Mechanical evaluation of newly developed mouthpiece using polyethylene terephthalate glycol for transoral robotic surgery

Validation of finite-element-simulated orthodontic forces produced by thermoplastic aligners: Effect of aligner geometry and creep

PURPOSE

Finite element (FE) models for determining the orthodontic forces delivered by clear aligners often lack validation. The aim of this study was to develop and validate accurate FE models for clear aligners, considering the small but important geometrical variations from the thermoforming process and the creep behavior of the aligner material.

METHODS AND MATERIALS

The tooth misalignment considered was a 2.4° torque aberration (rotation about the mesial-distal axis at the level of the center of resistance) of the maxillary left central incisor. FE models were created from Micro-CT scans of a model dental arch and five nominally identical aligners with the aforementioned misfit. Fitting of the aligners onto the dental arch was simulated using Abaqus's Interference Fit function, followed by surface-to-surface frictional interaction. Stress relaxation of the aligner material was measured using double-cantilever beam bending and modeled with a Prony series. The assembled FE models were validated by comparing the predicted forces and moments delivered to the maxillary left central incisor with experimental data, obtained with a custom-built but fully calibrated apparatus.

RESULTS

Good agreement between prediction and measurement was obtained for both the short- and long-term forces and moments. In the short-term, i.e., after 30 s, the dominant force in the labial-lingual direction had a maximum difference of 2.9% between experiment and simulation, and the dominant moment about the mesial-distal axis had a maximum difference of 8.3%. In the long-term, i.e., after 4 h, the experimental and numerical forces had a maximum difference of 8.4%. There were statistically significant differences in the forces delivered among the nominally identical aligners, which were predicted by the geometrically accurate FE models and attributed to the variations in the points of contact between the aligners and the dental arch. The decay in force applied was affected by both the viscoelastic material behavior and friction between the aligner and arch.

CONCLUSION

For accurate prediction of the forces and moments delivered by thermoplastic aligners, FE models that can accurately capture the point contacts between the aligners and the underlying teeth are essential. Stress relaxation of the aligners could be adequately modeled using the Prony series to represent the temporal changes of their elastic modulus.

Mechanical properties variation of samples fabricated by fused deposition additive manufacturing as a function of filler percentage and structure for different plastics

One of the key factors in manufacturing products by fused deposition molding (FDM) or layer-by-layer printing technology is the material intensity of the product. The task of reducing the amount of material required to manufacture a product without significant loss of mechanical properties is one of the most practically important technological tasks. Material saving in FDM printing of products allows to reduce financial costs and increase the speed of manufacturing of the final product without reducing (or not significantly reducing) the quality properties of the product. In our work it is demonstrated that using Combs filling type and materials of poly lactic acid (PLA) and polyethylene terephthalate glycol (PETG) it is possible to achieve material savings of up to 23% at 50% filling for PLA and 17% at 75% filling for PETG without significant reduction of product strength in comparison with other filling types. Exceptions are PLA samples with 100% fill and Lateral fill. Application of Kruskal-Wallis criterion and Dunn's criterion with Bonferroni multiple comparison correction showed that there were no statistically significant differences within the strength limits of samples made by FDM printing technology from PLA and PETG plastics (p-value = 0.0514), as well as samples with Triangle and Grid filling type (p-value = 1). Based on this result, three groups of samples statistically significantly differing in ultimate strength were identified by methods of hierarchical cluster analysis; in each group (except for group 1, which included samples made of PLA plastic with Lateral filling type and 100% filling), correlation analysis was performed (Spearman correlation was used). The results of the correlation analysis showed a stable average correlation between the percentage of filling, modulus along the secant 0.05-0.2% strain, ultimate strength and strain corresponding to the yield stress. Analysis of the correlation graph showed that the main parameter correlating with all mechanical properties of the specimen is the 0.05-0.2% strain modulus. Based on this conclusion, robust regression equations predicting the 0.05-0.2% strain modulus as a function of the percentage of specimen filling were constructed for the two selected groups. Analysis of the equations showed that in the third group of specimens, the average modulus of 0.05-0.2% strain is more than twice the modulus of 0.05-0.2% strain in the second group. The detected statistical regularities can be explained by the mechanism of strain hardening, the actual value of which depends on the structure of the macrodefect (type of filling), properties and volume of the material (percentage of filling) used in the fabrication of samples using FDM printing technology.

Investigation of Changes in Tooth Colour After the Use of Different Aligners

Clear aligner treatment is an orthodontic treatment that is custom-made with 3D printers without the use of conventional metal or porcelain wires and brackets. It is a modern orthodontic method used to correct tooth positions that need to be corrected aesthetically and functionally. Aim This study aimed to compare the discolouration of teeth and clear aligners after 15 days of full-time use of clear aligners. Materials and methods The 20 patients in the study group had used clear aligners for 45 days, including three different clear aligners for 15 days. In addition, 20 patients were included as a control group to measure the difference in tooth discolouration. Retaining attachments using G-Aenial (GC Corp, Tokyo, Japan) and 3M ESPE (St. Paul, MN, USA) flowable composites were placed crosswise to each patient in the distal regions of all lateral and canine teeth. The performance of three aligner plates (Zendura Flex (Bay Materials LLC, Fremont, CA, USA); Duran (ScheuDental GmbH, Iserlohn, Germany); and Taglus (Laxmi Dental Export Pvt. Ltd, Mumbai, India)), two fluid composite attachments, and two clear aligner cleaners regarding discoloration were tested. Each aligner was used for 15 days, and then the patient was moved to the next aligner. Colour change on the aligners and the patients' teeth were assessed from the canine to the middle third and mid-plane of the canine tooth using a VITA Easyshade V spectrophotometer (Bad Säckingen, Germany). An aligner cleaner was used immediately after the patients used their clear aligners, and then the measurements of the aligner color values were completed. The 120 aligners obtained were divided into two groups. Sixty aligners were treated with Fresh Guard (Efferdent, Lynchburg, VA, USA), and the other 60 were treated with Corega (GlaxoSmithKline, London, UK) tablets and stored in a glass of water. Results The colour stability of G-Aenial Flo was higher than that of the 3M ESPE fluid composite (p=0.040 and p=0.024). Our study determined that staining occurred in all the teeth we measured as a result of using aligner. Fresh Guard aligner cleaner caused more discoloration on Zendura and Duran aligners than Corega aligner cleaner (p<0.05). Taglus plaque was found to have more discoloration than Zendura and Duran aligner (p<0.05). Conclusion In conclusion, Duran clear aligners are preferable to other clear aligners in terms of discoloration. In addition, G-Aenial Flo can be recommended as an attachment or fluid composite because of its better color stability results.

Prevalence of haptic feedback in robot-mediated surgery: a systematic review of literature

With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.

Colour stabilities of three types of orthodontic clear aligners exposed to staining agents

The aim of this study was to evaluate and compare the colour stabilities of three types of orthodontic clear aligners exposed to staining agents in vitro. Sixty clear orthodontic aligners produced by three manufacturers (Invisalign, Angelalign, and Smartee) were immersed in three staining solutions (coffee, black tea, and red wine) and one control solution (distilled water). After 12-h and 7-day immersions, the aligners were washed in an ultrasonic cleaner and measured with a colourimeter. The colour changes (ΔE*) were calculated on the basis of the Commission Internationale de I'Eclairage L*a*b* colour system (CIE L*a*b*), and the results were then converted into National Bureau of Standards (NBS) units. Fourier transformation infrared (FT-IR) spectroscopy and scanning electron microscopy (SEM) were conducted to observe the molecular and morphologic alterations to the aligner surfaces, respectively. The three types of aligners exhibited slight colour changes after 12 h of staining, with the exception of the Invisalign aligners stained with coffee. The Invisalign aligners exhibited significantly higher ΔE* values (ranging from 0.30 to 27.81) than those of the Angelalign and Smartee aligners (ΔE* values ranging from 0.33 to 1.89 and 0.32 to 1.61, respectively, P<0.05). FT-IR analysis confirmed that the polymer-based structure of aligners did not exhibit significant chemical differences before and after the immersions. The SEM results revealed different surface alterations to the three types of aligner materials after the 7-day staining. The three types of aesthetic orthodontic appliances exhibited colour stability after the 12-h immersion, with the exception of the Invisalign aligners stained by coffee. The Invisalign aligners were more prone than the Angelalign and Smartee aligners to pigmentation. Aligner materials may be improved by considering aesthetic colour stability properties.