Effect of thermomechanical aging on force system of orthodontic aligners made of different thermoformed materials

• DOI: 10.1007/s00056-024-00527-0
• Publication Date: 2024-04-23T17:02:24Z
• Authors: Tarek M. Elshazly; Ludger Keilig; Diva Nang; Bijan Golkhani; Anna Weber; Hanaa Elattar; Sameh Talaat; Christoph Bourauel

Abstract Purpose The aim was to investigate the effect of aging by thermocycling and mechanical loading on forces and moments generated by orthodontic clear aligners made from different thermoplastic materials.

Methods A total of 25 thermoformed aligners made from 5 different materials, i.e., Essix ACE® and Essix® PLUS™ (Dentsply Sirona, Bensheim, Germany), Invisalign® (Align Technology, San Jose, CA, USA), Duran®+ (Iserlohn, Germany), Zendura™ (Fremont, CA, USA), underwent a 14-day aging protocol involving mechanical loading (a 0.2 mm vestibular malalignment of the upper left second premolar [tooth 25]) and thermocycling in deionized water (temperature range 5–55 °C). The 3D forces/moments exerted on tooth 25 of a resin model were measured at three time points: before aging (day 0), after 2 days and after 14 days of aging.

Results Before aging, extrusion–intrusion forces were 0.6–3.0 N, orovestibular forces were 1.7–2.3 N, and moments as mesiodistal rotation were 0.3–42.1 Nmm. In all directions, multilayer Invisalign® exhibited the lowest force/moment magnitudes. After aging, all materials showed a significant force/moment decay within the first 2 days, except Invisalign® for orovestibular and vertical translation. However, following thermomechanical aging, Duran®+ and Zendura™ aligners had equivalent or even higher vestibular forces (direction of mechanical load).

Conclusion Thermomechanical aging significantly reduced forces and moments during the first 48 h. Multilayer aligner materials exhibit lower initial forces and moments than single-layer ones, and were less influenced by aging. Material hardening was observed after subjecting some of the aligner materials to mechanical loading. Thus, orthodontists should be aware of possible deterioration of orthodontic aligners over time. This work also sheds light on how material selection impacts the mechanical behavior of aligners and may provide valuable guidance regarding optimal timing for the aligner changing protocol.