Angle Class I Malocclusion, Dental Crowding, Tooth Spacing
Conditions
Keywords
In office aligners, 3D printed aligners, Thermoformed Aligners, Tooth movement, Photopolymer Resin, Pain
Brief summary
The goal of this study is to evaluate and compare the clinical effectiveness of in-office directly 3D-printed clear aligners versus conventional multilayered thermoformed aligners. The main question it aims to answer is: Does the use of in-office direct-printed shape-memory aligners result in superior clinical effectiveness, compared to established multilayer thermoformed aligner systems? Researchers will compare a Direct-Printed Aligner (DPA) group using Senertek Clear-A V2 resin to a Thermoformed Aligner (TFA) group using Zendura FLX multilayer sheets to see if the additive manufacturing process improves clinical outcomes and patient satisfaction. Participants will: * Undergo initial records including intraoral digital scans, photos, and a panoramic radiograph for treatment planning. * Wear their assigned clear aligners (either direct-printed or thermoformed) for at least 22 hours per day, changing them every 7 days. * Attend follow-up appointments every 5 weeks.
Detailed description
This is a prospective, parallel-arm randomized controlled multi-center clinical trial, to assess and compare the clinical effectiveness of in-office 3D-printed clear aligners with multilayered thermoformed aligners. The subject population for this study will be male and female subjects aged 16-30 years who have fully erupted permanent dentition and mild dental crowding or spacing. Methodology: Patients requiring orthodontic treatment are randomly allocated into two groups. Experimental Group (DPA): Aligners are fabricated using additive manufacturing (direct 3D printing) with Senertek Clear-A V2 shape-memory resin. This process eliminates the intermediate physical model, potentially reducing cumulative manufacturing errors. Control Group (TFA): Aligners are fabricated by thermoforming multilayered thermoplastic sheets (Zendura FLX) over 3D-printed resin molds. Assessment: Digital models (STL files) will be obtained at the start (T0) and at the end of the treatment (T1). These will be compared to the digital treatment plan (Tp) using 3D superimposition and trigonometric analysis. Stable anatomical structures, such as the palatal rugae, will serve as reference points for superimposition. The primary outcome is the "Tracking Accuracy Percentage," which measures how closely the actual clinical tooth movement matches the digitally predicted movement. Secondary outcomes include clinical efficiency, patient-reported pain levels, and Manufacturing complexity, including total fabrication time.
Interventions
DEVICEDirect-Printed Aligner
Participants in this group will receive clear aligner therapy fabricated via direct-printing, utilizing a specialized light-curable resin (Clear-A V2, Senertek, İzmir, Turkey).
DEVICEThermoformed aligner
Participants in this group will treated with clear aligners fabricated via the conventional indirect method, involving the thermoforming of thermoplastic sheets (Zendura FLX, Zendura dental, Fremont, California) over 3D-printed dental molds.
Sponsors
University of Baghdad
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
15 Years to 30 Years
Healthy volunteers
Yes
Inclusion criteria
1. Adult patient with an age range of 15-30 with fully erupted all permanent dentitions excluding third molars, and a willingness to participate in the trial. 2. Angle Class I non-extraction cases, presented with mild crowding or spacing (\<5 mm) and dental rotation \<30° . 3. Good oral hygiene; no active caries/periodontal disease, no history of trauma or root resorption.
Exclusion criteria
1. Pregnancy, smoking, and systemic conditions affecting bone remodeling. 2. Subject with poor oral hygiene, using simplified oral hygiene index (OHI-S ≥ 3.1 ) (Greene \& Vermillion, 1963). 3. Patient with malposed lower second molars (need orthodontic alignment). 4. Allergy to materials used (resins, plastics, solvents). 5. History of trauma, root resorption, and dilacerated roots. 6. Previous extraction or history of previous orthodontic treatment.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Angular tooth movement tracking accuracy | The expected duration of subject participation from enrollment to the end of treatment is 6-12 months. | Digital models (Initial (T0), planned (Tp), and final (T1)) will be compared using trigonometry. Angular measurements of vestibulo-lingual tipping, mesio-distal tipping, and rotation, will be performed on the three digital casts that had been previously superimposed. |
| Linear tooth movement tracking accuracy | The expected duration of subject participation from enrollment to the end of treatment is 6-12 months. | Evaluation of the tracking accuracy of linear tooth movements (in millimeters) by superimposing three-dimensional digital dental models across three therapeutic stages: Initial (T0), Planned (Tp), and Final (T1). Trigonometric spatial analysis will be executed on the superimposed digital casts to quantify the absolute positional discrepancy between the virtually planned tooth position and the actual clinically achieved position. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Clinical efficiency | The expected duration of subject participation from enrollment to the end of treatment is 6-12 months. | The additional treatment time necessitated by refinements will be calculated and compared statistically between the study groups. |
| Evaluate degree of conversion | The expected duration of subject participation from enrollment to the end of treatment is 6-12 months. | The relative concentration of unreacted aliphatic carbon double bonds will be evaluated by measuring the peak areas of the aliphatic C=C stretching vibrations (at 1634 cm -1 and 1620 cm-1) and the stable internal standard (N-H bending absorption at 1523 cm-1) via the tangent baseline technique. These distinct spectral values will be mathematically aggregated using the standard normalized ratio equation: DC (%)=\[1-(R cured/R monomer)\]×100. Unit of Measure, percentage (%) of converted double bonds. |
| Shape memory property | 3 months | The percentage of shape recovery over time and the total deformation angles exhibited by both the direct-printed resin (Senertek Clear-A V2) and the thermoformed aligner sheets.Quantitative measurements will be recorded using a standardized thermo-mechanical bending test layout under controlled temperature intervals. |
| Color stability assessment | The expected duration of subject participation from enrollment to the end of treatment is 6-12 months. | Optical transmittance will be measured across the visible light spectrum to evaluate and compare the transparency degradation and color stability of direct-printed versus thermoformed aligners before and after in vivo aging. |
| Manufacturing complexity and fabrication time | The expected duration of subject participation from enrollment to the end of treatment is 6-12 months. | For each workflow, the total production time, hands-on labor, and material expenses will be recorded and analyzed. |
| Patient-Reported Treatment Discomfort | The expected duration of subject participation from enrollment to the end of treatment is 6-12 months. | Patient-reported pain or discomfort evaluated on a standard horizontal Visual Analogue Scale (VAS) ranging from 0 (no pain) to 100 (severe pain). Unit of Measure, millimeters (mm) on a 100 mm scale. |
Countries
Iraq
Contacts
CONTACTAli Rahman Issa, PhD student
STUDY_DIRECTORNoor Muhammed Garma, Assistant Professor
University of Baghdad, College of Dentistry, Department of Orthodontic.
Outcome results
None listed