J Clin Exp Dent. 2021;13(6):e549-51.

Prosthetic replacement of missing teeth with orthodontic retainer

Journal section: Orthodontics doi:10.4317/jced.58035

Publication Types: Research [Link]

Fixed lingual orthodontic retainer with bilateral missing lateral incisors

produced in PEEK material using CAD/CAM technology

Khaled Aboulazm 1, Constantin von See 2, Ahmed Othman 3

1
Assoc. Prof., MSc, PhD. Chairman of orthodontic department in Pharos Private University-Alexandria- Egypt
2
Univ. Prof., MSc. Director of digital technologies in dentistry and CAD/CAM department-Danube Private University-Krems-Austria
3
Ass. Prof. Dr, MSc. Orthodontic researcher in digital technologies in dentistry and CAD/CAM department-Danube Private
University-Krems-Austria

Correspondence:
Steiner Landstrasse 124
3500 Krems an der Donau- Austria
[Link]@[Link]

Aboulazm K, von See C, Othman A. Fixed lingual orthodontic retainer

Received: 10/11/2020
with bilateral missing lateral incisors produced in PEEK material using
Accepted: 20/12/2020 CAD/CAM technology. J Clin Exp Dent. 2021;13(6):e549-51.

Article Number: 58035 [Link]

© Medicina Oral S. L. C.I.F. B 96689336 - eISSN: 1989-5488
eMail: jced@[Link]
Indexed in:
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Abstract
Background: The aim of this investigation is to evaluate the feasibility of digital workflow for lingual fixed retainer
based on digital intraoral scan and appliance production from Polyetheretherketone (PEEK) material for clinical
consideration.
Material and Methods: Fully virtual lingual retainer with bilateral missing lateral incisors was designed using inlab
software (Dentsply Sirona, Pennsylvania, USA). The designed retainer was produced in PEEK material and clini-
cally adhered to lingual surfaces of the lower front teeth.
Results: Lingual retainer was successfully fabricated by full digital workflow and produced from PEEK material
for clinical usage.
Conclusions: Although full digital workflow can be clinically used for production of prefabricated lingual retainer,
however further software adaptions are required for improvement of the orthodontic workflow.

Key words: PEEK, CAD/CAM, digital orthodontics, lingual retainer.

Introduction days. Indirect orthodontic bonding, lateral cephalome-

The usage of CAD/CAM technology in dentistry has tric tracing, model analysis and appliances designing are
been enrolled for more than 30 years ago (1). Studies nowadays being digitally implemented (4-7). Orthodon-
were conducted to evaluate the involvement of digital tic fixed functional appliances can be digitally designed
workflow in clinical orthodontics and research fields and produced using the digital workflow for clinical usa-
(2,3). The reduction of chair time offered by single vi- ge and consideration (6).
sit is considered one of the main advantages in digital Polyetheretherketone (PEEK) material is a by polycy-
dentistry (3). However, the expenses of software and clic, aromatic, thermoplastic polymer that is semi-crys-
hardware still limit CAD/CAM clinical usage nowa- talline and has a linear structure. Also, for dental manu-

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J Clin Exp Dent. 2021;13(6):e549-51. Prosthetic replacement of missing teeth with orthodontic retainer

facturing and incorporation it has acceptable mechanical

and electrical properties such as resistance to high tem-
perature and hydrolysis (8). The usage of digitally desig-
ned and produced fixed lingual retainer in PEEK mate-
rial has not been clinically investigated, accordingly the
feasibility of producing a retainer via CAD/CAM will
be investigated.
Fig. 3: Lingual retainer with attached lateral incisors and retentive
holes produced via CAD/CAM technology using PEEK material.
Material and methods
A digital impression using Trios 3 (3Shape, Copenha-
gen, Denmark) for an orthodontic patient with missing Massachusetts, USA) preoperatively for evaluation the
lower bilateral lateral incisors was recorded after or- digitally fabricated retainer precision (Fig. 4).
thodontic finishing (Fig. 1). The digital impression was
imported as an .stl file into Inlab software (Sirona, Pen-
nsylvania, USA) to design the lingual retainer (Fig. 2).

Fig. 4: 3D printed model for pre-evaluation of the produced retainer.

After production of the retainer, etch and bonding te-

chnique was performed using a dual cured resin mo-
dified glass ionomer cement (GC, Tokyo, Japan). The
Fig. 1: Digital impression of bracket bonded lower dental arch using
Trios 3 intraoral camera (3Shape, Copenhagen, Denmark). resin-modified glass-ionomer cement showed the lowest
enamel discolouration and higher mechanical charac-
teristics (9,10). Accordingly, in this investigation the
G-CEM capsule was used as an adhesive resin for the
designed retainer. Before adherence, the lingual surfa-
ces of lower central incisors and canines were cleaned,
polished and sandblasted with 50µm (Skysea, China) to
eliminate any adhered bacteria and biofilms. The cement
base and catalyst were mixed following the manufactu-
rer’s instructions to endure homogeneity. The 3M Espe
Elipar device (3M, Minnesota, USA) was used for light
curing with wave length LED technology in a spectrum
range of 430nm – 480nm. Light device LED was applied
on the fixed retainer for the cement curing following ma-
nufacturer’s instructions for 2-4 seconds alternatively to
Fig. 2: Digitally designed lingual retainer with missing laterals inci-
sors using Inlab software (Sirona, Pennsylvania, USA). allow self-cure followed by removing material excess
and curing each tooth for 10 more seconds (Fig. 5).

The resulted design was exported as an .stl file and sent Results
to the dental lab for milling production using a MCX5 The .stl file for the designed retainer was forwarded di-
(Dentsply Sirona, Pennsylvania, USA) from PEEK ma- gitally to the dental Lab to produce the fixed lingual re-
terial. The restored lateral incisors were not welded nor tainer with attached missing bilateral lateral incisors via
soldered to the lingual retainer but it was produced as the milling technology and using PEEK material.
one-unit appliance to eliminate possible weak points and The appliance was delivered clinically with aesthetic
enhance the design mechanical properties (Fig. 3). For satisfaction and occlusion maintenance along with retai-
controlling purposes, 3D model was printed (Formlabs, ning the orthodontic results (Fig. 6).

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J Clin Exp Dent. 2021;13(6):e549-51. Prosthetic replacement of missing teeth with orthodontic retainer

Conclusions
1. It’s possible to fabricate lingual retainer via CAD/
CAM technology.
2. Digital lingual retainers can be used for replacing mis-
sing teeth.
3. PEEK material can be used as a production material
for the orthodontic fixed retainer.

Fig. 5: Produced modified lingual retainer adhered to the lingual References

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However, the concept of replacing missing teeth with gy: A Look at Infection Prevention in Dental Settings. Biomed Res Int.
fixed orthodontic retainer was not conducted nor in- 2019;2019:6092018.
vestigated. Thus, long term studies as well as long term Source of Funding
complication rates are missing. Successful maintaining The funding source(s) had no such involvement.
of space for possible prosthetic restoration is probably
considered important to avoid possible relapse after an Conflict of interest
None.
orthodontic treatment. Accordingly, it was a main con-
cept in this investigation designing criteria.
The main drawback of this study was the appliance ad-
herence bond breakage. The lack of investigated studies
to evaluate the possible bond between PEEK and resin
modified glass ionomer cement, leads to further expe-
rimental investigations required for evaluating the bon-
ding between PEEK material and resin modified glass
ionomer cements is indicated to be able to reduce the
risk of debonding.

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