Treatment Quality, Duration and Accuracy with LightForce™ 3D-Printed Custom Brackets and Clear Aligners

Abstract

Introduction: New custom 3D-printed bracket workflows have emerged during the past few years. LightForceTM (LF, Burlington, MA) is a custom 3D-printed labial bracket that is indirectly bonded to teeth. The manufacturer claims that they are precise in delivering tooth movement, accurate in bracket placement, efficient in clinic visits. Clear Aligners (CA) have been utilized more commonly in clinical practice with similar claims to 3D-printed brackets in terms of its precision, accuracy, and efficiency. In Addition, CAs are more esthetic, better in oral hygiene maintenance, less susceptible to white spot lesions compared to fixed orthodontic brackets, however, they have some drawbacks such as patients’ compliance is required in wearing their aligners, the main movement produced is tipping and the predictability of controlled tipping ≤ 50% of the required tooth movement. To our knowledge, the treatment quality, duration, and accuracy of LF customized 3-D printed brackets in comparison to CAs has not been investigated in the literature Objectives: The aims of this study were to compare the treatment quality, duration and accuracy of LF bracket system and CA therapy. Methods: This was a retrospective comparative study of patients presenting for comprehensive orthodontic treatment with either LF or CAs (Invisalign®, San Jose, CA) in one private practice. A total of 70 subjects were included (37 in the LF group and 33 in the CA group). The mean age at the start of the treatment was 13.42 ± 1.09 in LF group and 15.8 ± 3.36 in the CA group. Pre- and post-comprehensive treatment records were compared. Treatment quality was evaluated on post-treatment 3-D printed models and panoramic radiographs using the ABO Cast-Radiograph evaluation (C-R Eval) grading system. Treatment duration was compared between the groups in months. Treatment accuracy was evaluated by comparing the predicted (TP) and the achieved (T1) arch width changes at the canine, first premolar and first molar between the groups. Results: The total C-R Eval score was 35.08 ± 9.99 in the LF group and 32.55 ± 8.85 in the CA group. The scores showed no significant difference between the two groups (P=0.503). The treatment duration was 15.89 ± 3.49 in the LF and 14.39 ± 4.69 in the CA group and the difference was not statistically significant (P= 0.138). There was significant difference between LF and CA groups in TP-T1 of the maxillary inter- canine width (LF= 0.87, CA=0.23, P= 0.013) Conclusion: Treatment quality and duration were comparable between LF and CAs in mild to moderate crowding cases. CAs demonstrated accuracy in archwidth predictions, whereas LF showed accuracy in predicting maxillary inter-canine width, mandibular intermolar and inter-premolar widths. CAs showed higher accuracy in the prediction of maxillary inter-canine width than LF.