This paper introduces a novel method of 3D designing and 3D printing of a hybrid orthodontic tooth-borne personalized distalizer for treatment of unilateral Class II malocclusion. Research objectives were to clinically utilize 3D printed distalizers, appraise feasibility of this technique and compare two different biocompatible photopolymers (white and transparent). Frequency of distalizers' debonding and patients' aesthetical perception was evaluated on the set of 12 complete orthodontic treatments. The mean duration of treatment period with a bonded distalizer was 6.4 months. All cases were adults with unilateral Class II malocclusion managed with a hybrid approach as a part of Invisalign® comprehensive treatment. Results showed that such perspective practice is feasible for 3D design and in-office 3D printing of a personalized distalizer. Results also showed no clinically significant differences between both studied biopolymers. The paper discusses an evaluation of such personalized distalizer functionality with regard to the current state of the art and compares to conventional prefabricated alternatives like a Carriere® Distalizer™ appliance. Research showed a preference of patients towards transparent biocompatible photopolymer instead of the white A2 shade. The paper concludes that additive manufacturing from dental resins is a viable method in personalization and in-office 3D printing of orthodontic auxiliaries, particularly distalizers. New materials for orthodontic 3D printing endow enhanced individualization, thus more efficient treatment.

Department of Nuclear Physics and Biophysics Faculty of Mathematics Physics and Informatics Comenius University Mlynska Dolina F1 84248 Bratislava Slovakia

Department of Orthodontics and Cleft Anomalies Dental Clinic 3rd Medical Faculty Charles University Faculty Hospital Kralovske Vinohrady 10034 Prague Czech Republic

Department of Stomatology and Maxillofacial Surgery Faculty of Medicine Comenius University in Bratislava 81250 Bratislava Slovakia

Institute of Histology and Embryology Faculty of Medicine Comenius University in Bratislava 81372 Bratislava Slovakia

See more in PubMed

Huang H.-M. Medical Application of Polymer-Based Composites. Polymers. 2020;12:2560. doi: 10.3390/polym12112560. PubMed DOI PMC

Scribante A., Vallittu P.K., Özcan M. Fiber-Reinforced Composites for Dental Applications. BioMed Res. Int. 2018;2018:4734986. doi: 10.1155/2018/4734986. PubMed DOI PMC

Burgard N., Kienitz M., Jourdan C., Rüttermann S. The Influence of Modified Experimental Dental Resin Composites on the Initial in Situ Biofilm—A Triple-Blinded, Randomized, Controlled Split-Mouth Trial. Polymers. 2021;13:2814. doi: 10.3390/polym13162814. PubMed DOI PMC

Grzebieluch W., Kowalewski P., Grygier D., Rutkowska-Gorczyca M., Kozakiewicz M., Jurczyszyn K. Printable and Machinable Dental Restorative Composites for CAD/CAM Application—Comparison of Mechanical Properties, Fractographic, Texture and Fractal Dimension Analysis. Materials. 2021;14:4919. doi: 10.3390/ma14174919. PubMed DOI PMC

Chung Y.-J., Park J.-M., Kim T.-H., Ahn J.-S., Cha H.-S., Lee J.-H. 3D Printing of Resin Material for Denture Artificial Teeth: Chipping and Indirect Tensile Fracture Resistance. Materials. 2018;11:1798. doi: 10.3390/ma11101798. PubMed DOI PMC

Sfondrini M.F., Vallittu P.K., Lassila L.V.J., Viola A., Gandini P., Scribante A. Glass Fiber Reinforced Composite Orthodontic Retainer: In Vitro Effect of Tooth Brushing on the Surface Wear and Mechanical Properties. Materials. 2020;13:1028. doi: 10.3390/ma13051028. PubMed DOI PMC

Chen S., Yang J., Jia Y.-G., Lu B., Ren L. A Study of 3D-Printable Reinforced Composite Resin: PMMA Modified with Silver Nanoparticles Loaded Cellulose Nanocrystal. Materials. 2018;11:2444. doi: 10.3390/ma11122444. PubMed DOI PMC

Tappa K., Jammalamadaka U. Novel Biomaterials Used in Medical 3D Printing Techniques. J. Funct. Biomater. 2018;9:17. doi: 10.3390/jfb9010017. PubMed DOI PMC

Melo M.A. Bacterial Interactions with Dental and Medical Materials. J. Funct. Biomater. 2020;11:83. doi: 10.3390/jfb11040083. PubMed DOI PMC

Mai H.-N., Hyun D.C., Park J.H., Kim D.-Y., Lee S.M., Lee D.-H. Antibacterial Drug-Release Polydimethylsiloxane Coating for 3D-Printing Dental Polymer: Surface Alterations and Antimicrobial Effects. Pharmaceuticals. 2020;13:304. doi: 10.3390/ph13100304. PubMed DOI PMC

Jindal P., Juneja M., Bajaj D., Siena F.L., Breedon P. Effects of post-curing conditions on mechanical properties of 3D printed clear dental aligners. Rapid Prototyp. J. 2020;26:1337–1344. doi: 10.1108/RPJ-04-2019-0118. DOI

Vasques M.T., Mori M., Laganá D.C. Three-dimensional printing of occlusal devices for temporomandibular disorders by using a free CAD software program: A technical report. J. Prosthet. Dent. 2020;123:232–235. doi: 10.1016/j.prosdent.2018.12.017. PubMed DOI

Milovanović A., Sedmak A., Golubović Z., Mihajlović K.Z., Žurkić A., Trajković I., Milošević M. The effect of time on mechanical properties of biocompatible photopolymer resins used for fabrication of clear dental aligners. J. Mech. Behav. Biomed. Mater. 2021;119:104494. doi: 10.1016/j.jmbbm.2021.104494. PubMed DOI

Scribante A., Gallo S., Turcato B., Trovati F., Gandini P., Sfondrini M.F. Fear of the Relapse: Effect of Composite Type on Adhesion Efficacy of Upper and Lower Orthodontic Fixed Retainers: In Vitro Investigation and Randomized Clinical Trial. Polymers. 2020;12:963. doi: 10.3390/polym12040963. PubMed DOI PMC

Sfondrini M.F., Gallo S., Turcato B., Montasser M.A., Albelasy N.F., Vallittu P.K., Gandini P., Scribante A. Universal Adhesive for Fixed Retainer Bonding: In Vitro Evaluation and Randomized Clinical Trial. Materials. 2021;14:1341. doi: 10.3390/ma14061341. PubMed DOI PMC

Proffit W.R., Fields H.W., Moray L.J. Prevalence of malocclusion and orthodontic treatment need in the United States: Estimates from the NHANES III survey. Int. J. Adult Orthod. Orthognath. Surg. 1998;13:97–106. PubMed

Ke Y., Zhu Y., Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019;19:24. doi: 10.1186/s12903-018-0695-z. PubMed DOI PMC

Rossini G., Parrini S., Castroflorio T., Deregibus A., Debernardi C.L. Efficacy of clear aligners in controlling orthodontic tooth move-ment: A systematic review. Angle Orthod. 2015;85:881–889. doi: 10.2319/061614-436.1. PubMed DOI PMC

Nanda R., Garino F., Ojima K., Castroflorio T., Parrini S. Principles and Biomechanics of Aligner Treatment—E-Book. 1st ed. Volume 1. Elsevier Health Sciences; Amsterdam, The Netherlands: 2021. Chapter 12: The hybrid approach in Class II malocclusions treatment; pp. 149–160.

Bolla E., Muratore F., Carano A., Bowman S.J. Evaluation of maxillary molar distalization with the distal jet a comparison with other contemporary methods. Angle Orthod. 2002;72:481–494. PubMed

Grec R.H., Janson G., Branco N.C., Moura-Grec P.G., Patel M.P., Henriques J.F.C. Intraoral distalizer effects with conventional and skeletal anchorage a meta-analysis. Am. J. Orthod. Dentofacial Orthop. 2013;143:602–615. doi: 10.1016/j.ajodo.2012.11.024. PubMed DOI

Ravera S., Castroflorio T., Garino F., Daher S., Cugliari G., Deregibus A. Maxillary molar distalization with aligners in adult patients a multicenter retrospective study. Prog. Orthod. 2016;17:12. doi: 10.1186/s40510-016-0126-0. PubMed DOI PMC

Barakat D., Bakdach W.M., Youssef M. Treatment effects of Carriere Motion Appliance on patients with Class II malocclusion: A systematic review and meta-analysis. Int. Orthod. 2021;19:353–364. doi: 10.1016/j.ortho.2021.05.005. PubMed DOI

Scribante A., Gallo S., Bertino K., Meles S., Gandini P., Sfondrini M.F. The Effect of Chairside Verbal Instructions Matched with Instagram Social Media on Oral Hygiene of Young Orthodontic Patients: A Randomized Clinical Trial. Appl. Sci. 2021;11:706. doi: 10.3390/app11020706. DOI

Rossini G., Parrini S., Deregibus A., Castroflorio T. Controlling orthodontic tooth movement with clear aligners. An updated systematic review regarding efficacy and efficiency. J. Aligner Orthod. 2017;1:7–20.

Garino F., Castroflorio T., Daher S., Ravera S., Rossini G., Cugliari G., Deregibus A. Effectiveness of composite attachments in controlling upper-molar movement with aligners. J. Clin. Orthod. 2016;50:341–347. PubMed

Richter D.D., Nanda R.S., Sinha P.K., Smith D.W. Effect of behavior modification on patient compliance in orthodontics. Angle Orthod. 1998;68:123–132. PubMed

Lombardo L., Colonna A., Carlucci A., Oliverio T., Siciliani G. Class II subdivision correction with clear aligners using intermaxilary elastics. Prog. Orthod. 2018;1:19–32. doi: 10.1186/s40510-018-0221-5. PubMed DOI PMC

Nedwed V., Miethke R.R. Motivation, acceptance and problems of invisalign patients. J. Orofac. Orthop. 2005;66:162–173. doi: 10.1007/s00056-005-0429-0. PubMed DOI

Rosvall M.D., Fields H.W., Ziuchkovski J., Rosenstiel S.F., Johnston W.M. Attractiveness, acceptability, and value of orthodontic appliances. Am. J. Orthod. Dentofac. Orthop. 2009;135:276.e1–276.e12. doi: 10.1016/j.ajodo.2008.09.020. PubMed DOI

Shah N. Compliance with removable orthodontic appliances. Evid. Based Dent. 2017;18:105–106. doi: 10.1038/sj.ebd.6401268. PubMed DOI

Carano A., Testa M. The distal jet for upper molar distalization. J. Clin. Orthod. 1996;30:374–380. PubMed

Antonarakis G.S., Kiliaridis S. Maxillary molar distalization with noncompliance intramaxillary appliances in Class II malocclusion a systematic review. Angle Orthod. 2008;78:1133–1140. doi: 10.2319/101507-406.1. PubMed DOI

Carano A., Testa M., Siciliani G. The lingual distalizer system. Eur. J. Orthod. 1996;18:445–448. doi: 10.1093/ejo/18.1.445. PubMed DOI

Hilgers J.J. The pendulum appliance for Class II noncompliance therapy. J. Clin. Orthod. 1992;26:706–714. PubMed

Marure P.S., Patil R.U., Reddy S., Prakash A., Kshetrimayum N., Shukla R. The effectiveness of pendulum, K-loop, and distal jet distalization techniques in growing children and its effects on anchor unit a comparative study. J. Indian Soc. Pedod. Prev. Dent. 2016;34:331–340. PubMed

Byloff F.K., Darendeliler M.A., Clar E., Darendeliler A. Distal molar movement using the pendulum appliance. Part 2 the effects of maxillary molar root uprighting bends. Angle Orthod. 1997;67:261–270. PubMed

Chaqués-Asensi J., Kalra V. Effects of the pendulum appliance on the dentofacial complex. J. Clin. Orthod. 2001;35:254–257. PubMed

Byloff F.K., Darendeliler M.A. Distal molar movement using the pendulum appliance. Part 1 clinical and radiological evaluation. Angle Orthod. 1997;67:249–260. PubMed

Ghosh J., Nanda R.S. Evaluation of an intraoral maxillary molar distalization technique. Am. J. Orthod. Dentofac. Orthop. 1996;110:639–646. doi: 10.1016/S0889-5406(96)80041-2. PubMed DOI

Carrière L. A new Class II distalizer. J. Clin. Orthod. 2004;38:224–231. PubMed

Martel D. The Carriere distalizer simple and efficient. Int. J. Orthod. 2012;23:63–66. PubMed

Rodríguez H.L. Unilateral application of the Carriere distalizer. J. Clin. Orthod. 2011;45:177–180. PubMed

Sandifer C.L., English J.D., Colville C.D., Gallerano R.L., Akyalcin S. Treatment effects of the Carrière distalizer using lingual arch and full fixed appliances. J. World Fed. Orthod. 2014;3:e49–e54. doi: 10.1016/j.ejwf.2014.03.001. DOI

Nanda R. Biomechanics in Clinical Orthodontics. WB Saunders; Philadelphia, PA, USA: 1997.

Yin K., Han E., Guo J., Yasumura T., Grauer D., Sameshima G. Evaluating the treatment effectiveness and efficiency of Carriere Distalizer: A cephalometric and study model comparison of Class II appliances. Prog. Orthod. 2019;20:24. doi: 10.1186/s40510-019-0280-2. PubMed DOI PMC

Kim-Berman H., McNamara J.A., Jr., Lints J.P., McMullen C., Franchi L. Treatment effects of the Carriere® Motion 3D™ appliance for the correction of Class II malocclusion in adolescents. Angle Orthod. 2019;89:839–846. doi: 10.2319/121418-872.1. PubMed DOI PMC

Khosravi R., Cohanim B., Hujoel P., Daher S., Neal M., Liu W., Huang G. Management of overbite with the Invisalign appliance. Am. J. Orthod. Dentofac. Orthop. 2017;151:691–699. doi: 10.1016/j.ajodo.2016.09.022. PubMed DOI

Mantovani E., Parrini S., Coda E., Cugliari G., Scotti N., Pasqualini D., Deregibus A., Castroflorio T. Micro computed tomography evaluation of Invisalign aligner thickness homogeneity. Angle Orthod. 2021;91:343–348. doi: 10.2319/040820-265.1. PubMed DOI PMC

Kinzinger G.S., Wehrbein H., Gross U., Diedrich P.R. Molar distalization with pendulum appliances in the mixed dentition effects on the position of unerupted canines and premolars. Am. J. Orthod. Dentofac. Orthop. 2006;129:407–417. doi: 10.1016/j.ajodo.2005.12.004. PubMed DOI

McFarlane B. Class II Correction Prior to Orthodontics with the Carriere Distalizer. Int. J. Orthod. 2013;24:35–36. PubMed

Ahmed S.H. Three dimensional assessment of the long-term treatment stability after maxillary first molar distalization with Carriere distalizer appliance. [(accessed on 10 October 2021)];Life Sci. J. 2020 17:83–90. doi: 10.7537/marslsj170220.12. Available online: http://www.lifesciencesite.com/lsj/lsj170220/12_36058lsj170220_83_90.pdf. DOI

Wilson B., Konstantoni N., Kim K.B., Foley P., Ueno H. Three-dimensional cone-beam computed tomography comparison of shorty and standard Class II Carriere Motion appliance. Angle Orthod. 2021;91:423–432. doi: 10.2319/041320-295.1. PubMed DOI PMC

Hamilton C.F., Saltaji H., Preston C.B., Flores-Mir C., Tabbaa S. Adolescent patients’ experience with the Carriere distalizer appliance. Eur. J. Paediatr. Dent. 2013;14:219–224. PubMed

Areepong D., Kim K.B., Oliver D.R., Ueno H. The Class II Carriere Motion appliance: A 3D CBCT evaluation of the effects on the dentition. Angle Orthod. 2020;90:491–499. doi: 10.2319/080919-523.1. PubMed DOI PMC

Gupta D.K., Tuli A., Jain A. 3D printed material application in orthodontics. Pt 3Mater. Today Proc. 2020;28:1635–1642. doi: 10.1016/j.matpr.2020.04.856. DOI

Eliades T., Zinelis S. Three-dimensional printing and in-house appliance fabrication: Between innovation and stepping into the unknown. Am. J. Orthod. Dentofac. Orthop. 2021;159:1–3. doi: 10.1016/j.ajodo.2020.10.012. PubMed DOI

Guarnieri F.D.F., Briso A.L.F., Ramos F.d.S.e.S., Esteves L.M.B., Omoto É.M., Sundfeld R.H., Fagundes T.C. Use of auxiliary devices during retreatment of direct resin composite veneers. PLoS ONE. 2021;16:e0252171. doi: 10.1371/journal.pone.0252171. PubMed DOI PMC

Technical Data Sheet—Dental LT Clear (V2) [(accessed on 10 October 2021)]. Available online: https://formlabs-media.formlabs.com/datasheets/2001429-TDS-ENUS-0.pdf.

Formlabs Denture Resins—PKG-RS-F2-DT. [(accessed on 10 October 2021)]. Available online: https://dental.formlabs.com/store/denture-teeth-resin-1l/

Form Cure Time and Temperature Settings. [(accessed on 10 October 2021)]. Available online: https://s3.amazonaws.com/servicecloudassets.formlabs.com/media/Finishing/Post-Curing/115001414464-Form%20Cure%20Time%20and%20Temperature%20Settings/FormCurePost-CureSettings.pdf.

Safety Data Sheet—Dental LT Clear (V2) [(accessed on 10 October 2021)]. Available online: https://formlabs-media.formlabs.com/datasheets/2001421-SDS-ENEU-0.pdf.

Safety Data Sheet—Denture Teeth. [(accessed on 10 October 2021)]. Available online: https://formlabs-media.formlabs.com/datasheets/1902185-SDS-ENEU-0.pdf.

Technical Data Sheet—Denture Base and Teeth. [(accessed on 10 October 2021)]. Available online: https://dental-media.formlabs.com/datasheets/1802131-TDS-ENEU-0.pdf.

Form 2—3D Printer Technical Data Sheet—Online. [(accessed on 10 October 2021)]. Available online: https://formlabs.com/3d-printers/form-2.

Cha H.S., Park J.M., Kim T.H., Lee J.H. Wear Resistance of 3D-Printed Denture Tooth Resin Opposing Zirconia and Metal Antagonists. J. Prosthet. Dent. 2020;124:387–394. doi: 10.1016/j.prosdent.2019.09.004. PubMed DOI

Espinar-Escalona E., Barrera-Mora J.M., Llamas-Carreras J.M., Solano-Reina E., Rodríguez D., Gil F.J. Improvement in adhesion of the brackets to the tooth by sandblasting treatment. J. Mater. Sci. Mater. Med. 2012;23:605–611. doi: 10.1007/s10856-011-4509-y. PubMed DOI

Goracci C., Cacciatore G. Early treatment of a severe Class II malocclusion with the Forsus fatigue resistant device. Eur. J. Paediatr. Dent. 2017;18:199–207. doi: 10.23804/ejpd.2017.18.03.06. PubMed DOI

Graf S., Vasudavan S., Wilmes B. CAD/CAM Metallic Printing of a Skeletally Anchored Upper Molar Distalizer. J. Clin. Orthod. 2020;54:140–150. PubMed

Thurzo A., Kočiš F., Novák B., Czako L., Varga I. Three-Dimensional Modeling and 3D Printing of Biocompatible Orthodontic Power-Arm Design with Clinical Application. Appl. Sci. 2021;11:9693. doi: 10.3390/app11209693. DOI

Tamaya N., Kawamura J., Yanagi Y. Tooth Movement Efficacy of Retraction Spring Made of a New Low Elastic Modulus Material, Gum Metal, Evaluated by the Finite Element Method. Materials. 2021;14:2934. doi: 10.3390/ma14112934. PubMed DOI PMC

Thurzo A., Kosnáčová H.S., Kurilová V., Kosmeľ S., Beňuš R., Moravanský N., Kováč P., Kuracinová K.M., Palkovič M., Varga I. Use of Advanced Artificial Intelligence in Forensic Medicine, Forensic Anthropology and Clinical Anatomy. Healthcare. 2021;9:1545. doi: 10.3390/healthcare9111545. PubMed DOI PMC

Dalessandri D., Sangalli L., Tonni I., Laffranchi L., Bonetti S., Visconti L., Signoroni A., Paganelli C. Attitude towards Telemonitoring in Orthodontists and Orthodontic Patients. Dent. J. 2021;9:47. doi: 10.3390/dj9050047. PubMed DOI PMC

Federici Canova F., Oliva G., Beretta M., Dalessandri D. Digital (R)Evolution: Open-Source Softwares for Orthodontics. Appl. Sci. 2021;11:6033. doi: 10.3390/app11136033. DOI

Zinelis S., Panayi N., Polychronis G., Papageorgiou S.N., Eliades T. Comparative analysis of mechanical properties of orthodontic aligners produced by different contemporary 3D printers. Orthod. Craniofacial Res. 2021:1–6. doi: 10.1111/ocr.12537. PubMed DOI PMC

Urbanova W., Klimova I., Brudnicki A., Polackova P., Kroupova D., Dubovska I., Rachwalski M., Fudalej P.S. The Slav-Cleft: A Three-Center Study of the Outcome of Treatment of Cleft Lip and Palate. Part 1: Craniofacial Morphology. J. Cranio-Maxillofac. Surg. 2016;44:1767–1776. doi: 10.1016/j.jcms.2016.06.010. PubMed DOI

Sfondrini M.F., Pascadopoli M., Gallo S., Ricaldone F., Kramp D.D., Valla M., Gandini P., Scribante A. Effect of Enamel Pretreatment with Pastes Presenting Different Relative Dentin Abrasivity (RDA) Values on Orthodontic Bracket Bonding Efficacy of Microfilled Composite Resin: In Vitro Investigation and Randomized Clinical Trial. Materials. 2022;15:531. doi: 10.3390/ma15020531. PubMed DOI PMC

Miletić I., Baraba A., Basso M., Pulcini M.G., Marković D., Perić T., Ozkaya C.A., Turkun L.S. Clinical Performance of a Glass-Hybrid System Compared with a Resin Composite in the Posterior Region: Results of a 2-Year Multicenter Study. J. Adhes. Dent. 2020;22:235–247. doi: 10.3290/J.JAD.A44547. PubMed DOI

Alifui-Segbaya F., Varma S., Lieschke G.J., George R. Biocompatibility of Photopolymers in 3D Printing. 3D Print. Addit. Manuf. 2017;4:185–191. doi: 10.1089/3dp.2017.0064. DOI

Schuster M., Turecek C., Kaiser B., Stampfl J., Liska R., Varga F. Evaluation of Biocompatible Photopolymers I: Photoreactivity and Mechanical Properties of Reactive Diluents. J. Macromol. Sci. Part A. 2007;44:547–557. doi: 10.1080/10601320701235958. DOI

Force Degradation of Intermaxillary Latex Elastics: Comparative In Vitro and In Vivo Study

Pierre Robin Sequence and 3D Printed Personalized Composite Appliances in Interdisciplinary Approach

Where Is the Artificial Intelligence Applied in Dentistry? Systematic Review and Literature Analysis

Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study