3D-Printed Vs Thermoformed Retainers: Comparison of Post-Treatment Stability, Changes in Mechanical Properties and Patients' OHRQoL

NCT ID: NCT05968625

Last Updated: 2023-09-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-03-28

Study Completion Date

2024-10-31

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

Following completion of orthodontic treatment, prolonged retention with either part-time or full-time wear of retainers is crucial in preventing relapse. Clear thermoformed retainers (TFR) are easy to fabricate and popular among orthodontic patients. With the advent of digital orthodontics and the development of biocompatible photopolymerizable resin, it is now possible to fabricate direct 3D-printed retainers.

The aim of this study is to determine and compare the post-treatment stability of dentition, changes in thickness and mechanical properties of the retainers, and oral health-related quality of life (OHRQoL) of patients wearing direct 3D-printed retainers and conventional thermoformed retainers over a retention period of 6 months.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Primary Objective:

1\. To determine and compare the post-treatment stability for direct 3D printed retainers (3DPR) and conventional TFR (TFR) at baseline (T0), 3 months (T1) and 6 months (T2).

Secondary Objectives:

1. To determine and compare the thickness and mechanical properties for 3DPR and TFR after 6 months of usage.
2. To determine and compare the OHRQoL of patients wearing 3DPR and TFR at T0, T1 and T2.

Sample size calculation:

Sample size calculation is based on the study done by Kumar \& Bansal (2011) which compared the effectiveness of two different removable retainers on stability. With an effect size of 1.127, α = 0.05, and power = 0.80. Using G\*Power version 3.1.9.7 software, the total number of samples is n = 22 (11 subject per group). This number is increased by 30% to account for the dropout rate to produce the final sample size, n = 30 (15 subjects per group).

Methodology:

Subjects who have completed their orthodontic treatment (fulfil the inclusion and exclusion criteria) and are ready for debond, will be invited to participate in the research and consecutively recruited, between April 2023 until September 2023, in the Postgraduate Orthodontic Clinic, Dental Specialists and Research Tower, Faculty of Dentistry, Universiti Malaya, Malaysia. Patient information sheets and consent forms will be issued to the subjects that fulfil the criteria. Only consented respondents will be recruited.

All 30 subjects will be randomly allocated (simple randomization with 1:1 allocation) to either the TFR group or the 3DPR group by using number generated list provided by www.random.org . The randomization will be performed by the main supervisor, who is not involve in the treatment, data collection and data analysis of the research. The operator will be concealed from the group allocation. The allocation will be revealed to the operator on the day of debond appointment with a opaque white envelope.

All the subjects will undergo the same standard debond process. and receive a post debond thermoformed retainers within 24 hours which they are required to part-time for every night (8-12 hours).

The subjects will be reviewed after 1 week (T0) for scanning of teeth with Trios 3 intraoral scanner. The interventional retainers (TFR or 3DPR) will be issued after 2 weeks. The subjects are instructed to wear the retainers part-time (8-12 hours) for every nights. A pamphlet that contains detailed information on the care of retainers will also be provided to every subject. All the subjects will be reviewed after 3 months (T1) and at 6 months (T2) after wearing the interventional retainers.

The primary outcome is to assess the post-treatment stability after part time wear of the retainers for a period of 6 months. The subject's upper and lower dentition will be scanned by using intraoral scanner at T0, T1, and T2. The measurements will be performed digitally using 3Shape orthodontic analyzer software. Overjet, overbite, intermolar width, and little irregularity index will be measured.

OHIP-14 questionnaire will be given to the participants to answer during T0, T1 and T2. All the retainers will be retrieved at T2 to undergo mechanical test.

Statistical Analysis:

The data collected will be entered into SPSS software (version 26.0). i. Chi-square tests will be used to compare baseline characteristics between the 2 groups.

ii. Repeated measures ANOVA or paired t-test will be used to determine the mean differences in post treatment stability, thickness of retainers, mechanical properties of retainers and OHIP-14 scores at different time intervals. The p-value will be set to less than 0.05.

iii. Two samples independent t test will be used to compare the post-treatment stability, changes in thickness, mechanical properties, and OHIP-14 scores between TFR and 3DPR group. The p-value will be set to less than 0.05.

iv. Shapiro-Wilk tests will be referred, and non-parametric tests will be performed for skewed data.

Data will be analyzed following the intention-to-treat analysis.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Orthodontic Retention

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Direct 3D-printed retainers
Primary Study Purpose

SCREENING

Blinding Strategy

SINGLE

Outcome Assessors
This is a single-blinded study, where the statistician that analyzes the data is blinded. The subjects are impossible to blind due to subtle differences in the physical appearance of both appliances.

Blinding of the operator will not be possible due to the differences in clinical procedures involved in fabrication of TFR and 3DPR.

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

Thermoformed retainers (TFR)

Thermoformed retainers are constructed from an Erkodur blank (ERKODENT® Erich Kopp GmbH, Pfalzgrafenweiler, Germany) with 1.0 mm in thickness, following the manufacturer's instructions.

Group Type EXPERIMENTAL

Thermoformed retainers

Intervention Type DEVICE

conventional thermoformed retainers fabricated on stone models.

Direct 3-D printed retainers (3DPR)

Private dental laboratories directly print the retainers using a NextDent 3D printer and NextDent ortho Flex resin. Thickness of 0.80mm

Group Type EXPERIMENTAL

3D-printed retainers

Intervention Type DEVICE

3D-printed retainers fabricated directly by DLP printer.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Thermoformed retainers

conventional thermoformed retainers fabricated on stone models.

Intervention Type DEVICE

3D-printed retainers

3D-printed retainers fabricated directly by DLP printer.

Intervention Type DEVICE

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Fixed appliance treatment in both arches and indicated for VFR in the retention phase as part of their original treatment plan.
* No intention to relocate within the study period; able to attend the three-monthly review appointments for half a year.

Exclusion Criteria

* Single-arch or sectional fixed appliances.
* Space dentition.
* Hypodontia requiring tooth replacement on the retainer as a temporary measure.
* Previous treatment with maxillary expansion.
* Indicated for fixed retainer or double retention regime (such as VFRs fitted over fixed retainers).
* Premature debond from the original fixed appliances course.
* Cleft lip and/or palate; or orthognathic cases.
* Learning difficulties and inability to read written instructions/ questionnaire in English or Malay
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University of Malaya

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

DR BOO HUI SHAN

Principle Investigator, Doctorate (Orthodontics) Postgraduate Student

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Associate Professor Dr. Saritha Sivarajan

Role: STUDY_DIRECTOR

Faculty of Dentistry, Universiti Malaya

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Orthodontic Postgraduate Clinic, Faculty of Dentistry, Universiti Malaya.

Kuala Lumpur, Kuala Lumpur, Malaysia

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

Malaysia

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Dr. Boo Hui Shan

Role: CONTACT

+60102705306

Associate Professor Dr. Saritha Sivarajan

Role: CONTACT

+6037967 4802 ext. 4562

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Dr. Boo Hui Shan

Role: primary

+60102705306

Associate Professor Dr. Saritha Sivarajan

Role: backup

+60379674802 ext. 4562

References

Explore related publications, articles, or registry entries linked to this study.

Williams A, Bencharit S, Yang IH, Stilianoudakis SC, Carrico CK, Tufekci E. Effect of print angulation on the accuracy and precision of 3D-printed orthodontic retainers. Am J Orthod Dentofacial Orthop. 2022 Jan;161(1):133-139. doi: 10.1016/j.ajodo.2021.01.020.

Reference Type BACKGROUND
PMID: 35012743 (View on PubMed)

Rowland H, Hichens L, Williams A, Hills D, Killingback N, Ewings P, Clark S, Ireland AJ, Sandy JR. The effectiveness of Hawley and vacuum-formed retainers: a single-center randomized controlled trial. Am J Orthod Dentofacial Orthop. 2007 Dec;132(6):730-7. doi: 10.1016/j.ajodo.2006.06.019.

Reference Type BACKGROUND
PMID: 18068589 (View on PubMed)

Naeem OA, Bencharit S, Yang IH, Stilianoudakis SC, Carrico C, Tufekci E. Comparison of 3-dimensional printing technologies on the precision, trueness, and accuracy of printed retainers. Am J Orthod Dentofacial Orthop. 2022 Apr;161(4):582-591. doi: 10.1016/j.ajodo.2021.03.016.

Reference Type BACKGROUND
PMID: 35337648 (View on PubMed)

Kumar AG, Bansal A. Effectiveness and acceptability of Essix and Begg retainers: a prospective study. Aust Orthod J. 2011 May;27(1):52-6.

Reference Type BACKGROUND
PMID: 21696115 (View on PubMed)

Kessler A, Hickel R, Reymus M. 3D Printing in Dentistry-State of the Art. Oper Dent. 2020 Jan/Feb;45(1):30-40. doi: 10.2341/18-229-L. Epub 2019 Jun 7.

Reference Type BACKGROUND
PMID: 31172871 (View on PubMed)

Jindal P, Juneja M, Siena FL, Bajaj D, Breedon P. Mechanical and geometric properties of thermoformed and 3D printed clear dental aligners. Am J Orthod Dentofacial Orthop. 2019 Nov;156(5):694-701. doi: 10.1016/j.ajodo.2019.05.012.

Reference Type BACKGROUND
PMID: 31677678 (View on PubMed)

Etemad-Shahidi Y, Qallandar OB, Evenden J, Alifui-Segbaya F, Ahmed KE. Accuracy of 3-Dimensionally Printed Full-Arch Dental Models: A Systematic Review. J Clin Med. 2020 Oct 20;9(10):3357. doi: 10.3390/jcm9103357.

Reference Type BACKGROUND
PMID: 33092047 (View on PubMed)

Cousley RR. Introducing 3D printing in your orthodontic practice. J Orthod. 2020 Sep;47(3):265-272. doi: 10.1177/1465312520936704. Epub 2020 Jul 6.

Reference Type BACKGROUND
PMID: 32627658 (View on PubMed)

Cole D, Bencharit S, Carrico CK, Arias A, Tufekci E. Evaluation of fit for 3D-printed retainers compared with thermoform retainers. Am J Orthod Dentofacial Orthop. 2019 Apr;155(4):592-599. doi: 10.1016/j.ajodo.2018.09.011.

Reference Type BACKGROUND
PMID: 30935614 (View on PubMed)

Can E, Panayi N, Polychronis G, Papageorgiou SN, Zinelis S, Eliades G, Eliades T. In-house 3D-printed aligners: effect of in vivo ageing on mechanical properties. Eur J Orthod. 2022 Jan 25;44(1):51-55. doi: 10.1093/ejo/cjab022.

Reference Type BACKGROUND
PMID: 33950232 (View on PubMed)

Al-Moghrabi D, Salazar FC, Pandis N, Fleming PS. Compliance with removable orthodontic appliances and adjuncts: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2017 Jul;152(1):17-32. doi: 10.1016/j.ajodo.2017.03.019.

Reference Type BACKGROUND
PMID: 28651764 (View on PubMed)

Al-Moghrabi D, Littlewood SJ, Fleming PS. Orthodontic retention protocols: an evidence-based overview. Br Dent J. 2021 Jun;230(11):770-776. doi: 10.1038/s41415-021-2954-7. Epub 2021 Jun 11.

Reference Type BACKGROUND
PMID: 34117437 (View on PubMed)

Thickett E, Power S. A randomized clinical trial of thermoplastic retainer wear. Eur J Orthod. 2010 Feb;32(1):1-5. doi: 10.1093/ejo/cjp061. Epub 2009 Oct 14.

Reference Type BACKGROUND
PMID: 19828592 (View on PubMed)

Saub R, Locker D, Allison P. Derivation and validation of the short version of the Malaysian Oral Health Impact Profile. Community Dent Oral Epidemiol. 2005 Oct;33(5):378-83. doi: 10.1111/j.1600-0528.2005.00242.x.

Reference Type BACKGROUND
PMID: 16128798 (View on PubMed)

Mohd Tahir N, Wan Hassan WN, Saub R. Comparing retainers constructed on conventional stone models and on 3D printed models: a randomized crossover clinical study. Eur J Orthod. 2019 Aug 8;41(4):370-380. doi: 10.1093/ejo/cjy063.

Reference Type BACKGROUND
PMID: 30321319 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

UMG013E-2023

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

UNIVERSITI MALAYA

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.