafunction (ie, clenching) and the dynamic parafunction (ie, grinding). In the present paper, the authors evaluated the swallowing (an oral function/parafunction) with the surface electromyography in patients with TMD. MATERIALS AND METHODS: Twenty patients with TMD problems (nonhealthy patients, NHP) (mean age: 33 ±â€Š1.994; 8 men and 12 women) and 20 healthy matched subjects (HP) (34.4 ±â€Š2.782; 6 men and 14 women) were selected and examined. On each patient, an 8-channel surface electromyography was done during saliva swallowing. RESULTS: Nonhealthy patients presented higher masseter and temporalis activation (P < 0.05) and an unbalancing of temporalis and submental muscles activation (P < 0.05) than the HP. DISCUSSION: Nonhealthy patients presented a time of swallow higher than HP (P < 0.001). Nonhealthy patients presented a higher muscles activation and time of swallow than HP and a decrease of muscles balancing activation.

Rate of Relapse After Enucleation of Solid/Multicystic Ameloblastoma Followed by Piezoelectric or Conventional Peripheral Ostectomy.

The use of piezo surgery is characterized by a good cutting ability associated with a higher soft tissues respect. Such skills have led to an increment of the use of such systematic in the clinical practice. The aim of this study was to figure out whether the use of piezo surgery may show clinical advantages when enucleation is followed by peripheral ostectomy for the treatment of solid/multicystic ameloblastoma. A retrospective case-control study was performed, including patients treated with piezo surgery or conventional drilling in a single center in Italy. Results of this investigation revealed a lower rate of relapse, at 5 years' follow-up for patients treated with piezo surgery. Although characterized by low power of evidences, the results of this investigation encourage the development of further studies related to the use of piezo surgery for the treatment of solid/multicystic ameloblastoma.

Effects of crown movement on periodontal biotype: a digital analysis.

Orthodontic treatment has important correlations with periodontal changes. Various mechanical and biological factors are involved in determining such changes, but anatomical and morphological variables, generally addressed as periodontal biotype, play a key role. In measurement of such modifications, digital and non-contact reverse engineering technologies may be of tremendous advantage. The aim of this study is to retrospectively evaluate, in a series of digitized dental casts, some of the parameters addressing periodontal biotype and correlate them to extent and direction of tooth movement. Pre- (T0) and post-treatment (T1) dental casts of 22 patients were scanned by 3Shape TRIOS 3® scanner. A number of variables (crown ratio, gingival margin position, gingival contour, papillae position, gingival scallop) were investigated and their variations calculated after digital measurements on single casts at T0 and T1, or after direct measurement (T1 vs T0) on the superimposition and alignment of digital models. Univariate and multivariate statistics were then performed. No significant correlation was detected between the sagittal or vertical movement of dental crown and displacement of the gingival margin. On the other hand, vestibular gingival contour resulted significantly altered by vestibular and extrusion movements. Further studies are needed to ascertain the differential effect of bone and soft tissue on such modifications. The relationship between orthodontic treatment and the periodontium overcomes the consideration of gingival recession and includes all the concepts of periodontal biotype with its characteristics. Digital technologies and non-contact reverse engineering techniques now available have the potential to allow a more precise definition of such a relationship.

Conservative vs Radical Approach for the Treatment of Solid/Multicystic Ameloblastoma: A Systematic Review and Meta-analysis of the Last Decade.

PURPOSE: To examine whether a difference exists in the relapse rate between the conservative and radical approaches after the treatment of solid/multicystic ameloblastoma (SMA), a systematic review of the literature based on evidence of the last decade was performed. MATERIALS AND METHODS: The search strategy incorporated examinations of electronic databases, supplemented by hand searches. A search of four electronic databases, including Ovid MEDLINE, PubMed, EMBASE and Web of Science, was carried out for relevant studies published in the English language from January 2005 to September 2015. Cross referencing and hand research was used to identify further articles. Relative Risk (RR) as effect estimates was calculated in both fixed and random effects models. RESULTS: Of 4234 abstracts screened, only 26 articles met the inclusion criteria and were screened in full text. Of these, only 4 were included in the final meta-analysis. CONCLUSION: The inverse of variance test revealed a statistical difference in the relapse rate for SMA treatment with the conservative vs radical approach. The higher recurrence rate after a conservative approach compared to the surgical approach is significant. However, this review cannot give any recommendation due to the lack of clinical evidence.

Centering Ability of ProTaper Next and WaveOne Classic in J-Shape Simulated Root Canals.

Introduction. The aim of this study was to evaluate and compare the shaping and centering ability of ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) and WaveOne Classic systems (Dentsply Maillefer) in simulated root canals. Methods. Forty J-shaped canals in resin blocks were assigned to two groups (n = 20 for each group). Photographic method was used to record pre- and postinstrumentation images. After superimposition, centering and shaping ability were recorded at 9 different levels from the apex using the software Autocad 2013 (Autodesk Inc., San Rafael, USA). Results. Shaping procedures with ProTaper Next resulted in a lower amount of resin removed at each reference point level. In addition, the pattern of centering ability improved after the use of ProTaper Next in 8 of 9 measurement points. Conclusions. Within the limitations of this study, shaping procedures with ProTaper Next instruments demonstrated a lower amount of resin removed and a better centering ability than WaveOne Classic system.

Reliabilty of recording occlusal contacts by using intraoral scanner and articulating paper - A prospective study.

OBJECTIVE: The recording of occlusal contacts is a pivotal step in many dental procedures, yet the lack of a standardized method could introduce clinical errors. The aim of this study was to compare the occlusal contacts recorded using a intraoral scanner to the contacts recorded using articulating paper. As a secondary outcome, the subjective clinical assessment made using the two methods was compared between different observers. METHODS: Twenty-eight records were analysed for this study. Digital scan and intraoral photos of the coloured marks impressed by articulating paper were taken at the same time point for every patient. Using a standardized occlusal template, two operators recorded the number of occlusal contacts for every tooth provided by the two techniques. Then, 11 clinicians analysed the collected records and answered questions about the quality of the occlusions observed. RESULTS: The statistical analysis showed significant differences between the number of contacts recorded by digital scan and those recorded by the photographed articulation marks, except in the case of the upper central incisors and first premolars. The Kappa Fleiss showed slight and fair agreement between clinicians when judging the occlusions. CONCLUSION: The occlusal contacts recorded using the intraoral scanner and those recorded with the articulating paper did not match, and overall the clinicians showed low agreement when rating the recorded data. CLINICAL SIGNIFICANCE: Despite of the great clinical importance of occlusal contact there is a lack of a precise method for recording and collecting occlusal contacts.

Thermoplastic clear dental aligners under cyclic compression loading: A mechanical performance analysis using acoustic emission technique.

The objective of this work is to analyse the performance of clear aligners made of thermoplastic materials. Within this framework, the damage evolution stages and damage states of the aligners at different cycles of the compressive loading are evaluated using the Acoustic Emission (AE) technique. Three different clear aligner systems were prepared: thermoformed PET-g (polyethylene terephthalate glycol) and PU (polyurethane), and additively manufactured PU. Cyclic compression tests are performed to simulate 22500 swallows. The mechanical results show that the energy absorbed by the thermoformed PET-g aligner remains stable around 4 Nmm throughout the test. Although the PU-based aligners show a higher energy absorption of about 7 Nmm during the initial phase of the cyclic loading, this gradually decreases after 12500 cycles. The time-domain based, and frequency-based parameters of the stress wave acoustic signals generated by the aligners under compression loading are used to identify the damage evolution stages. The machine learning-based AE results reveal the initiation and termination of the different damage states in the aligners and the frequency-based results distinguish the different damage sources. Finally, the microscopy results validated the damage occurrences in the aligners identified by the AE results. The mechanical test results indicate that the thermoformed PET-g has the potential to match the performance and requirements of the dentistry of the popular Invisalign (additively manufactured PU). The AE results have the potential to identify at which cycles the aligners may start losing their functionality.