Porcelain laminate veneer conditioning for orthodontic bonding: SEM-EDX analysis

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.

Influence of the Application Time of Silane for the Bonding Performance between Feldspar or Lithium Disilicate Ceramics and Luting Resin Composites

A correct silanization time is essential for successful surface functionalization and sufficient bonding to dental ceramics. The shear bond strength (SBS) of lithium disilicate (LDS) and feldspar (FSC) ceramics and luting resin composite was investigated with respect to different silanization times, taking into account the physical properties of the individual surfaces. The SBS test was performed with a universal testing machine, and the fracture surfaces were evaluated by stereomicroscopy. The surface roughness of the prepared specimens was analyzed after etching. Changes in surface properties due to surface functionalization were evaluated by surface free energy (SFE) via contact angle measurement. Fourier transform infrared spectroscopy (FTIR) was used to determine the chemical binding. The roughness and SBS of the control group (no silane, etched) were higher for FSC than for LDS. Regarding the SFE, the dispersive fraction increased and the polar fraction decreased after silanization. FTIR confirmed the presence of silane on the surfaces. The SBS of LDS showed a significant increase from 5 to 15 s, depending on the silane and luting resin composite. For FSC, cohesive failure was observed for all samples. For LDS specimens, a silane application time of 15 to 60 s is recommended. Based on clinical conditions, no difference between the silanization times was observed for FSC specimens, indicating that etching alone produces sufficient bonding.

Effect of Er:YAG laser pretreatment on glass-ceramic surface in vitro

This study investigated the feasibility of using an Er:YAG laser to pretreat glass-ceramic surface and evaluate the effect of the treatment on the bonding strength and marginal adaptation between glass-ceramic and dentin. Glass-ceramic samples (CEREC Blocs) and third molars were cut into 6 mm × 6 mm × 2 mm plates. Thirty ceramic plates were randomly divided into 5 groups: group A (control), group B (pretreated with 9.6% hydrofluoric acid [HF]), group C (pretreated with the Er:YAG laser at 300 mJ and 15 Hz), group D (pretreated with the Er:YAG laser at 400 mJ and 15 Hz), and group E (pretreated with the Er:YAG laser at 500 mJ and 15 Hz). The surface morphologies of the samples in each group were studied under a scanning electron microscope, and the sample displaying optimal etching parameters was selected for subsequent experiments. Based on the surface treatments, 30 ceramic and dentin plates were randomly allocated into 3 groups: the control, laser, and acid-etching groups. After bonding a ceramic plate to a dentin plate, the microleakage and bonding strength were measured, and the pretreatment effects of the Er:YAG laser and 9.6% HF were compared. Group E exhibited an etching effect that was more pronounced and uniform than that in groups C and D. Microleakage and bonding strength analyses revealed that the laser and acid-etching groups differed significantly from the control group in dye penetration depth and shear strength (P < 0.05), although the laser and acid-etching groups did not differ from each other. Both 9.6% hydrofluoric acid and Er:YAG laser pretreatments can coarsen glass-ceramic surfaces, improve the marginal adaptation and bonding strength between the glass-ceramic and dentin, and decrease microleakage of the materials. The two treatments showed no apparent differences in pretreatment outcomes.

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.

Orthodontic Bonding: Review of the Literature

BACKGROUND

Patients seeking orthodontic treatment are increasing, and clinicians often have to place brackets on various surfaces aside from enamel. It is crucial to know what materials or instruments are required to bond brackets to each surface.

OBJECTIVE

This study aims to serve as a clinical guideline for the safest and most effective approaches taken to condition various surfaces for bonding to orthodontic brackets and provide background knowledge on the subject.

MATERIALS AND METHODS

PubMed and EBSCO databases were searched, along with the use of Google Scholar search engine, to obtain relevant articles published in English in peer-reviewed journals, from 1955 to 2020. Keywords used were Shear bond strength; Orthodontic bracket; Base design; Etching; Sandblasting; Laser; Conditioning; Enamel; Ceramic; Porcelain; Gold; Amalgam; Composite.

CONCLUSION

Even though orthophosphoric acid is the most widely used enamel conditioning agent, laser etching should be considered to avoid enamel decalcification. Hydrofluoric acid is the current standard for ceramic conditioning; however, its use intraorally should be minimized due to its toxicity. Orthophosphoric acid, CoJet-Sand air abrasion, and laser etching are viable alternatives for conditioning ceramic. Monobond Etch & Prime is toxic and should not be used intraorally. Composite can be conditioned by bur roughening, and the use of ceramic brackets is recommended. Amalgam and gold surfaces can be conditioned adequately by air abrasion. Despite the claims of many authors, the maximum shear forces that orthodontic brackets are subjected to are not 6-8 mega pascal (MPa). Further investigation is required in that regard. More in vivo studies need to be performed to confirm the in vitro results.

Light Activation and Thermocycling Methods on the Shear Bond Strength of Brackets Bonded to Porcelain Surfaces

The present study was evaluated the effect of different light activation and thermocycling methods on the shear bond strength (SBS) and on the adhesive remnant index (ARI) of metal brackets bonded to feldspathic ceramic. Hundred metal brackets were bonded to 20 porcelain cylinders, divided into four groups (n=25) based on light activation and thermocycling processes. The cylinders were etched with 10% hydrofluoric acid for 60 s and coated with two layers of silane. The brackets were bonded with Transbond XT composite resin. Light activation in Groups 1 and 3 was performed during 3 s using the VALO Ortho Cordless appliance with irradiance 3,200 mW/cm2 and in Groups 2 and 4 for 40 s using Optilight Max appliance with irradiance 1,200 mW/cm². The samples were stored in deionized water at 37°C for 24 h and the samples from Groups 1 and 2 were submitted to the SBS test at a rate of 1 mm/min, whereas the samples from Groups 3 and 4 were submitted to 7,000 thermal cycles (5°/55°C) before to the SBS test. The data were assessed by two-way analysis of variance and by Tukey's test (a=0.05). No significant difference was observed between SBS means in the different light activation devices used. The samples subjected to thermocycling revealed lower SBS values (p≤0.05). There was predominance of score 0 for ARI in all groups. Therefore, the different light activation methods did not interfere in SBS, but thermocycling reduced SBS.

Effect of Er:YAG Laser Etching on the Shear Bond Strength and Microleakage of Self-Glazed Zirconia Ceramics

Objective: To investigate the effect of Er:YAG laser irradiation on the shear bond strength (SBS) and microleakage of self-glazed zirconia (SZ) ceramics. Background: SZ is a novel type ceramic; laser irradiation has started to be used in the surface treatment of different ceramics, while SZ has been rarely studied to improve the bond quality. Methods: One hundred twenty blocks (5 mm × 5 mm × 5 mm) of SZ ceramics were produced and split into eight groups following different surface treatments (n = 15): Group A: no treatment; Group B: standard grid processing; and Group C-H: different Er:YAG laser power settings (100, 200, 300, 400, 500, and 600 mJ). Ten blocks of each group received the measurement of SBS and fracture mode analysis, three blocks underwent the evaluation of the microleakage depths, and the other two blocks were observed under the scanning electronic microscopy (SEM). Results: Group F obtained the highest SBS and the lowest microleakage depth without damaging the ceramic surface structure, which was statistically significant compared with the control group and gridding group (p < 0.05), whereas the difference was not statistically significant (p > 0.05) between group E and group F. The results of bonding performance were consistent with failure types and observation of surface characterizations in SEM images. Conclusions: According to the results here, Er:YAG irradiation had effect on surface treatment. In addition, 400 mJ Er:YAG could increase the SBS and decrease the microleakage depth on SZ ceramics without damaging the surface structure.

Adhesive luting of orthodontic devices to silica-based ceramic crowns-comparison of shear bond strength and surface properties

OBJECTIVES

The aim of this study was to analyse the impact of different clinical conditioning approaches and an ammonium polyfluoride- and trimethoxysilylpropyl methacrylate-based experimental primer for intraoral luting of buccal tubes on silica-based ceramic surfaces.

MATERIALS AND METHODS

A total of 60 leucite-reinforced glass ceramic molar crowns were conditioned using different methods (n = 10): I-roughening, hydrofluoric acid, silane; II-roughening, silane; III-roughening, experimental coupling agent; IV-experimental coupling agent; V-roughening; VI-no treatment. A buccal tube was adhesively luted to the ceramic surface. Subsequently, water storage, thermocycling and chewing simulation were carried out. The shear bond strength (SBS) was determined, and changes in the surface were assessed.

RESULTS

All tubes of the control group (group VI) debonded after incubation. The conditioning methods using coupling agents revealed mean values for SBS of 61.56 MPa (group I), 45.53 MPa (group III), 41.65 MPa (group II), and 23.14 MPa (group IV). In groups I-III, both composite residues and cracks/tear-outs were detected.

CONCLUSIONS

The conditioning of silicate ceramic surfaces with a suitable coupling agent system appears to allow sufficient adhesive luting of buccal tubes. The intraoral luting of fixed appliance elements on silicate ceramic surfaces using an ammonium polyfluoride- and trimethoxysilylpropyl methacrylate-based ceramic primer can withstand orthodontic forces.

CLINICAL RELEVANCE

Ammonium polyfluoride- and trimethoxysilylpropyl methacrylate-based ceramic primers revealed promising results for the intraoral adhesive luting of orthodontic devices to silica-based ceramic crowns.

The critical bond strength of orthodontic brackets bonded to dental glass-ceramics

OBJECTIVES

To evaluate the critical bond strength (σ) of ceramic and metal brackets to a lithium disilicate-based glass-ceramic.

MATERIALS AND METHODS

Two hundred and forty ceramic specimens (IPS e-max CAD) were randomly distributed in 12 experimental groups (n = 20). Two ceramic brackets (monocrystalline, BCm; and polycrystalline, BCp) and a metal bracket (BM) were bonded to glass-ceramic specimens after one of the following surface treatments: HF-hydrofluoric acid applied for 60 s; S-silane applied for 3 min; HFS-HF followed by S; and MDP-application of an adhesive containing a phosphate monomer (MDP). All brackets were bonded to the treated glass-ceramic using a resin cement, stored in 37 °C water for 48 h before shear bond strength testing. Optical (OM) and scanning electron (SEM) microscopies were used for fractographic analysis. Data was statistically analyzed using Kruskal-Wallis and Student-Newman-Keuls (α = 0.05).

RESULTS

BCm bonded to glass-ceramic treated with either HFS or HF showed the highest median σ values, respectively, 10.5 MPa and 8.5 MPa. In contrast, the BCp bonded to glass-ceramic treated with MDP showed the lowest median σ value (0.8 MPa), which was not statistically different from other MDP-treated groups.

CONCLUSIONS

The failure mode was governed by the glass-ceramic surface treatment, not by the bracket type. Quantitative (σ values) and qualitative (fracture mode) data suggested a minimum of 5 MPa for brackets bonded to glass-ceramic, which is the lower critical limit bond strength for a comprehensive orthodontic treatment.

CLINICAL RELEVANCE

Bonding brackets to glass-ceramic requires micromechanical retention.

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.