Enhancing biofilm resistance and preserving optical translucency of 3D printed clear aligners through carboxybetaine-copolymer surface treatment

Objectives: This study aimed to use a carboxybetaine methacrylate (CBMA) copolymer solution to surface treat 3D printed clear aligners at different fabrication stages, to impart antifouling properties, and assess the surface treatment at various fabrication stages' impact on physico-mechanical characteristics. Methods: Surface treatments using a blend of 2-hydroxyethyl methacrylate (HEMA) and CBMA, termed CCS, were performed at various stages of 3D printed clear aligner fabrication. Experimental groups, CB1, CB2, and CB3, were determined by the stage of surface treatment during post-processing. CB1, CB2, and CB3 received treatment before post-curing, after post-curing, and after post-processing, respectively. Untreated samples served as controls. Physical and mechanical properties were assessed through tensile testing, Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry (DSC), and UV-Vis spectroscopy. The surface was further characterized through scanning electron microscopy and contact angle measurements. The cytotoxicity was assessed with 7-day elution and agar diffusion assays. Lastly, bacterial biofilm resistance was evaluated using confocal laser scanning microscopy. Crystal violet assay was performed using Streptococcus mutans. Results: Surface treatment during CB1 stage exerted the most significantly unfavorable influence on properties of the 3D printed aligner resin. CB2 samples showed the maximum preservation of translucency even after 7-day aging. CB2 and CB3 phases showed enhanced hydrophilicity of sample surfaces with reduced adhesion of multispecies biofilm and S. mutans. Significance: Application of CCS surface treatment immediately after post-curing (CB2) can enhance the biofilm resistance of 3D printed clear aligners while maintaining high fidelity to optical translucency and constituent mechanical properties.