Mesures de colorimétrie et de spectrophotométrie de différentes gouttières thermoplastiques d’alignement orthodontique avant et après l’exposition à différents substrats colorants et à des produits nettoyants

INTRODUCTION: Manufacturers of orthodontic aligners suggest that users take off removable appliances every time they consume solid foods or any drink (except water). This is to avoid a color change within the clear thermoplastic material of which they are made. Prior studies have focused on a limited set of aligners, excluding some popular American brands on the market. OBJECTIVES: The main objective of this study is to evaluate the stain resistance of the polymer forming three different American aligner brands. A secondary aim is to evaluate the stain-removal potential of two cleaning techniques for these devices. A tertiary goal is to determine the type of polymer forming the internal and external surfaces of the studied brands of aligners. MATERIALS AND METHODS: The removable appliances were exposed to different staining agents common in a regular diet (coffee, red wine, black tea and cola) or to a control solution made of a Biotene® Oral Balance saliva replacement gel. The three brands evaluated were Invisalign®, ClearCorrect® and Minor Tooth Movement®. Following exposure, the same aligners were cleaned during fifteen minutes with either the Invisalign® cleaning crystals or the Cordless Sonic Cleaner combined with a Retainer Brite® tablet. Colorimetry data was acquired via a calibrated scanner and the Adobe Photoshop® software, using a CIELAB color space approach to compare color changes (E)  in aligners exposed to various media. The CIE color parameters (L*, a*, b*) of each specimen were measured before immersion (T0), after a twelve-hour exposure (T1), after a seven-day exposure (T2) and after cleaning (T3). Those color differences were then converted into National Bureau of Standards (NBS) units to facilitate the clinical interpretation. Statistics methods (Levene’s test, ANOVA, Brunner-Langer model, Tukey’s range test and t-test) were used to identify interactions between the brands themselves or between the brands and the cleaning methods. A p value < 0.05 was considered statistically significant. RESULTS AND DISCUSSION: This study suggests that an exposure of twelve hours to instant coffee affects significantly the color of the Invisalign® aligners compared to the two other brands. A twelve-hour immersion into red wine also causes a statistically significant color change for the Invisalign® devices compared to their competitors. After seven days of exposure, a more conspicuous intrinsic color change is observed in the Invisalign® aligners exposed to instant coffee and red wine. In both media, the results are statistically significant for the Invisalign® appliances compared to the ClearCorrect® and the Minor Tooth Movement® aligners. The black tea creates an important extrinsic color change in the three brands after seven days. While normal exposure conditions would not typically consist of 12 h to 7 days of continuous exposure, these data indicate that repeated, cumulative exposure may be problematic. The two cleaning methods tend to show a better efficacy in removing extrinsic stains from black tea compared to intrinsic stains of other substrates. The infrared spectrophotometry confirms that the internal and external surfaces of each studied brand of aligners were made of the same polymer. ATR FTIR spectra of polyurethane-based material are observed for the Invisalign® and the ClearCorrect® devices. However, for the Minor Tooth Movement® aligners, the ATR FTIR analysis shows that the appliances are a polyethylene glycol terephthalate polyester. CONCLUSION: The Invisalign® aligners were more prone to pigmentation from coffee and red wine than the ClearCorrect® or the Minor Tooth Movement® devices. Black tea caused important extrinsic stains on the surface of the three tested brands.

Keyphrases: Aligner, Orthodontics, Colorimetry, Staining, Cleaning