Transfer Accuracy of Three Indirect Bonding Trays: An In Vitro Study with 3D Scanned Models

Objective

The goal of the current study is to compare the transfer accuracy of two different conventional indirect bonding trays with 3D-printed trays.

Methods

Twenty-two patients' upper dental models were duplicated, scanned and brackets were bonded digitally. Different indirect bonding trays (double vacuum formed, transparent silicone and 3D-printed) were prepared according to three groups. These trays were used for the transfer of the brackets to the patients' models, then models with brackets were scanned. GOM Inspect software was used for the superimposition of virtual bracket setups and models with brackets. A total of 788 brackets and tubes were analyzed. Transfer accuracies were determined according to the clinical limit of 0.5 mm for linear and 2° for angular measurements.

Results

3D-printed trays had significantly lower linear deviation values than other trays for all planes (p<0.05). 3D-printed trays have significantly lower torque and tip deviation values than other groups (p<0.05). Transfer deviations were within the clinically acceptable limit for all transfer trays in horizontal, vertical and transverse planes. Deviation values of the molars were higher than those of the other tooth groups for all trays in the horizontal and vertical planes (p<0.05). Brackets were generally deviated toward the buccal direction in all tray groups.

Conclusion

The transfer accuracy of 3D-printed transfer trays was more successful than the double vacuum formed and transparent silicone trays in the indirect bonding technique procedure. Deviations in the molar group were greater than those in the other tooth groups for all transfer trays.

A new method for successful indirect bonding in relation to bond strength

The aim of the work was to develop a new transfer method for indirect bonding of brackets to improve the bond strength by applying a uniform contact pressure over the entire dental arch. This has a great potential to reduce the bracket loss rate during clinical treatment. A suitable shape memory polymer (SMP) was selected and prepared in the chemistry laboratory. This SMP applies a force to the brackets during bonding and thus increases the bond strength by applying uniform contact pressure. Various transfer trays were equipped with SMP platelets and the transfer of brackets from the plaster model to the real human tooth model was performed in vitro. The transfer accuracy and bond strength of the bonded brackets were investigated by 3D-overlay and shear tests, respectively. The transfer accuracy was technique sensitive and showed higher accuracy for the trays with SMPs and self-curing silicones than for the vacuum formed trays with SMPs. The bond strength of the indirectly bonded brackets with SMPs was on average 1-2 MPa higher than the bond strength of the brackets indirectly bonded with a conventional two-layer vacuum formed tray without SMPs. Thus, transfer trays with SMPs can provide a significant improvement in bond strength during indirect bonding after appropriate adjustment.

Comparison of Two 3D-Printed Indirect Bonding (IDB) Tray Design Versions and Their Influence on the Transfer Accuracy

Objective: This study aims to investigate the transfer accuracy of two different design versions for 3D-printed indirect bonding (IDB) trays. Materials and Methods: Digital plaster models of 27 patients virtually received vestibular attachments on every tooth using OnyxCeph³™ (Image Instruments, Chemnitz, Germany). Based on these simulated bracket and tube positions, two versions of transfer trays were designed for each dental arch and patient, which differed in the mechanism of bracket retention: Variant one (V1) had arm-like structures protruding from the tray base and reaching into the horizontal and vertical bracket slots, and variant two (V2) had a pocket-shaped design enclosing the brackets from three sides. Both tray designs were 3D-printed with the same digital light processing (DLP) printer using a flexible resin-based material (IMPRIMO® LC IBT/Asiga MAX™, SCHEU-DENTAL, Iserlohn, Germany). Brackets and tubes (discovery® smart/pearl, Ortho-Cast M-Series, Dentaurum, Ispringen, Germany) were inserted into the respective retention mechanism of the trays and IDB was performed on corresponding plaster models. An intraoral scan (TRIOS® 3W, 3Shape, Copenhagen, Denmark) was performed to capture the actual attachment positions and compared to the virtually planned positions with Geomagic© Control (3D Systems Inc., Rock Hill, SC, USA) using a scripted calculation tool, which superimposed the respective tooth surfaces. The resulting attachment deviations were determined in three linear (mesiodistal, vertical and orovestibular) and three angular (torque, rotation and tip) directions and analyzed with a descriptive statistical analysis. A comparison between the two IDB tray designs was conducted using a mixed model analysis (IBM, SPSS® Statistics 27, Armonk, NY, USA). Results: Both design versions of the 3D-printed IDB trays did not differ significantly in their transfer accuracy (p > 0.05). In total, 98% (V1) and 98.5% (V2) of the linear deviations were within the clinically acceptable range of ±0.2 mm. For the angular deviations, 84.9% (V1) and 86.8% (V2) were within the range of ±1°. With V1, most deviations occurred in the mesiodistal direction (3.3%) and in rotation (18%). With V2, most deviations occurred in the vertical direction (3.8%) and in palatinal and lingual crown torque (16.3%). Conclusions: The transfer accuracies of the investigated design versions for 3D-printed IDB trays show good and comparable results albeit their different retention mechanisms for the attachments and are, therefore, both suitable for clinical practice.

Accurate Bracket Placement with an Indirect Bonding Method Using Digitally Designed Transfer Models Printed in Different Orientations-An In Vitro Study

Objective: A digital workflow opens up new possibilities for the indirect bonding (IDB) of brackets. We tested if the printing orientation for bracket transfer models on the build platform of a 3D printer influences the accuracy of the following IDB method. We also evaluated the clinical acceptability of the IDB method combining digitally planned and printed transfer models with the conventional fabrication of pressure-molded transfer trays. Materials and Methods: In total, 27 digitally planned bracket transfer models were printed with both 15° and 75° angulation from horizontal plane on the build platform of a digital light processing (DLP) printer. Brackets were temporarily bonded to the transfer models and pressure-molded trays were produced on them. IDB was then performed using the trays on the respective plaster models. The plaster models were scanned with an optical scanner. Digitally planned pre-bonding and scanned post-bonding bracket positions were superimposed with a software and resulted in three linear and three angular deviations per bracket. Results: No statistically significant differences of the transfer accuracy of printed transfer models angulated 15° or 75° on the 3D printer build platform were found. About 97% of the linear and 82% of the angular deviations were within the clinically acceptable range of ±0.2 mm and ±1°, respectively. The highest inaccuracies in the linear dimension occurred in the vertical towards the gingival direction and in the angular dimension in palatal crown torque. Conclusion: For the IDB method used, the printing orientation on the build platform did not have a significant impact on the transfer accuracy.

Bonding techniques in lingual orthodontics

Bonding techniques in lingual orthodontics differ slightly from their counterparts in labial treatment, although there are many shared features. If protocols are followed correctly, bonding outcomes are very predictable and lingual bracket bonding can be integrated into a mixed orthodontic practice with the minimum of disruption. Here, we highlight the fundamentals of both chemical and light/dual cure bonding procedures using lingual appliances, and discuss special bonding circumstances. Although not exhaustive, this article will provide essential information for those operators embarking on the bonding of lingual appliances.