Effect of blood and saliva contamination on bond strength of brackets bonded with a protective liquid polish and a light-cured adhesive

Effect of contamination and decontamination methods on the bond strength of adhesive systems to dentin: A systematic review

INTRODUCTION

In a suitable condition, it is important to perform any dental restorative procedure using an operatory field isolated. Then, the aim of this study was to compare the bond strength of composite restorations to dentin affected by any contamination agent through a systematic review.

METHODS

This systematic review was performed following the PRISMA 2020 guidelines. The literature search was conducted until September 2022 by scanning the following databases: Embase, PubMed, Scielo, Scopus, and Web of Science. Manuscripts evaluated the bond strength of resin-based materials to permanent human dentin contaminated with blood or saliva were selected for full-text review. The risk of bias was assessed by the RoBDEMAT tool.

RESULTS

A total of 3750 papers resulted from the search from all databases. After the full-text reading, a total of 62 articles remained for the qualitative analysis. The contamination agents used were blood, saliva, and hemostatic agents. A great variety of protocols were used to contaminate the dentin surface, and the contamination process occurred in several steps of the bonding process, including before and after the etching process, after the primer application and after the adhesive application. Also, several decontamination procedures were tested, including reapplication of the etching material, rinsing with water, chlorhexidine or sodium hypochlorite and reapplication of the adhesive system.

CONCLUSION

Any contamination with blood or saliva impaired the bond strength of resin-based materials to dentin. Decontamination procedures including water-spray and reapplication of the bonding system could revert the impairment produced by the saliva or blood contamination. The use of hemostatic agents as a method of blood decontamination is not recommended.

CLINICAL SIGNIFICANCE

Clinicians should avoid contamination during a bonding procedure, otherwise, a reduction in the bond quality is expected.

Bonded lingual retainer adhesives and discoloration : An in vitro study

PURPOSE

This in vitro study was conducted to compare the discoloration of a flowable self-adhesive composite, a highly filled composite adhesive, and a liquid polish applied highly filled composite adhesive for bonded lingual retainers.

METHODS

Thirty composite discs were fabricated and divided into three groups: group 1, flowable self-adhesive (GC Ortho Connect™ Flow [GCO], GC Orthodontics, Tokyo, Japan); group 2, highly filled composite adhesive (Transbond™ LR [TLR], 3M Unitek, Monrovia, CA, USA); and group 3, highly filled composite adhesive with liquid polish (TLR and BisCover LV™ [TLRB], BISCO Inc, Schaumburg, IL, USA). L*a*b* values were measured by spectrophotometer prior to (T0) and following (T1) immersion in coffee. T1 - T0 differences were calculated as ∆L*, ∆a*, ∆b*, and ∆E*ab values. The Shapiro-Wilk test was performed to determine whether the data were normally distributed. The values that did not fit the normal distribution were evaluated with the Kruskal-Wallis one-way analysis of variance (ANOVA), and Dunn's test was used for multiple comparisons. The level of significance was p < 0.05.

RESULTS

The difference between the TLR and TLRB groups was statistically significant for ∆E*ab (P = 0.007). ∆E*ab value of TLR group was greater than ∆E*ab value of TLRB group. The differences between the GCO and TLR groups (p = 0.001) and the TLR and TLRB groups (p = 0.010) were statistically significant for ∆a*. ∆a* values of GCO and TLRB groups were greater than ∆a* value of TLR group. The difference between the TLR and TLRB groups was statistically significant (p = 0.003) for ∆b*. ∆b* value of TLR group was greater than ∆b* value of TLRB group.

CONCLUSIONS

Using a Transbond LR polished with BisCover LV or only GC Ortho Connect Flow for lingual retainer bonding reduces coffee-induced discoloration.

Tensile and shear bond strengths of a stainless steel used in orthodontic brackets bonded to bovine enamel using two types of resin cement

The purpose of this study was to examine the relationship between the bond strength of stainless steel with two types of resin cements (MMA- and composite-based) on bovine enamel depending on the directionality of the applied force. The specimens were either placed in water or subjected to thermal cycles (TC), and the shear or tensile bond strengths (SBS or TBS) were determined. The SBS showed significantly greater than the TBS for both types of cement, and the SBS and TBS for composite-based cement had larger than MMA-based one. No significant difference in SBS was observed in the cements even after being subjected to TC. Cohesive failures of the cement and bovine enamel in the composite-based group, while adhesive failures were observed in MMA-based one. Consequently, the direction of the force at both cements affected the retention of stainless steel, and MMA-based cement was preferred when prioritizing less enamel damages.

Shear bond strength after using sealant before bonding: a systematic review and meta-analysis of in vitro studies

OBJECTIVES

Decalcification during orthodontic treatment is significantly increased. To prevent this negative impact, new treatments with sealants before bonding brackets are commonly been used. This systematic review discusses current knowledge on shear bond strength when using sealant before bonding.

MATERIALS AND METHODS

A systematic review and meta-analysis were performed to identify studies that address shear bond strength after using a sealant before bonding brackets. The search was carried out using common electronic databases in addition to individual searches. Both screening and study eligibility analysis were performed according to PRISMA and Cochrane Guidelines for systematic reviews. Several terms describing shear bond strength after using a sealant before bonding brackets were searched. Particular attention was paid to bond failure and bracket loss. For the statistical outcome, all results were shown in a forest plot based on standardized mean differences (SMD) with a random-effects model to respect heterogeneity of these studies. To assess the heterogeneity of the different trials, I2-value and the Q-Test were performed.

RESULTS

The initial search identified 416 studies. After a thorough selection process, a total of 15 articles met the inclusion criteria. All 15 articles reported results of in vitro studies. Papers were divided into four subgroups according to their used product: ProSeal, Transbond bonding, the combination of Transbond bonding and ProSeal and Clearfil Protect Bond. The results of this review demonstrate a high heterogeneity of the studies. The SMD of the examined 15 articles show nearly no difference between the control and the intervention groups in shear bond strength (p < 0.0001; OR - 0.12; Cl - 0.47-0.23). Forest plots for comparison of the subgroups depict no difference in shear bond strength as well.

CONCLUSIONS

This meta-analysis concludes that there is no additive benefit for shear bond strength when using sealant before bonding. However, additional randomized controlled studies should be performed to analyze impact of sealants on bonding strength and bracket loss in more detail.

CLINICAL RELEVANCE

Using sealants before orthodontic bonding does not reduce shear bond strength.

Effect of Decontamination Treatments on Micro-Shear Bond Strength between Blood-Saliva-Contaminated Post-Etched Dentin Substrate and Composite Resin

Blood–saliva contamination negatively affects the bonding potential of adhesive agents. The study aimed to assess the effect of various cleaning protocols on micro-shear bond strength (μSBS) between blood–saliva-contaminated post-etched dentin and composite resin in total-etch and self-etch adhesives. The cleaning methods tested were water rinsing, 37.5% phosphoric acid (H3PO4) re-etching, 6% sodium hypochlorite (NaoCl), 2% chlorhexidine gluconate (CXG), isopropyl alcohol (IPA), and pumice. Nono-hybrid composite cylinders with a 3-mm diameter and 2-mm height were directly cured over the dentin substrate, stored for 24 h, and subjected to 12,000 thermocycles. The shear force was exerted with a 200-μm knife-edged chisel-shaped head from a universal testing machine. The type of failure was assessed with stereomicroscope magnified images. The obtained data were evaluated by Kruskal–Wallis and Mann–Whitney U post-hoc tests. Water-rinsed contaminated dentin surfaces showed substantially reduced μSBS in the total etch from 25.93 to 20.29 Mpa and the corresponding values for the one-step self-etch adhesive were 10.10 to 8.8. Re-etching with 37.5% H3Po4 resulted in a recovery of bonding potential in both total-etch (24.58 Mpa) and self-etch adhesive (9.23 Mpa). Alternately, NaoCl and pumice cleaning showed promising results for the total-etch (23.51 Mpa) and self-etch (7.79 Mpa).

Effect of Dental Chair Light on Enamel Bonding of Orthodontic Brackets Using Light Cure Based Adhesive System: An In-Vitro Study

AIM

The aim of this in vitro study was to evaluate the influence of the Dental chair light on the bond strength of light cured composite resin.

MATERIALS AND METHODS

Sixty therapeutically extracted human premolar teeth were randomly allocated to two groups of 30 specimens each. In both groups light cured composite resin (Transbond XT) and MBT premolar metal brackets (3M Unitek) was used to bond brackets. In group I and II light curing was done using Light-emitting diode light curing units without and with the dental chair light respectively. After bonding, all samples were stored in distilled water at room temperature for 24 hours and subsequently tested for shear bond strength and Adhesive Remnant Index (ARI) scores. Data was subjected to Mann Whitney U statistical test.

RESULTS

Results indicated that there was significantly higher shear bond strength (7.71 ± 1.90) for the Group II (composite cured with LED and dental chair light) compared with Group I (composite cured with LED LCU only) (5.74 ± 1.13).the obtained difference was statistically significant. There was no statistical significant difference between ARI scores in between the groups.

CONCLUSIONS

light cure bonding with dental chair light switched on will produce greater bond strength than the conventional bonding. However, the ARI score were similar to both the groups. It is advised that the inexperienced orthodontist should always switch off the dental chair light while bonding for enough working time during the bracket placement.

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.

Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances: a prospective clinical trial

INTRODUCTION

In this study, we tested the efficacy of a tooth sealant polish (Biscover LV; Bisco, Schaumberg, Ill) to prevent enamel demineralization (white spot lesions) for the full duration of orthodontic treatment with fixed appliances. The trial design was an alternating-tooth split-mouth design.

METHODS

Patients starting treatment with bonded appliances in a private practice were enrolled. The 6 maxillary anterior teeth received the test sealant or no sealant. The nonblinded orthodontists visually examined the teeth immediately after debonding and rated the presence and severity of white spot lesions using a 4-point scale. The difference in incidence of white spot lesions on treated and control teeth was tested with multivariate binary logistic regression for repeated measures by using the generalized estimating equations approach.

RESULTS

Sixty-five subjects were enrolled, and 3 were lost to follow-up, leaving 62 for analysis. There was a slightly lower incidence of white spot lesions on treated teeth (13.5%; 95% confidence interval, 8.6-18.4) compared with the control teeth (17.7%; 95% confidence interval, 12.4-23.7). This difference was statistically significant in the multivariate model (Wald chi-square, 5.07; df = 1; P = 0.024). The odds ratio was equal to 0.68 (95% confidence interval, 0.47-0.95) that treated teeth would show white spot lesions relative to the control teeth. White spot lesion severity was nearly the same for treated and control teeth (mean ± SD = 1.17 ± 0.47 and 1.20 ± 0.48, respectively; Wald chi-square, 3.03; df = 1; P = 0.082). No serious adverse effects were reported.

CONCLUSIONS

The sealant did not prevent all white spot lesions for the full duration of treatment. The sealant demonstrated a clinically small but statistically significant ability to prevent white spot lesions.

Shear bond strength of orthodontic brackets and disinclusion buttons: effect of water and saliva contamination

PURPOSE

The aim of this study was to assess the effect of water and saliva contamination on the shear bond strength and failure site of orthodontic brackets and lingual buttons.

MATERIALS AND METHODS

120 bovine permanent mandibular incisors were randomly divided into 6 groups of 20 specimens each. Both orthodontic brackets and disinclusion buttons were tested under three different enamel surface conditions: (a) dry, (b) water contamination, and (c) saliva contamination. Brackets and buttons were bonded to the teeth and subsequently tested using a Instron universal testing machine. Shear bond strength values and adhesive failure rate were recorded. Statistical analysis was performed using ANOVA and Tukey tests (strength values) and Chi squared test (ARI Scores).

RESULTS

Noncontaminated enamel surfaces showed the highest bond strengths for both brackets and buttons. Under water and saliva contamination orthodontic brackets groups showed significantly lower shear strengths than disinclusion buttons groups. Significant differences in debond locations were found among the groups under the various enamel surface conditions.

CONCLUSIONS

Water and saliva contamination of enamel during the bonding procedure lowers bond strength values, more with orthodontic brackets than with disinclusion buttons.

Effects of contamination by either blood or a hemostatic agent on the shear bond strength of orthodontic buttons

OBJECTIVE

To evaluate the effects of contamination by either blood or a hemostatic agent on the shear bond strength (SBS) of orthodontic buttons.

METHODS

We used 45 freshly extracted, non-carious, impacted third molars that were divided into 3 groups of 15. Each tooth was etched with 37% phosphoric acid gel for 30 s. Human blood or the blood stopper agent was applied to the tooth surface in groups I and II, respectively. Group III teeth were untreated (controls). Orthodontic buttons were bonded to the teeth using light-curing composite resin. After bonding, the SBS of the button was determined using a Universal testing machine. Any adhesive remaining after debonding was assessed and scored according to the modified adhesive remnant index (ARI). ANOVA with post-hoc Tukey's test was used to determine significant differences in SBS and Fisher's exact test, to determine significant differences in ARI scores among groups.

RESULTS

ANOVA indicated a significant difference between groups (p < 0.001). The highest SBS values were measured in group III (10.73 ± 0.96 MPa). The SBS values for teeth in groups I and II were significantly lower than that of group III (p < 0.001). The lowest SBS values were observed in group I teeth (4.17 ± 1.11 MPa) (p < 0.001).

CONCLUSIONS

Contamination of tooth surfaces with either blood or hemostatic agent significantly decreased the SBS of orthodontic buttons. When the contamination risk is high, it is recommended to use the blood stopper agent when bonding orthodontic buttons on impacted teeth.

Disinclusion of unerupted teeth by mean of self-ligating brackets: effect of blood contamination on shear bond strength

Objectives: The aim of this study was to assess the effect of blood contamination on the shear bond strength and failure site of three different orthodontic self-ligating brackets. Study Design: 240 bovine permanent mandibular incisors were randomly divided into 12 groups of 20 specimens each. Orthodontic self-ligating brackets were tested under four different enamel surface conditions: a) dry, b) blood contamination before priming, c) blood contamination after priming, d) blood contamination before and after priming. Brackets were bonded to the teeth and subsequently tested using a Instron universal testing machine. Shear bond strength values and adhesive failure rate were recorded. Statistical analysis was performed using ANOVA and Tukey tests (strength values), and Chi squared test (ARI Scores). Results: Non-contaminated enamel surfaces showed highest bond strengths for all self ligating brackets. Under blood-contamination shear bond strengths lowered for all brackets tested. Groups contaminated before and after primer application showed the lowest shear bond strength. Significant differences in debond locations were found among the groups under the various enamel surface conditions. Conclusions: Blood contamination of enamel during the bonding procedure lowers bond strength values of self ligating brackets, expecially when contamination occur in different times of the bonding procedure.

Key words:Disinclusion, self ligating brackets, blood, contamination, enamel, orthodontics, oral surgery.

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.

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.

Shear bond strength of brackets bonded with hydrophilic and hydrophobic bond systems under contamination

OBJECTIVE

To compare, in vitro, the shear bond strength (SBS) of two bond systems: Transbond XT/XT primer (TXT/XT) and Transbond Plus Color Change/Transbond Self Etching Primer (TPCC/TSEP).

MATERIALS AND METHODS

Each system was examined under four enamel surface conditions (dry, water, saliva, and blood), and 160 bovine teeth were divided into eight groups of 20 according to enamel surface condition. Group 1 used TPCC/TSEP and Group 2 used TXT/XT under dry conditions; Group 3 used TPCC/TSEP and Group 4 used TXT/XT with water; Group 5 used TPCC/TSEP and Group 6 used TXT/XT under saliva; and Group 7 used TPCC/TSEP and Group 8 used TXT/XT with blood. Brackets were bonded, and the samples were thermocycled 500 times between 5 degrees C and 55 degrees C; they were then submitted to a shear bond test with a universal testing machine with a 50 kgf load cell at 5 mm/min.

RESULTS

Although water and saliva affected TXT/XT more than they affected TPCC/TSEP, there were no significant differences among the groups (Groups 3 and 4: P = .940; Groups 3 and 5 and Groups 4 and 6: P = 1.000; Groups 3 and 6: P = .988; Groups 4 and 5: P = .690; and Groups 5 and 6: P = .861).

CONCLUSIONS

The presence of blood resulted in the lowest SBS from both bond systems, but especially from TXT/XT. TPCC/TSEP resulted in a higher SBS than TXT/XT under all conditions except the dry enamel surface.

Effect of blood contamination on shear bond strength of orthodontic brackets and disinclusion buttons

Our aim was to assess the effect of blood contamination on the shear bonding strength and sites of failure of orthodontic brackets and bondable buttons. We randomly divided 160 bovine permanent mandibular incisors into 8 groups of 20 specimens each. Both orthodontic brackets (Step brackets, Leone, Sesto Fiorentino, Italy) and bondable buttons (Flat orthodontic buttons, Leone, Sesto Fiorentino, Italy) were tested on four different enamel surfaces: dry; contamination with blood before priming; after priming; and before and after priming. Brackets and buttons were bonded to the teeth and subsequently tested using a Instron universal testing machine. Shear bonding strength and the rate of adhesive failures were recorded. Data were analysed using the analysis of variance (ANOVA), Scheffè tests, and the chi-square test. Uncontaminated enamel surfaces showed the highest bonding strengths for both brackets and buttons. When they were contaminated with blood, orthodontic brackets had significantly lower shear strengths than bondable buttons (P=0.0001). There were significant differences in sites of failure among the groups for the various enamel surfaces (P=0.001). Contamination of enamel by blood during bonding lowers the strength of the bond, more so with orthodontic brackets than with bondable buttons.

Effect of Saliva Contamination and Decontamination on Bovine Enamel Bond Strength of Four Self-etching Adhesives

Salivary contamination before and after priming could significantly reduce the enamel bond strength of self-etching adhesives. Proper isolation should be performed before and during application of the adhesives and placement of the resin composite. Thorough water-spraying could significantly improve the μTBS of saliva-contaminated enamel.