sustainability

Article
Sustainability in Healthcare Sector: The Dental Aligners Case
Chiara Caelli 1, * , Francesco Tamburrino 2, * , Carlo Brondi 1 , Armando Viviano Razionale 2 ,
Andrea Ballarino1 and Sandro Barone 2

1 CNR STIIMA—Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing,
National Research Council, Via Alfonso Corti 12, 20133 Milan, Italy; [email protected] (C.B.);
[email protected] (A.B.)
2 Department of Civil and Industrial Engineering, University of Pisa, Largo Lucio Lazzarino 1, 56122 Pisa, Italy;
[email protected] (A.V.R.); [email protected] (S.B.)
* Correspondence: [email protected] (C.C.); [email protected] (F.T.)

Abstract: Additive manufacturing is a technology gaining ground in fields where a high degree
of product customization is required; in particular, several aspects need to be explored concerning
traditional technologies, such as the variety of materials and their consumption. It also remains to be
clarified whether these technologies can contribute to the ecological transition when applied in health-
care. This study compares two technologies for producing clear dental aligners: thermoforming and
direct 3D printing. The former method thermoforms a polymeric disc over 3D-printed, customized
models. The second, more innovative approach involves directly printing aligners using Additive
Manufacturing (AM), specifically applying Digital Light Processing (DLP) technology. The study
conducts a comparative Life Cycle Assessment (LCA) analysis to assess the environmental impact
of these two different manufacturing processes. The research results highlight that adopting direct
printing through AM can bring advantages in terms of environmental sustainability, thanks to the
reduction in raw materials and electricity consumption. These drops are drivers for the decreased
potential environmental impacts across all impact categories considered within the EF 3.1 method.
Furthermore, lowering the amount of raw material needed in the direct printing process contributes
to a notable decrease in the overall volume of waste generated, emphasizing the environmental
benefits of this technique.

Citation: Caelli, C.; Tamburrino, F.; Keywords: sustainability; healthcare; additive manufacturing; life cycle assessment
Brondi, C.; Razionale, A.V.; Ballarino,
A.; Barone, S. Sustainability in
Healthcare Sector: The Dental
Aligners Case. Sustainability 2023, 15,
1. Introduction
16757. https://doi.org/10.3390/
su152416757 Additive manufacturing is a processing technology that responds to high customiza-
tion needs [1]. At the same time, its application can imply critical issues related to envi-
Academic Editor: Barbara Motyl
ronmental aspects, such as the consumption of ad hoc materials and energy use; therefore,
Received: 26 October 2023 additive technology should be coupled with preliminary environmental assessment [2,3].
Revised: 28 November 2023 In such a perspective, there are specific sectors in which additive manufacturing could be
Accepted: 6 December 2023 profitable both in terms of functional performance and environmental efficiency: in fact,
Published: 12 December 2023 strong needs for customization characterize these sectors. A possible application for the
healthcare sector is then presented.
Since the 20th century, the growing awareness of malocclusion and its related conse-
quences have led to various orthodontic approaches for repositioning teeth. Adolescent
Copyright: © 2023 by the authors.
and adult patients who are aware of their malocclusion traits and are not satisfied with
Licensee MDPI, Basel, Switzerland.
their dental appearance tend to suffer from psychosocial concerns. However, the treatment
This article is an open access article
of malocclusion has historically been related to invasive appliances that severely affect the
distributed under the terms and
conditions of the Creative Commons
wearer’s daily life. This aspect has improved with the introduction of clear and removable
Attribution (CC BY) license (https://
aligners [4]. The standard manufacturing process of the aligners and the practice of compa-
creativecommons.org/licenses/by/ nies producing an excess of orthodontic aligners are at odds with environmental concerns.
4.0/).

Sustainability 2023, 15, 16757. https://doi.org/10.3390/su152416757 https://www.mdpi.com/journal/sustainability

Sustainability 2023, 15, 16757 2 of 14

There is a growing demand from orthodontists to minimize the environmental impact of

aligner production [5].
The present study aims to quantitatively analyze and compare two technologies for
producing clear aligners from a sustainability standpoint. This comparison is possible
through Life Cycle Assessment (LCA), a methodology regulated by ISO 14040:2006 [6]
and ISO 14044:2006 [7]. LCA enables a quantitative assessment of the potential environ-
mental impact associated with product manufacturing. The two analyzed technologies
were thermoforming in-mould aligners and direct 3D printing. In particular, the Digital
Light Processing (DLP) photopolymerization has been chosen among all AM technologies,
with the primary data available. The innovative aspect of this study is the quantitative
assessment of the life cycle impact for each of the two technologies analyzed and the
following comparison regarding the same functional unit.
This study consists of four sections: Introduction, Materials and Methods, Results,
and Conclusions and Future research. The former summarizes the state of the art and the
evolution of technologies used in orthodontics. The second, aligned with reference stan-
dards, defines the goal and scope of the study and describes the necessary data inventory,
focusing on materials, logistics, and energy. In the third section, the results and critical
issues of the study are presented and discussed, and in the last paragraph, the study’s
conclusions are drawn.

State of the Art

Historically, in the early 1900s, malocclusion was treated by positioning metal rings
cemented to teeth to support wires for applying moving forces. This approach caused
many dental caries: it was almost impossible to maintain correct dental hygiene because
of the limited offering of tools in the market, the mechanical encumbrance of the rings,
and subsequent dental plaque formation [8]. The 1960s saw the introduction of stainless
steel brackets to support wires, while in the 1970s, transparent or translucent non-metallic
brackets were used.
In 1997, a significant development occurred in orthodontics with the introduction of
the first aligners designed for orthodontic treatment. This innovation was driven by patient
demand for more comfortable and less intrusive methods to improve dental alignment.
Unlike traditional braces, aligners are aesthetically pleasing and do not cause discomfort to
the lips. Additionally, their transparent appearance and the ability to remove them while
eating and maintaining oral hygiene are additional benefits [8,9]. However, clear aligner
therapy involves altering the teeth’s position, angulation, and rotation, thereby enhancing
all parameters necessary for proper and healthy occlusion and articulation. While it may
address mild non-extraction cases more quickly and efficiently, it does demand more time
compared to fixed appliance treatment for patients with more complex issues [4,9]. It is
important to emphasise that it makes sense to compare different technologies for produc-
ing aligners capable of acting on the same problems and not between other orthodontic
treatment techniques.
In the past decade, the most widespread technology for producing clear aligners
was the manufacture of dental models that express the desired tooth movement. The
traditional process involves five steps: acquiring the original dental anatomy, developing
the teeth movement model, 3D printing of models, thermoforming, and the cutting of the
aligners [10,11]. The thermoforming equipment is shown in Figure 1.
Three-dimensional printing, also called additive manufacturing, is a set of technologies
based on adding materials, usually layer upon layer, through different techniques (material
extrusion, material jetting, powder bed fusion, vat photo-polymerization, etc.), and this
production process might be impractical for large-scale production. Still, it can be especially
applicable for all those applications requiring a high level of individual customization, such
as dental aligners [10–12]. Recent techniques have enabled clinicians to print the aligners
directly, eliminating model production and thermoforming steps. The direct additive
manufacturing technique increases efficiency and reduces waste, eliminating inaccuracies
Sustainability 2023, 15, 16757 3 of 14

associated with the 3D printing of models and thermoforming processes. Moreover, several
advantages over conventional fabrication are present: digitally designed borders, smooth
edges, no need for undercuts, higher precision without errors introduced by model mould-
ing and thermoforming, and customizable intra-aligner thickness. However, in the current
context, there is a low diffusion of this methodology of manufacturing aligners, mainly
related to some limitations of the technologies and materials involved [8,10,11]. This study
involves a sustainability-oriented comparison of these two technologies for producing clear
aligners. It could catalyze aligner companies to invest in research and development in the
additive manufacturing approach.

Figure 1. Thermoforming equipment.

2. Materials and Methods

The direct 3D printing of aligners is a technology with many plus points, but being less
established as a process, it has some limiting factors. The choice of material to be used is one
of them. Indeed, the material should be biocompatible and transparent, with low stiffness
and good elasticity, resilient and resistant to its use in human saliva [4]. Moreover, these
materials have to be selected among the classified as Class IIa long-term biocompatible
resins and conform to the essential requirements and provisions of the Council Directive
93/42/EEC and Medical Device Directive 2007/47/EC [13].
The biocompatibility of aligners is one of the most discussed issues because patient
safety has to be assured. When dealing with additive manufacturing of photosensitive
resins (e.g., through technologies like Material Jetting and VAT photopolymerization), the
toxicity of 3D printed materials decreases as they undergo post-polymerization. Therefore,
post-curing is essential to eliminate the toxicity levels, removing uncured resin and making
the printed material safer for intraoral usage [14]. The recommended protocol suggests UV
curing and subsequent washing; these steps guarantee increased mechanical properties
and reduced cytotoxicity [15]. With traditional technology, different polymers are used to
produce the 3D-printed model and the thermoforming of aligners. The material used for the
model comprises acrylic monomers and oligomers, and the supports are made of a mixture
of acrylic oligomers, glycols and glycerine. Differently, PETG copolyester is the chosen
material for thermoforming the aligners. Additive manufactured aligners can reduce the
variety of materials used as it is no longer necessary to have a model on which the plastic
disc is thermoformed. Various additive manufacturing technologies might be used to print
clear aligners directly: fused deposition modelling, selective laser sintering, selective laser
melting, direct pellets fused deposition, stereolithography, multi-jet photo-cured polymer
process, or continuous liquid interface production technology [11,16].
However, VAT photopolymerization (VPP) is currently the most appropriate choice
among AM technologies due to its exceptional resolution and accuracy. Additionally, its
ability to achieve high transparency in 3D printed components makes it a viable option and
is, in part, already used in orthodontics. Moreover, in the case of Digital Light Processing
(DLP) technology, the material used for the support is the same as the one used for the
aligners. This could contribute to the goal of reducing material variety. DLP is part of the
VAT photopolymerization family, in which a liquid photopolymer is put in a resin tank
Sustainability 2023, 15, 16757 4 of 14

and is selectively cured by light-activated polymerization to create a solid polymer. In

particular, in DLP-based approaches, light exposure is carried out by projecting a single
digital image (mask), polymerizing every single layer simultaneously, reducing the printing
time compared to other technologies [8,11].
This study consists of a comparative life cycle analysis between two processes for
producing dental aligners, one more familiar and one innovative. The software OpenLCA
v1.11.0 and the database Ecoinvent v3.9.1 were used to perform the numerical calculations.
An attributional approach was adopted for the study, with the choice of database processes
built according to the allocation cut-off method.

2.1. Goal and Scope Definition

In the International Standard ISO 14040 [6] are indicated the mandatory information
that should be declared: the goal and the scope of the study, the functional unit and
the target audience. The purpose of this study is to quantify the environmental burdens
associated with the manufacturing of dental aligners to allow a comparison of the potential
impacts related to the two production technologies. The chosen functional unit is 40
dental aligners, which constitute an average complete set needed for treatment, with their
packaging. Each pair of aligners is used for two to three weeks and, after this time, replaced
with the next one for continued treatment. The analyzed system includes the production of
precursors from raw materials, logistics, and the aligners’ manufacturing: this is a cradle-
to-gate study. Since primary data on the use and disposal of aligners are unavailable, it is
impossible to include the use and disposal steps. In the production processes, many steps
are considered, from the cast production to the finishing and packaging, and the difference
between the materials used is considerable. In fact, the polymer used for thermoforming
can not be used for direct 3D printing of the aligner. The system boundaries are reported
in Figures 2 and 3 for the thermoforming and the additive manufacturing techniques,
respectively.
The target audience of this study consists of healthcare professionals, especially den-
tists and orthodontists, researchers, LCA practitioners, and additive manufacturing op-
erators. In almost all cases, primary data, measured directly in the field, were used for
all technologies analyzed. Support was received from AirNivol Srl, an Italian company
specializing in designing and producing dental aligners, which provided a substantial
portion of its primary production data. However, some modelling was necessary for the
polymers present in the process and was carried out starting from the scientific literature
and the procedures already available in the Ecoinvent database.

2.2. Inventory Characterization

As a cradle-to-gate analysis, the starting point involves extracting raw materials and
producing precursors and materials used in manufacturing. This phase is similar for all
three technologies, differing only in the materials used. The data used are primary in
quantities, but processes already present in the database were used for modelling. Since
no chemicals were available, ad hoc processes were created in some cases, exploiting the
technical information in the literature, such as the most widespread synthesis method, and
the process flows already present within Ecoinvent. The table with all the chosen database
files is reported in Appendix A.
The first steps of manufacturing are the production of the plaster cast and its scanning;
these are not always performed in the system considered because, in about 80% of cases,
a digital scan is provided by the dentist, and therefore, it is not necessary to produce the
cast starting from the impression. Thus, a mass allocation was performed in the modelling:
only 20% of the material and energy consumption related to these two steps was counted.
From this point forward, thermoforming and 3D printing technology modelling differ
significantly and will be described individually in the following subsections.
Sustainability 2023, 15, 16757 5 of 14

Figure 2. System boundary of the process which uses the thermoforming technology.

Figure 3. System boundary of the process using additive manufacturing technology.

2.2.1. Thermoforming
Once the scan of the patient’s dental arches has been obtained, technicians proceed to
the models’ design on which plastic discs will be thermoformed. The following steps are
preparing the printer, cleaning its plate and nesting, and 3D printing the models required
for the entire treatment with PolyJet technology. This technology belongs to the Material
Jetting additive manufacturing method. It uses multiple print heads to deposit ultra-thin
layers of liquid material onto a build platform, which are cured instantly with UV light. It is
renowned for producing high-resolution, multi-material, and full-color 3D-printed objects.
Sustainability 2023, 15, 16757 6 of 14

Two different polymeric materials are needed to print the models: one for the models and
one for the supports. A fraction of these materials are considered to be discarded during
the purging process of the 3D printer. After printing, the supports are removed by washing
with high-pressure water jets. The resulting wastewater, contaminated with the printing
material, is then sent to the water treatment plant. Following the cleaning of the models,
thermoforming is performed: a disc of thermoplastic material, specifically a polyethylene
terephthalate glycol (PETG) copolymer, is heated and moulded over the model to obtain
the dental aligner. The result of the thermoforming application is shown in Figure 4.

Figure 4. Results of the thermoforming process: aligner thermoformed on the printed model.

The following stages are laser marking, the cutting of aligners, where excess material
is removed with a milling machine, and packing. The packaging includes plastic bags
in which the aligners are inserted in pairs, a rigid plastic case, a cardboard box, and the
information material.

2.2.2. Additive Manufacturing

The exact starting point is assumed to be the same as the thermoforming procedure
for direct printing. With the scan of the patient’s dental arches, the design of the aligners
can begin. Then, after computer modelling, the printer can be prepared and nested, and
the aligners’ direct printing can occur. The primary distinction between this technology
and thermoforming lies in the absence of printed models. In this case, the aligners are
printed directly, reducing waste and material usage and eliminating inaccuracies associated
with both the 3D printing of models and the thermoforming process. The printing result
is shown in Figure 5. The DLP is part of the VPP family and consists of selective curing
of a liquid photopolymer: the light exposure is performed by projecting a single mask to
polymerize every single layer simultaneously [8,11].
The composition of the material used for the direct printing of aligners is described
by [17] as an aliphatic vinyl ester-urethane polymer, possibly cross-linked with methacry-
late functionalization.
After printing, the supports necessary for this step are removed manually, followed
by a 30 min water wash, to eliminate residuals of resin that were not polymerized and part
of the remaining supports. Then, UV post-curing is essential in producing dental aligners
because it guarantees increased mechanical properties and reduced cytotoxicity of the
materials used. In the present study, a UV post-curing duration of 30 min was considered.
After laser marking, the dental aligners are packed using plastic bags, in which the pairs of
aligners are inserted; the rigid plastic case and the information material are added to the
cardboard box of the user package.
Sustainability 2023, 15, 16757 7 of 14

Figure 5. Result of direct printing DLP technology: the clear aligner with supports.

2.2.3. Materials
The modelling of the polymeric materials, used both for the production of the model,
in the case of thermoforming, and for the production of the aligners, was carried out from
the existing sheets in the Ecoinvent database. As the materials used were not available
in the database, the precise composition of which was obtained from the safety material
data sheets, modelling of the most common synthesis routes was used, taking information
from the literature regarding the operating conditions and energy required for production.
Following this method, an attempt was made to remain as faithful as possible to the
materials used, avoiding generic data sheets. In the case of plastic packaging materials,
such as bags and rigid cases for aligners, the approach involved consulting the data sheets
from the specific plastic material database. Additionally, the manufacturing processes,
bag extrusion and injection moulding for rigid cases were integrated into the analysis to
provide a comprehensive understanding.

2.2.4. Energy and Logistics

Concerning modelling the electricity used, the only energy source in the system bound-
ary considered is the Italian residual mix (“electricity, low voltage, residual mix|electricity,
low voltage|Cutoff, U (IT)”), as it is taken from the national grid because there are no cer-
tificates on the energy purchased. The system boundary chosen also includes the transport
phase of all the raw materials to the manufacturing step. For most materials, data sheets
have been selected from the market-type database, mainly at a European level, which
is already considered an average transport, as more detailed information is unavailable.
Instead, as regards the transport of the packaging, for which the distances are known,
expressed in km, but not the specific means of transportation, the data sheet “market for
transport, freight, lorry, unspecified |transport, freight, lorry, unspecified|Cutoff, U (RER)”
was chosen.

3. Results
In this section, the life cycle assessment results are presented. They include an exami-
nation of the primary drivers for each technology discussed and a comparative analysis
between thermoforming and the considered additive manufacturing application. Moreover,
the hypotheses and the sensitivity analysis results will be discussed. The method chosen
to assess potential environmental impacts is EF 3.1, which provides results on 25 impact
categories. The results are presented for the main categories, and there will be a partic-
ular focus on four of them; even in the field of additive manufacturing, different impact
assessment methods and different categories are used, and by following what is reported
Sustainability 2023, 15, 16757 8 of 14

in the literature, it was chosen to delve deeper into these categories: climate change, energy
resources, acidification, and eutrophication [18,19].

3.1. Comparative Analysis

According to ISO 14044 [7], in a comparative study, the systems are evaluated with
the same functional unit and equivalent methodological considerations, such as perfor-
mance, system boundary, and data quality. The chosen functional unit is a complete set
of 40 aligners capable of performing orthodontic treatment on several cycles. This study
is cradle-to-gate, i.e., it starts with the extraction of raw materials, their processing to
obtain intermediate products, the actual production of the aligners by thermoforming or
direct printing, and their packaging. Thus, the chosen functional unit is the same for both
technologies, and the system boundaries are perfectly comparable.
The results of this comparative study, referring to a functional unit, are shown in
Figure 6 in terms of potential environmental impacts for the main impact categories of
the EF 3.1 method. The numerical values on which the plots are based are reported in
Appendix B. When analyzing the overall results over the whole system, it can be observed
that thermoforming has a higher potential impact for all impact categories considered
concerning direct 3D printing. The smallest gap occurs in the “Land use” category with a
31% change, and the more significant gap occurs in the “Ozone depletion” category with
a 98% reduction in impact. An in-depth analysis focused on the main vectors between
the categories of materials, wastes, energy, transport, and packaging was carried out to
investigate the reasons that led to such clear-cut results in more detail.
As mentioned above, the impact categories selected are Acidification, Climate change,
Energy resources and Eutrophication, freshwater, marine and terrestrial, and the detailed
results are shown in Figures 7 and 8.
Analyzing in detail the comparison of the impacts represented in Figures 7 and 8, it is
observable that for thermoforming, the main impact is given for almost all impact categories
by the raw materials used. Another significant portion of the impact is provided by energy
and waste, depending on the category considered. It is also worth noting that there is a
significant decrease in the impacts of direct printing using DLP technology, attributable
to the material, energy, and waste contributions. Conversely, since the packaging is the
same for the two technologies, there is an impact with the same absolute value but a much
greater relative value in the case of 3D printing.

3.2. Interpretation and Discussion

The consistent reduction in environmental impact, for all impact categories considered,
for additive technology compared to thermoforming is substantially due to the decrease
in the quantity of material and energy used, depicted in Figure 9. In fact, by using direct
printing technology, there is no longer the consumption of material and electricity linked to
printing the model; therefore, waste material and water use will also be lower. Furthermore,
the significant difference in the quantity of water used is due to the washing of the soluble
supports after printing the models in the case of thermoforming, using special equipment;
on the contrary, for direct printing, only a small amount of water is needed to remove the
residuals of resin that were not polymerized.

3.3. Limitations of the Study

The study’s main limitation is linked to the materials used for producing the models,
thermoforming and direct printing. The material safety data sheets, when available, report
only the families to which the mixture’s components belong and not the specific compound.
Within the particular case of the material used for direct printing, not even the safety data
sheet is available as it has a patented composition; therefore, the modelling of such material
is based on information available in the literature. Furthermore, only limited chemical
compounds are available in the Ecoinvent database, and a simulation of a realistic synthesis
route and its operating conditions is necessary.
Sustainability 2023, 15, 16757 9 of 14

Figure 6. Results of the comparative LCA calculation performed with EF 3.1 impact method.

Figure 7. Impacts per FU for acidification, climate change and energy resources impact categories.
Sustainability 2023, 15, 16757 10 of 14

Figure 8. Impacts per FU for the eutrophication impact category.

Figure 9. Percentage reduction in energy and material consumption between technologies.

4. Conclusions and Future Research

In this comparative LCA study, the environmental impacts associated with two pro-
duction processes of dental aligners have been evaluated: thermoforming and direct 3D
printing through Digital Light Processing (DLP). This analysis aimed to provide insights
into the sustainability of these processes considering a cradle-to-gate perspective, encom-
passing all life cycle stages, from raw material extraction to aligner fabrication. The new
methodology demonstrates a substantial reduction in environmental impacts by decreasing
the amount of material used. It is necessary to contextualise the results, mentioning that
this technology was analyzed for the specific application of dental aligners and, therefore,
the application of environmental effectiveness in the biomedical field should be extended
to other possible areas of application, comparing it with different technologies and for
long-lasting items.
Sustainability 2023, 15, 16757 11 of 14

It should also be mentioned that the study refers to an exploratory application in the
biomedical field. The large-scale dissemination and actual environmental impact should
also include market factors related to costs and raw material availability. Only qualitative
considerations can be made from a cost perspective regarding the two presented methods.
From a live production cost standpoint, direct printing of aligners may be less competitive
than thermoforming. This difference is primarily due to a significant impact on the final
cost of the printing material, given the low availability of compatible materials, certified
for dental use, and possessing the appropriate mechanical properties. However, it is
essential to highlight that direct printing avoids the fixed costs associated with producing
models for thermoforming and their disposal. In a future perspective, where the number of
available materials could increase, prices would likely be reduced. An extended assessment
that considers environmental and economic aspects could explore future perspectives for
making informed decisions in the dental aligner production industry, aligning with the
broader goals of sustainability and responsible manufacturing practices. A final aspect
concerns the improvability of the presented model, which should include an update of the
existing databases and a greater disclosure of the material composition, overcoming patent
barriers.
In conclusion, the results of this study suggest that the direct printing of dental aligners
has a lower environmental impact than thermoforming. This advantage is primarily
attributed to the efficient use of materials, reduced energy consumption, and minimized
waste generation associated with DLP.

Author Contributions: Conceptualization, F.T. and C.B.; Methodology, C.C. and C.B.; Investigation,
C.C., F.T. and A.V.R.; Software, C.C.; Formal analysis, C.C.; Data curation, F.T. and A.V.R.; Visualiza-
tion, C.C.; Writing—original draft, C.C., F.T. and C.B.; Writing— review & editing, C.C., F.T., C.B. and
A.V.R.; Supervision, A.B. and S.B.; Project administration, A.B. and S.B. All authors have read and
agreed to the published version of the manuscript.
Funding: This research received no external funding.
Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Conflicts of Interest: The authors declare no conflict of interest.

Appendix A
The table that includes all of the references for the Ecoinvent 3.9.1 database sheets
used to represent the two distinct production processes can be found below.

Table A1. Sheets selected from the Ecoinvent 3.9.1 database.

Tech Process Step Item Provider

THF Cast production Cast material market for gypsum, mineral | gypsum, mineral | Cutoff, U (RER)

THF Cast production Cast material market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

THF Cast production Water market for tap water | tap water | Cutoff, U (Europe without Switzerland)

THF Cast production Cast market for waste gypsum | waste gypsum | Cutoff, U (Europe without Switzerland)

THF Scanning Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF Design of models Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF Printing plate preparation and nesting Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF AM printing Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF AM printing Model material Model material

THF AM printing Model material market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

THF AM printing Support material Support material

THF AM printing Support material market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)
Sustainability 2023, 15, 16757 12 of 14

Table A1. Cont.

Tech Process Step Item Provider

THF AM printing Purges market for hazardous waste, for incineration | hazardous waste, for incineration | Cutoff, U (Europe without Switzerland)

THF Supports removal Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF Supports removal Water market for tap water | tap water | Cutoff, U (Europe without Switzerland)

THF Supports removal Wastewater market for wastewater, average | wastewater, average | Cutoff, U (Europe without Switzerland)

THF Thermoforming Aligners material PETG

THF Thermoforming Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF Laser marking Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF Finishing Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

THF Finishing Material waste market for waste plastic, mixture | waste plastic, mixture | Cutoff, U (IT)

THF Packaging Plastic bags LDPE bag

THF Packaging Cardboard box folding boxboard carton production | folding boxboard carton | Cutoff, U (RER)

THF Packaging Info book paper production, woodcontaining, supercalendered | paper, woodcontaining, supercalendered | Cutoff, U (RER)

THF Packaging Byte case PP case

THF Packaging Plastic bags market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

THF Packaging Cardboard box market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

THF Packaging Info book market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

THF Packaging Byte case market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

AM DLP Cast production Cast material market for gypsum, mineral | gypsum, mineral | Cutoff, U (RER)

AM DLP Cast production Cast material market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

AM DLP Cast production Water market for tap water | tap water | Cutoff, U (Europe without Switzerland)

AM DLP Cast production Cast waste market for waste gypsum | waste gypsum | Cutoff, U (Europe without Switzerland)

AM DLP Scanning Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

AM DLP Design of aligners Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

AM DLP Printing plate preparation and nesting Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

AM DLP AM printing Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

AM DLP AM printing Aligner material Aligner AM DLP

AM DLP AM printing Aligner material market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

AM DLP AM printing Material waste market for waste plastic, mixture | waste plastic, mixture | Cutoff, U (IT)

AM DLP AM printing Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

AM DLP Supports removal Water market for tap water | tap water | Cutoff, U (Europe without Switzerland)

AM DLP Supports removal Wastewater market for wastewater, average | wastewater, average | Cutoff, U (Europe without Switzerland)

AM DLP UV post-curing Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

AM DLP Laser marking Electric energy electricity, low voltage, residual mix | electricity, low voltage | Cutoff, U (IT)

AM DLP Packaging Plastic bags LDPE bag

AM DLP Packaging Cardboard box folding boxboard carton production | folding boxboard carton | Cutoff, U (RER)

AM DLP Packaging Info book paper production, woodcontaining, supercalendered | paper, woodcontaining, supercalendered | Cutoff, U (RER)

AM DLP Packaging Byte case PP case

AM DLP Packaging Plastic bags market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

AM DLP Packaging Cardboard box market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

AM DLP Packaging Info book market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

AM DLP Packaging Byte case market for transport, freight, lorry, unspecified |transport, freight, lorry, unspecified | Cutoff, U (RER)

Appendix B
The comparative Life Cycle Assessment study’s numerical results, including all of the
impact categories typical of the EF 3.1 method, are shown in the table below.

Table A2. Numerical results of the comparative analysis reported by impact category.

Impact Category THF AM DLP

acidification 4.077 × 10−2 1.119 × 10−2
climate change (GWP100) 1.251 × 101 3.120 × 100
climate change: biogenic 4.602 × 10−2 1.537 × 10−2
climate change: fossil 1.245 × 101 3.099 × 100
Sustainability 2023, 15, 16757 13 of 14

Table A2. Cont.

Impact Category THF AM DLP

climate change: land use and land use change 9.599 × 10−3 5.742 × 10−3
ecotoxicity: freshwater 1.309 × 102 2.228 × 101
ecotoxicity: freshwater, inorganics 9.837 × 101 1.264 × 101
ecotoxicity: freshwater, organics 3.257 × 101 9.637 × 100
energy resources: non-renewable 1.889 × 102 5.215 × 101
eutrophication: freshwater 3.160 × 10−3 7.543 × 10−4
eutrophication: marine 1.257 × 10−2 2.500 × 10−3
eutrophication: terrestrial 8.218 × 10−2 2.023 × 10−2
human toxicity: carcinogenic 6.141 × 10−9 1.827 × 10−9
human toxicity: carcinogenic, inorganics 3.350 × 10−9 6.145 × 1010
human toxicity: carcinogenic, organics 2.791 × 10−9 1.212 × 10−9
human toxicity: non-carcinogenic 1.462 × 10−7 3.158 × 10−8
human toxicity: non-carcinogenic, inorganics 1.359 × 10−7 2.975 × 10−8
human toxicity: non-carcinogenic, organics 1.030 × 10−8 1.830 × 10−9
ionising radiation: human health 9.190 × 10−1 3.155 × 10−1
land use 7.305 × 101 5.065 × 101
abiotic depletion potential (ADP) 8.306 × 10−5 1.889 × 10−5
ozone depletion (ODP) 3.798 × 10−6 9.062 × 10−8
particulate matter formation 4.518 × 10−7 1.662 × 10−7
photochemical oxidant formation 3.041 × 10−2 8.898 × 10−3
water use 4.322 × 100 1.041 × 100

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