Conformation Effect on the Mechanical and Microbiological Behavior of Invisible Orthodontic Aligners

Abstract

Invisible orthodontic aligners are having a great impact on tooth movement in an aesthetic and effective way. Different techniques, models, and clinical aspects have been studied for their proper use. However, the aim of this research has been to determine the effect of the shaping process on mechanical properties and their bacterial behavior. For this study, 40 original polyurethane plates and 40 identical models, obtained by hot forming the original plates, were used. The static tensile mechanical properties were studied with a Zwick testing machine using testing speeds of 5 mm/min at a temperature of 37 °C. The original plate and the aligner have been studied with a creep test by subjecting the samples to a constant tension of 30 N, and determining the elongation using a long-distance, high-resolution microscope at different time periods between 1 and 720 h. Studies of water absorption has been realized with artificial saliva for 5 h. Bacterial cultures of Streptococcus oralis and Actinomyces viscosus strains were grown on the original plates and on new and used models, to determine the proliferation of each bacterium through metabolic activity, colony-forming units, and LIVE/DEAD assays. The mechanical results showed an increase in the strength of the inserts with respect to the models obtained from 3.44 to 3.95 MPa in the elastic limit and a lower deformation capacity. It has been proven that the transition zone in the creep curves lasts longer in the original plate, producing the rapid increase in deformation at a shorter time (400 h) in the aligner. Therefore, the shaping process reduces the time of dental correction exerted by the aligner. The results of the bacterial culture assays show an increase in the number of bacterial colonies when the aligners have been used and when the polyurethane is conformed due to the internal energy of the model, with respect to the original polyurethane. It has been observed that between the original plate and the aligner there are no statistically significant differences in water absorption and therefore the forming process does not affect water absorption. A slight increase in water absorption can be observed, but after five hours of exposure, the increase is very small.

Keywords: conformation; invisible aligners; mechanical properties; polyurethane.

Figure 1

Stress–strain test for determination of mechanical properties.

Figure 2

Elongation of original plate and aligner appliance loaded at 30 N in relation to the time in hours.

Figure 3

Surface of the polyurethane plate (a). Surface of the new aligner (b).

Figure 4

Water absorption up to 1 month.

Figure 5

Streptococcus oralis (a) and Actinomyces viscosus (b) colony-forming units of different used and new dental positions and the original plaque.

Figure 6

Streptococcus oralis (a) and Actinomyces viscosus (b) metabolic activity of different used and new dental positions and the original plaque.

Figure 7

LIVE/DEAD images of new aligners for molar, premolar, and incisor and used aligners (old) for the same teeth and the original plate.