Bond strength of thermoformed and 3D-printed aligners with universal primer versus one-step aligner adhesive with and without sandblasting: An in vitro study.

Abstract

Chairside bonding of auxiliaries directly to aligners can avoid remanufacturing trays, but optimal protocols may be substrate-specific across modern thermoformed and 3D-printed materials. This study aimed to compare bond strength and failure mode across six representative aligner materials using a universal primer-orthodontic adhesive combination and a one-step aligner adhesive, with and without sandblasting. Polyethylene terephthalate glycol-modified (PETG), thermoplastic polyurethane (TPU), and glycol-modified polycyclohexylenedimethylene terephthalate (PCTG), together with three 3D-printed resins (TA-28, TC-85DAC, DCA), were prepared as 0.76-mm plates (n = 64). Specimens received alumina sandblasting or no treatment, then were bonded with either of two bonding strategies (n = 16). After thermocycling, bond strength was tested, and failures were scored by ARI. Two- and three-way ANOVA and proportional-odds modeling assessed effects (α = 0.05). Bond strength showed significant main effects of material and sandblasting, with significant material-sandblasting and material-primer interactions. The primer main effect was not significant. Post hoc tests confirmed substrate-specific rankings. PETG with Bond Aligner (non-sandblasted) reached 26.71 MPa, while DCA with universal primer (sandblasted) reached 22.36 MPa. Sandblasting generally increased bond strength, with some exceptions. Failure mode was material-dependent and not completely parallel with bond strength. Bonding efficacy depends on the aligner substrate. For thermoformed trays, a one-step aligner adhesive is preferable, with sandblasting contraindicated for PETG but advantageous for more elastic TPU and PCTG. For 3D-printed trays, a universal primer-orthodontic adhesive combination performs more consistently, with sandblasting benefiting DCA and TA-28, whereas TC-85DAC performs slightly better without it.