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Review Article

More than just aligning the teeth: Clear aligners with multi-functional prowess

Yang Chen1,§, Lei-Ming Cao1,§, Nian-Nian Zhong1, Zi-Zhan Li1, Lin-Lin Bu1,2( ), Fang-Yi Huo1,3( ), Hong He1,4( )
State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
Department of Oral and Maxillofacial-Head Neck Oncology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China
Department of Zhuankou Clinical Branches, School and Hospital of Stomatology, Wuhan University, Wuhan 430000, China
Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China

§ Yang Chen and Lei-Ming Cao contributed equally to this work.

Show Author Information

Graphical Abstract

Novel clear aligners (CAs), modified with drugs or selected biomaterials, are promising to provide additional medical functions to patients, such as whitening, anti-bacteria, remineralization, accelerating teeth movement, and personalized functions, which is superior to the traditional CAs with common complications.

Abstract

With the increasing demand for beauty and health, clear aligners (CAs) have been widely applied among patients with malocclusion. However, patients treated with CAs also face some potential complications, such as demineralization, dental caries, and periodontal diseases. In addition, some patients have additional needs to improve their quality of life, such as bleaching teeth. In order to prevent or solve these problems, the modification of CAs is a promising method because their extensive long-term contact with tooth surfaces makes them ideal devices for implementing adjuvant medical functions.

In this review, we discuss various advanced CAs with medical functions based on the clinical needs of patients. As far as we know, the additional functions of CAs mainly include antibacterial, remineralization, whitening, and accelerating tooth movement. These functions are achieved by two major pathways, the combination of CAs with drugs/biomaterials and increasing the capacity or affinity of drugs. In addition, we discuss the current limitations of in vitro experiments which are designed to explore the effectiveness and properties of novel CAs, and the challenges of bringing a multifunctional appliance from proposal to clinical application. At the end of this review, we provide insights into the broader prospects for the improvement of CAs.

Keywords

advanced clear alignersmedical device modificationdrug delivery systempersonalized medicine

References

[1]

Lombardo, G.; Vena, F.; Negri, P.; Pagano, S.; Barilotti, C.; Paglia, L.; Colombo, S.; Orso, M.; Cianetti, S. Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis. Eur. J. Paediatr. Dent. 2020, 21, 115–122.
Crossref Google Scholar
[2]

Yassir, Y. A.; Nabbat, S. A.; McIntyre, G. T.; Bearn, D. R. Clinical effectiveness of clear aligner treatment compared to fixed appliance treatment: An overview of systematic reviews. Clin. Oral. Investig. 2022, 26, 2353–2370.
Crossref Google Scholar
[3]
Huang, H. Discussion on the marketing strategy of Invisalign in China Southwestern University of Finance and Economics 2019.
[4]

Tartaglia, G. M.; Mapelli, A.; Maspero, C.; Santaniello, T.; Serafin, M.; Farronato, M.; Caprioglio, A. Direct 3D printing of clear orthodontic aligners: Current state and future possibilities. Materials 2021, 14, 1799.
Crossref Google Scholar
[5]

Jiang, Q.; Li, J. L.; Mei, L.; Du, J.; Levrini, L.; Abbate, G. M.; Li, H. Periodontal health during orthodontic treatment with clear aligners and fixed appliances: A meta-analysis. J. Am. Dent. Assoc. 2018, 149, 712–720.e12.
Crossref Google Scholar
[6]

Lu, H. L.; Tang, H. F.; Zhou, T.; Kang, N. Assessment of the periodontal health status in patients undergoing orthodontic treatment with fixed appliances and Invisalign system: A meta-analysis. Medicine 2018, 97, e0248.
Crossref Google Scholar
[7]

Azeem, M.; Ul Hamid, W. Incidence of white spot lesions during orthodontic clear aligner therapy. J. World Fed. Orthod. 2017, 6, 127–130.
Crossref Google Scholar
[8]

Shi, Y. Y.; Zhang, N. N.; Liu, J. J.; Wang, J. B.; Shen, S. H.; Zhang, J. X.; An, X. L.; Si, Q. Z. Preparation of nanocomposites for antibacterial orthodontic invisible appliance based on piezoelectric catalysis. Sensors 2023, 23, 5336.
Crossref Google Scholar
[9]

De Felice, M. E.; Nucci, L.; Fiori, A.; Flores-Mir, C.; Perillo, L.; Grassia, V. Accuracy of interproximal enamel reduction during clear aligner treatment. Prog. Orthod. 2020, 21, 28.
Crossref Google Scholar
[10]

Alajmi, S.; Shaban, A.; Al-Azemi, R. Comparison of short-term oral impacts experienced by patients treated with Invisalign or conventional fixed orthodontic appliances. Med. Princ. Pract. 2020, 29, 382–388.
Crossref Google Scholar
[11]

Baik, U. B.; Kim, H.; Chae, H. S.; Myung, J. Y.; Chun, Y. S. Teeth discoloration during orthodontic treatment. Korean J Orthod. 2017, 47, 334–339.
Crossref Google Scholar
[12]

Al-Zainal, M. H.; Anvery, S.; Al-Jewair, T. Clear aligner therapy may not prevent but may decrease the incidence of external root resorption compared to full fixed appliances. J. Evid. Based Dent. Pract. 2020, 20, 101438.
Crossref Google Scholar
[13]

Yazdi, M.; Daryanavard, H.; Ashtiani, A. H.; Moradinejad, M.; Rakhshan, V. A systematic review of biocompatibility and safety of orthodontic clear aligners and transparent vacuum-formed thermoplastic retainers: Bisphenol-A release, adverse effects, cytotoxicity, and estrogenic effects. Dent. Res. J. 2023, 20, 41.
Crossref Google Scholar
[14]

Seleem, D.; Dadjoo, S.; Ha, A.; Santos, C.; Mirfarsi, S.; Matsumura-Lem, K.; Lazarchik, D. Effect of 10% Carbamide peroxide on tooth shade, plaque index and gingival index during Invisalign treatment. Dent. J. 2021, 9, 48.
Crossref Google Scholar
[15]

Cheng, Y. X.; Fang, S. S.; Liu, X. L.; Li, X.; Song, Z. X.; Ma, Y. N.; Jin, Z. L. Development and performance of a clear aligner film loaded with sustained release hydrogen peroxide gel. Front. Mater. 2023, 10, 1137672.
Crossref Google Scholar
[16]

Low, B.; Lee, W.; Seneviratne, C. J.; Samaranayake, L. P.; Hägg, U. Ultrastructure and morphology of biofilms on thermoplastic orthodontic appliances in “fast” and “slow” plaque formers. Eur. J. Orthod. 2011, 33, 577–583.
Crossref Google Scholar
[17]

Charavet, C.; Gourdain, Z.; Graveline, L.; Lupi, L. Cleaning and disinfection protocols for clear orthodontic aligners: A systematic review. Healthcare 2022, 10, 340.
Crossref Google Scholar
[18]

Zhang, M. Q.; Liu, X. M.; Xie, Y. Z. Y.; Zhang, Q.; Zhang, W.; Jiang, X. Y.; Lin, J. X. Biological safe gold nanoparticle-modified dental aligner prevents the Porphyromonas gingivalis biofilm Formation. ACS Omega 2020, 5, 18685–18692.
Crossref Google Scholar
[19]

Chen, Z. T.; Chu, Z. Y.; Jiang, Y. C.; Xu, L. L.; Qian, H. S.; Wang, Y. Y.; Wang, W. N. Recent advances on nanomaterials for antibacterial treatment of oral diseases. Mater. Today Bio 2023, 20, 100635.
Crossref Google Scholar
[20]

Slavin, Y. N.; Asnis, J.; Häfeli, U. O.; Bach, H. Metal nanoparticles: Understanding the mechanisms behind antibacterial activity. J. Nanobiotechnol. 2017, 15, 65.
Crossref Google Scholar
[21]

Makvandi, P.; Wang, C. Y.; Zare, E. N.; Borzacchiello, A.; Niu, L. N.; Tay, F. R. Metal-based nanomaterials in biomedical applications: Antimicrobial activity and cytotoxicity aspects. Adv. Funct. Mater. 2020, 30, 1910021.
Crossref Google Scholar
[22]

Zhao, Y. Y.; Tian, Y.; Cui, Y.; Liu, W. W.; Ma, W. S.; Jiang, X. Y. Small molecule-capped gold nanoparticles as potent antibacterial agents that target Gram-negative bacteria. J. Am. Chem. Soc. 2010, 132, 12349–12356.
Crossref Google Scholar
[23]

Yougbare, S.; Chang, T. K.; Tan, S. H.; Kuo, J. C.; Hsu, P. H.; Su, C. Y.; Kuo, T. R. Antimicrobial gold nanoclusters: Recent developments and future perspectives. Int. J. Mol. Sci. 2019, 20, 2924.
Crossref Google Scholar
[24]

Cui, Y.; Zhao, Y. Y.; Tian, Y.; Zhang, W.; Lü, X. Y.; Jiang, X. Y. The molecular mechanism of action of bactericidal gold nanoparticles on Escherichia coli. Biomaterials 2012, 33, 2327–2333.
Crossref Google Scholar
[25]

Zheng, W. S.; Jia, Y. X.; Chen, W. W.; Wang, G. L.; Guo, X. F.; Jiang, X. Y. Universal coating from electrostatic self-assembly to prevent multidrug-resistant bacterial colonization on medical devices and solid surfaces. ACS Appl. Mater. Interfaces 2017, 9, 21181–21189.
Crossref Google Scholar
[26]

Xie, Y. Z. Y.; Liu, Y.; Yang, J. C.; Liu, Y.; Hu, F. P.; Zhu, K.; Jiang, X. Y. Gold nanoclusters for targeting methicillin-resistant Staphylococcus aureus in vivo. Angew. Chem., Int. Ed. 2018, 57, 3958–3962.
Crossref Google Scholar
[27]

Xie, Y. Z. Y.; Zhang, M. Q.; Zhang, W.; Liu, X. M.; Zheng, W. F.; Jiang, X. Y. Gold nanoclusters-coated orthodontic devices can inhibit the formation of Streptococcus mutans biofilm. ACS Biomater. Sci. Eng. 2020, 6, 1239–1246.
Crossref Google Scholar
[28]

Xie, Y. Z. Y.; Zheng, W. F.; Jiang, X. Y. Near-infrared light-activated phototherapy by gold nanoclusters for dispersing biofilms. ACS Appl. Mater. Interfaces 2020, 12, 9041–9049.
Crossref Google Scholar
[29]

Gharpure, S.; Ankamwar, B. Synthesis and antimicrobial properties of zinc oxide nanoparticles. J. Nanosci. Nanotechnol. 2020, 20, 5977–5996.
Crossref Google Scholar
[30]

Anita, P.; Sathyanarayana, H. P.; Kumar, K.; Ramanathan, K.; Kailasam, V. Antimicrobial efficacy of zinc oxide nanoparticle-coated aligners on Streptococcus mutans and Candida albicans. Am. J. Orthod. Dentofacial Orthop. 2023, 163, 338–346.
Crossref Google Scholar
[31]
Wu, T. Y. Novel antibacterial tooth socket. CN Patent 2,123,081,03U, January 8, 2021.
[32]
Sun, N. N.; Chen, J.; Xu, F.; Meng, L. Q.; Bi, J. P. Low-temperature preparation method of PETG headgear surface silver-doped titanium dioxide Nano-antibacterial composite coating. CN Patent 1,109,832,75A, April 10, 2020.
[33]
Zhang, J. X.; Xie, L. H.; Liu, X.; Li, H.; Li, H. W. Anti-caries invisible orthodontic appliance with antibacterial coating as well as preparation method and application of anti-caries invisible orthodontic appliance. CN Patent 1,153,862,56A, November 25, 2022.
[34]
An, X. L.; Si, Q. Z.; Shi, Y. Y.; Zhang, J. X.; He, X. L. Novel material for piezoelectric self-cleaning antibacterial invisible orthodontic appliance, and preparation method and test method thereof. CN Patent 1,137,175,03A, November 30, 2021.
[35]

Aliasghari, A.; Khorasgani, M. R.; Vaezifar, S.; Rahimi, F.; Younesi, H.; Khoroushi, M. Evaluation of antibacterial efficiency of chitosan and chitosan nanoparticles on cariogenic streptococci: An in vitro study. Iran. J. Microbiol. 2016, 8, 93–100.
Google Scholar
[36]

Kawaguchi, K.; Iijima, M.; Miyakawa, H.; Ohta, M.; Muguruma, T.; Endo, K.; Nakazawa, F.; Mizoguchi, I. Effects of chitosan fiber addition on the properties of polyurethane with thermo-responsive shape memory. J. Biomed. Mater. Res. B Appl. Biomater. 2017, 105, 1151–1156.
Crossref Google Scholar
[37]

Worreth, S.; Bieger, V.; Rohr, N.; Astasov-Frauenhoffer, M.; Töpper, T.; Osmani, B.; Braissant, O. Cinnamaldehyde as antimicrobial in cellulose-based dental appliances. J. Appl. Microbiol. 2022, 132, 1018–1024.
Crossref Google Scholar
[38]

Zhou, Z. Y.; Zhou, S. G.; Zhang, X. R.; Zeng, S. H.; Xu, Y.; Nie, W. Y.; Zhou, Y. F.; Xu, T.; Chen, P. P. Quaternary ammonium salts: insights into synthesis and new directions in antibacterial applications. Bioconjugate Chem. 2023, 34, 302–325.
Crossref Google Scholar
[39]
Hu, F.; Guo, H. S.; Li, G. B.; Li, H.; Wang, P. H. Long-acting antibacterial material and preparation method thereof, long-acting antibacterial dental diaphragm and long-acting antibacterial invisible appliance. CN Patent 1,114,846,41A, August 4, 2020.
[40]
Liu, M.; Tao, L.; Hu, J. Y. Quaternary ammonium salt antibacterial dental diaphragm and preparation method thereof. CN Patent 1,160,357,36A, May 2, 2023.
[41]

Park, S.; Jeong, H. J.; Moon, J. H.; Jang, E. Y.; Jung, S.; Choi, M.; Choi, W.; Park, K.; Ahn, H. W.; Hong, J. Polysilsesquioxane with potent resistance to intraoral stress: Functional coating material for the advanced dental materials. Appl. Surf. Sci. 2022, 578, 152085.
Crossref Google Scholar
[42]
Xu, Y. H.; Zhang, C. Z.; Zhang, C. X. Long-acting antibacterial material, dental diaphragm and long-acting invisible appliance. CN Patent 1,129,988,84A, June 22, 2021.
[43]

Yan, J. R.; Cao, L. Y.; Luo, T.; Qin, D. C.; Hua, F.; He, H. In vitro evaluation of a novel fluoride-coated clear aligner with antibacterial and enamel remineralization abilities. Clin. Oral. Investig. 2023, 27, 6027–6042.
Crossref Google Scholar
[44]

Albhaisi, Z.; Al-Khateeb, S. N.; Abu Alhaija, E. S. Enamel demineralization during clear aligner orthodontic treatment compared with fixed appliance therapy, evaluated with quantitative light-induced fluorescence: A randomized clinical trial. Am. J. Orthod. Dentofacial Orthop. 2020, 157, 594–601.
Crossref Google Scholar
[45]
Berger, V.; Green Buzhor, M.; Evstafeva, D.; Mügeli, L.; Leroux, J. C. 3D printing of a controlled urea delivery device for the prevention of tooth decay. Int. J. Pharm. 2023 , 631, 122528.
[46]
Zhang, C.; Dai, D. N.; Chen, Y. M.; Wang, J. R.; He, L. W.; Shao, L. Q. Fluorine-containing antibacterial invisible appliance for improving enamel demineralization and preparation method of fluorine-containing antibacterial invisible appliance. CN Patent 1,126,188,02A, April 9, 2021.
[47]
Jiao, S. S.; Wang, D.; Tao, B. Yang, X. Nano-complexes for enamel remineralization. U.S. Patent 10406078(B2), September 10, 2019.
[48]
Zhang, C.; Chen, Y. M.; Wang, J. R.; He, L. W.; Dai, D. N.; Shao, L. Q. Hydrogel coating tooth invisible orthodontic appliance and preparation method thereof. CN Patent 1,146,180,23A, June 14, 2022.
[49]

Luque-Martinez, I.; Reis, A.; Schroeder, M.; Muñoz, M. A.; Loguercio, A. D.; Masterson, D.; Maia, L. C. Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: A systematic review and meta-analysis. Clin. Oral. Investig. 2016, 20, 1419–1433.
Crossref Google Scholar
[50]

Lazarchik, D. A.; Van Haywood, B. Use of tray-applied 10 percent carbamide peroxide gels for improving oral health in patients with special-care needs. J. Am. Dent. Assoc. 2010, 141, 639–646.
Crossref Google Scholar
[51]

Basting, R. T.; Amaral, F. L. B.; França, F. M. G.; Flório, F. M. Clinical comparative study of the effectiveness of and tooth sensitivity to 10% and 20% carbamide peroxide home-use and 35% and 38% hydrogen peroxide in-office bleaching materials containing desensitizing agents. Oper. Dent. 2012, 37, 464–473.
Crossref Google Scholar
[52]

Motokawa, M.; Sasamoto, T.; Kaku, M.; Kawata, T.; Matsuda, Y.; Terao, A.; Tanne, K. Association between root resorption incident to orthodontic treatment and treatment factors. Eur. J. Orthod. 2012, 34, 350–356.
Crossref Google Scholar
[53]

Pinto, A. S.; Alves, L. S.; Maltz, M.; Susin, C.; Zenkner, J. E. A. Does the duration of fixed orthodontic treatment affect caries activity among adolescents and young adults. Caries Res. 2018, 52, 463–467.
Crossref Google Scholar
[54]

Wang, Q.; Zhang, J.; Yao, G.; Lou, W. H.; Zhang, T. Y.; Zhang, Z. H.; Xie, M. W.; Gan, X. Y.; Pan, T. S.; Gao, M. et al. Effective orthodontic tooth movement via an occlusion-activated electromechanical synergistic dental aligner. ACS Nano 2023, 17, 16757–16769.
Crossref Google Scholar
[55]
Cinader, D. K. Jr.; Oxman, J. D.; Wang, Y. Z. Dental appliance with cosmetic therapeutic aqueous solution. U.S. Patent 11642199(B2), May 9, 2023.
[56]
Zhang, J. Y. Storage medicine formula does not have stealthy tooth in groove of support and rescues ware. CN Patent 2,053,596,66U, July 6, 2016.
[57]
Wang, H. Tooth appliance. CN Patent 213310456U, June 1, 2021.
[58]
Huang, C. Y. Composite tooth socket for loading medicines. CN Patent 2,115,349,47U, September 22, 2020.
[59]
Mason, D.; Sambu, S.; Li, C. H.; Chen, Y. Dental appliance having ornamental design. U.S. Patent 10201409(B2), February 12, 2019.
[60]

Shpack, N.; Greenstein, R. B. N.; Gazit, D.; Sarig, R.; Dan Vardimon, A. Efficacy of three hygienic protocols in reducing biofilm adherence to removable thermoplastic appliance. Angle Orthod. 2014, 84, 161–170.
Crossref Google Scholar
[61]
Huang, C. Y. Composite tooth socket with adsorption and storage functions. CN Patent 2,112,438,22U, August 14, 2020.
[62]
Huang, C. Y. Composite tooth socket for oral treatment. CN Patent 2,119,351,44U, November 17, 2020.
[63]
Cullen, J. E.; Livingston, M. A.; McFarlane, M.; Stevens, I. H. Dental appliance comprising orthodontic/oral bracket and dissolvable membrane. CN Patent 1,163,677,90A, June 30, 2023.
[64]
Jiang, H. L.; Fu, J. H.; Li, M. G.; Wang, S. S.; Zhuang, B.; Sun, H. Y.; Ge, C.; Feng, B.; Jin, Y. G. 3D-printed wearable personalized orthodontic retainers for sustained release of clonidine hydrochloride. AAPS PharmSciTech 2019 , 20, 260.
[65]
Zeng, Y.; Zhang, X.; Chen, W.; Kuang, Y. Desensitization reagent fixing device for treating dentin hypersensitivity. CN Patent 2,092,364,44U, August 13, 2019.
[66]

Kulkarni, R.; Payne, A. S.; Werth, V. P.; Sollecito, T. P.; Stoopler, E. T. Custom dental trays with topical corticosteroids for management of gingival lesions of mucous membrane pemphigoid. Int. J. Dermatol. 2020, 59, e211–e213.
Google Scholar
[67]

Drago, J. Z.; Modi, S.; Chandarlapaty, S. Unlocking the potential of antibody-drug conjugates for cancer therapy. Nat. Rev. Clin. Oncol. 2021, 18, 327–344.
Crossref Google Scholar
[68]

Xu, Y. Y.; Luo, Y. F.; Weng, Z. Z.; Xu, H. C.; Zhang, W.; Li, Q.; Liu, H. J.; Liu, L. B.; Wang, Y. M.; Liu, X. X. et al. Microenvironment-responsive metal-phenolic nanozyme release platform with antibacterial, ROS scavenging, and osteogenesis for periodontitis. ACS Nano 2023, 17, 18732–18746.
Crossref Google Scholar
[69]

Liang, Z. T.; Chen, D.; Jiang, Y.; Su, Z. K.; Pi, Y. X.; Luo, T.; Jiang, Q. Z.; Yang, L.; Guo, L. Multifunctional lithium-doped mesoporous nanoparticles for effective dentin regeneration in vivo. Int. J. Nanomed. 2023, 18, 5309–5325.
Crossref Google Scholar
[70]

Shi, Z. H.; Lu, Y. L.; Shen, S. Y.; Xu, Y.; Shu, C.; Wu, Y.; Lv, J. J.; Li, X.; Yan, Z. P.; An, Z. J. et al. Wearable battery-free theranostic dental patch for wireless intraoral sensing and drug delivery. npj Flex. Electron. 2022, 6, 49.
Crossref Google Scholar
[71]

Montoya, C.; Roldan, L.; Yu, M.; Valliani, S.; Ta, C.; Yang, M.; Orrego, S. Smart dental materials for antimicrobial applications. Bioact. Mater. 2023, 24, 1–19.
Google Scholar
[72]
Yue, J.; Pan, J. S.; Wei, H. L.; Wang, G.; Sun, Z. X. Invisible appliance with drainage hole. CN Patent 2,164,393,34U, May 6, 2022.
[73]
Yue, J.; Pan, J. S.; Wei, H. L.; Wang, G.; Sun, Z. X. Invisible appliance capable of preventing teeth from demineralizing. CN Patent 211213598U, August 11, 2020.
[74]

Cao, L. Y.; Yan, J. R.; Luo, T.; Yan, H. Y.; Hua, F.; He, H. Antibacterial and fluorescent clear aligner attachment resin modified with chlorhexidine loaded mesoporous silica nanoparticles and zinc oxide quantum dots. J. Mech. Behav. Biomed. Mater. 2023, 141, 105817.
Crossref Google Scholar
Nano Research
Volume 17 Issue 8,
August 2024
Pages 7665-7674
DOI: 10.1007/s12274-024-6631-4
Cite this article:
Chen Y, Cao L-M, Zhong N-N, et al. More than just aligning the teeth: Clear aligners with multi-functional prowess. Nano Research, 2024, 17(8): 7665-7674. https://doi.org/10.1007/s12274-024-6631-4
Topics:
Coatings Polymer films

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Received: 02 February 2024
Revised: 08 March 2024
Accepted: 12 March 2024
Published: 18 June 2024
© Tsinghua University Press 2024
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