Colorimetric and spectrophotometric measurements of orthodontic thermoplastic aligners exposed to various staining sources and cleaning methods

Background Manufacturers of orthodontic aligners suggest that users remove appliances every time they consume solid foods or any drink (except water). This is to avoid a color change within the clear thermoplastic material of which they are made. However, limited quantitative evidence exists to guide users and practitioners in this regard. Herein, we evaluated the color stability of the polymer forming three different American brands of aligners and the stain-removal potential of two cleansers to provide such guidelines. Methods The removable appliances (300 specimens, 100 per brand) were exposed to different staining agents common in a regular diet (coffee, black tea, red wine, cola) or to a control solution in vitro over 12 h or 7 days. The three brands evaluated were Invisalign (R), ClearCorrect (R) and Minor Tooth Movement (R). These were then cleaned by using either Invisalign (R) cleaning crystals or the Cordless Sonic Cleaner combined with a Retainer Brite (R) tablet. The CIELAB color space approach was used to compare color changes (Delta E) in aligners before immersion (T0), after a 12-h exposure (T1), after a 7-day exposure (T2) and after cleaning (T3). Statistical methods (Levene's test, ANOVA, Brunner-Langer model, Tukey's range test and t-test) were used to identify interactions between the brands themselves or between the brands and the cleaning methods. Statistical analyses were performed at the .05 significance level. Results A 12-h or 7-day exposure to instant coffee or red wine significantly colored the Invisalign (R) aligners compared to the two other brands. Black tea created an important extrinsic color change for all three brands after 7 days. Clinically, both cleaning methods showed a better efficacy in removing stains from black tea compared to other staining agents. Conclusions The Invisalign (R) aligners were more prone to pigmentation than the ClearCorrect (R) or the Minor Tooth Movement (R) devices after an exposure to coffee or red wine. Black tea caused important stains on the surface of the three tested brands. Both cleansing methods performed similarly.