Evaluation of Compatibility of Different Attachment Types Used in Orthodontic Clear Aligners with Electron Microscopy

Abstract

Background/Objectives: The effectiveness of clear aligner therapy depends significantly on the precision of force delivery through the aligner–attachment interface. This study aimed to evaluate the microscopic compatibility between different orthodontic clear aligner materials (Duran+ and Zendura FLX) and attachment designs (rectangular and optimized) using scanning electron microscopy (SEM). Methods: Fifty-six samples were divided into four groups: rectangular attachments with Duran+ aligners (n = 14), rectangular attachments with Zendura FLX aligners (n = 14), optimized attachments with Duran+ aligners (n = 14), and optimized attachments with Zendura FLX aligners (n = 14). Attachments were bonded to bovine incisors using standardized protocols. Clear aligners were thermoformed at 220 °C for 40 s. Cross-sectional samples were analyzed using SEM at 250× magnification. Gap measurements were taken at seven points for rectangular attachments and five points for optimized attachments. Results: Gap measurements ranged from 14.75 ± 1.41 µm to 91.07 ± 3.11 µm. Zendura FLX demonstrated significantly better adaptation than Duran+ with rectangular attachments (42.10 ± 1.07 µm vs. 44.52 ± 1.51 µm, p < 0.001). Optimized attachments showed better overall adaptation than rectangular attachments. All combinations showed regional variation with the largest gaps at gingival borders (67.18–91.07 µm) and the smallest at flat buccal surfaces (14.75–20.98 µm). Conclusions: Perfect adaptation was not achieved with any material–attachment combination tested. Material selection and attachment design significantly influence microscopic adaptation, with multi-layer materials and optimized geometries showing superior performance. These findings provide mechanical explanations for clinical limitations in clear aligner therapy.