Orthodontic bonding using glass ionomer cement: an in vitro study

Caries-Preventive Effects of Fluoride-Releasing Materials

The plaque-retentive properties of fixed orthodontic appliances result in a severe challenge on surfaces generally not susceptible to caries. Lesions may develop within a month in the absence of fluoride, and clinical studies have shown that from 50 to 75% of orthodontic patients develop decalcifications on labial surfaces during treatment. Fluoride mouthrinses reduce the occurrence, although compliance is often poor. Orthodontic bonding agents and cements releasing fluoride, which reduce the need for cooperation, have been introduced. Few clinical studies have been done to prove the cariostatic properties of fluoride-releasing materials in orthodontics. In short-term caries model studies, glass ionomers and a glass filler containing light-cured adhesive that releases relatively large amounts of fluoride have shown cariostatic properties. However, during severe challenges such as occur with orthodontic appliances, fluoride alone has limited cariostatic properties. The combination of fluoride with antimicrobial agents, and the use of acidic fluoride solutions depositing acid-resistant coatings of calcium fluoride and titanium have shown to give better clinical effects than fluoride alone during extreme conditions. Fluoride-releasing materials may therefore be considered as useful supplements to these procedures.

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.

Use of a self-etching primer in combination with a resin-modified glass ionomer: effect of water and saliva contamination on shear bond strength

The purpose of this study was to evaluate the effects of 3 different enamel conditioners (10% polyacrylic acid, 37% phosphoric acid, and self-etching primer) on the shear bond strength and site of bond failure of a resin-modified glass ionomer (Fuji Ortho LC, GC Europe, Leuven, Belgium) bonded onto dry, water-moistened, and saliva-moistened enamel. One hundred eighty bovine permanent mandibular incisors were randomly divided into 12 groups; each group consisted of 15 specimens. Three different enamel surface conditions were studied: dry, soaked with water, soaked with saliva. One hundred eighty stainless steel brackets were bonded with the resin-modified glass ionomer. After bonding, all samples were stored in distilled water for 24 hours and then tested in a shear mode on a testing machine. After self-etching primer application, Fuji Ortho LC produced the highest shear bond strengths under all the different enamel surface conditions; these values were significantly higher than those achieved in the remaining groups, except when Fuji Ortho LC was used in combination with 37% phosphoric acid on dry enamel. Fuji Ortho LC bonded without enamel conditioning produced the lowest shear bond strengths. The bond strength of the groups conditioned with 10% polyacrylic acid was significantly lower than that of the groups etched with 37% phosphoric acid, except when both conditioners were used on enamel soaked with water.

Self-etching vs. traditional bonding systems in orthodontics: an in vitro study

The need for a bonding system that is consistently reliable, biocompatible, and most of all, easy to use and is unaffected by saliva contamination, has led to the development of products that did not require the initial step of etching the enamel surface. In these new systems elements of etching, priming and bonding are all in one component. The aim of this study was to compare the bonding strength of brackets with a traditional technique to the Prompt L-Pop (monocomponent adhesive) using the same composite resin. The results showed no statistical differences in detachment values of these two groups.

An 18-month clinical study of bond failures with resin-modified glass ionomer cement in orthodontic practice

The purpose of this study was to evaluate, over an 18-month period, the clinical performances of a resin-modified glass ionomer cement for bonding orthodontic brackets and to analyze various factors that influenced their survival and failure rates. Two orthodontists using the edgewise technique participated in this study; 6113 brackets, including 20 molar tubes, were bonded with Fuji Ortho LC (GC, Europe, N.V. Leuven, Belgium) in 135 patients. Ceramic, metal, and resin brackets were tested, and both operators used the same bonding method for the brackets. The survival rate and the failure rate of the brackets were evaluated. The rates were determined by operator, bracket type, tooth position in the dental arch, and age and sex of the patients. Bracket survival rates were estimated using the Kaplan-Meier test. The Cox-Mantel statistical test with a level of significance set at 0.05 was used to compare survival curves. The chi-square test was used at a level of P < .05 to compare failure rates. The overall failure rate for the sample was 7%, and the overall survival rate was equal to 0.918. Age had no significant influence on the failure rate (P = .07); however, it had a significant influence on the survival rate (P < .01). The best survival rates were obtained in the groups aged 16 to 20 years (S[t] = 0.943) and older than 20 years (S[t] = 0.929). The difference between males and females was not statistically significant in terms of failure rate (P = .17). However, the Cox-Mantel test showed a higher bracket survival rate for the males (S[t] = 0.924) than for the females (S[t] = 0.839) (P < .00001). The influence of the operator was not statistically significant on the failure rate (P = .08); however, it was significant on the survival rate (P < .0002). Location in the arch had a significant influence on the failure and survival rates. The worst results were obtained in the upper incisors and the canines, and the best results in the lower premolars. Fifteen percent of the molar tubes failed; their survival rate was equal to 0.833. The failure rate was significantly greater for resin brackets than for metal or ceramic brackets (P = .007). The highest survival rate was obtained with ceramic brackets (P = .0001). This in vivo study showed that bonding brackets and molar tubes with Fuji Ortho LC is compatible with clinical orthodontic practice.

The effect of long-term water storage on the tensile strength of orthodontic brackets bonded with resin-reinforced glass-ionomer cements

The purpose of this study was to evaluate in vitro the effect of water storage on the tensile bond strength of orthodontic brackets bonded with Vitremer and Fuji II LC resin-reinforced glass-ionomer cements. Seventy-two extracted human premolars were randomly divided into 6 groups and the bonding strengths of the resin-reinforced glass-ionomer cements were compared to control groups bonded with Concise composite resin at 24 hours and 9 months. The brackets were bonded on prepared teeth and a tensile load was applied to dislodge the brackets held in a special device from Lloyd 1000R testing machine. The effects of duration of water exposure, type of bonding material and interaction between long-term water exposure and type of bonding material on the bonding strength were described using the Weibull regression model. The mean tensile bond strength of resin-reinforced glass-ionomers after 24 hours water storage was significantly lower than the mean of the control samples. The results of this study showed no effect of water exposure on the tensile bond strength of brackets bonded with Vitremer glass-ionomer cement. The mean bonding strength of brackets bonded with Fuji II LC without enamel pre-conditioning significantly increased after 9-months water storage as compared to Fuji samples exposed to water for 24 hours. The results of this investigation allow to conclude: 1. Long-term water storage had not decreased the bond strength of resin-reinforced glass-ionomers applied as orthodontic adhesives, 2. Weibull regression model is an adequate and flexible tool to evaluate the bonding properties of dental materials.

Enamel demineralization adjacent to orthodontic brackets bonded with hybrid glass ionomer cements: an in vitro study

Enamel demineralization is recognized as a possible side effect of bonding orthodontic brackets with composite resins. Fluoride-releasing restorative materials have been shown to inhibit tooth demineralization. The purpose of this study was to evaluate two fluoride-releasing hybrid glass ionomer bonding agents for inhibition of enamel demineralization surrounding orthodontic brackets under two experimental conditions. This in vitro study used 72 extracted human premolars. Twenty-four teeth were bonded with Advance resionomer, 24 were bonded with Fuji Ortho LC hybrid glass ionomer and 24 were bonded with Transbond XT composite resin as the control. The teeth were cycled in an artificial caries challenge three times daily for 30 days. Half of the teeth in each group were brushed twice daily with a fluoridated dentifrice, and the other half were not brushed. Demineralization of enamel surrounding orthodontic brackets was evaluated with polarized light microscopy. Enamel lesions were photographed under maximum illumination. Images were projected, and demineralized areas were traced. Both average depth and area were measured with a sonic digitizer. Analysis of variance (P <.0001) and Duncan's test (P <.05) indicated significant differences in depth and area of demineralized enamel such that lesion size was: Transbond XT no brush > Transbond XT brush > Advance no brush = Advance brush = Fuji Ortho LC no brush = Fuji Ortho brush. The promising results of this in vitro study warrant further clinical investigation of hybrid glass ionomer adhesives as orthodontic bonding agents to minimize enamel demineralization.

Cariostatic effect of a light-cured, resin-reinforced glass-ionomer for bonding orthodontic brackets in vivo. A combined study using microradiography and confocal laser scanning microscopy

The aim of this study was to evaluate in vivo the cariostatic potential of the resin-reinforced glass-ionomer (Vitremer core build-up restorative; 3M Dental Product Division) when used as a bonding agent for orthodontic brackets. The mineral distribution and topography of the enamel surface adjacent to the bracket base was determined by quantitative microradiography (TMR) and confocal laser scanning microscopy (CLSM). The study was designed in split-mouth technique using 9 pairs of premolars to be extracted for orthodontic reasons. One tooth of each pair was bonded with the resin-reinforced glass-ionomer, and the control contralateral premolar with the non-fluoridated composite (Concise, 3M Dental Products Division). After 4 weeks all teeth were extracted and stored until analysis. The lesion depths and mineral loss values in enamel adjacent to brackets bonded with Vitremer were significantly lower than in teeth bonded with the composite, indicating that the resin-reinforced glass-ionomers significantly reduced caries lesion development in vivo. CLSM images show a severe cariogenic challenge around orthodontic brackets and support TMR measurements.

Light-cured glass ionomer cement as a bracket adhesive with different types of enamel conditioners

Eighty bovine incisors were ground on 320-grit silicone carbide paper and cleaned with fluoride-free prophylaxis paste. The enamel surface conditions were: 1. no conditioning; 2. salicylic acid (10%, 10s); 3. benzoic acid (10%, 10s); 4. air polishing with sodium hydrogen carbonate/Prophy-Jet; 5. Prophy-Jet, followed by polyacrylic acid (PAA, 10%, 10 s); 6. PAA, followed by saliva contamination; 7. PAA; 8. phosphoric acid (37%, 10 s). Fuji Ortho II LC (GC) was used as a bracket adhesive in groups 1 t0 7, and in group 8 Concise orthodontic (3M). Stainless steel lingual buttons were placed by hand. Polymerisation with visible light was carried out 20 s from mesial, distal, incisal and gingival. After 24 h storage in tap water at room temperature the shear bond strengths were tested in accordance with ISO specification TC 106/SC/WG16. Mean values of the groups were compared using Student's t-test. Group 7 (PAA) attained the highest mean shear strength (in comparison with control group): 28 MPa. This was both significantly different from the control group (Concise, 33 MPa) and highly significant in comparison with the other groups (< 16 MPa). The shear bond strength of Fuji Ortho II LC on PAA conditioned enamel indicates the clinical applicability of this material.

Probability of failure of orthodontic brackets bonded with different cementing agents

OBJECTIVES

The aim of this study was to compare the maximum loads at failure and the probability of failure of three glass ionomer cements and a composite cement bonding orthodontic brackets to human premolar teeth.

METHODS

The cements studied included a conventional glass ionomer cement, two resin-modified glass ionomer cements and a composite cement. The roots of 200 human premolar teeth were embedded in acrylic resin and the buccal enamel surface of the crown prepared as required. Each cement used to bond the bracket to the enamel was weighted, and light-cured where required. The specimens were stored for 10 min or 24 h at 37 degrees C and 100% humidity. A tensile shear force was applied via a wire loop placed under the wings of the bracket. The maximum load at failure was noted and subjected to Weibull analysis to compare probabilities of survival for each cement. The data obtained was also analyzed using a Kruskal-Wallis test followed by comparison of the groups using Mann-Whitney tests.

RESULTS

Comparison of the loads at failure revealed that the composite cement was significantly stronger than the glass ionomer cements at 10 min and 24 h (p<0.05). Weibull analysis of the results gave values for the Weibull moduli and probabilities of survival for an orthodontic bracket under a given load for each cement at 10 min and 24 h.

SIGNIFICANCE

. Glass ionomer cements give a number of clinically significant advantages over composite cement in the retention of brackets. The resin-modified glass ionomer cements tested had a higher probability of survival than the conventional cement tested at 24 h. However, further improvements in their early bond strength would be clinically beneficial.

Retention capacity of the bracket bases of new esthetic orthodontic brackets

Tensile bond strength and bond failure locations were evaluated in vitro for three types of direct bonding cements (self-cured diacrylate, dual-cured diacrylate, and dual-cured glass ionomer) with four types of brackets (stainless steel, polycarbonate, ceramic, and ceramic-polycarbonate) by using a plastic cylinder as the substrate. A highly filled, self-cured diacrylate cement gave the highest bond strength values with the polycarbonate, stainless steel, and ceramic-polycarbonate brackets. A dual-cured diacrylate cement gave the highest bond strength with a mechanically retained ceramic bracket. The dual-cured glass ionomer cement gave the highest bond strength values with a silanated ceramic bracket. All bond failures occurred at the bracket/cement interface with the stainless steel bracket, whereas failure locations were at the bracket/cement interface and within the cement with the polycarbonate bracket. Bond failures occurred between bracket and cement, within the cement, and within the bracket with the ceramic brackets.

Bond strengths of ceramic brackets using different bonding techniques

A series of laboratory investigations was carried out to compare the shear-type bond strengths and site of bond failure of ceramic orthodontic brackets bonded to etched enamel. When light-cured composite resin was used as the luting agent, there was no reduction in bond strength when using 2.5 per cent nitric acid to etch the enamel, compared to 37 per cent phosphoric acid. The use of the two resin modified glass ionomer cements were found to give rise to significantly lower bond strengths than composite resin when used for placing ceramic brackets. Significantly less composite resin remained on the enamel surface following bracket removal in those samples etched with nitric acid.

Effects of cyclic stressing on attachment bond strength using glass ionomer cement and composite resin

Bonded orthodontic brackets were subjected to cyclic loading in order to simulate the effect of occlusal forces. The subsequent effect on bond strength was determined. Stainless steel, mesh-based brackets were bonded to extracted teeth with either composite resin or glass ionomer cement. A jig was designed to subject each bracket to a preselected loading level and the 24-hour shear/peel bond strength of both stressed and unstressed brackets was subsequently measured. Cyclic loading brought about a comparative decrease in bond strength when using both types of material. The potential implications of selecting these different types of bonding material for clinical use are discussed.

A 12-month clinical evaluation of a light-activated glass polyalkenoate (ionomer) cement for the direct bonding of orthodontic brackets

Glass polyalkenoate cements have the unique properties of physicochemically bonding to enamel and base metals and to leach fluoride over prolonged periods. These cements have been modified to provide a dual setting with both light activation and chemical cure to produce a more rapid set. This article reports a 12-month clinical trial of a light-activated glass polyalkenoate cement for the direct bonding of orthodontic brackets, compared with a standard composite bonding adhesive. There was no significant difference in failure rates of direct bonded orthodontic brackets cemented with Fuji II LC light-activated glass polyalkenoate cement (GC Industrial Co., Tokyo, Japan) (3.3%) compared with System I+ composite bonding resin (Ormco Corp., Glendora, Calif.) (1.6%).

A comparative study of the shear bond strengths of four different crystal growth solutions

Previously, solutions based on polyacrylic acid have been found to initiate crystal growth on the enamel surface. Such crystals have been proposed as being suitable for the attachment of orthodontic brackets via a conventional composite interface, the advantages being improved clean-up characteristics and reduced damage to the enamel. In order to try and improve the reliability of the technique this base solution has been modified by the authors, by the addition of various ionic salts. The strength of the resultant bond was assessed for the base solution of 50 per cent polyacrylic acid and concentrated sulphuric, and for three more solutions modified by the addition of the sulphates of lithium, magnesium, and potassium, respectively. A standard acid/etch method of bracket attachment was also included for the purposes of comparison. The bond strength of each material was assessed by shear testing, performed on human extracted premolar teeth to a standard method. As might have been expected the acid/etch system proved to be the strongest method of bonding brackets. Amongst the crystal solutions, the addition of lithium sulphate provided the highest mean shear strength at 80 per cent of that for acid etch. Therefore, this latter solution provides the most potential for development in the future.