Orthodontic bonding to several ceramic surfaces: are there acceptable alternatives to conventional methods?

Effectiveness of surface polishing after debonding of metal brackets from different CAD-CAM materials

PURPOSE

The purposes of this study were to compare and evaluate the surface texture of different restorative computer-aided design and computer-aided manufacturing (CAD/CAM) materials before bonding and after debonding of metal orthodontic brackets.

MATERIALS AND METHODS

A total of 60 rectangular ceramic test specimens (n = 20 in each group) were prepared using feldspathic ceramic blocks (FLD; served as control), hybrid ceramic blocks (HC), and lithium disilicate ceramic blocks (LDC). Surface roughness (Ra) analysis was conducted using a profilometer before bonding the metal brackets. After the debonding and polishing procedures, a second surface roughness analysis was conducted on each specimen. The shear bond strength (SBS) test was applied to each specimen using a universal test machine for debonding the metal brackets. The debonded specimens were examined under a stereomicroscope and scored using a 4-step adhesive remnant index (ARI). The Ra and SBS values and the ARI scores were saved, and the data were analyzed statistically at a significance level of 0.05. One specimen from each group was examined under atomic force microscopy to visualize surface roughness. Furthermore, one specimen from each group was additionally prepared for scanning electron microscopy analysis.

RESULTS

Statistically significant differences in SBS measurements were observed between all three groups. The highest SBS values were obtained from the FLD group, the lowest from the LDC group. The HC group showed significantly (P = 0.001) lower Ra values than the LDC and FLD groups after debonding and polishing. No significant differences were observed in the ARI scores between the groups.

CONCLUSIONS

Hybrid ceramics could be a suitable alternative for fixed restorations in adult patients receiving subsequent treatments with fixed orthodontic appliances.

Comparison of shear bond strength of metallic brackets bonded to ceramic surfaces utilizing different adhesive systems: An in vitro study

OBJECTIVE

To compare the shear bond strength (SBS) of orthodontic brackets bonded to three different types of ceramic surfaces (feldspathic, lithium disilicate, and zirconium) using Assure® Plus All and Transbond™ XT adhesives.

MATERIALS AND METHODS

The sample comprised 72 monolithic computer-aided design and computer-aided manufacturing (CAD/CAM) ceramic samples that were randomly divided into six groups of 12 specimens each. Three groups (G1, feldspathic ceramic; G3, lithium disilicate ceramic; G5, zirconium surfaces) were bonded to metal brackets using Assure® Plus All adhesive, whereas the remaining three groups (G2, G4, G6; with the ceramic type in the same order as that in the previous groups) were bonded to metal brackets using Transbond™ XT. The samples were then subjected to 10,000 thermocycles. The SBS was calculated using the shear tests. The site of bonding failure was classified using the adhesive remnant index (ARI) score. One-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used for statistical analyses at a 5% significance level.

RESULTS

Statistically significant differences were observed in the mean SBS values of the groups (P < 0.001). The mean SBS for G6 (zirconium plus Transbond™ XT) (2.52 MPa) was significantly lower than that for all other groups. Furthermore, statistically significant differences were found in the ARI score distribution among the groups (P < 0.001). Differences were identified between G6 and G3 (lithium disilicate Plus All Assure® Plus All) and G5 (zirconium plus Assure® Plus All).

CONCLUSIONS

The mean bonding strength of brackets with Assure® Plus All was higher than that with Transbond™ XT for all three types of ceramics. However, all groups, except the zirconium plus Transbond™ XT group, showed acceptable bonding strength for orthodontic purposes. The application of hydrofluoric acid followed by silane and finally the Assure® Plus All adhesive system is adequate for bonding brackets to any of the ceramic tested surfaces.

The effect of ceramic surface conditioning on bond strength of metallic brackets: An in vitro study

OBJECTIVE

To compare the shear bond strength (SBS) of brackets bonded to three different types of ceramic surfaces (feldspathic ceramic, lithium disilicate ceramic, and zirconia), conditioned with either hydrofluoric acid or sandblasting, using Assure® Plus All bonding agent.

MATERIALS AND METHODS

A total of 72 monolithic CAD/CAM ceramic specimens were divided into six groups of 12 samples. Three groups (G1: feldspathic ceramic, G3: lithium disilicate ceramic, G5: zirconia surfaces) were conditioned with 9.6% hydrofluoric acid, while the remaining three (G2, G4, G6; with ceramic type in the same order as the previous three groups) were prepared with 50 μm aluminum oxide sandblasting. Premolar brackets were bonded using light-cured Assure® Plus All. The SBS and adhesive remnant index (ARI) were recorded and submitted to inferential analysis using one-way analysis of variance and Kruskal-Wallis tests, respectively. The significance level was set at 5% (P ≤ 0.05).

RESULTS

The mean SBS values for the three different ceramic groups conditioned with hydrofluoric acid (G1: 7.2 ± 1.5 MPa, G3: 9.3 ± 2.3 MPa, G5: 8.5 ± 2.0 MPa) were significantly higher than those obtained for the groups prepared by sandblasting before bonding (G2: 7.5 ± 1.8 MPa, G4: 4.4 ± 2.0 MPa, G6: 4.3 ± 2.8 MPa).

CONCLUSIONS

The hydrofluoric acid treatment produced a favorable SBS for all three examined ceramic types before bracket bonding with Assure® Plus All. In comparison, sandblasting yielded a satisfactory SBS only with feldspathic surfaces. Furthermore, the ARI indicated a higher frequency of mixed-adhesive failures except for lithium disilicate conditioned with sandblasting. Therefore, using hydrofluoric acid is likely to be especially recommended when the clinician is not aware of the brand of ceramic restorative material.

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 to silicate ceramics: impact of different pretreatment methods on shear bond strength between ceramic restorations and ceramic brackets

Objective

The study aims to investigate the shear bond strength (SBS) between silicate ceramic restorations and ceramic brackets after different pretreatments and aging methods.

Material and methods

Leucite (LEU) and lithium disilicate (LiSi) specimens were pretreated with (i) 4% hydrofluoric acid + silane (HF), (ii) Monobond Etch&Prime (MEP), (iii) silicatization + silane (CoJet), and (iv) SiC grinder + silane (SiC). Molars etched (phosphoric acid) and conditioned acted as comparison group. SBS was measured after 24 h (distilled water, 37 °C), 500 × thermocycling (5/55 °C), and 90 days (distilled water, 37 °C). Data was analyzed using Shapiro–Wilk, Kruskal–Wallis with Dunn’s post hoc test and Bonferroni correction, Mann–Whitney U, and Chi² test (p < 0.05). The adhesive remnant index (ARI) was determined.

Results

LEU pretreated with MEP showed lower SBS than pretreated with HF, CoJet, or SiC. LiSi pretreated with MEP resulted in lower initial SBS than pretreated with HF or SiC. After thermocycling, pretreatment using MEP led to lower SBS than with CoJet. Within LiSi group, after 90 days, the pretreatment using SiC resulted in lowest SBS values. After HF and MEP pretreatment, LEU showed lower initial SBS than LiSi. After 90 days of water storage, within specimens pretreated using CoJet or SiC showed LEU higher SBS than LiSi. Enamel presented higher or comparable SBS values to LEU and LiSi. With exception of MEP pretreatment, ARI 3 was predominantly observed, regardless the substrate, pretreatment, and aging level.

Conclusions

MEP pretreatment presented the lowest SBS values, regardless the silicate ceramic and aging level. Further research is necessary.

Clinical relevance

There is no need for intraoral application of HF for orthodontic treatment.

Orthodontic Attachment Adhesion to Ceramic Surfaces

Ceramic materials are constantly evolving, achieving good functionality and aesthetics. Bonding to ceramics may be difficult because of high toxicity procedures and risk of surface damage. The review aims to answer several research questions: Is there a golden standard for bonding to ceramic? Are there adhesives or types of photopolymerization lamps that produce a higher bond strength on certain types of ceramics rather than others? Articles focusing on the bonding process of orthodontic attachments to ceramic surfaces searched in Pubmed, Medline and Embase, published between 1990 and 2018 were revised. Exclusions concerned bonding to non-ceramic surfaces, bonding to ceramic surfaces that are not destined for orthodontics or laser usage. Forty-nine articles that matched the inclusion criteria were researched. The following categories of original research articles were compared and discussed: metallic brackets bonding to ceramic surfaces, ceramic brackets to ceramic surfaces, bonding to new types of ceramics, such as zirconia, lithium disilicate, different photopolymerisation devices used on bonding to ceramics. Some types of adhesive may achieve minimal bond strength (6-8 MPa) even on glazed ceramic. Ceramic surface preparation may be done by sandblasting or hydrofluoric acid (60s application and 9.6%) with generally similar results. Studies rarely show any statistical difference and there are reduced number of samples in most studies. Ceramic brackets show better adhesion to ceramic surfaces and the same bonding protocol is advised. A higher bond strength may lead to ceramic surface. Few studies focus on newer types of ceramics; additional research is necessary. There is no clear evidence that a certain type of photopolymerization device produces higher shear bond strength values.

Shear Bond Strength of the Metal Bracket to Zirconium Ceramic Restoration Treated by the Nd: YAG Laser and Other Methods: An In Vitro Microscopic Study

Introduction: Providing reliable bonding of the bracket base and the zirconia surface is required to apply orthodontic force. The purpose of this scientific experiment was to evaluate the efficacy of three different methods of surface preparation for Zirconia, including surface roughening, sandblasting and the Nd: YAG laser, in the shear bond strength (SBS) of the orthodontic brackets. Methods: Fifty-four discs of zirconia were divided into three groups of 18: A) Hydrofluoric acid etching, B) sandblasting, and C) Nd: irradiation using the power of 1.5 W for 10 seconds. After bonding the brackets, the samples were slowly thermo-cycled (1000 times) for 24 hours. The SBS test was performed by a universal testing machine at a head speed of 0.5 mm/min. The adhesive remnant index (ARI) was scored at a magnification of 10 in the stereo microscope. All data were collected and analyzed using the variance, Kruskal-Wallis, Tukey, Don, and Weibull tests (α = 0.05). Results: The HF acid etching group (6.11± 0.94 MPa) had the highest SBS, which was followed by the laser group (6 ± 0.61 MPa) and the sandblast group (3.1080 ± 0.82 MPa). There was a significant statistical difference between the laser and HF groups and the sandblast group (P < 0.05) and no significant difference between the HF group and the laser group (P = 0.03). Conclusion: Based on the obtained bond strength, the Nd: YAG laser with a power of 1.5 W could be a substitute treatment method for the HF acid-etching.

Bond strength of metal brackets to feldspathic ceramic treated with different surface conditioning methods: an in vitro study

Purpose:

To compare MEP which is originally manufactured for increasing bond strength between organic resins and ceramic with conventional surface treatment methods in preparation of leucite-reinforced FC surfaces regarding shear bond strength (SBS) of stainless steel brackets and the mode of bond failure.

Materials and methods:

Forty specimens that were fabricated from FC material and glazed were randomly assigned to four surface conditioning methods: (1) CoJet Sand; (2) MEP; (3) HF acid etching followed by silane coupling agent; (4) Diamond bur followed by silane coupling agent. The SBS was determined using universal testing machine. Bond failure sites were classified according to Adhesive Remnant Index (ARI).

Results:

No statistically significant difference (p less than 0.05) was found in SBS between the groups while significant intergroup differences were detected concerning ARI scores (p less than 0.001). Group 1 had ARI score 1 and 2 indicating mode of failure at the adhesive interface with greater percentage of the adhesive left on bracket base. The other groups had higher frequency of ARI score 3 and 2. The quantity of the ARI retained on the ceramic surface was highest in Group 3, followed by Group 4 and Group 2.

Conclusion:

MEP can be a suitable alternative for bonding metal brackets to FC surface.

Shear bond strength evaluation of metallic brackets bonded to a CAD/CAM PMMA material compared to traditional prosthetic temporary materials: an in vitro study

INTRODUCTION

Orthodontic treatment for adults is currently increasing, and therefore the need to bond brackets to restorations and temporary crowns. The use of CAD/CAM PMMA provisional restorations for orthodontic purposes have not yet been described, and there is currently insufficient information regarding the strength of bracket adhesion.

OBJECTIVE

This study aimed at evaluating the effects of thermocycling (TC) and surface treatment on shear bond strength (SBS) of brackets to different provisional materials.

METHODS

Forty specimens were made from each material [PMMA (Telio Lab), bis-acryl (Telio CS C&B), and PMMA CAD/CAM (Telio CAD)], sandpapered, and divided according to surface treatment (pumiced or sandblasted) and TC (half of the samples = 1,000 cycles, 5°C/55°C water baths) (n = 10/group). Stainless-steel brackets were bonded to the specimens (using Transbond XT), and SBS testing was performed. Data were analyzed by three-way ANOVA and LSD post-hoc tests (α = 0.05). Failure types were classified with adhesive remnant index (ARI) scores.

RESULTS

SBS values ranged from 1.5 to 14.9 MPa. Sandblasted bis-acryl and sandblasted auto-curing PMMA groups presented similar values (p> 0.05), higher than the CAD/CAM material (p< 0.05), with or without TC. When thermocycled, pumiced bis-acryl showed higher SBS than pumiced acrylic (p= 0.005) and CAD/CAM materials (p= 0.000), with statistical difference (p= 0.009). TC showed negative effect (p< 0.05) for sandblasted bis-acryl and pumiced acrylic groups. ARI predominant score was mostly zero (0) for CAD/CAM, 1 and 2 for bis-acryl, and 1 for acrylic groups.

CONCLUSION

In general, bis-acryl material showed the highest SBS values, followed by acrylic and CAD/CAM materials, which showed SBS values lower than an optimum strength for bonding brackets.

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.

Bond Strength of Metal and Ceramic Brackets on Resin Nanoceramic Material With Different Surface Treatments

Objective

This study aimed to evaluate the effects of different surface conditoning methods on surface texture and shear bond strength (SBS) of brackets bonded to resin nanoceramic material.

Methods

Ceramic specimens were divided into two groups as metal brackets and ceramic brackets. In each group, the following five subgroups were conditoned with orthophosphoric acid (OPA), hydrofluoric acid (HFA), silica coating with Cojet, Nd: Yag laser, and Femtosecond (Fs) laser. Extra samples were used for scanning electron microscopy and 3D profilometer evaluation.

Results

All surface conditioning methods caused optimum or higher SBS. Metal brackets had higher SBS than porcelain brackets, but this difference reached statistical significance only in Fs laser group. OPA caused surface modification comparable to HFA because of polymer content of resin nanoceramic. Although Fs laser and Cojet conditioning caused optimum or higher SBS, surface damage of these methods to the resin nanoceramic specimens clearly seen on 3D profilometer.

Conclusion

HFA and Nd: Yag laser are effective surface conditioning methods for resin nanoceramics. OPA combined with silane application caused optimum SBS and can be used as an alternative to HFA. Surface texture changes should be considered to determine surface damage while deciding the optimum surface conditioning method for ceramics other than SBS.

Shear Bond Strength of Metal Brackets to Porcelain Using a Universal Adhesive

Introduction:

Bracket bonding to porcelain has high failure rate compared to bonding to enamel.

Aim:

This study aimed to assess the shear bond strength (SBS) of metal brackets to porcelain using a universal adhesive.

Material and Methods:

In this in vitro experimental study, 40 porcelain blocks (1x1x1 cm³)were divided into four groups (n=10). The porcelain surfaces were etched with 10% hydrofluoric (HF) acid and bonded to metal brackets using Transbond XT composite and the following bonding protocols: Transbond XT bonding agent alone in group 1, silane plus Transbond XT bonding agent in group 2, silane plus universal adhesive (G-Premio bond) in group 3 and universal adhesive alone in group 4. The SBS was measured using a universal testing machine at a crosshead speed of 1 mm/minute. Fracture surfaces were evaluated under a stereo microscope, and the adhesive remnant index (ARI) scores were determined.

Results:

The highest and the lowest SBS values were noted in groups 3 (17.06±2.58 MPa) and 4 (9.85±4.76 MPa), respectively. Type of adhesive had no significant effect on SBS (P=0.611). However, the effect of application of silane on SBS was significant (P=0.000). Groups subjected to the application of silane showed higher SBS values than others. The mode of failure was mainly adhesive in groups 2 and 3, and adhesive and mixed in groups 1 and 4. The difference in ARI scores was statistically significant (P=0.016).

Conclusion:

Universal adhesive and Transbond XT were not significantly different in SBS. However, application of silane significantly increased the bond strength.

Influence of hydrofluoric acid etching time and concentration on shear bond strength of metal brackets to ceramic surfaces

Abstract Introduction Surface treatment prior to bonding ceramic brackets with hydrofluoric acid is indicated because of its ability to promote morphological changes necessary for adhesion. Objective To evaluate the shear bond strength (RUC) of metal brackets bonded to the feldspar ceramic surface under the action of hydrofluoric acid (AF), in different concentrations (5% and 10%) and different application times (30 and 60 seconds). Material and method Four nickel-chrome metal blocks that received an application of feldspathic ceramic were used, to which 80 metal brackets (Abzil/3M) were bonded and divided into 4 Groups (n=20) according to the acid etching procedure. The blocks were etched with 5% hydrofluoric acid for 30 and 60 seconds (AF5/30 and AF5/60, respectively) and 10% hydrofluoric acid for 30 and 60 seconds (AF10/30, AF10/60, respectively). The resin composite used was Transbond XT (3M) and the presence of a glazer was maintained on the ceramic surface. The specimens were placed on a Universal test machine Instron 4411 (Instron Corp, USA) to which a chisel was adapted to perform the shear test at a speed of 1mm/min. The data were submitted to the analysis of variance (ANOVA) and the Adhesive Remnant Index was evaluated. Result In the time interval of 30 seconds, there was no significant difference for the 5% and 10% hydrofluoric acid concentrations. In the 60-second time interval, the 10% concentration showed significantly higher shear bond strength values (p<0.05). The ARI showed predominance of scores 1 and 2. Conclusion It was concluded that 10% hydrofluoric acid showed higher shear bond strength values in 60 seconds of etching, while 5% hydrofluoric acid showed no significant difference between the etching times.

Shear bond strength of metal brackets to ceramic surfaces using a universal bonding resin

Background

Assure Plus is a recently introduced universal adhesive with the ability to bond to various restorations. This study compared the shear bond strength of brackets bonded to two types of ceramics using conventional bonding agent and Assure Plus. Surface damage caused by debonding was also evaluated.

Material and Methods

In this in vitro study, 40 feldspathic and lithium disilicate ceramic discs were sandblasted, etched with 9.6% hydrofluoric acid and divided into two groups. In group 1, silane was applied and air-dried followed by application of Transbond XT primer, which was light-cured. In group 2, Assure Plus was applied and air-dried. In both groups, maxillary central incisor brackets were bonded. After incubation in distilled water at 37°C for 24 hours and 2000 thermal cycles, bond strength was measured using a universal testing machine, and the adhesive remnant index (ARI) and failure modes were determined. ANOVA and LSD tests were used to compare bond strength values; chi-squared test was used to compare ARI scores.

Results

Bracket bond to lithium disilicate by Assure Plus was significantly stronger than that to Feldspathic porcelain (P=0.041). Only in the Assure Plus/lithium disilicate group did some adhesive remain on the surface following debonding (40% of samples, P<0.05). Cohesive porcelain fracture had the lowest frequency in the lithium disilicate/Assure Plus group.

Conclusions

Assure Plus provided high bond strength between ceramic and brackets and minimized damage to lithium disilicate ceramic during debonding. Assure Plus is recommended for use in orthodontic treatment of adults with ceramic restorations.

Key words:Adhesives, ceramics, dental bonding, shear bond strength.

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.

Shear bond strength of ceramic brackets bonded to surface-treated feldspathic porcelain after thermocycling

Purpose:

The aim of this study was to evaluate the effect of six different surface conditioning methods on the shear bond strength of ceramic brackets bonded to feldspathic porcelain.

Materials and methods:

A total of 60 feldspathic porcelain disks were fabricated and divided into six subgroups including 10 specimens in each. Specimens were first treated one of the following surface conditioning methods, namely, 37% phosphoric acid (G-H3PO4), 9.4% hydrofluoric acid (G-HF), grinding with diamond burs (G-Grinding), Nd:YAG laser (G-Nd:YAG), Airborne-particle abrasion (G-Abrasion). Specimens were also coated with silane without surface treatment for comparison (G-Untreated). A total of 60 ceramic brackets were bonded to porcelain surfaces with a composite resin and then subjected to thermocycling 2500× between 5°C and 55°C. The shear bond strength test was carried out using a universal testing device at a crosshead speed of 0.5 mm/min. Failure types were classified according to the adhesive remnant index. Analysis of variance and Tukey tests were used for statistical analysis (α = 0.05). Microstructure of untreated and surface-treated specimens was investigated by scanning electron microscopy.

Results:

Using G-Abrasion specimens resulted in the highest shear bond strength value of 8.58 MPa for feldspathic porcelain. However, the other specimens showed lower values: G-Grinding (6.51 MPa), G-Nd:YAG laser (3.37 MPa), G-HF (2.71 MPa), G-H3PO4 (1.17 MPa), and G-Untreated (0.93 MPa).

Conclusion:

Airborne-particle abrasion and grinding can be used as surface treatment techniques on the porcelain surface for a durable bond strength. Hydrofluoric acid and phosphoric acid etching methods were not convenient as surface treatment methods for the feldspathic porcelain.

Effects of different etching methods and bonding procedures on shear bond strength of orthodontic metal brackets applied to different CAD/CAM ceramic materials

OBJECTIVE

To investigate the shear bond strength (SBS) of orthodontic metal brackets applied to different types of ceramic surfaces treated with different etching procedures and bonding agents.

MATERIALS AND METHODS

Monolithic CAD/CAM ceramic specimens (N = 120; n = 40 each group) of feldspathic ceramic Vita Mark II, resin nanoceramic Lava Ultimate, and hybrid ceramic Vita Enamic were fabricated (14 × 12 × 3 mm). Ceramic specimens were separated into four subgroups (n = 10) according to type of surface treatment and bonding onto the ceramic surface. Within each group, four subgroups were prepared by phosphoric acid, hydrofluoric acid, Transbond XT primer, and Clearfill Ceramic primer. Mandibular central incisor metal brackets were bonded with light-cure composite. The SBS data were analyzed using three-way analysis of variance (ANOVA) and Tukey HSD tests.

RESULTS

The highest SBS was found in the Vita Enamic group, which is a hybrid ceramic, etched with hydrofluoric acid and applied Transbond XT Adhesive primer (7.28 ± 2.49 MPa). The lowest SBS was found in the Lava Ultimate group, which is a resin nano-ceramic etched with hydrofluoric acid and applied Clearfill ceramic primer (2.20 ± 1.21 MPa).

CONCLUSIONS

CAD/CAM material types and bonding procedures affected bond strength ( P < .05), but the etching procedure did not ( P > .05). The use of Transbond XT as a primer bonding agent resulted in higher SBS.

Effect of different surface treatments for ceramic bracket base on bond strength of rebonded brackets

The aim of this study was to evaluate the shear bond strength of rebonded ceramic brackets after subjecting the bracket base to different treatments. Seventy-five premolars were selected and randomly distributed into five groups (n=15), according to the type of the bracket surface treatment: I, no treatment, first bonding (control); II, sandblasting with aluminum oxide; III, sandblasting + silane; IV, silica coating + silane; and V, silicatization performed in a laboratory (Rocatec system). The brackets were fixed on an enamel surface with Transbond XT resin without acid etching. The brackets were then removed and their bases were subjected to different treatments. Thereafter, the brackets were fixed again to the enamel surface and the specimens were subjected to shear bond strength (SBS) test. The adhesive remnant index (ARI) was then evaluated for each specimen. Data were subjected to ANOVA and Tukey's tests (α=0.05). A statistically significant difference was observed only between Rocatec and the other groups; the Rocatec group showed the lowest SBS values. The highest SBS values were observed for group 1, without any significant difference from the values for groups II, III and IV. Most groups had a higher percentage of failures at the enamel-resin interface (score 1). It was concluded that the surface treatments of rebonded ceramic brackets were effective, with SBS values similar to that of the control group, except Rocatec group.

Influence of tooth brushing on adhesion strength of orthodontic brackets bonded to porcelain

BACKGROUND

Adhesive resin composite, which is used to bond orthodontic bracket to tooth surface is exposed to the influence of wear by tooth brushing and wear may influence loosening of the bracket.

OBJECTIVE

The aim of this study was to evaluate in vitro the effect of tooth brushing on the adhesion strength of orthodontic brackets bonded to surface treated porcelain.

METHOD

A total of 90 glazed porcelain fused to metal facets (PFM) were randomly assigned into 3 groups according to the surface treatment to be received. Group 1 was conditioned with hydrofluoric acid (HF), group 2 conditioned with grit-blasting (GB) and group 3 conditioned with tribochemical silica coating (RC). The groups were evaluated for surface roughness (Ra) before and after surface treatment. Next, 15 samples from each group were subjected to brushing and remaining 15 samples served as the baseline (n=15). Adhesion strength (shear bond strength)was recorded using a universal testing machine. Data collected were analyzed by ANOVA and Tukey's multiple comparison post hoc analysis.

RESULTS

Tooth brushing decreased the bond strength in all groups. The highest adhesion strength (baseline and after brushing) was observed in group 3 (26.8 ± 1.77 MPa and 23.57 ± 1.02 MPa) and the lowest was found in group 1 (9.6 ± 1.5 MPa and 5.87 ± 0.77 MPa). Group 3 specimens exhibited the highest Ra (1.24 ± 0.08).

CONCLUSION

It was found that tooth brushing of the exposed adhesive resin composite at the bracket-bonding substrate interface lowers the bonding strength regardless of the surface treatment of the substrate.

Bonding of Metal Orthodontic Attachments to Sandblasted Porcelain and Zirconia Surfaces

This study evaluates tensile bond strength (TBS) of metal orthodontic attachments to sandblasted feldspathic porcelain and zirconia with various bonding protocols. Thirty-six (36) feldspathic and 36 zirconia disc samples were prepared, glazed, embedded in acrylic blocks and sandblasted, and divided into three groups according to one or more of the following treatments: hydrofluoric acid 4% (HF), Porcelain Conditioner silane primer, Reliance Assure® primer, Reliance Assure plus® primer, and Z Prime™ plus zirconia primer. A round traction hook was bonded to each sample. Static tensile bond strength tests were performed in a universal testing machine and adhesive remnant index (ARI) scoring was done using a digital camera. One-way ANOVA and Pearson chi-square tests were used to analyze TBS (MPa) and ARI scores. No statistically significant mean differences were found in TBS among the different bonding protocols for feldspathic and zirconia, p values = 0.369 and 0.944, respectively. No statistically significant distribution of ARI scores was found among the levels of feldspathic, p value = 0.569. However, statistically significant distribution of ARI scores was found among the levels of zirconia, p value = 0.026. The study concluded that silanization following sandblasting resulted in tensile bond strengths comparable to other bonding protocols for feldspathic and zirconia surface.

Bond strength of metal brackets bonded to a silica-based ceramic with light-cured adhesive : Influence of various surface treatment methods

OBJECTIVE

The purpose of this work was to evaluate the effects of several surface treatment methods on the shear bond strengths of metal brackets bonded to a silica-based ceramic with a light-cured adhesive.

MATERIALS AND METHODS

Silica-based ceramic (IPS Classic(®)) with glazed surfaces was cut into discs that were used as substrates. A total of 80 specimens were randomly divided into four groups according to the method used: 9.6 % hydrofluoric acid (group 1), 9.6 % hydrofluoric acid (HF) + silane coupling agent (group 2), sandblasting (aluminum trioxide, 50 μm) + silane (group 3), and tribochemical silica coating (CoJet™ sand, 30 μm) + silane (group 4). Brackets were bonded to the treated specimens with a light-cure adhesive (Transbond XT, 3 M Unitek). Shear bond strength was tested after bracket bonding, and the Adhesive Remnant Index (ARI) scores were quantified after debonding.

RESULTS

Group 4 showed the highest bond strength (12.3 ± 1.0 MPa), which was not significantly different from that of group 3 (11.6 ± 1.2 MPa, P > 0.05); however, the bond strength of group 4 was substantially higher than that of group 2 (9.4 ± 1.1 MPa, P < 0.05). The shear bond strength of group 1 (3.1 ± 0.6 MPa, P< 0.05) was significantly lower than that of the other groups.

CONCLUSION

Shear bond strengths exceeded the optimal range of ideal bond strength for clinical practice, except for the isolated HF group. HF acid etching followed by silane was the best suited method for bonding on IPS Classic(®). Failure modes in the sandblasting and silica-coating groups revealed signs of damaged ceramic surfaces.

Influence of surface treatments on bond strength of metal and ceramic brackets to a novel CAD/CAM hybrid ceramic material

This study evaluated the effect of four different surface treatments methods on the shear bond strength (SBS) of ceramic and metal brackets to Vita Enamic (VE) CAD/CAM hybrid ceramic. A total of 240 plates (10 mm × 10 mm × 3 mm) were cut from VE ceramic blocks and divided into two groups. In each group, four subgroups were prepared by hydrofluoric acid (HF); phosphoric acid (H3PO4); diamond ceramic grinding bur; and silica coating using CoJet system (CJ). Maxillary central incisor metal (Victory Series) and ceramic (Clarity) brackets were bonded with light-cure composite and then stored in artificial saliva for 1 week and thermocycled. The SBS test was performed, and the failure types were classified with adhesive remnant index scores. Surface morphology of the ceramic was characterized after treatment using a scanning electron microscope. Data were analyzed using two-way ANOVA, Tukey HSD test, and Weibull analysis. SBS was significantly affected by the type of bracket and by type of treatment (P < 0.001). Specimens treated with CJ presented with significantly higher SBS compared to other groups (P < 0.05). Improvements in SBS values (MPa) were found in the following order: CJ > HF > Bur > H3PO4. Ceramic bracket showed higher SBS compared to metal bracket. Adhesive failures between the ceramic and composite resin were the predominant mode of failure in all groups. Surface treatment of VE CAD/CAM hybrid ceramic with silica coating enhanced the adhesion with ceramic and metal brackets.

Influence of ceramic surface treatment on shear bond strength of ceramic brackets

OBJECTIVE

To compare four different surface treatment methods and determine which produces adequate bond strength between ceramic brackets and facets of porcelain (feldspathic), and evaluate the Adhesive Remnant Index (ARI) scores.

MATERIALS AND METHODS

Ten facets of porcelain specimens with glazed surfaces were used for each group. The specimens were randomly assigned to one of the following treatment conditions of the porcelain surface: (1) no surface treatment (control group), (2) fine diamond bur + orthophosphoric acid gel 37%, (3) hydrofluoric acid (HFL) 10%, and (4) HFL 10% + silane. Ceramic brackets were bonded with the adhesive cement Transbond XT. The shear bond strength values were measured on a universal testing machine at a crosshead speed of 0.5 mm/min.

RESULTS

There was a significant difference (P<0.05) between the control group and all other groups. There was no significant difference (P<0.05) between treated porcelain surface with diamond bur + orthophosphoric acid gel 37% (4.8 MPa) and HFL 10% (6.1 MPa), but the group treated with HFL 10% had clinically acceptable bond strength values. The group treated with HFL 10% + silane (17.5 MPa) resulted in a statistically significant higher tensile bond strength (P<0.05). In group 4, 20% of the porcelain facets displayed damage.

CONCLUSION

Etching of the surface with HFL increased the bond strength values. Silane application was recommended to bond a ceramic bracket to the porcelain surface in order to achieve bond strengths that are clinically acceptable.

Orthodontic bonding to porcelain: a systematic review

OBJECTIVE

To use a systematic review to determine which materials and technique/protocol present the highest success rate in bonding brackets to porcelain surfaces.

MATERIALS AND METHODS

Different databases were searched without limitations up to July 2013. Additionally, the bibliographies of the finally selected articles were hand searched to identify any relevant publications that were not identified earlier. In vitro and in vivo articles were included.

RESULTS

No in vivo articles were found that fulfilled the inclusion criteria. A total of 45 in vitro articles met all inclusion criteria. They were published between 2000 to July 2013.

CONCLUSIONS

The best protocol described in this review is the etching of 9.6% hydrofluoric acid for 1 minute, rinsed for 30 seconds, and then air-dried. The etching of hydrofluoric acid should be followed by an application of silane. Considering the harmful effects of etching with hydrofluoric acid, another appropriate suggestion is mechanical roughening with sandblasting followed by an application of silane.

Comparison of shear bond strength of metal brackets bonded to porcelain surface using different surface conditioning methods: an in vitro study

AIM

To evaluate and compare the shear bond strength of metal brackets bonded to ceramic surfaces using different conditioning methods and to assess the site of bond failure after debonding.

MATERIALS AND METHODS

A total of 70 ceramic surfaces were produced with uniform shape, size and composition. The samples were divided into 7 groups (each of 10 samples). Group 1 was the control group (untreated surface); in group 2 the surface were roughened with a diamond bur; in group 3 the surface were etched with hydrofluoric acid; in group 4 the surfaces were sandblasted; in group 5 the surfaces roughened with bur and silane applied; in group 6 the surfaces were etched with hydrofluoric acid and silane applied and in group 7 the surfaces were sandblasted and silane applied. To all the above groups, metal orthodontic brackets were bonded with light cure adhesive. The brackets were later stored in artificial saliva and incubated at 37°C (24 hours). The samples were then subjected to shear bond strength test using an Instron universal testing machine. The debonded porcelain surfaces were then studied under stereomicroscope to assess site of bond failure.

RESULTS

Sandblasting the ceramic surface and silane application showed the highest bond strength. Stereomicroscope examination after debonding showed that the bond failure is at bracket-adhesive interface in four groups namely hydrofluoric acid, sandblasting, hydrofluoric acid with silane and sandblasting with silane.

CONCLUSION

Sandblasting with silane combination produced the highest shear bond strength, so it is a clinically suitable method for bonding orthodontic metal brackets onto ceramic surface.

CLINICAL RELEVANCE

Bonding orthodontic brackets to ceramic crowns of patients has been a tough task. In this study, different conditioning methods were used to treat the ceramic surfaces before bonding. The results showed that sandblasting the ceramic surface prior to application of silane produced the highest shear bond strength which is clinically suitable to reduce bond failures.

Factors affecting the shear bond strength of metal and ceramic brackets bonded to different ceramic surfaces

The aims of this study were to evaluate the shear bond strength (SBS) of metal and ceramic brackets bonded to two different all-ceramic crowns, IPS Empress 2 and In-Ceram Alumina, to compare the SBS between hydrofluoric acid (HFA), phosphoric acid etched, and sandblasted, non-etched all-ceramic surfaces. Ninety-six all-ceramic crowns were fabricated resembling a maxillary left first premolar. The crowns were divided into eight groups: (1) metal brackets bonded to sandblasted 9.6 per cent HFA-etched IPS Empress 2 crowns; (2) metal brackets bonded to sandblasted 9.6 per cent HFA-etched In-Ceram crowns; (3) ceramic brackets bonded to sandblasted 9.6 per cent HFA-etched IPS Empress 2 crowns; (4) ceramic brackets bonded to sandblasted 9.6 per cent HFA-etched In-Ceram crowns; (5) metal brackets bonded to sandblasted 37 per cent phosphoric acid-etched IPS Empress 2 crowns; (6) metal brackets bonded to sandblasted 37 per cent phosphoric acid-etched In-Ceram crowns; (7) metal brackets bonded to sandblasted, non-etched IPS Empress 2 crowns; and (8) metal brackets bonded to sandblasted, non-etched In-Ceram crowns. Metal and ceramic orthodontic brackets were bonded using a conventional light polymerizing adhesive resin. An Instron universal testing machine was used to determine the SBS at a crosshead speed of 0.1 mm/minute. Comparison between groups was performed using a univariate general linear model and chi-squared tests. The highest mean SBS was found in group 3 (120.15 +/- 45.05 N) and the lowest in group 8 (57.86 +/- 26.20 N). Of all the variables studied, surface treatment was the only factor that significantly affected SBS (P < 0.001). Acid etch application to sandblasted surfaces significantly increased the SBS in groups 1, 2, 5, and 6. The SBS of metal brackets debonded from groups 1, 3, and 5 were not significantly different from those of groups 2, 4, and 6. All debonded metal brackets revealed a similar pattern of bond failure at the adhesive-restorative interface. However, ceramic brackets had a significantly different adhesive failure pattern with dominant failure at the adhesive-bracket interface. Ceramic fractures after bracket removal were found more often in groups 1-4. No significant difference in ceramic fracture was observed between the IPS Empress 2 and In-Ceram groups.

Porcelain Refinishing with Two Different Polishing Systems after Orthodontic Debonding

Objective: To compare the effects of two polishing systems on the surface roughness of three types of porcelain after orthodontic debonding.

Materials and Methods: A total of 90 porcelain discs were fabricated from feldspathic (n = 30), leucite-based (n = 30) or lithia disilicate–based (n = 30) ceramics. Ten samples in each group served as the control and received no surface treatment. The remaining 60 samples in three of the porcelain groups were bonded with lower incisor brackets and debonded using a testing machine in shear mode at a rate of 1 mm/minute crosshead speed. After debonding, the remaining adhesive resin was removed with a tungsten carbide bur. Then, two experimental subgroups (10 each) in each porcelain group were treated as follows: in the first subgroup, porcelain polishing wheel and polishing paste were applied, whereas in the second, polishing was performed using a series of Sof-Lex discs. The average surface roughness (Ra) of the all samples was evaluated using SPM/AFM (surface probe microscope/atomic force microscope). Data were statistically analyzed by analysis of variance for each porcelain material and polishing method.

Results: The polishing techniques affected surface roughness significantly. There were significant differences between the groups; higher Ra values were obtained with the use of porcelain polishing wheel and polishing paste (P &lt; .001).

Conclusion: The application of Sof-Lex discs can produce smoother porcelain surfaces than porcelain polishing wheel and polishing paste.