Effect of blood contamination on shear bond strength of brackets bonded with a self-etching primer combined with a resin-modified glass ionomer

The Influence of Various Adhesive Systems and Polishing Methods on Enamel Surface Roughness after Debonding of Orthodontic Brackets: A Three-Dimensional In Vitro Evaluation

A slight alteration of the enamel surface is inevitable upon debonding of orthodontic brackets, adhesive removal, and finishing/polishing. The aim of this in vitro study was to compare two adhesives and three polishing methods by measuring enamel surface roughness using confocal laser scanning microscopy (CLSM). Brackets were bonded on 42 extracted human premolars using Transbond XT (Transbond group) or Fuji Ortho (Fuji group). After debracketing, adhesives were removed with a tungsten carbide bur, and surfaces were polished using Sof-Lex discs, a rotary brush with a prophylactic paste (Depural), or a prophylactic cup with two polishing pastes (n = 7 in each subgroup). Surface roughness (S_a, S_ku, S_q, and S_z) was measured using CLSM and compared before treatment (T₁), after debracketing and adhesive removal (T₂), and after polishing (T₃). The data were statistically analyzed using the Mann-Whitney U and Kruskal-Wallis tests with Bonferroni correction. The time required for adhesive removal was measured and compared using a two-sample t-test. Surface roughness at T₂ increased compared to T₁, but the difference was significant only for the Fuji group (p < 0.01). The time required to remove Transbond XT (94.1 ± 6.8 s) was significantly higher compared to Fuji (72.1 ± 5.9 s, p < 0.0001). Polishing with Sof-Lex discs resulted in lower surface roughness compared to T₁ (p = 0.018). Using Depural and polishing pastes showed no significant difference in surface roughness compared to T₁, except for a significant decrease in S_a and S_q for Transbond (p = 0.043) and in S_ku for Fuji (p = 0.018) after polishing with Depural. In conclusion, the removal of Transbond took significantly longer, but there were fewer residues of composite resin on the enamel surface. Sof-Lex discs decreased enamel roughness, whereas enamel morphology and roughness were similar to the pre-treatment state after polishing with polishing pastes.

Incorporation of Zirconium Oxide Nanoparticles in Adhesive Resin for Bonding of Brackets to Enamel Conditioned with Er,Cr:YSGG, Photodynamic Therapy, and Phosphoric Acid

Objective: To evaluate the effect of enamel conditioning methods, that is, total-etch and rinse (TER), Er,Cr:YSGG (ECYL), and photodynamic therapy (PDT) on the shear bond strength (SBS) of orthodontic metallic brackets bonded using Zirconium oxide experimental adhesive (ZOEA). Methods: Sixty human incisor buccal surfaces were cleaned and allocated into three groups based on the method of enamel surface treatment, that is, TER using 37% phosphoric acid gel, methylene blue photosensitizer activated by PDT and ECYL (n = 20 each). Each group was further divided into two subgroups (n = 10) based on the type of adhesive, that is, ZOEA and experimental adhesive (EA). Metallic brackets were seated using composite resin. Samples were placed in a universal testing machine for SBS and failure mode using the ARI index. One-way analysis of variance and post hoc Tukey were used for multiple comparisons. ARI was presented in percentages in different investigated groups. Results: TER+ZOEA (17.16 ± 0.41 MPa) displayed the highest bond integrity. However, group PDT+EA (11.34 ± 0.25 MPa) demonstrated the lowest bond scores. The intergroup comparison revealed that the TER system displayed significantly higher SBS values than the PDT and ECYL groups (p < 0.05). The intragroup comparison revealed that enamel conditioned with TER and brackets bonded with ZOEA and EA displayed comparable bond integrity (p > 0.05). Conclusions: Enamel conditioned with TER bonded to a metallic bracket displayed better bond strength than PDT and ECYL. Zirconium oxide nanoparticles incorporated in adhesive have proved to be promising in improving the bond integrity of adhesive.

Rapid bonding and easy debonding of orthodontic appliances with 4-META/MMA-TBB resin using thermal heating

4-Methacryloyloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butylborane (4-META/MMA-TBB) resin is widely used as a direct bonding adhesive for orthodontic appliances because of its strong bonding ability. However, its clinical disadvantages include long setting times and difficult debonding with subsequent residual adhesive left on the enamel surface. To resolve these problems, thermal heating was applied to orthodontic appliances. The setting time was dramatically reduced by thermal heating (160°C for 5 s), with the shear bond strength remaining the same as that stated in the manufacturer's instructions. Debonding of appliances following thermal heating (160°C for 20 s) could be easily performed, decreasing the amount of adhesive left on enamel. These conditions were not accompanied by an increase in the heat pain threshold of pulpal dentin. These results suggest that the use of thermal heating in the bonding/debonding of 4-META/MMA-TBB resin may resolve its clinical weaknesses, making its ease of use similar to light-cured resin.

Prototype of a new tip developed to be coupled to dental light-curing units for optimizing bonding of orthodontic brackets and accessories

OBJECTIVE

Development of a new device to be coupled to light-curing units for bonding orthodontic brackets and accessories, and test its efficacy in an in vitro mechanical trial. The inner surface of the device is mirrored and is based on physical concepts of light refraction and reflection. The main advantage of such device is the reduced clinical time needed for bonding and the low possibility of contamination during the process.

METHODS

One hundred and twenty specimens were used for testing the shear bond strength of brackets bonded with the device. The Adhesive Remnant Index (ARI) was also determined. The sample was divided into 2 groups. In group 1 a halogen light-curing unit was used while in group 2 a led light-curing unit was used. Each group was then subdivided. In subgroups H1 and L1, a conventional light guide rod was used while in subgroups H2 and L2 bonding was performed with the mirrored device coupled to the tip of the guide light rod.

RESULTS

The values obtained for the shear bond strength and the ARI in the subgroups were compared. Results showed that there was no statistically significant difference for the shear strength (p > 0.05) and the ARI (p > 0.05) between the subgroups.

CONCLUSIONS

The tests of mechanical trials and the ARI analysis showed that the new device fulfilled the requirements for bonding orthodontic accessories, and that the time for bonding was reduced to half, being necessary only one light exposure.

Effect of different methods for decontaminating tooth enamel after contact with blood before bonding orthodontic buttons

PURPOSE

To evaluate the best method for decontaminating tooth enamel contaminated by contact with blood before bonding orthodontic buttons.

MATERIALS AND METHODS

The labial surfaces of 195 bovine incisors initially received prophylaxis, followed by 37% phosphoric acid etching, adhesive application, and light polymerization. After this, the labial surfaces of all teeth were contaminated with blood. The teeth were then randomly divided into 13 groups (n = 15), comprising the control group (treated according to the manufacturer's recommendations) and 12 experimental groups treated by the following decontamination methods: group 1, no decontamination; group 2, washing with distilled water; group 3, washing with physiologic solution; group 4, jets of air; group 5, gauze; group 6, cotton wool; group 7, distilled water plus jets of air; group 8, distilled water plus gauze; group 9, distilled water plus cotton wool; group 10, physiologic solution plus jets of air; group 11, physiologic solution plus gauze; and group 12, physiologic solution plus cotton wool.

RESULTS

No statistical differences were shown between the control group and groups 4, 7, 10, and 11 (P > .05). The lowest bond strength values were shown in group 1, in which no decontamination was performed, and groups 6 and 12, which were decontaminated with cotton wool and physiologic solution plus cotton wool, respectively.

CONCLUSIONS

The best method of decontaminating enamel contaminated with blood is washing with physiologic solution, followed by drying with jets of air and gauze or drying with jets of air only.

Effect of fluoridated paste on the failure rate of precoated brackets bonded with self-etching primer: a prospective split-mouth study

INTRODUCTION

The aim of this prospective randomized clinical trial was to determine the effect of using fluoridated paste (Dentsply, York, Pa) compared with plain pumice (Ortho Technology, Tampa, Fla) on the clinical bond failure rates of precoated brackets bonded with self-etching primer.

METHODS

A split-mouth technique was used. The teeth in the maxillary right and mandibular left quadrants were prepared with a fluoridated paste only, and the teeth in the maxillary left and mandibular right quadrants were prepared with plain pumice before bonding the precoated brackets. A total of 627 brackets in 34 orthodontic patients (20 female, 14 male) were included in this study; 315 brackets were bonded after pumice treatment, and 312 were bonded after paste treatment. The patients were followed for 6 months to determine the rates of bracket failure.

RESULTS

The overall failure rate was 8%. The failure rates for pumice and paste were 4.8% and 11.2%, respectively. The McNemar test showed a statistically significant difference between the 2 groups. Based on tooth type, the failure rate of the maxillary canine and the mandibular central incisor brackets were significantly different for paste and pumice. There was also a difference in the survival rates of the brackets in both groups.

CONCLUSIONS

Preparation of the enamel surface with fluoridated paste before bonding with self-etching primer is not recommended. However, the use of plain pumice is recommended, even if it is time-consuming.

Influence of decontamination procedures on shear forces after contamination with blood or saliva

INTRODUCTION

Despite rapid development in adhesive technology, contamination of bonding surfaces remains a major problem. The aims of this study were to evaluate the influence of contamination on bond strength and to investigate possible decontamination procedures.

METHODS

Four bonding systems were evaluated for their shear bond strengths under 5 bonding situations: control (without contamination and decontamination); contamination with blood; contamination with saliva; decontamination with water and air, and repriming after blood contamination; and decontamination with water and air, and repriming after saliva contamination. The 25 specimens of each group consisted of composite blocks bonded to bovine teeth. Shear forces were measured with a testing machine after thermocycling.

RESULTS

The 3 composite primers showed similar behavior. With the exception of Transbond SEP (3M Unitek, Monrovia, Calif) with saliva contamination, all contaminated samples showed greatly reduced shear forces. The control and decontaminated groups showed shear forces about 20 MPa. The resin-modified glass ionomer, however, did not reach clinically sufficient bond strengths in either setup.

CONCLUSIONS

Decontamination with water and air and repriming is sufficient after contamination with blood or saliva. Etching again is not necessary. The bond strength of Transbond SEP was not significantly altered by saliva contamination and can be recommended for conventional bonding procedures.

Artificial saliva contamination effects on bond strength of self-etching primers

OBJECTIVE

To test the hypothesis that there is no difference in the bond strength with or without contamination with artificial saliva when using two different self-etching primers (Transbond Plus and iBond) in comparison with a conventional acid-etching method (37% phosphoric acid and Transbond XT) for bonding of orthodontic brackets.

MATERIALS AND METHODS

One hundred fifty extracted human premolars were randomly allocated to six different groups, with 25 teeth in each group. Orthodontic metal brackets (APC II, Victory Twin 22 UNIV) were used. For contamination, a saliva replacement (Ptyalin) was applied. After contamination the surface was air-dried for 5 seconds and the bonding procedure continued. The bonded teeth were stored in deionized water at 37 degrees C for 30 days and then thermocycled for 24 hours before debonding with a universal testing machine. The load was recorded at bond failure. The location of adhesive failure was determined under magnification using the adhesive remnant index (ARI).

RESULTS

Clinically acceptable bond strengths were found for all primers used in this study. The contamination by saliva significantly decreased the bond strength when using the conventional acid-etching method (t = 0.0001). Self-etching primers were less influenced by saliva contamination. There was no significant difference in the ARI score among the groups (P > .05).

CONCLUSIONS

Saliva contamination significantly decreased the bond strength when the conventional acid-etching method was used. The self-etching primers were influenced the least. The bond strengths achieved for the self-etching primers and the conventional etching method after saliva contamination were not significantly different.

Development of an easy-debonding orthodontic adhesive using thermal heating

We produced experimentally a new bonding material that consisted of a mixture of a base resin (4-META/MMA-TBB resin adhesive) and thermoexpandable microcapsules for safe, easy debonding. Microcapsules in the base resin would start expansion at 80 degrees C, leading to a remarkable decrease in bond strength. Stainless steel brackets were bonded to bovine permanent mandibular incisors using bonding materials containing the microcapsules at different contents. After thermal cycling or heating, the shear bond strength of the brackets was measured. Shear bond strength of the bonding materials containing 30-40 wt% microcapsules decreased to about one-third or one-fifth that of the base resin on heating. Heating the brackets for eight seconds increased the temperature in the pulp chamber by 2 degrees C, which should not induce pulp damage. Results obtained suggested that the new bonding material should prove useful for removing brackets easily at the time of bracket debonding without any pain or enamel cracks, while maintaining the bonding strength during active orthodontic treatment.

Effect of Enamel Etching on Tensile Bond Strength of Brackets Bonded In Vivo with a Resin-reinforced Glass Ionomer Cement

Objective: To evaluate the influence of enamel etching on tensile bond strength of orthodontic brackets bonded with resin-reinforced glass ionomer cement.

Materials and Methods: The sample group consisted of 15 patients who had indications for extraction of four premolars for orthodontic reasons, equally divided into two different groups according to bracket and enamel preparation. Brackets were bonded in vivo, by the same operator, using a split mouth random technique: Group 1 (control), phosphoric acid + Fuji Ortho LC; Group 2, Fuji Ortho LC without acid conditioning. The teeth were extracted after 4 weeks using elevators. An Instron Universal Testing Machine was used to apply a tensile force directly to the enamel-bracket interface at a speed of 0.5 mm/min. The groups were compared using a Mann-Whitney U-test and Weibull analysis.

Results: Mean results and standard deviations (in MPa) for the groups were: Group 1, 6.26 (3.21), Group 2, 6.52 (2.73). No significant difference was observed in the bond strengths of the two groups evaluated (P = .599).

Conclusions: Fuji Ortho LC showed adequate shear bond strength and may be suitable for clinical use.

Orthodontic materials research and applications: Part 1. Current status and projected future developments in bonding and adhesives

The purpose of this opinion article, to be presented in 2 parts, is to project immediate future developments expected in orthodontic materials research and applications. Analysis of the material is structured around 2axes: presentation of evidence summarizing the current status in various fields, and formulation of a hypothesis for short-term future developments. This first part of the article deals with advances and developments in bonding to enamel. Projected adhesive developments include greater use of high-energy lamps for polymerization in light-cured systems, universal application of molar tube bonding, widespread use of self-etching primers, broader acceptance of glass ionomers in their conventional and modified modes, and elimination of 2-phase adhesives in favor of no-mix and light-cured adhesives. Long-term future adhesive applications might also include biomimetic approaches, adopting mechanisms used by living organisms to adhere to surfaces.