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Direct 3D Printing of Clear Orthodontic Aligners: Current State and Future Possibilities

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Direct 3D Printing of Clear Orthodontic Aligners: Current State and Future Possibilities materials Review Direct 3D Printing of Clear Orthodontic Aligners: Current State and Future Possibilities Gianluca M. Tartaglia 1,2, Andrea Mapelli 1, Cinzia Maspero 1,2 , Tommaso Santaniello 3, Marco Serafin 1,2,* , Marco Farronato 1,2 and Alberto Caprioglio 1,2 1 Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; [email protected] (G.M.T.); [email protected] (A.M.); [email protected] (C.M.); [email protected] (M.F.); [email protected] (A.C.) 2 Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy 3 Department of Physics, University of Milan, 20100 Milan, Italy; [email protected] * Correspondence: marco.serafi[email protected] Abstract: The recent introduction of three-dimensional (3D) printing is revolutionizing dentistry and is even being applied to orthodontic treatment of malocclusion. Clear, personalized, removable aligners are a suitable alternative to conventional orthodontic appliances, offering a more comfortable and efficient solution for patients. Including improved oral hygiene and aesthetics during treatment. Contemporarily, clear aligners are produced by a thermoforming process using various types of thermoplastic materials. The thermoforming procedure alters the properties of the material, and the intraoral environment further modifies the properties of a clear aligner, affecting overall performance of the material. Direct 3D printing offers the creation of highly precise clear aligners with soft edges, digitally designed and identically reproduced for an entire set of treatment aligners; offering a better fit, higher efficacy, and reproducibility. Despite the known benefits of 3D printing and the popularity Citation: Tartaglia, G.M.; Mapelli, A.; of its dental applications, very limited technical and clinical data are available in the literature about Maspero, C.; Santaniello, T.; Serafin, M.; Farronato, M.; Caprioglio, A. directly printed clear aligners. The present article discusses the advantages of 3D printed aligners Direct 3D Printing of Clear in comparison to thermoformed ones, describes the current state of the art, including a discussion Orthodontic Aligners: Current State of the possible road blocks that exist such as a current lack of approved and marketed materials and Future Possibilities. Materials and limited existence of aligner specific software. The present review suggests the suitability of 3D 2021, 14, 1799. https://doi.org/ direct printed aligners is superior to that of thermoformed manufactured aligners because of the 10.3390/ma14071799 prior’s increased accuracy, load resistance, and lower deformation. It is an overall more stable way to produce an aligner where submillimeter movements can make a difference in treatment outcome. Academic Editor: Luca Contardo Direct 3D printing represents a complex method to control the thickness of the aligner and therefore has a better ability to control the force vectors that are used to produce tooth movement. There is Received: 7 February 2021 currently no other approved material on the market that can do this. The conclusion of this article is Accepted: 2 April 2021 that we encourage further in vitro and in vivo studies to test these new technologies and materials. Published: 5 April 2021 Keywords: 3D printing; clear aligners; dental printing resin; malocclusion; narrative review; or- Publisher’s Note: MDPI stays neutral thodontics with regard to jurisdictional claims in published maps and institutional affil- iations. 1. Background Brief History Orthodontics is now approaching its fourth revolution since its inception as a spe- Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. cialty of dentistry in the early 1900s. In those days, malocclusion was treated with the This article is an open access article application of metal rings cemented to teeth to support wires for applying moving forces. distributed under the terms and This initial treatment strategy for the correction of dental and skeletal malocclusion was conditions of the Creative Commons often accompanied by a huge number of dental caries because it was almost impossible Attribution (CC BY) license (https:// to maintain correct dental hygiene due to the limited offering of dental hygiene tools in creativecommons.org/licenses/by/ the market at that time and to the mechanical encumbrance of the cemented rings and 4.0/). Materials 2021, 14, 1799. https://doi.org/10.3390/ma14071799 https://www.mdpi.com/journal/materials Materials 2021, 14, x FOR PEER REVIEW 2 of 11 Materials 2021, 14, 1799 2 of 11 market at that time and to the mechanical encumbrance of the cemented rings and subse- subsequentquent dental dental plaque plaque formation formation on the on theteeth. teeth. Later Later in the in the 1960s, 1960s, the the rings rings were were substituted substi- tutedby the by first the firstbrackets brackets to support to support wires wires made made from from stainless stainless steel, steel, which which offered offered several several ad- advantages,vantages, such such as as high high strength, strength, durability, durability, reduced reduced friction, friction, improved improved salivary salivary flow, flow, less lessfood food collection, collection, and and they they were were relatively relatively easy easy to form. to form. This This wonderful wonderful technological technological jump jumprepresented represented a revolution a revolution and was and made was made possible possible due to due the todevelopment the development of dental of den-science talmaterials science materialsable to bond able the to bond brackets the brackets directly directly onto the onto teeth. the teeth.The conventional The conventional brackets bracketsmade of made transparent of transparent or translucent or translucent non-metal non-metalliclic material material were were introduced introduced in inthe the early early1970s 1970s (Figure (Figure 1). The1). The first first transparent transparent brackets brackets made made of ofunfilled unfilled polycarbonate polycarbonate were were later laterreplaced replaced by byceramic-reinforced, ceramic-reinforced, fiberglass-reinforced,fiberglass-reinforced, and and polycarbonate-reinforced polycarbonate-reinforced bracketsbrackets with with a a metallic metallic insert insert to to minimize minimize creep creep deformation deformation [1, 2[1,2].]. Later, Later, ceramic ceramic brackets brackets (monocrystalline(monocrystalline sapphire sapphire and and polycrystalline polycrystalline ceramic) ceramic) were were used; used; however, however, the the hardness hardness ofof those those materials materials could could cause cause enamel enamel abrasion abrasion [3]. [3]. FigureFigure 1. 1.Conventional Conventional orthodontic orthodontic treatment treatment (a) and(a) and thermoformed thermoformed clear clear aligner aligner with itswith 3D its printed 3D moldprinted (b). mold (b). SimilarlySimilarly to to advances advances in in material material used used for fo brackets,r brackets, there there has has been been a technological a technological progressionprogression in in the the different different types types of of archwire archwire have have been been used used since since the the popularization popularization of of orthodonticorthodontic treatment. treatment. InitialInitial useuse ofof traditionaltraditional stainlessstainless steelsteel archwire waswas eventually re- replacedplaced by by clear clear optica opticall fiberfiber (Optiflex),(Optiflex), Teflon Teflon coated coated wire, wire, epoxy epoxy coated coated wire, wire, titanium titanium plasticplastic coated coated wire wire and and Bioforce Bioforce wire wire [3 ].[3]. This This technological technological development development led led to the to the third third revolutionrevolution and and represents represents current current contemporary contemporary orthodontic orthodontic science. science. TowardsTowards the the end end of of the the last last century century and and in in the th firste first decade decade of thisof this century, century, the the first first alignersaligners forfor orthodontic orthodontic purposes purposes appeared appeared [4 ].[4]. This This revolutionary revolutionary development development was was mainlymainly driven driven by by the the pressure pressure of of patients patients seeking seeking more more comfortable comfortable and and less less intrusive intrusive orthodonticorthodontic procedures procedures for for their their teeth.teeth. Indeed, since their introduction as a a treatment treatment op- optiontion in in orthodontics, orthodontics, aligners aligners have enjoyedenjoyed great great popularity popularity and and the the number number of patientsof patients undergoing orthodontic treatment with aligners has only increased. The use of aligners in undergoing orthodontic treatment with aligners has only increased. The use of aligners in orthodontics has created a paradigm shift for dentistry and has encouraged people of all orthodontics has created a paradigm shift for dentistry and has encouraged people of all ages, including older adults, to seek treatment for their malocclusion. ages, including older adults, to seek treatment for their malocclusion. The aim of the present narrative review is to review the history of clear aligners’ man- ufacturingThe aim processes of the from present thermoforming narrative review to 3D direct is to printing;review the to discusshistory the of advantagesclear aligners’ ofmanufacturing 3D printed
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