CO2 laser conditioning of porcelain surfaces for bonding metal orthodontic brackets

The Effect of Various Lasers on the Bond Strength Between Orthodontic Brackets and Dental Ceramics: A Systematic Review and Meta-Analysis

Background/objective: This systematic review and meta-analysis aimed to assess how laser conditioning affected brackets bonded to dental ceramics' shear bond strength (SBS). Materials and methods: The study was conducted by searching Pubmed/Medline, Scopus, Embase, Web of Science, the Cochrane Library, and Google Scholar up to September 14, 2022. In addition, the reference lists of the relevant articles were checked manually. Articles that compared SBS of laser-treated feldspathic, lithium disilicate, or zirconia surfaces with other standard techniques for bonding metal or ceramic orthodontic brackets were considered. Using a random-effects model, data pooling was carried out as the weighted mean difference (WMD). Results: This study initially contained 1717 reports, and following review, 32 articles were deemed suitable for our meta-analysis. The pooling results showed that the treatments with lasers such as "Er:YAG" [WMD = -1.12 MPa; 95% confidence interval (CI): -1.93 to -0.31], "Er:YAG + Silane" (WMD = -3.08 MPa; 95% CI: -4.77 to -1.40), and "Nd: YAG + Silane" (WMD = -2.58 MPa; 95% CI: -3.76 to -1.40) had statistically significant lower adhesion values compared with controls. Contrarily, "Ti:Sapphire femtosecond" demonstrated significantly higher bonding values (WMD = 0.94 MPa; 95% CI: 0.29-1.60). In contrast, other interventions obtained no statistically significant difference in SBS. Conclusions: Most of the laser groups showed results comparable with those of conventional approaches. Although more research is necessary for definitive conclusions, laser treatment may be an effective option for treating the surfaces of ceramic materials.

In vitro comparative study between adhesion forces obtained on zirconia ceramic micromechanically treated with femtosecond laser (1027 nm), carbon dioxide laser (10,600 nm), and aluminum-oxide particles

Conventional surface roughening treatments used for silica-based ceramics in order to improve subsequent adhesion become unreliable for zirconia ceramics. Laser conditioning can be a good alternative. The purpose of this in vitro study was to compare conventional (macro) shear bond strength (SBS) values obtained between resin composite and zirconium oxide ceramic samples grouped according to different micromechanical treatments received, and examine differences in surface roughness. One-hundred and fifty disks of sintered zirconia were randomly divided into 5 groups and roughened as follows: (1) Group NOT, no surface treatment; (2) Group APA, abraded with 50-μm aluminum-oxide (Al2O3) particles; (3) Group TBS, abraded with 30-μm aluminum-oxide particles covered with silica; (4) Group CO2, irradiated with a CO2 laser which emitted in continuous wave mode at 3 W of power; and (5) Group FEM, irradiated with a pulsed femtosecond laser, with an incident energy of 10 μJ, a frequency of 1000 Hz, and a fluence of 1.3 kJ/cm2. All surfaces were treated with a MDP-containing adhesive/silane coupling agent mixture upon which were prepared and light polymerized composite resin cylinders. Shear bond strength was measured and samples were observed by scanning electron microscopy (SEM). Statistically significant differences (p < 0.05) were found among all groups, except between CO2 and FEM, which showed the highest adhesion values (15.12 ± 2.35 MPa and 16.03 ± 2.73 MPa). SEM revealed differences in surface patterns. CO2 laser irradiation can be an alternative to sandblasting, although it could also weaken the ceramic. Suitable surface patterns on zirconia ceramics can be obtained with ultrashort pulsed radiation emitted by a pulsed femtosecond laser.

LASER as a tool for surface modification of dental biomaterials: A review

In recent years, the application of lasers for modifying the surface topography of dental biomaterials has received increased attention. This review paper aims to provide an overview of the current status on the utilization of lasers as a potential tool for surface modification of dental biomaterials such as implants, ceramics, and other materials used for restorative purposes. A literature search was done for articles related to the use of lasers for surface modification of dental biomaterials in English language published between October 2000 and March 2023 in Scopus, Pubmed and web of science, and relevant articles were reviewed. Lasers have been mainly used for surface modification of implant materials (71%), especially titanium and its alloys, to promote osseointegration. In recent years, laser texturing has also emerged as a promising technique to reduce bacterial adhesion on titanium implant surfaces. Currently, lasers are being widely used for surface modifications to improve osseointegration and reduce peri-implant inflammation of ceramic implants and to enhance the retention of ceramic restorations to the tooth. The studies considered in this review seem to suggest laser texturing to be more proficient than the conventional methods of surface modification. Lasers can alter the surface characteristics of dental biomaterials by creating innovative surface patterns without significantly affecting their bulk properties. With advances in laser technology and availability of newer wavelengths and modes, laser as a tool for surface modification of dental biomaterials is a promising field, with excellent potential for future research.

Debonding of LDSVs utilising Er,Cr:YSGG laser irradiation with fractional technique: an in vitro study

BACKGROUND

The removal of porcelain laminate veneers with rotary instruments could be accompanied by microfractures because differentiation of the veneer from the dental structure and resin cement is not a highly selective procedure. This can lead to scratches and overheating of the enamel and patient discomfort. Therefore, this in vitro research aimed to examine the effectiveness of the 2790 nm Er,Cr:YSGG laser utilizing a fractional technique to debond lithium disilicate veneer.

METHODS

Six groups of 30 extracted permanent bovine mandibular incisors were selected. Twenty-five samples, G1-5, (n = 5) laser-irradiated groups, and the last five samples (C) were considered the control group. The tested groups were irradiated with 3-5 W output power of Er,Cr:YSGG laser for time intervals of 50 s. During irradiation, the temperature in the pulp chamber was monitored using a thermocouple connected to a digital multilogger thermometer inside the sample's pulp chamber. Subsequently, the shear bond strength was measured for all groups. Furthermore, the remaining adhesive index was measured using a stereomicroscope, the area was analysed, and then transformed into scores. Finally, one untreated sample and two samples of the highest power value from laser-treated groups were examined using a scanning electron microscope (SEM) for their surface morphology.

RESULTS

All debonding protocols were safe regarding intrapulpal temperature increment. The highest temperature elevation was recorded at 5 W, which increased by 1.7 °C. Considering the shear bond strength measurement, there was a significant reduction after laser irradiation for G1-5 compared with group C.

CONCLUSIONS

Er,Cr:YSGG laser with a fractional technique can be used successfully for veneer removal. Besides safe temperature rising, veneers can be reused because there was neither a fractured specimen during the whole study nor major irregularities or cracks shown in SEM pictures analysis for the veneer surfaces; thus, they can be removed quickly, safely, and comfortably using Er,Cr:YSGG. © 2023 Australian Dental Association.

Shear bond strength of orthodontic molar tubes to composite restoration bonded with particular adhesives after different surface pre-treatments

OBJECTIVE

To evaluate in vitro the shear bond strength of orthodontic molar tubes to composite restoration bonded with particular adhesives after different surface pre-treatments.

SETTING AND SAMPLE POPULATION

The sample population is 60 extracted molars.

MATERIALS AND METHODS

After the teeth were thermocycled, they were randomly divided into six groups according to the adhesive and various surface pre-treatments that had been applied. The surface pre-treatments included sandblasting with 50-μm aluminium oxide particles and roughening with diamond bur and 37% phosphoric acid. Transbond XT Adhesive Primer (3M Unitek) (TXT) and Assure Plus (Reliance Orthodontic Products) adhesives were used in the study. Following the application of the adhesives, the brackets were bonded to the surfaces of the teeth. Shear bond strength was measured using a universal testing machine. Data were analysed with one-way ANOVA and LSD tests (P = .05). The adhesive remnant index (ARI) was determined using a stereomicroscope. Data from the ARI scores were submitted to Pearson's chi-squared test (P = .05).

RESULTS

The highest shear bond strengths were obtained in the Assure Plus group 15.05 ± 3.72 MPa after sandblasting (P < .05). The lowest shear bond strengths were found in the TXT group (7.52 ± 2.89 MPa; P < .05). Sandblasting and bur pre-treatment for TXT and Assure Plus adhesives increased shear bond strength in both of them. There were no significant differences in the ARI scores between the groups (P > .05).

CONCLUSION

Sandblasting and roughening pre-treatment can increase the bond strength of teeth with composite restoration. Assure Plus is also more effective than conventional adhesive systems.

Orthodontic Bracket Removal Using LASER-Technology-A Short Systematic Literature Review of the Past 30 Years

Background: Since fixed orthodontic treatment is widely spread and one of its inconveniences is bracket removal, as this affects enamel integrity as well as being a cause of discomfort to the patient, studies have searched for the most adequate bracket removal technique, many of them focusing on using laser-technology. Methods: Our review focused on articles published investigating methods of orthodontic bracket removal using laser technology in the last 30 years. Results: 19 relevant studies were taken into consideration after a thorough selection. Different types of laser devices, with specific settings and various testing conditions were tested and the investigators presented their pertinent conclusions. Conclusions: Most studies were performed using ceramic brackets and the best results in terms of prevention of enamel loss, temperature stability for the tooth as well as reduced chair time were obtained with Er:YAG lasers.

What Is the Most Effective Technique for Bonding Brackets on Ceramic-A Systematic Review and Meta-Analysis

Background: There has been an increase in demand for orthodontic treatment within the adult population, who likely receive restorative treatments using ceramic structures. The current state of the art regarding the most effective method to achieve an appropriate bond strength of brackets on ceramic surfaces isn’t consensual. This systematic review aims to compare the available surface treatments to ceramics and determine the one that allows to obtain the best bond strength. Methods: This systematic review followed the PRISMA guidelines and the PICO methodology was used, with the question “What is the most effective technique for bonding brackets on ceramic crowns or veneers?”. The research was carried out in PubMed, Web of Science, Embase and Cochrane Library databases. In vitro and ex vivo studies were included. The methodological quality was evaluated using the guidelines for reporting of preclinical studies on dental materials by Faggion Jr. Results: A total of 655 articles searched in various databases were initially scrutinized. Sevety one articles were chosen for quality analysis. The risk of bias was considered medium to high in most studies. The use of hydrofluoric acid (HF), silane and laser afforded the overall best results. HF and HF plus laser achieved significantly highest bond strength scores in felsdphatic porcelain, while laser was the best treatment in lithium disilicate ceramics. Conclusions: The most effective technique for bonding brackets on ceramic is dependent on the type of ceramic.

Effects of Novel versus Conventional Porcelain Surface Treatments on Shear Bond Strength of Orthodontic Brackets: A Systematic Review and Meta-Analysis

BACKGROUND

Despite the importance of identifying proper novel porcelain preparation techniques to improve bonding of orthodontic brackets to porcelain surfaces, and despite the highly controversial results on this subject, no systematic review or meta-analysis exists in this regard.

OBJECTIVE

To comparatively summarize the effects of all the available porcelain surface treatments on the shear bond strength (SBS) and adhesive remnant index (ARI) of orthodontic brackets (metal, ceramic, polycarbonate) bonded to feldspathic porcelain restorations. Search Methods. A search was conducted for articles published between January 1990 and February 2021 in PubMed, MeSH, Scopus, Web of Science, Cochrane, Google Scholar, and reference lists. Eligibility Criteria. English-language articles comparing SBS of feldspathic porcelain's surface preparation methods for metal/ceramic/polycarbonate orthodontic brackets were included. Articles comparing silanes/bonding agents/primers without assessing roughening techniques were excluded. Data Analysis. Studies were summarized and risk of bias assessed. Each treatment's SBS was compared with the 6 and 10 MPa recommended thresholds. Studies including comparator (HF [hydrofluoric acid] + silane + bonding) were candidates for meta-analysis. ARI scores were dichotomized. Fixed- and random-effects models were used and forest plots drawn. Egger regressions and/or funnel plots were used to assess publication biases.

RESULTS

Thirty-two studies were included (140 groups of SBS, 82 groups of ARI). Bond strengths of 21 studies were meta-analyzed (64 comparisons in 14 meta-analyses). ARIs of 12 articles were meta-analyzed (28 comparisons in 8 meta-analyses). Certain protocols provided bond strengths poorer than HF + silane + bonding: "abrasion + bonding, diamond bur + bonding, HF + bonding, Nd:YAG laser (1 W) + silane + bonding, CO₂ laser (2 W/2 Hz) + silane + bonding, and phosphoric acid + silane + bonding." Abrasion + HF + silane + bonding might act almost better than HF + silane + bonding. Abrasion + silane + bonding yields controversial results, being slightly (marginally significantly) better than HF + silane + bonding. Some protocols had controversial results with their overall effects being close to HF + silane + bonding: "Cojet + silane + bonding, diamond bur + silane + bonding, Er:YAG laser (1.6 W/20 Hz) + silane + bonding." Few methods provided bond strengths similar to HF + silane + bonding without much controversy: "Nd:YAG laser (2 W) + silane + bonding" and "phosphoric acid + silane + bonding" (in ceramic brackets). ARIs were either similar to HF + silane + bonding or relatively skewed towards the "no resin on porcelain" end. The risk of bias was rather low. Limitations. All the found studies were in vitro and thus not easily translatable to clinical conditions. Many metasamples were small.

CONCLUSIONS

The preparation methods HF + silane + bonding, abrasion + HF + silane + bonding, Nd:YAG (2 W) + silane + bonding, and phosphoric acid + silane + bonding (in ceramic brackets) might provide stronger bonds.

Effect of laser irradiation on bond strength between zirconia and resin cement or veneer ceramic: A systematic review and meta-analysis

Aim:

This systematic review with meta-analysis aimed to evaluate the effect of the laser treatment on bond strength between Y-TZP and the resin cement or with the veneering ceramic, and the effect on the alteration of the Y-TZP surface roughness.

Settings and Design:

Systematic review and meta analysis following PROSPERO guidelines.

Materials and Methods:

A comprehensive review was performed up to September 2020 on four databases (PubMed/MEDLINE, Embase, Scopus, and Cochrane Library), using the combination of keywords: “laser AND zirconia AND surface treatment AND bond strength”.

Statistical Analysis Used:

The meta-analysis was based on the Mantel–Haenszel and inverse variance methods. The continuous outcome was evaluated by mean difference and the corresponding 95% confidence intervals.

Results:

A total of 37 studies were identified for the inclusion of data, with only in vitro studies. The types of laser reported in the studies were: Er:YAG, Nd:YAG, Er,Cr:YSGG, CO2, Femtosecond, and Yb lasers. A random-effect model found statistically significant differences between lasers and control groups of Y-TZP (P < 0.00001; MD: 3.08; 95% CI: 2.58 to 3.58). Only the bond strength with the Er:YAG laser did not present statistical difference (P = 0.51; MD: 0.22; 95% CI: −0.44–0.88). In another analysis, a random-effect model found a statistically significant difference between the laser and control groups on surface roughness (P < 0.00001; MD: 0.96; 95% CI: 0.86 to 1.06).

Conclusions:

Laser irradiation is capable to improve the Y-TZP surface roughness and the bond strength of zirconia with resin cement and veneering ceramics. However, there is a lack of laser protocol for the zirconia surface, a fact that makes a simple and direct comparison difficult.

Comparison of lithium disilicate-reinforced glass ceramic surface treatment with hydrofluoric acid, Nd:YAG, and CO2 lasers on shear bond strength of metal brackets

OBJECTIVES

To evaluate and compare the effects of different surface conditioning methods of lithium disilicate-reinforced ceramic on shear bond strength (SBS) of metallic brackets.

MATERIALS AND METHODS

Thirty-six lithium disilicate ceramic blocks mounted in acrylic resin blocks were assigned to 3 groups (n = 12): 9.6% hydrofluoric acid (HF); neodymium-doped yttrium aluminium garnet (Nd:YAG) laser; and carbon dioxide (CO₂) laser. The glass ceramic surfaces were primed with a silane, and the brackets were bonded using a light-cured composite resin. SBS test was carried out in a universal testing machine at 0.5 mm/min crosshead speed until the brackets were debonded. The remaining adhesive was evaluated under a stereomicroscope in terms of the adhesive remnant index (ARI). The surface hardness was determined with a 100-gr force using a microhardness tester. Glass ceramic surface changes were evaluated using the scanning electron microscope. One-way ANOVA and post hoc Tamhane tests were used to compare microhardness values, and Kruskal-Wallis and Mann-Whitney U tests were used to analyze SBS values and ARI.

RESULTS

The median and interquartile range of SBS values in 3 groups were 6.48 (1.56-15.18), 1.26 (0.83-1.67), and 0.99 MPa (0.70-2.10), respectively. Microhardness analysis revealed significant differences between the CO₂ laser and intact porcelain groups (P = 0.003), without significant differences between the other groups. Group 1 exhibited the highest ARI.

CONCLUSION

Neither CO₂ nor Nd:YAG lasers resulted in adequate surface changes for bonding of brackets on ceramics compared with the samples conditioned with HF. CO₂ laser decreased the microhardness of ceramics.

CLINICAL RELEVANCE

Surface conditioning with HF resulted in clinically acceptable SBS values.

Effect of different surface treatment methods on the shear bond strength of orthodontic brackets to temporary crowns

INTRODUCTION

The number of adult patients seeking orthodontic treatment has been consistently increasing. Since the placing of the final restoration must be postponed until the completion of the orthodontic treatment, provisional restoration is recommended for the duration of the orthodontic treatment. These surfaces have special chemical properties, which necessitate the orthodontists to prepare the bonding area with special measures.

METHODS

Polycarbonate and polymethylmethacrylate (PMMA) crowns (n=80) were randomly subdivided into 4 groups. Conditioning methods were grinding, sandblasting, CO₂ laser and methyl methacrylate application. Samples underwent SBS testing. A scanning electron microscope (SEM) analysis was carried out. The data was analysed with ANOVA, Student t-test and Post-hoc test. Adhesive remnant index (ARI) was analysed with Chi² test.

RESULTS

In all surface treatments, the mean Shear Bond Strength (SBS) of PMMA was significantly higher than that of polycarbonate (P<0.001). In the polycarbonate groups, there was a significant difference between the mean SBS of the four treatment methods (P<0.001). However, there were no significant differences in PMMA group (P=0.076). In both crown materials, the mode of the failure was adhesive type, regardless of the conditioning method (P>0.05).

CONCLUSIONS

PMMAs rendered higher bond strength than polycarbonates. In PMMA, all the surface treatment methods resulted in acceptable bond strength. However, if bonding the brackets to polycarbonate crown is needed, other conditioning methods are preferred over CO₂ laser.

Evaluation of the effect of different surface conditioning methods on shear bond strength of metal brackets bonded to aged composite restorations

INTRODUCTION

There are controversies regarding the most reliable conditioning method of the aged composite surface to ensure optimum bond strength. The purpose of this study was to evaluate the shear bond strength of metal brackets to microhybrid composite restorations after different surface preparation techniques.

MATERIALS AND METHODS

A total of sixty microhybrid composite samples were prepared using upper right central incisor celluloid crown as a mold. Samples were treated with 4 different surface conditioning methods: (1) etching, (2) sandblasting, (3) grinding, and (4) CO₂ laser irradiation. Samples were then bonded with metal brackets and underwent shear bond strength testing. A scanning electron microscope was carried out and the data was analysed by one-way ANOVA and post-hoc Tukey test. Bond failure was examined by stereomicroscope and scored based on adhesive remnant index (ARI). Kruskal-Wallis test was used to compare ARI values (α=0.05).

RESULTS

Shear bond strength values in the sandblasting group (17.18±1.53MPa) were significantly higher than the other groups. There was no significant difference between the grinding (12.87±3.38MPa) and laser (11.08±1.37MPa) groups (P=0.09). The lowest values were recorded in the etching group (6.78±1.69MPa). There was a significant difference in ARI scores among the four groups (P<0.001). ARI scores were mostly 2 and 3 in the sandblasting and grinding group, while in the etching and laser groups ARI was mostly 0 and 1.

CONCLUSIONS

Surface preparation by sandblasting and CO₂ laser provides clinically acceptable results with regards to bond strength and ARI score, however grinding and acid etching failed to produce the same results.

The Effect of Fractional CO2 Laser Irradiation on Shear Bond Strength of Resin Cement to Feldspathic Porcelain

Introduction: This study investigated the effect of fractional CO2 laser on shear bond strength (SBS) of resin cement to feldspathic porcelain. Methods: Sixty blocks of unglazed feldspathic porcelain were randomly divided into 5 groups of 12 by treatment. Group 1 and 2 underwent etching with 9.6% hydrofluoric acid (HF) and air abrasion with alumina particles, respectively. In groups 3 and 4, a fractional CO2 laser was applied for 10 seconds using 20 W/10 mJ (group 3) or 15 W/20 mJ (group 4). The specimens in group 5 were first treated by fractional CO2 laser (15 W/20 mJ) and then etched by HF acid. After silane application, a resin cement (Clearfil SA) was poured into plastic molds over the porcelain surface and light cured. SBS was assessed by a universal testing machine and the type of bond failure was determined. Results: Analysis of variance (ANOVA) indicated a significant difference in SBS among the study groups (P<0.001). Pairwise comparison demonstrated that the application of fractional CO2 laser followed by HF acid yielded SBS that was significantly greater than that of the other groups (P<0.05). The SBS of both laser groups (groups 3 and 4) were comparable to each other and significantly lower than the other groups (P<0.05). No significant difference was found in the distribution of failure modes among the groups (P=0.522) Conclusion: The application of fractional CO2 laser followed by HF acid treatment can improve SBS of resin cement to feldspathic porcelain and could be recommended when demanding extra retention.

Scanning electron microscope comparative surface evaluation of glazed-lithium disilicate ceramics under different irradiation settings of Nd:YAG and Er:YAG lasers

OBJECTIVE

To evaluate the surface of glazed lithium disilicate dental ceramics after irradiation under different irradiation settings of Nd:YAG and Er:YAG lasers using a scanning electron microscope (SEM).

MATERIALS AND METHODS

Three glazed-press lithium disilicate ceramic discs were treated with HF, Er:YAG, and Nd:YAG, respectively. The laser-setting variables tested were laser mode, repetition rate (Hz), power (W), time of exposure (seconds), and laser energy (mJ). Sixteen different variable settings were tested for each laser type, and all the samples were analyzed by SEM at 500× and 1000× magnification.

RESULTS

Surface analysis of the HF-treated sample showed a typical surface texture with a homogenously rough pattern and exposed ceramic crystals. Er:YAG showed no effect on the surface under any irradiation setting. The surface of Nd:YAG-irradiated samples showed cracking, melting, and resolidifying of the ceramic glaze. These changes became more pronounced as the power increased. At the highest power setting (2.25 W), craters on the surface with large areas of melted or resolidified glaze surrounded by globules were visible. However, there was little to no exposure of ceramic crystals or visible regular surface roughening.

CONCLUSIONS

Neither Er:YAG nor Nd:YAG dental lasers exhibited adequate surface modification for bonding of orthodontic brackets on glazed lithium disilicate ceramics compared with the control treated with 9.5% HF.

The effect of surface treatment with a fractional carbon dioxide laser on shear bond strength of resin cement to a lithium disilicate-based ceramic

BACKGROUND

This study investigated the impact of different surface treatments, including fractional carbon dioxide (CO₂) laser on shear bond strength (SBS) of resin cement to lithium disilicate ceramic.

MATERIALS AND METHODS

In this in vitro study, 72 blocks of IPS e.max CAD ceramic were randomly divided into six groups in terms of treatment (n = 12). Group 1 underwent etching with 9.6% hydrofluoric (HF) acid, whereas group 2 was subjected to air abrasion with aluminum oxide particles. Groups 3 and 4 were treated with a fractional CO₂ laser for 10 s using 10 W/14 mJ (group 3) or 20 W/10 mJ (group 4). In groups 5 and 6, the CO₂ laser was applied similar to that in groups 3 and 4, respectively; then, the specimens were etched by HF acid. After silane application, luting cement was bonded to the specimens. The SBS was assessed with a universal testing machine, and the type of bond failure was determined. Data were analyzed by ANOVA, Duncan, and Fisher's exact tests.

RESULTS

Surface conditioning with fractional CO₂ laser alone resulted in significantly lower SBS than HF acid treatment (P < 0.05). Bond strengths of the specimens treated with a combination of laser irradiation and acid etching were significantly greater than all the other groups (P < 0.05). No significant difference was found in the distribution of failure modes among the groups (P = 0.337).

CONCLUSION

The combination of fractional CO₂ laser irradiation and HF acid etching could be recommended when extra retention is required for lithium disilicate-based restorations, whereas laser treatment alone cannot produce sufficient SBS.

Evaluation of Different Types of Lasers in Surface Conditioning of Porcelains: A Review Article

To achieve proper bond strength for porcelains, adequate surface roughness is essential, which is traditionally gained by sandblasting or acid etching with hydrofluoric (HF) acid. Nowadays with the development of laser systems, serious efforts were made to apply this new instrument for surface etching of porcelains due to easy usage, safety, and more efficiency. There are different kinds of lasers and porcelains, so choosing the ones which will be good match for each other is crucial. Besides that, changing the irradiation setting can be beneficial as well. This article reviewed 33 related studies and summarized results of etching accomplished by Nd:YAG, Er:YAG, Er,Cr:YSGG and CO2 lasers on different types of porcelains considering different laser settings and evaluation methods to bring a comprehensive insight.

Shear Bond Strength of Al₂O₃ Sandblasted Y-TZP Ceramic to the Orthodontic Metal Bracket

As the proportion of adult orthodontic treatment increases, mainly for aesthetic reasons, orthodontic brackets are directly attached to yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) restorations. This, study analyzed the shear bond strength (SBS) between various surface treated Y-TZP and orthodontic metal brackets. The Y-TZP specimens were conditioned by 110 μm Al₂O₃ sandblasting, or sandblasting followed by coating with one of the primers (silane, MDP, or an MDP-containing silane primer). After surface treatment, the orthodontic metal bracket was bonded to the specimen using a resin cement, and then 24 h storage in water and thermal cycling (5000 cycles, 5-55 °C), SBS was measured. Surface roughness was analyzed for surface morphology, and X-ray photoelectron spectroscopy (XPS) was employed for characterization of the chemical bond between the Y-TZP and the MDP-based primers (MDP, MDP containing silane primer). It was found that after surface treatment, the surface roughness of all groups increased. The groups treated with 110 μm Al₂O₃ sandblasting and MDP, or MDP-containing silane primer showed the highest SBS values, at 11.92 ± 1.51 MPa and 13.36 ± 2.31 MPa, respectively. The SBS values significantly decreased in all the groups after thermal cycling. Results from XPS analysis demonstrated the presence of chemical bonds between Y-TZP and MDP. Thus, the application of MDP-based primers after Al₂O₃ sandblasting enhances the resin bond strength between Y-TZP and the orthodontic metal bracket. However, bonding durability of all the surface-treated groups decreased after thermal cycling.

Evaluation of the effect of four surface conditioning methods on the shear bond strength of metal bracket to porcelain surface

OBJECTIVE

This study evaluated the effect of superpulse CO2 laser irradiation and deglazing of porcelain surfaces on the shear bond strength (SBS) of metal orthodontic brackets, and compared it with two conventional etching techniques.

METHODS

Forty-eight Feldspathic porcelain fused to metal specimens embedded in cylindrical acrylic resin tubes were fabricated, and all the specimens were divided into four groups. In Group 1, the specimens were roughened with a diamond bur and etched with hydrofluoric acid (HFA) gel for 4 min. In Group 2, the specimens were roughened with a bur and irradiated by a CO2 laser with a 2 W power setting for 20 sec. In Group 3, the specimens were only irradiated by a CO2 laser. In Group 4, the porcelain surface was sandblasted with 50 μm aluminum oxide. Before bonding, the bracket silane was applied on the porcelain surfaces. SBS was evaluated by a Universal testing machine (Zwickroll, Germany). The remaining adhesive after the bond failure was evaluated using an adhesive remnant index (ARI). Statistical analysis was conducted by analysis of variance (ANOVA), Tukey, and Kruskal-Wallis tests.

RESULTS

ANOVA revealed significant differences in SBS among the four groups (p<0.001). Group 1 demonstrated significantly higher bond strength (13.13±2.47) when compared with the other groups. Group 2 showed higher bond strength (9.60±1.91) when compared with group 4 (6.40±1.67) (p=0.016). Group 1 displayed the highest ARI scores among the groups.

CONCLUSIONS

Deglazing combined with HFA etching produced the highest bond strength, but CO2 laser irradiation provided adequate bond strength and allowed for elimination of the HFA step. Deglazing is not recommended as a preliminary step before CO2 laser conditioning.

Surface treatment with a fractional CO2 laser enhances shear bond strength of resin cement to zirconia

AIMS

The present study investigated the effect of different surface treatments on shear bond strength (SBS) of resin cement to zirconia.

MATERIALS AND METHODS

Ninety zirconia blocks were prepared and divided into 6 groups of 15 by treatment. Group 1 served as the control group, whereas groups 2 and 3 were treated with air abrasion and a universal primer (Monobond plus), respectively. The remaining zirconia copings were treated with a fractional CO2 laser for 10 seconds using 10 W/10 mJ (group 4), 10 w/14 mJ (group 5) or 20 W/10 mJ (group 6). A luting cement (Clearfil SA) was bonded to the treated zirconia surfaces and cured for 40 seconds. SBS was measured with a universal testing machine and the type of bond failure was determined.

RESULTS

There was a statistically significant difference in SBS among the study groups (p<0.001). The highest SBS values were observed in the groups treated with the fractional CO2 laser at settings of 20 W/10 mJ (28.1 MPa) or 10 W/14 mJ (27.4 MPa), followed by the specimens treated with the universal primer (22.8 MPa). The control specimens exhibited the lowest SBS (9.4 MPa) among the study groups (p<0.05). There was no significant difference in the distribution of failure modes among the groups (p=0.871).

CONCLUSIONS

The application of fractional CO2 laser can improve bond strength of resin cement to zirconia ceramic, and thus it could be considered as an appropriate alternative to conventional methods of zirconia surface treatment.

Effect of femtosecond laser treatment on the shear bond strength of a metal bracket to prepared porcelain surface

OBJECTIVE

The aim of this study was to investigate the effects of femtosecond laser treatment (Group FS) on the shear bond strength (SBS) of a metal bracket to prepared porcelain surface, and to compare it with other surface treatment techniques [50 μm Al2O3 sandblasting (Group SB), 9.6% hydrofluoric acid gel (Group HF), and neodymium-doped yttrium aluminium garnet (Nd:YAG laser) (Group NY)].

BACKGROUND DATA

Because of the increasing number of adult patients in current orthodontic practice, achieving sufficient bond strength of composite resin to porcelain restorations without bond failure during the treatment is a challenge for orthodontists.

METHODS

In total, 80 glazed feldspathic porcelain samples were prepared and randomly assigned to four groups of 20. Treated surfaces were treated with a silane agent. Brackets were bonded to porcelain samples. The specimens were stored in distilled water for 24 h and then thermocycled for 500 cycles between 5° and 55°C. The SBS of the brackets was tested with a universal testing machine at a crosshead speed of 1 mm/min, until bonding failure occurred. The data were analyzed statistically using analysis of variance (ANOVA) and Tamhane multiple comparisons tests. The results of ANOVA indicated that the SBS values varied according to the surface treatment method (p<0.001).

RESULTS

Results of the Tamhane post-hoc tests indicated that the bond strength in Group NY (5.11±1.53) was significantly lower than the other groups (p<0.05). There were no statistically significant differences among Groups SB (9.07±3.76), HF (9.09±3.51), and FS (11.58±4.16) (p=0.28).

CONCLUSIONS

The results of this study showed that FS treatment produced high SBS of the processes assessed; therefore, it appears to be an effective method for bonding orthodontic metal brackets to prepared porcelain surfaces.

Microleakage and shear bond strength of orthodontc brackets bonded to hypomineralized enamel following different surface preparations

Objectives: This study investigated the effects of several conditioning methods on shear bond strength (SBS) and microleakage of orthodontic brackets bonded to demineralized enamel. Study Design: One hundred premolars were selected and immersed in a cariogenic solution for 12 weeks. The teeth were randomly assigned into 5 groups. In groups 1 and 2, the teeth underwent acid etching for 30 and 120 seconds, respectively. In group 3, a combination of laser and acid etching was employed. A self-etch primer (SEP) was applied in group 4 and in group 5, the teeth were exposed to acidulated phosphate fluoride (APF) for 4 minutes before etching. After bracket bonding, the teeth were immersed in methylen blue for 12 hours and then were mounted in acrylic resin. SBS was determined with an Instron Universal Testing Machine and the amount of microleakage under the brackets was assessed under a stereomicroscope. Results: The lowest SBS was related to the SEP group and the highest one was observed in the specimens prepared by APF+acid etching. There was a significant difference in SBS (p=0.009), but not in microleakage (p=0.971) of the study groups. The SBS of the specimens treated with SEP was significantly Lower than the other groups, which were not significantly different from each other. The SEP group displayed a higher frequency of bond failure at the enamel-adhesive interface. Conclusions: Enamel preparation with SEP provided the lowest SBS among the groups. All groups showed some degree of microleakage. There was no significant correlation between SBS and microleakage.

Key words:Bond strength, microleakage, bonding, self-etch primer, Er:YAG laser.

The effect of fractional CO2 laser irradiation on remineralization of enamel white spot lesions

This study investigated the combined effect of fractional CO(2) laser irradiation and fluoride on treatment of enamel caries. Sixty intact premolars were randomly assigned into four groups and then stored in a demineralizing solution to induce white spot lesions. Tooth color was determined at baseline (T1) and after demineralization (T2). Afterwards, the teeth in group 1 remained untreated (control), while group 2 was exposed to an acidulated phosphate fluoride (APF) gel for 4 min. In groups 3 and 4, a fractional CO(2) laser was applied (10 mJ, 200 Hz, 10 s) either before (group 3) or through (group 4) the APF gel. The teeth were then immersed in artificial saliva for 90 days while subjected to daily fluoride mouthrinse and weekly brushing. Color examinations were repeated after topical fluoride application (T3) and 90 days later (T4). Finally, the teeth were sectioned, and microhardness was measured at the enamel surface and at 30 and 60 μ from the surface. In both lased groups, the color change between T1 and T4 stages (∆E(T1-T4)) was significantly lower than those of the other groups (p < 0.05). Laser irradiation followed by fluoride application (group 3) caused a significant increase in surface microhardness compared to APF alone and control groups (p < 0.05). Microhardness at depths of 30 and 60 μ was also significantly greater in group 3 compared to those of all other groups (p < 0.05). Application of a fractional CO(2) laser before fluoride therapy is suggested for recovering the color and rehardening of demineralized enamel.