Distributed Force Measurement and Mapping Using Pressure-Sensitive Film and Image Processing for Active and Passive Aligners on Orthodontic Attachments

Zamani, Nurul Syahira Mohamad; Ashari, Asma; Ali, Sawal Hamid Md; Beng, Gan Kok; How, Reuben Axel Wee Ming; Wahab, Rohaya Megat Abdul; Mohamed, Alizae Marny Fadzlin Syed; Sinnasamy, Sindhu; Mokhtar, Mohd Hadri Hafiz

doi:10.1109/access.2022.3175210

Cited by 13 publications

(16 citation statements)

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“…The in vitro study by Zamani et al [ 50 ] reported a similar magnitude of the force in active aligners with ellipsoidal attachment generating an average mean force of 6.18 N and 6.34 N for rectangular attachment. Notwithstanding, the authors used both active and passive CAs.…”

Section: Discussionmentioning

confidence: 80%

“…In our work, pressure mapping was achieved via a non-destructive technique [ 49 ]. The method for force measurement was adopted from Zamani et al [ 50 ]. The orthodontic force generated by the CA was measured using the pressure-sensitive film (Fuji Prescale Film, Fujifilm Corporation, Tokyo, Japan).…”

Section: Methodsmentioning

confidence: 99%

“…The selected mask was mapped with the original image and converted into HSV (hue, saturation, value) colour space for intensity visualisation before topographical mapping. A detailed prescription of the system was explained in the paper by Zamani et al [ 50 ].…”

Section: Methodsmentioning

confidence: 99%

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Effect of attachment flash on clear aligner force delivery: an in vitro study

Kiong,

Ashari,

Zamani

et al. 2024

BMC Oral Health

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Background The introduction of auxiliaries such as composite attachment has improved the force delivery of clear aligner (CA) therapy. However, the placement of the attachment may give rise to a flash, defined as excess resin around the attachment which may affect CA force delivery. This in vitro study aims to determine the differences in the force generated by the attachment in the presence or absence of flash in CA. Materials and methods Tristar Trubalance aligner sheets were used to fabricate the CAs. Thirty-four resin models were 3D printed and 17 each, were bonded with ellipsoidal or rectangular attachments on maxillary right central incisors. Fuji Prescale pressure film was used to measure the force generated by the attachment of CA. The images of colour density produced on the films were processed using a calibrated pressure mapping system utilising image processing techniques and topographical force mapping to quantify the force. The force measurement process was repeated after the flash was removed from the attachment using tungsten-carbide bur on a slow-speed handpiece. Results The intraclass correlation coefficient showed excellent reliability (ICC = 0.96, 95% CI = 0.92–0.98). The average mean force exerted by ellipsoidal attachments with flash was 8.05 ± 0.16 N, while 8.11 ± 0.18 N was without flash. As for rectangular attachments, the average mean force with flash was 8.48 ± 0.27 N, while 8.53 ± 0.13 N was without flash. Paired t-test revealed no statistically significant difference in the mean force exerted by CA in the presence or absence of flash for both ellipsoidal (p = 0.07) and rectangular attachments (p = 0.41). Rectangular attachments generated statistically significantly (p < 0.001) higher mean force than ellipsoidal attachments for flash and without flash. Conclusion Although rectangular attachment generated a significantly higher force than ellipsoidal attachment, the force generated by both attachments in the presence or absence of flash is similar (p > 0.05).

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Section: Discussionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

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Effect of attachment flash on clear aligner force delivery: an in vitro study

Kiong,

Ashari,

Zamani

et al. 2024

BMC Oral Health

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“…Figures 2 and 3 present the network meta-findings' analysis. Out of the 16 studies that we selected for the systematic review and subsequent meta-analysis, 1 was a comparative clinical trial [24], 2 were prospective studies [22,29], and the rest were in vitro studies that investigated different aligner materials [10,11,13,14,23,[25][26][27][28][30][31][32]. In the clinical trial by Ercoli et al [24], the study compared the Nuvola ® and Fantasy ® systems, looked at their material characteristics, and identified when to employ aligners.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Apart from this, the overall quality of the available evidence using the GRADE Pro software [GRADEpro GDT: GRADEpro Guideline Development Tool. McMaster University and Evidence Prime, 2022] was judged to be moderate for the in vitro studies and the prospective clinical studies [10,11,13,14,22,23,[25][26][27][28][29][30][31][32] that analyzed the effects of aligner materials and attachments on orthodontic activity, and high for the one clinical trial [24] that was included in the review.…”

Section: Risk Of Bias Assessment Within the Studymentioning

confidence: 99%

A Systematic Review and Network Meta-Analysis on the Impact of Various Aligner Materials and Attachments on Orthodontic Tooth Movement

Alam

Kanwal²,

Shqaidef

et al. 2023

JFB

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The majority of patients strongly favor the use of aligners in the present time, especially with the advancement in esthetic dentistry. Today’s market is flooded with aligner companies, many of which share the same therapeutic ethos. We therefore carried out a systematic review and network meta-analysis to evaluate research that had looked at various aligner materials and attachments and their effect on orthodontic tooth movement in relevant studies. A total of 634 papers were discovered after a thorough search of online journals using keywords such as “Aligners”, “Orthodontics”, “Orthodontic attachments”, “Orthodontic tooth movement”, and “Polyethylene” across databases such as PubMed, Web of Science, and Cochrane. The authors individually and in parallel carried out the database investigation, removal of duplicate studies, data extraction, and bias risk. The statistical analysis demonstrated that the type of aligner material had a significant impact on orthodontic tooth movement. The low level of heterogeneity and significant overall effect further support this finding. However, there was little effect of attachment size or shape on tooth mobility. The examined materials were primarily concerned with influencing the physical/physicochemical characteristics of the appliances and not tooth movement directly. Invisalign (Inv) had a higher mean value than the other types of materials that were analyzed, which suggested a potentially greater impact on orthodontic tooth movement. However, its variance value indicated that there was also greater uncertainty associated with the estimate compared to some of the other plastics. These findings could have important implications for orthodontic treatment planning and aligner material selection. Registration: This review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42022381466).

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Effect of material composition and thickness of orthodontic aligners on the transmission and distribution of forces: an in vitro study

Elshazly,

Bourauel,

Ismail

et al. 2024

Clin Oral Invest

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Objectives To investigate the effects of material type and thickness on force generation and distribution by aligners. Materials and methods Sixty aligners were divided into six groups (n = 10): one group with a thickness of 0.89 mm using Zendura Viva (Multi-layer), four groups with a thickness of 0.75 mm using Zendura FLX (Multi-layer), CA Pro (Multi-layer), Zendura (Single-layer), and Duran (Single-layer) sheets, and one group with a thickness of 0.50 mm using Duran sheets. Force measurements were conducted using Fuji® pressure-sensitive films. Results The lowest force values, both active and passive, were recorded for the multi-layered sheets: CA Pro (83.1 N, 50.5 N), Zendura FLX (88.9 N, 60.7 N), and Zendura Viva (92.5 N, 68.5 N). Conversely, the highest values were recorded for the single-layered sheets: Duran (131.9 N, 71.8 N) and Zendura (149.7 N, 89.8 N). The highest force was recorded at the middle third of the aligner, followed by the incisal third, and then the cervical third. The net force between the incisal and cervical thirds (FI-FC) showed insignificant difference across different materials. However, when comparing the incisal and middle thirds, the net force (FI-FM) was higher with single-layered materials. Both overall force and net force (FI-FM) were significantly higher with 0.75 mm compared to those with a thickness of 0.50 mm. Conclusions Multi-layered aligner materials exert lower forces compared to their single-layered counterparts. Additionally, increased thickness in aligners results in enhanced retention and greater force generation. For effective bodily tooth movement, thicker and single-layered rigid materials are preferred. Clinical relevance This research provides valuable insights into the biomechanics of orthodontic aligners, which could have significant clinical implications for orthodontists. Orthodontists might use this information to more effectively tailor aligner treatments, considering the specific tooth movement required for each individual patient. In light of these findings, an exchangeable protocol for aligner treatment is suggested, which however needs to be proven clinically. This protocol proposes alternating between multi-layered and single-layered materials within the same treatment phase. This strategy is suggested to optimize treatment outcomes, particularly when planning for a bodily tooth movement.

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Distributed Force Measurement and Mapping Using Pressure-Sensitive Film and Image Processing for Active and Passive Aligners on Orthodontic Attachments

Abstract: The authors would like to express their gratitude to the technicians, especially Daniel Liam from WhiteSmileclear Laboratory Services, for their assistance and supporting staff from Universiti Kebangsaan Malaysia (UKM).

Cited by 13 publications

References 50 publications

Effect of attachment flash on clear aligner force delivery: an in vitro study

Effect of attachment flash on clear aligner force delivery: an in vitro study

A Systematic Review and Network Meta-Analysis on the Impact of Various Aligner Materials and Attachments on Orthodontic Tooth Movement

Effect of material composition and thickness of orthodontic aligners on the transmission and distribution of forces: an in vitro study

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