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Influence of attachment bonding protocol on precision of the attachment in aligner treatments

Einfluss des Attachment-Klebeprotokolls auf die Genauigkeit des Attachments bei Aligner-Behandlungen

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Abstract

Aim

Precise bonding of attachments in aligner treatment is crucial to achieve the intended tooth movement. Thus, we evaluated five different bonding protocols for attachments used in aligner treatments with the goal of identifying the most precise protocol.

Methods

One ellipsoid and one rectangular attachment were exemplarily chosen and examined. All attachments were bonded using the same template aligner, which was produced by thermoforming. The bonding process was repeated 30 times with each protocol for statistical analysis. The protocols differed in the type of composite used (high viscous, low viscous), the additional application of a perforation in the attachment reservoir, and the use of a two-phase procedure with high viscous composite. All bonded attachments were laser scanned and compared to the attachments of a master model using a surface/surface matching algorithm to determine the precision, i.e., highest aberrations (maximum vertical distance) between the attachment of the master and results obtained from the various bonding protocols. Furthermore, the excessive amounts of composite bonded around the attachments were measured and compared.

Results

The two-phase procedure had a median aberration of 0.13 mm and a median amount of excessive composite of 7.40 mm2 (ellipsoid attachment). With the low viscous composite without a perforation in the template reservoir, similar results were achieved (median 0.13 mm) regarding the maximum vertical distance, but had an excess area of 33.50 mm2.

Conclusion

In this in vitro study, the bonding protocol influenced the precision of bonded attachments. The bonding protocol with high viscous composite without a perforation in the attachment reservoir was the most inaccurate. The use of a low viscous composite or attachments made by a two-phase procedure with high viscous composite revealed more precise results.

Zusammenfassung

Ziel

Die präzise Übertragung der geplanten Attachments auf die Zähne stellt eine Grundvoraussetzung für die Umsetzung der beabsichtigten Zahnbewegung dar. Daher evaluierten wir 5 unterschiedliche Attachment-Klebeprotokolle im Rahmen einer Alignerbehandlung mit dem Ziel, das Protokoll mit der höchsten Genauigkeit zu ermitteln.

Methode

Ein ellipsoides und ein rechteckiges Attachment wurden exemplarisch für die Untersuchungen ausgewählt und mit ein und derselben thermoplastisch hergestellten Templateschiene auf Studienmodelle geklebt. Um statistische Analysen zu ermöglichen, wurden für beide Attachments die Klebeversuche für jedes Protokoll 30-mal wiederholt. Die Protokolle unterschieden sich in der Art des verwendeten Kunststoffs (hochviskös, niedrigviskös), in der zusätzlichen Anbringung einer Perforation im Attachmentreservoir und in der Anwendung eines 2‑phasigen Vorgehens mit hochviskösem Komposit. Die Attachments wurden gescannt und mithilfe der Best-fit-Methode mit den gescannten Attachments eines Mastermodells überlagert. Um die Präzision zu bestimmen, wurde der maximale vertikale Abstand zwischen dem Attachment des Mastermodells und der Oberfläche des geklebten Attachments für jedes Protokoll gemessen. Zusätzlich wurde die Fläche des Kunststoffüberschusses um jedes Attachment erfasst und unter den Protokollen verglichen.

Ergebnisse

Bei einer mittleren Abweichung von 0,13 mm und einer durchschnittlichen Fläche an Kunststoffüberschuss von 7,40 mm2 (ellipsoides Attachment) zeigten sich die präzisesten Ergebnisse beim Klebeprotokoll mit den in einem 2‑phasigen Vorgehen mit hochviskösem Komposit hergestellten Attachments. Bezogen auf die maximale vertikale Distanz wurden ähnliche Ergebnisse beim Protokoll mit niedrigviskösem Kunststoff ohne Perforation im Attachmentreservoir ermittelt (0,13 mm im Median), es zeigte sich aber eine erhöhte durchschnittliche Kunststoffüberschussfläche von 33,50 mm2.

Schlussfolgerung

Diese In-vitro-Studie zeigt, dass das Klebeprotokoll die Präzision des Attachments beeinflusst. Das Protokoll mit hochviskösem Kunststoff ohne Perforation im Reservoir zeigte die größten Abweichungen zum Mastermodell. Bei Verwendung von fließfähigem Komposit oder von in einem 2‑phasigen Prozess mit hochviskösem Kunststoff angefertigten Attachments ergaben sich präzisere Ergebnisse.

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Authors and Affiliations

  1. Orthodontic practice, Mittelstraße 4, 53879, Euskirchen, Germany

    Julia Weckmann

  2. Department of Orthodontics, University Hospital of Cologne, Kerpener Straße 32, 50931, Cologne, Germany

    Sven Scharf, Isabelle Graf & Bert Braumann

  3. Orthodontic private practice, Richard-Wagner-Straße 9–11, 50674, Cologne, Germany

    Jörg Schwarze

  4. Department of Oral Technology, University of Bonn, Welschnonnenstraße 17, 53111, Bonn, Germany

    Ludger Keilig & Christoph Bourauel

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  1. Julia Weckmann
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Correspondence to Sven Scharf.

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Conflict of interest

J. Weckmann, S. Scharf, I. Graf, J. Schwarze, L. Keilig, C. Bourauel and B. Braumann declare that they have no competing interests.

Ethical standards

For this article no studies with human participants or animals were performed by any of the authors. All studies performed were in accordance with the ethical standards indicated in each case.

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Weckmann, J., Scharf, S., Graf, I. et al. Influence of attachment bonding protocol on precision of the attachment in aligner treatments. J Orofac Orthop 81, 30–40 (2020). https://doi.org/10.1007/s00056-019-00204-7

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  • DOI: https://doi.org/10.1007/s00056-019-00204-7

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