MicroCT X-ray comparison of aligner gap and thickness of six brands of aligners: an in-vitro study

Background: To investigate and compare the gap (i.e. fit) and thickness of six aligner systems (Airnivol, ALL IN, Arc Angel, F22, Invisalign and Nuvola) using industrial computed tomography (CT). The null hypothesis was that there would be no detectable differences in either measurement between the aligners investigated. Materials and methods: Passive aligners of each brand were fitted to one single resin cast prototyped from an STL file from a single patient. The samples obtained were examined under high-resolution micro-CT, and the resulting tomographic microphotographs and volumetric data were compared. 3D analysis investigated the gap volume, the mean gap width and the maximum gap width of each sample. A total of 204 linear 2D measurements were made on 18 microtomographic images to investigate the aligner gap and thickness among different systems. Investigated regions were the central incisor, canine and first molar. The resulting measurements were analysed by ANOVA and compared using Tukey’s post hoc analysis (P < 0.05). Results: 3D analysis revealed that the F22 displayed lower gap volume and mean gap width, followed by Airnivol and Invisalign, whereas Airnivol the lowest maximum gap width. 2D analysis showed that F22 had the lowest mean gap and aligner thickness at all teeth investigated. Comparison of the 2D point values revealed statistically significant differences between brands in terms of both measurements (P < 0.05), with the exception of six points in the gap analysis and one in the thickness analysis. Conclusions: There are differences between the six aligner systems examined in terms of 2D and 3D measurements of aligner thickness and gap.