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CC BY 4.0 · Eur J Dent 2024; 18(01): 174-181
DOI: 10.1055/s-0043-1761452
Original Article

Effectiveness of the Attachment Design and Thickness of Clear Aligners during Orthodontic Anterior Retraction: Finite Element Analysis

Ananto Ali Alhasyimi 
1   Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
,
Aulia Ayub 
1   Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
,
Cendrawasih Andusyana Farmasyanti
1   Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Abstract

Objective Clear aligner treatment (CAT) provides orthodontic patients with a comfortable treatment alternative; however, this device has limited capacity to facilitate tooth movements. Although composite attachment has been proposed to facilitate tooth displacement, some of its aspects, such as aligner thickness, can influence CAT's precision. This work aimed to compare the stress distribution patterns produced by clear aligners with different thicknesses and composite attachment shapes during anterior retraction.

Materials and Methods Maxillary models consisting of clear aligners, maxillary teeth, and various attachments to the upper central incisor's labial surface were generated. Three models were built to mimic the retraction of the upper central incisors. Each had a distinct attachment design (rectangular attachment, ellipsoid attachment, and pyramidal attachment) and various aligner thicknesses (0.75, 0.85, 0.95, 1.05, and 1.15 mm). Upper central incisor retraction was accomplished using clear aligners. Finite element analysis was used to examine the built models. Stress distribution pattern was examined.

Results The greater the thickness of the aligner, the higher the stress experienced by the teeth. The 0.75 mm-thick aligner induces the lightest stress with a minimum of 0.0037623 MPa and a maximum of 0.32859 MPa. Meanwhile, the 1.5 mm-thick aligner has the highest stress with a minimum of 0.004679 MPa and a maximum of 0.43858 MPa. The force distribution on rectangular attachments appears evenly distributed. The maximum pressure force on rectangular attachments has a minimum of 0.38828 MPa, which is smaller than the maximum on ellipsoid and pyramidal attachments at 0.40933 and 0.45099 MPa, respectively.

Conclusion The best aligner thickness is 0.75 to 0.85 mm for anterior retraction. An aligner with 0.95 mm thickness can still be used when a remarkable amount of tooth movement force is needed; however, this exception is only applicable to a limited number of clear aligner trays. The ellipsoid attachment is the best type of attachment because the resulting force is substantial and evenly distributed.

Keywords

attachment - clear aligner - force - orthodontic - retraction - thickness


Publication History

Article published online:
24 March 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Indriasari V, Suparwitri S, Christnawati C, Alhasyimi AA. Different effects of soybean isoflavone genistein on transforming growth factor levels during orthodontic tooth movement among young and old rabbits. F1000 Res 2019; 8: 2074
    Google Scholar
  • 2 Alhasyimi AA, Rosyida NF, Rihadini MS. Postorthodontic relapse prevention by administration of grape seed (Vitis vinifera) extract containing cyanidine in rats. Eur J Dent 2019; 13 (04) 629-634
    Google Scholar
  • 3 Ben Gassem AA. Does clear aligner treatment result in different patient perceptions of treatment process and outcomes compared to conventional/traditional fixed appliance treatment: a literature review. Eur J Dent 2022; 16 (02) 274-285
    Google Scholar
  • 4 Meto A, Colombari B, Castagnoli A, Sarti M, Denti L, Blasi E. Efficacy of a copper-calcium-hydroxide solution in reducing microbial plaque on orthodontic clear aligners: a case report. Eur J Dent 2019; 13 (03) 478-484
    Google Scholar
  • 5 Zheng M, Liu R, Ni Z, Yu Z. Efficiency, effectiveness and treatment stability of clear aligners: a systematic review and meta-analysis. Orthod Craniofac Res 2017; 20 (03) 127-133
    Google Scholar
  • 6 Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod 2015; 85 (05) 881-889
    Google Scholar
  • 7 Tepedino M, Paoloni V, Cozza P, Chimenti C. Movement of anterior teeth using clear aligners: a three-dimensional, retrospective evaluation. Prog Orthod 2018; 19 (01) 9
    Google Scholar
  • 8 White DW, Julien KC, Jacob H, Campbell PM, Buschang PH. Discomfort associated with Invisalign and traditional brackets: a randomized, prospective trial. Angle Orthod 2017; 87 (06) 801-808
    Google Scholar
  • 9 Bilello G, Fazio M, Amato E, Crivello L, Galvano A, Currò G. Accuracy evaluation of orthodontic movements with aligners: a prospective observational study. Prog Orthod 2022; 23 (01) 12
    Google Scholar
  • 10 Chen W, Qian L, Qian Y, Zhang Z, Wen X. Comparative study of three composite materials in bonding attachments for clear aligners. Orthod Craniofac Res 2021; 24 (04) 520-527
    Google Scholar
  • 11 Yokoi Y, Arai A, Kawamura J, Uozumi T, Usui Y, Okafuji N. Effects of attachment of plastic aligner in closing of diastema of maxillary dentition by finite element method. J Healthc Eng 2019; 2019: 1075097
    Google Scholar
  • 12 Goto M, Yanagisawa W, Kimura H, Inou N, Maki K. A method for evaluation of the effects of attachments in aligner-type orthodontic appliance: three-dimensional finite element analysis. Orthod Waves 2017; 76 (04) 207-214
    Google Scholar
  • 13 Kim WH, Hong K, Lim D, Lee JH, Jung YJ, Kim B. Optimal position of attachment for removable thermoplastic aligner on the lower canine using finite element analysis. Materials (Basel) 2020; 13 (15) 3369
    Google Scholar
  • 14 Costa R, Calheiros FC, Ballester RY, Gonçalves F. Effect of three different attachment designs in the extrusive forces generated by thermoplastic aligners in the maxillary central incisor. Dental Press J Orthod 2020; 25 (03) 46-53
    Google Scholar
  • 15 Wheeler TT. Orthodontic clear aligner treatment. Semin Orthod 2017; 23 (01) 83-89
    Google Scholar
  • 16 Phan X, Ling PH. Clinical limitations of Invisalign. J Can Dent Assoc 2007; 73 (03) 263-266
    Google Scholar
  • 17 Iared W, Koga da Silva EM, Iared W, Rufino Macedo C. Esthetic perception of changes in facial profile resulting from orthodontic treatment with extraction of premolars: a systematic review. J Am Dent Assoc 2017; 148 (01) 9-16
    Google Scholar
  • 18 Hedayati Z, Shomali M. Maxillary anterior en masse retraction using different antero-posterior position of mini screw: a 3D finite element study. Prog Orthod 2016; 17 (01) 31
    Google Scholar
  • 19 Jiang T, Wu RY, Wang JK, Wang HH, Tang GH. Clear aligners for maxillary anterior en masse retraction: a 3D finite element study. Sci Rep 2020; 10 (01) 10156
    Google Scholar
  • 20 Hartono N, Soegiharto BM, Widayati R. The difference of stress distribution of maxillary expansion using rapid maxillary expander (RME) and maxillary skeletal expander (MSE)-a finite element analysis. Prog Orthod 2018; 19 (01) 33
    Google Scholar
  • 21 Seo JH, Eghan-Acquah E, Kim MS. et al. Comparative analysis of stress in the periodontal ligament and center of rotation in the tooth after orthodontic treatment depending on clear aligner thickness-finite element analysis study. Materials (Basel) 2021; 14 (02) 324
    Google Scholar
  • 22 Bergomi M, Wiskott HW, Botsis J, Mellal A, Belser UC. Load response of periodontal ligament: assessment of fluid flow, compressibility, and effect of pore pressure. J Biomech Eng 2010; 132 (01) 014504
    Google Scholar
  • 23 Melsen B, Cattaneo PM, Dalstra M. et al. The importance of force levels in relation to tooth movement. Semin Orthod 2007; 13: 220-233
    Google Scholar
  • 24 Liu DS, Chen YT. Effect of thermoplastic appliance thickness on initial stress distribution in periodontal ligament. Adv Mech Eng 2015;7(04):
    Google Scholar
  • 25 Hong K, Kim WH, Eghan-Acquah E, Lee JH, Lee BK, Kim B. Efficient design of a clear aligner attachment to induce bodily tooth movement in orthodontic treatment using finite element analysis. Materials (Basel) 2021; 14 (17) 4926
    Google Scholar
  • 26 Hohmann A, Wolfram U, Geiger M. et al. Periodontal ligament hydrostatic pressure with areas of root resorption after application of a continuous torque moment. Angle Orthod 2007; 77 (04) 653-659
    Google Scholar