In vitro evaluation of a fluoride-releasing orthodontic resin

Comparative Evaluation of Fluoride Release From Chemically Cured and Light-Cured Orthodontic Bonding Agents and Surface Alteration of Enamel: An in vitro Study

Introduction: Fluoride is known to reduce demineralization and enhance remineralization which is desirable around orthodontic brackets.

Material and methods: This study was carried out to determine the rate of fluoride release, fluoride content of enamel, and surface alteration of enamel from orthodontic bonding agents. Thirty extracted maxillary first premolars were divided into 2 groups of 15 teeth each. Group A—teeth were bonded with a chemically cured orthodontic bonding agent containing fluoride (Rely-a-Bond, Reliance, Itasca) and group B—teeth were bonded with a light-cured orthodontic bonding agent containing fluoride (Light Bond Reliance, Itasca). All individual sample teeth were used to estimate fluoride release and fluoride content of enamel. The same samples were also used to evaluate enamel surface alterations. The rate of fluoride release from the above 2 orthodontic bonding agents were measured in artificial saliva on day 1, 2, 3, 4, 5, 6, 7, 14, 30, 60, and 90. The fluoride content of the enamel was evaluated on day “0” and day “90” of bonding. The samples were also evaluated for the surface changes in enamel using scanning electron microscope (SEM).

Results: The results showed that (a) chemically cured and light-cured bonding agent showed a dramatic decrease in the concentration of fluoride release from day “1” to day “2,” (b) the concentration of fluoride release kept decreasing from day “1” to day “90” of measurement in both the groups, and (c) SEM of the bracket margins bonded with chemically cured bonding agent and light-cured bonding agent revealed particle depositions of irregular shape and size on day “90.”

Conclusion: Light-cured bonding agent (Light Bond) released higher concentration of fluoride as compared to chemically cured bonding agent (Rely-a-Bond). Light-cured bonding agent (Light Bond) showed higher increase in fluoride content of enamel than chemically cured bonding agent (Rely-a-Bond).

Antibacterial Activity and Bonding Ability of an Orthodontic Adhesive Containing the Antibacterial Monomer 2-Methacryloxylethyl Hexadecyl Methyl Ammonium Bromide

Irreversible white spot lesion (WSL) occurs in up to 50% of patients during orthodontic treatment. Therefore, orthodontic adhesives need to be able to inhibit or reduce bacterial growth in order to prevent or minimize WSL. This study evaluated the antibacterial effect and shear bond strength (SBS) of a resin-based orthodontic adhesive containing the antibacterial monomer 2-methacryloxylethyl hexadecyl methyl ammonium bromide (MAE-HB). MAE-HB was added at three concentrations (1, 3, and 5 wt%) to a commercial orthodontic adhesive Transbond XT, while the blank control comprised unmodified Transbond XT. Their antibacterial effects on Streptococcus mutans were investigated after 0 and 180 days of aging. The SBS of metal brackets bonded to the buccal enamel surface of human premolars was assessed. Compared with the blank control, the MAE-HB-incorporated adhesive exhibited a significant contact inhibitory effect on the growth of S. mutans (P < 0.05), even after 180 days of aging. SBS and adhesive remnant index values revealed that the bonding ability of the experimental adhesive was not significantly adversely affected by the incorporation of MAE-HB at any of the three concentrations. Therefore, orthodontic adhesives with strong and long-lasting bacteriostatic properties can be created through the incorporation of MAE-HB without negatively influencing bonding ability.

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.

The effects of in vitro fluoride mouth rinse on the antibacterial properties of orthodontic cements

OBJECTIVES

To investigate the ability of orthodontic cements to regain their antibacterial effect after aging for 1 month, followed by 2 weeks of fluoride 'recharging' through daily fluoride rinse.

MATERIALS AND METHODS

Four orthodontic cements were tested: composite resin-based materials (Transbond XT and Transbond Plus), a conventional glass ionomer cement (CX Plus) and dual-cured resin-reinforced glass ionomer cement (Fuji ORTHO LC) by direct contact test. After polymerization and a 30-day aging process, the samples were rinsed daily with 0.05% NaF solution for 14 days. Twenty-four hours after the last fluoride rinse, Streptococcus mutans cells (approximately 1 x 10(6) ) were placed on the surface of each sample for 1 h at 37°C to establish direct contact. Bacterial growth was monitored for 24 h by temperature-controlled spectrophotometry. Similar experiments were conducted after aging for 48 h and 72 h after the last fluoride rinse. One-way anova, two-way anova, and Tukey's multiple comparison test were applied to the data.

RESULTS

Twenty-four hours after the last fluoride rinse, the resin-modified glass ionomer and the glass ionomer showed potent antibacterial properties, whereas the composite-based material Transbond XT encouraged bacterial growth. After 72 h, only Fuji Ortho LC maintained its bacteriostatic properties while all the other tested materials showed no antibacterial activity.

CONCLUSIONS

Fourteen days daily fluoride rinse temporarily revives the antibacterial properties of the resin-modified glass ionomer cement and glass-ionomer-based cement.

Effects of the addition of fluoride to a 4-META/MMA-TBB-based resin adhesive on fluoride release, acid resistance of enamel and shear bond strength in vitro

This study investigated fluoride release, acid resistance and shear bond strength (SBS) of new 4-META/MMA-TBB-based fluoride-containing resin adhesive (Super-Bond/F3). Super-Bond, Transbond Plus and Fuji Ortho LC were selected for comparison. Fluoride release into distilled water during 6-month period was measured using disk-shaped specimens. Brackets were bonded to human premolars with each material and then the specimens for the nanoindentation test were subjected to alternating immersion (demineralizing and remineralizing solutions); the hardness and elastic modulus of the enamel around bracket were determined. Rest of the specimens was subjected to examine the SBS. Super-Bond/F3 and Fuji Ortho LC showed significantly greater fluoride release compared with the other materials. The reductions in hardness and the elastic modulus for Super-Bond/F3 and Fuji Ortho LC were lower than those for the other materilas. Super-Bond and Super-Bond/F3 showed significantly greater SBS than Fuji Ortho FC. In conclusion, Super-Bond/F3 showed high fluoride-release, cariostatic potential and equivalent SBS.

Avaliação da atividade antimicrobiana de adesivo ortodôntico associado a verniz de clorexidina e timol na colagem de braquetes

OBJETIVO: avaliar a atividade antimicrobiana da associação de um adesivo ortodôntico com um verniz de clorexidina e timol. MÉTODOS: foram utilizados 32 pré-molares humanos divididos em 4 grupos. O grupo 1 consistiu do grupo controle, no qual o adesivo utilizado para a colagem do braquete não estava associado a nenhum agente antimicrobiano. Os grupos 2, 3 e 4 foram colados com um sistema adesivo associado a um verniz de clorexidina e timol. Os grupos 3 e 4 foram armazenados em água por 7 dias e 30 dias, respectivamente, enquanto os corpos de prova do grupo 2 foram, logo depois da colagem, colocados em ágar semeado com Streptococcus mutans por 48h a 37ºC. RESULTADOS: os grupos experimentais, com exceção do grupo controle, apresentaram atividade antimicrobiana com tendência de redução do seu potencial de ação com maior tempo de imersão em água. CONCLUSÃO: a associação do verniz de clorexidina a um sistema adesivo utilizado em Ortodontia apresenta-se vantajosa pela sua atividade antimicrobiana.

Fluoride release and cariostatic potential of orthodontic adhesives with and without daily fluoride rinsing

INTRODUCTION

In this study, we aimed to evaluate the fluoride-release profiles and caries lesion development in an enamel model with brackets cemented with 4 orthodontic adhesives with and without daily fluoride exposure.

METHODS

Four orthodontic adhesives (Ketac Cem mu, 3M ESPE, Seefeld, Germany; Fuji Ortho LC, GC Corporation, Tokyo, Japan; Light-Bond, Reliance Orthodontic Products, Itasca, Ill; and Transbond XT, 3M Unitek, Monrovia, Calif) were used. Brackets were bonded on bovine enamel with each adhesive (n = 10) and subjected to alternate cycles of demineralizing (pH 4.55) and remineralizing (pH 6.8) solutions. Unbracketed enamel samples served as a reference. Five samples from each group were immersed in a fluoride mouth rinse (250 ppm fluoride) for 1 minute each day (test groups). Fluoride release was measured at regular intervals over 28 days. The mineral distribution of peribracket enamel after 28 days was quantified by transversal microradiographs.

RESULTS

Fluoride-release profiles of Ketac Cem mu, Fuji Ortho LC, and Light-Bond were high for the first 24 hours and reached a constant level after 2 weeks. Fuji Ortho LC released significantly more fluoride than did the other adhesives in both the control and test groups (P <0.01, repeated measures ANOVA and Bonferroni test). Enamel bonded with Fuji Ortho LC had significantly shallower lesions and less mineral loss (P <0.01, 2-way ANOVA, and Tukey HSD).

CONCLUSIONS

Bonding of orthodontic brackets with Fuji Ortho LC resulted in less peribracket enamel demineralization with and without daily fluoride rinsing, mainly due to its better fluoride-release profile. In contrast, Transbond XT and Light-Bond offered few cariostatic effects to the enamel.

Antimicrobial Effects of Zinc Oxide in an Orthodontic Bonding Agent

Objective: To test the null hypothesis that the addition of zinc oxide (ZnO) has no effect on the antimicrobial benefits and shear bond strength of a light-cured resin-modified glass ionomer.

Materials and Methods: ZnO was added to Fuji Ortho LC to create mixtures of 13% ZnO and 23.1% ZnO. Specimen discs of the modified bonding agent were incubated with Streptococcus mutans for 48 hours in a disc diffusion assay that was used to measure zones of bacterial inhibition. In addition, brackets were bonded to bovine deciduous incisors with the modified bonding agents, and shear bond strength was evaluated with a universal testing machine.

Results: The modified samples showed that antimicrobial activity increased as the concentration of ZnO increased. There were significant differences (P &lt; .05) in antimicrobial activity. Post hoc tests showed that the antibacterial effects were 1.6 times greater with 23.1% ZnO than with 13% ZnO. There was no difference between Transbond and 0% ZnO (the negative control). After 1 month of daily rinsing, the antibacterial effects of 23.1% ZnO and 13% ZnO decreased 65% and 77%, respectively, but both maintained significant effects over the negative controls. There were no significant differences (P = .055) in shear bond strength between any of the mixture comparisons.

Conclusions: The incorporation of ZnO into Fuji Ortho LC added antimicrobial properties to the original compound without significantly altering the shear bond strength. ZnO holds potential for preventing decalcification associated with orthodontic treatment.

Shear Bond Strength of Orthodontic Brackets Bonded using Conventional vs One and Two Step Self-etching/adhesive Systems

OBJECTIVE

To assess and compare the effects of one- and two-step self-etching primer and adhesive with conventional acid-etching and bonding system on the shear bond strength of orthodontic brackets.

MATERIALS AND METHODS

The one-step self-etching primer and adhesive used was Clearfil tri-S bond, the two-step fluoride-releasing antibacterial self-etching primer and adhesive was Clearfil Protect Bond, and the fluoride-releasing conventional acid-etching and bonding system was Kurasper F Bond. Brackets were bonded to defect-free human premolars (n = 14 per group) according to each manufacturer's recommendations by using light-cured bracket adhesive Kurasper F Paste with a light-emitting diode of a light-curing unit. The specimens were stored in deionized water at 37 degrees C for 48 hours and then tested in shear with a universal testing machine at a crosshead speed of 5 mm/min until the brackets debonded. The mode of failure of the brackets was determined by a modified adhesive remnant index.

RESULTS

Mean shear bond strength values were 9.00 MPa for Kurasper F Bond, 9.55 MPa for Clearfil Protect Bond, and 9.48 MPa for Clearfil tri-S Bond. One-way analysis of variance detected no statistically significant difference among groups (P = .98, P > .05). The predominant failure for the three groups was at the bracket-adhesive interface leaving less than 25% of the adhesive on the bracket base.

CONCLUSIONS

One-step self-etching adhesive and two-step fluoride-releasing antibacterial self-etching adhesive have sufficient mechanical properties for the bonding of orthodontic brackets.

Antimicrobial properties of an orthodontic adhesive combined with cetylpyridinium chloride

INTRODUCTION

Patients undergoing fixed appliance treatment are at greater risk for increases in salivary and plaque levels of Streptococcus mutans and an elevated risk of dental caries. Cetylpyridinium chloride (CPC) is known to be an effective antiplaque agent. The purpose of this study was to investigate whether incorporating CPC into a commercially available orthodontic adhesive would impart antimicrobial properties without altering the diametral tensile strength of the material.

METHODS

CPC was added to a commercially available, filled, photo-activated bracket adhesive (Transbond XT, Unitek 3M, Monrovia, Calif) in varying amounts, to obtain specimens with CPC concentrations of 0% (control), 2.5%, 5.0%, and 10.0% by weight. Adhesive discs 2 mm thick and 4 mm in diameter were incubated with Streptococcus mutans for 48 hours. The diameters of the zones of bacterial inhibition were measured in an agar disc diffusion assay; specimens of each concentration were tested every other week for 196 days. Other discs were soaked in distilled water for 180 days. The amount of CPC released into the water from the modified discs was measured and recorded on days 7, 15, 30, 60, and 180 by using a spectrophotometer at 254 nm. Diametral tensile strength of the modified adhesive discs was measured with a universal testing machine, and the effect of water aging was also evaluated.

RESULTS

The measured zone of bacterial inhibition increased as CPC content increased. All CPC-adhesive specimens maintained antimicrobial activity up to 196 days. No zone of bacterial inhibition was measured around the control specimens. CPC release was observed through the end of 180-day period, but the greatest release was recorded in the first week. There was no significant difference (P < .05) in diametral tensile strength between the 2.5% CPC-adhesive group and the control; there were significant differences among the 5.0% and 10.0% CPC-adhesive groups and the control. Water aging had no significant effect on diametral tensile strength other than decreasing it for the test group containing 10.0% CPC.

CONCLUSIONS

The incorporation of 2.5% CPC in adhesive material imparted antimicrobial activity without altering diametral tensile strength.

Fluorides for the prevention of white spots on teeth during fixed brace treatment

BACKGROUND

White spots can appear on teeth during fixed brace treatment because of early decay around the brace attachments. Fluoride is effective at reducing decay in susceptible individuals and is routinely prescribed in various different forms to patients during orthodontic treatment.

OBJECTIVES

To evaluate the effectiveness of fluoride in preventing white spots during orthodontic treatment and to compare the different modes of delivery of fluoride.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (to 22 August 2002); CENTRAL (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to week July 2003). Authors of trials were contacted for further data.

SELECTION CRITERIA

Trials were selected if they met the following criteria: a randomised or quasi-randomised clinical trial, involving the use of a fluoride-containing product compared with no use or use of a non-fluoride control and enamel demineralisation was assessed during or after orthodontic treatment.

DATA COLLECTION AND ANALYSIS

Six reviewers independently, in duplicate, extracted data. The primary outcome was the difference in the presence or absence of white spots between experimental and control patients for parallel design studies, and between experimental and control quadrants, for split-mouth design studies. Potential sources of heterogeneity were examined. Sensitivity analyses were undertaken for the items assessed for quality and publication bias.

MAIN RESULTS

The primary outcome of the review was the presence or absence of white spots by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Other outcomes such as differences in size and severity of white spots, any patient based outcomes, such as perception of white spots could not be included because there were insufficient data. Fifteen trials, with 723 participants, provided data for this review. None of the studies fulfilled all of the methodological quality assessment criteria. There is some evidence that a daily sodium fluoride mouthrinse reduces the severity of enamel decay surrounding a fixed brace (weighted mean difference for lesion depth -70.0; 95% CI -118.2 to -21.8) and that use of a glass ionomer cement for bracket bonding reduces the prevalence (Peto OR 0.35; 95% CI 0.15 to 0.84) and severity of white spots (weighted mean difference for mineral loss -645 vol%.microm; 95% CI -915 to -375) compared with composite resins.

REVIEWERS' CONCLUSIONS

There is some evidence that the use of topical fluoride or fluoride-containing bonding materials during orthodontic treatment reduces the occurrence and severity of white spot lesions, however there is little evidence as to which method or combination of methods to deliver the fluoride is the most effective. Based on current best practice in other areas of dentistry, for which there is evidence, we recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.

Fluoride release from orthodontic band cements-a comparison of two in vitro models

OBJECTIVES

To compare, in vitro, the fluoride release from a conventional glass ionomer cement (Ketac-Cem), a resin-modified glass ionomer cement (3M-Multicure) and a polyacid modified composite (Ultra Band-Lok) using a banded tooth model and a disc model with the same mean cement weight.

METHODS

Forty pairs of caries-free third molars were collected and divided into two groups, each of 20 teeth. One tooth from each pair was banded with Ketac-Cem and the other with Ultra Band-Lok or 3M-Multicure; the average band size for each cement group was the same. Two coats of nail varnish were painted on each tooth to within 1mm of the band margin. Five discs (4.5mm diameter and 2mm depth) were prepared for each cement, these dimensions having been calculated so that the mean cement weight of the banded tooth model matched that of the disc model for each cement. The fluoride released into 2ml of deionised water, from each banded tooth or disc, was measured at regular intervals over 30 days using an Orion ion-selective electrode connected to an ion analyser.

RESULTS

At 30 days, for both banded tooth and disc models, the mean cumulative fluoride release was greatest from 3M-Multicure followed by Ketac-Cem, which in turn released more fluoride than Ultra Band-Lok. These differences were all significant (p<0.05). Despite having the same mean cement weight, the banded tooth model for Ketac-Cem and 3M-Multicure released approximately 3-4 times more cumulative fluoride than the disc model after 30 days (p<001). For Ultra Band-Lok, both models released comparable levels of fluoride (p>0.05).

CONCLUSIONS

Cement type, specimen geometry and surface area appear to influence significantly fluoride release characteristics.

Fluoride release from orthodontic cements-effect of specimen surface area and depth

OBJECTIVE

The aims of this in vitro study were firstly to compare fluoride release from a disc model of two orthodontic cements with various surfaces varnished, reducing the surface area by 25, 50 and 75%; secondly, to measure the fluoride release from previously exhausted discs of the same cements following removal of various depths of surface material.

METHODS

Forty discs of each cement, Fuji Ortho LC and Ultra Band-Lok, (6mm diameter by 3mm) were divided into two groups of 20 discs each. For each material, the first group was divided further into four groups of five discs, one group acting as control, while the other three groups were varnished reducing the surface area by 25, 50 and 75%, respectively. The second group was exhausted initially over a 60 day pre-experimental period and was subsequently divided into four groups of five discs, one group acting as control. The other three groups had material ground from one of the flat surfaces, to depths of 10, 100 or 1000 microm, to reveal a fresh surface. In both studies, the discs were immersed either daily (up to day 20) or twice weekly (up to day 60) in fresh 2ml aliquots of deionised water. The fluoride concentration in the deionised water was measured at the end of the experimental period.

RESULTS

For each cement, the relationship between the cumulative fluoride release and the percentage of the surface covered was clearly non linear at both 5 and 60 days. Fuji Ortho LC proved to release significantly greater amounts of fluoride at both 5 days and 60 days compared with Ultra Band-Lok. The results for Ultra Band-Lok were also significant when compared to the control group, but significantly less fluoride was released when compared with Fuji Ortho LC. When comparing the 25 and 50% covered discs, the amount of fluoride released was not significantly different for both cements. Furthermore, the relationship between fluoride release and depth was clearly non linear for both cements.

CONCLUSIONS

For the materials tested in this study, reducing the surface area of the discs did not reduce the cumulative fluoride release in a linear fashion. In addition, the previously exhausted discs began to release fluoride again, but this fell to concentrations similar to the control discs after the initial 5-day period for both cements. This suggests that further traces of previously unreleased fluoride had become available from the subsurface of these cements. The pattern of fluoride release was similar for all models tested.

Comparison of fluoride release protocols for in-vitro testing of 3 orthodontic adhesives

The objective of this study was to compare the fluoride release of 3 orthodontic adhesives using disks and bracketed teeth with different storage protocols. The adhesives used were a resin-modified glass ionomer (RMGI) (Fuji Ortho LC; GC America, Aslip, Ill), a polyacid-modified composite resin (PMCR)(Assure; Reliance Orthodontic Products, Itasca, Ill), and a composite control, Transbond XT (3M Unitek, Monrovia, Calif). Metal brackets were bonded to the buccal and lingual surfaces of 120 extracted human premolars. Five plastic containers holding 4 teeth (8 brackets) were used for each adhesive protocol. The samples were stored in containers holding 4 mL of deionized water at 37 degrees C for 28 and 84 days for the brackets and disks, respectively. The bracketed samples released larger initial amounts of fluoride compared with the disk samples during the first 5 to 6 days for both fluoride-releasing adhesives. The PMCR (Assure) released more fluoride (mg/cm(2)/day) than did the RMGI (Fuji Ortho LC) in all protocols with the exception of daily protocols when values diminished below the RMGI values near the 24th day and between the 56th and the 70th days for the bracketed and disk samples, respectively. Inconsistent values for fluoride release were noted in the bracket and disk samples when compared with daily versus cumulative water changes. Daily water changes revealed higher fluoride release levels (brackets), but this trend was not evident in the disk samples. Daily water changes may yield more clinically relevant data on fluoride release.

Fluoride release from new light-cured orthodontic bonding agents

The purpose of this study was to compare the rates of fluoride release with time from 1 nonfluoridated and 3 fluoride-containing orthodontic bonding materials in distilled water and artificial saliva. Materials tested were Assure (Reliance Orthodontic Products, Itasca, Ill), Fuji Ortho LC (GC, Tokyo, Japan), Python (TP Orthodontics, LaPorte, Ind), and Transbond XT (3M Dental Products, Monrovia, Calif). Ten specimens of each material type were stored in distilled water, and 10 of each type were stored in artificial saliva at 37 degrees C. Fluoride release was measured with an ion-specific electrode. Readings were taken periodically for a total time period of 6 months. At day 1, Assure released the most fluoride into distilled water (66.2 microg/cm(2)) and into artificial saliva (65.8 microg/cm(2)), followed by Fuji Ortho LC (25.9 microg/cm(2); 18.8 microg/cm(2)), Python (6.3 microg/cm(2); 4.2 microg/cm(2)), and Transbond (0.1 microg/cm(2); 0.1 microg/cm(2)). The fluoride release rates were highest during the first days of testing, declining to lower but more stable levels. At the end of 6 months, Fuji Ortho LC released the most fluoride (3.8 microg/cm(2); 3.5 microg/cm(2)) followed by Assure (3.1 microg/cm(2); 2.8 microg/cm(2)), Python (2.6 microg/cm(2); 1.7 microg/cm(2)), and Transbond (0.1 microg/cm(2); 0.1 microg/cm(2)). The type of storage medium did not dramatically affect fluoride release. The second part of the study, undertaken after a year of sample storage, tested the 20 samples of Assure for a further 2-week period, after exposure to running and still distilled water. Although fluoride release rates declined with time, they were still higher than the 1.5 microg/cm(2) level that is referenced as inhibiting decalcification of enamel in a clinical environment. Release rates were similar in running and still water at all time points. Throughout the 6-month period, all 3 fluoride-containing materials had rates of fluoride release that could theoretically inhibit decalcification of enamel.

A comparison of fluoride release by resin-modified GIC and polyacid-modified composite resin

The objective of this study was to compare the fluoride release of 2 fluoride-containing orthodontic adhesives from bracketed teeth and adhesive disks, a resin-modified glass ionomer cement (Fuji Ortho LC, encapsulated; GC America Corp, Aslip, Ill) and a polyacid-modified composite resin (Assure; Reliance Orthodontic Products, Itasca, Ill). A composite resin without fluoride (Transbond XT; 3M Unitek, Monrovia, Calif) was used as a reference control. Metal brackets were bonded to the buccal surfaces of 120 human premolars (40 teeth per adhesive), and disks were made from each adhesive. The deionized storage water was changed, and fluoride release was measured at specified intervals up to 28 days for the bracketed teeth and up to 150 days for the disks. Fuji Ortho LC released 75% more accumulated fluoride than Assure (6.61 microg/bracket vs 3.77 microg/bracket) from bracketed teeth over the 28-day observation period. Assure released more fluoride per day than did Fuji Ortho LC from the disks during the first 3 months. For the rest of the 150-day period, Fuji Ortho LC released more fluoride per day than did Assure. The amount of fluoride released by these materials varied dramatically with different water-changing protocols. The large discrepancy between fluoride released from disks compared with that released from bracketed teeth suggests that caution must be used in extrapolating fluoride-release levels of adhesive disks to in vivo treatment conditions.

An ex vivo assessment of a resin-modified glass ionomer cement in relation to bonding technique

OBJECTIVE

This study assessed a resin modified glass ionomer bonding system, Fuji ortho L.C. using different bonding techniques and compared it with a composite control (Transbond).

DESIGN

Ex vivo study. Twenty extracted premolar teeth in each group were bonded as follows: (i) Group 1 Control (Transbond); (ii) Group 2 Fuji ortho L.C. without an etch procedure/wet enamel surface; (iii) Group 3 Fuji ortho L.C. without an etch procedure/dry enamel surface; (iv) Group 4 Fuji ortho L.C. using a conventional acid etch technique.

OUTCOME

Shear bond strength, site of bond failure and adhesive remnant index.

RESULTS

Brackets bonded as recommended by the manufacturer (Group 2) have significantly (p < 0.001) lower bond strengths compared with the control (Group 1). Bonding with an etch technique (Group 4) will significantly (p < 0.001) increase the bond strength compared with the other Fuji groups. All the Fuji groups tended to fail at the enamel/resin interface with lower ARI scores compared with the control.

CONCLUSION

The lower bond strength of Fuji ortho L.C. would limit its use as a routine bonding agent. When bonded with an acid etch technique, the bond strength may be sufficient for low loading situations such as the upper anterior teeth.

An ex vivo assessment of resin-modified glass ionomer bonding systems in relation to ceramic bracket debond

This ex vivo study assessed three new resin-modified glass ionomer cements (Fuji ORTHO LC, Vitremer, and Dyract-Cem) in relation to ceramic bracket removal. It was hypothesized that the use of these cements would facilitate bracket removal and eliminate debond complications Eighty extracted premolar teeth were divided into four groups of 20 teeth and bonded with Intrigue brackets using each of the resin-modified cements (groups 1, 2, and 3), the control group 4 was bonded with Concise chemically-cured adhesive. The teeth were debonded by applying a shear load using an Instron universal testing machine. The mean force to debond was calculated for each group and each tooth was examined under the stereomicroscope to record the site of bond failure and the Adhesive Remnant Index (ARI). The results showed that the resin-modified cements were very effective at eliminating ceramic bracket debond problems. Bracket fracture was eliminated compared with a 40 per cent fracture rate with the control and the ARI scores were all reduced. The elimination of debond problems appears to be related to the significantly reduced (P < 0.001 using ANOVA and Tukey tests) mean and maximal debond forces compared with the control.

Effect of light-cure time on the initial shear bond strength of a glass-ionomer adhesive

With the introduction of photosensitive (light-cured) restorative materials in dentistry, various methods were suggested to enhance the polymerization of these materials including layering and the use of more powerful light-curing devices. The purpose of this study was to determine the effects of increasing the light-cure time on the initial shear bond strength (in the first half hour) of a resin-modified glass-ionomer adhesive. Eighty-six teeth were divided into 4 groups according to either; (1) the adhesive system used, namely resin, reinforced glass ionomer, or composite, and (2) the light-cure time for the glass ionomer adhesive, namely 40, 45, and 50 seconds. The bonding approach followed the manufacturer's instructions unless otherwise specified. The results of the analysis of variance comparing the 4 experimental groups (F = 19.4) indicated the presence of significant differences between the groups (P =. 0001). In general, the shear bond strength was greater for the composite adhesive system (¿x(-) = 5.2 +/- 2.9 MPa), followed by the 2 groups bonded with the resin-reinforced glass-ionomer adhesive and light cured for 50 seconds (¿x(-) = 3.8 +/- 1.1 MPa) and 45 seconds (¿x(-) = 3.4 +/- 2.7 MPa). On the other hand, the shear bond strength was significantly lower for the group bonded with the glass ionomer adhesive and light cured for 40 seconds only (¿x(-) = 0.4 +/- 1.0 MPa). The present findings indicated the following: (1) the resin-reinforced glass-ionomer adhesive has a significantly lower shear bond strength in the first half hour after bonding when compared to a composite resin adhesive; (2) the initial bond strength of the glass-ionomer adhesive was significantly increased by increasing the light-cure time for an additional 5 to 10 seconds; (3) the mean increase in the shear bond strength between 5 and 10 seconds of additional light curing was not significant but the variability was less with the longer cure time.

Shear bond strength of composite, glass ionomer, and acidic primer adhesive systems

The purpose of this study was to determine the shear bond strengths of orthodontic brackets bonded with one of three methods: (1) a glass ionomer adhesive with a 20% polyacrylic acid enamel conditioner; (2) a composite resin adhesive used with 37% phosphoric acid etchant and a conventional primer; or (3) the same composite resin used with an acidic primer that combines the etchant with the primer in one application. The brackets were bonded to the teeth according to one of three protocols. Group I teeth were etched with 37% phosphoric acid and bonded with Transbond XT (3M Unitek, Monrovia, Calif) following the manufacturer's instructions. Group I acted as the control group. Group II teeth were etched with an acidic primer (Clearfil Liner Bond 2. J.C. Moritta Kuraway, Japan) that contains both the acid (Phenyl-P) and the primer (HEMA and dimethacrylate) and was placed on the enamel for 30 seconds; the adhesive used to bond the brackets was Transbond XT as in Group I. Group III teeth were etched with 20% polyacrylic acid and the brackets were bonded with Fuji Bond LC (G.C. America, Chicago, Ill). A steel rod with one flattened end was attached to the crosshead of a Zwick test machine (Zwick GmbH & Co, Ulm, Germany). An occlusogingival load was applied to the bracket, producing a shear force at the bracket-tooth interface. The results indicated that the resin/phosphoric acid adhesive system (control group) provided the strongest shear bond strength x = 10.4 +/- 2.8 MPa). The glass ionomer adhesive system provided a significantly lower bond strength (x = 6.5 +/- 1.9 MPa). The least shear bond strength was present when the acidic primer was used with an orthodontic adhesive (x = 2.8 +/- 1.9 MPa). In the present study, the use of either a fluoride-releasing glass ionomer or an acidic primer in combination with an available orthodontic composite adhesive resulted in a significantly reduced shear bond strength when compared with that of the conventional composite resin adhesive system. At the present time, the orthodontist and the patient are better served by using phosphoric acid/composite resin adhesive system or other equivalent systems that provide a clinically reliable bond strength between the bracket, the adhesive, and the enamel surface.

Fluoride release from orthodontic bonding agents: a comparison of three in vitro models

The aim of this in vitro study was to compare fluoride release from two cement disc models (partially varnished and unvarnished) of three orthodontic bonding materials with fluoride release from the same materials when used to bond an orthodontic bracket onto a tooth surface. A resin-modified glass ionomer cement (Vitremer) and a compomer material (Dyract Ortho) were compared with a conventional resin adhesive (Right-On). Ten discs (3.0 mm diameter and 1.5 mm thick) of each material were manufactured in a silicone mould and ten premolar teeth were bonded with orthodontic brackets using each material. All the premolar teeth were covered with nail varnish up to the bracket periphery and five of the discs for each material were coated with nail varnish on both upper and lower surfaces which halved the surface area. The fluoride released into 2 ml of deionised water, from each tooth or disc, was measured at regular intervals over 60 days. At 60 days, cumulative fluoride release was highest from the unvarnished discs, less for the varnished discs and least from the tooth-bracket model for both test materials. Despite having twice the surface area, the unvarnished disc model released only 1.2 to 1.5 times more fluoride than the varnished disc model. Compared with the tooth-bracket model, the unvarnished discs released 3.0 to 4.5 times more fluoride, whereas the varnished discs released only 2.2 to 3.7 times more fluoride. For the materials tested in this study, halving the surface of the discs did not reduce the cumulative fluoride release by half. The tooth/bracket model with minimal bonding material demonstrated substantial cumulative fluoride release. The pattern of fluoride release was similar for all models tested.

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.

Fluoride release and cariostatic ability of a compomer and a resin-modified glass ionomer cement used for orthodontic bonding

OBJECTIVES

The aims of this study were to compare the local and systemic uptake of fluoride released from a compomer material (Dyract Ortho) and a resin-modified glass ionomer cement (Vitremer) with that of a conventional resin adhesive (Right-On) and to compare the cariostatic ability of each of the test materials with that of the resin control.

METHODS

Twenty six patients were randomly allocated to have a bracket bonded to a premolar on one side of the arch with one of the test materials and on the opposite side with the control material. Premolars destined for extraction as part of an orthodontic treatment plan were selected for bonding. A non-fluoride toothpaste was used by all participants for 4 weeks prior to bracket bonding and throughout the 4 week trial period. Fluoride release was measured in saliva, plaque and urine samples taken pre-bonding and 4 weeks post-bonding. Enamel demineralisation was assessed by scoring the buccal surface of each extracted tooth using a caries index.

RESULTS

Neither Vitremer nor Dyract Ortho altered salivary or urinary fluoride concentration significantly 4 weeks post-bonding but plaque fluoride concentration increased significantly around premolars bonded with Vitremer. The test materials as a combined group were associated with significantly less demineralisation than the control material but there was no significant difference in cariostatic ability detected between either Dyract Ortho or Vitremer when each group was compared separately with the control.

CONCLUSIONS

Fluoride released from Dyract Ortho or Vitremer is likely to exert a local and not a systemic effect. In a 4-week clinical study, the cariostatic ability of the fluoride-releasing cements, as a combined group, was superior to that of the non-fluoride releasing control but there was no significant difference in cariostatic ability between the two test materials when each test group was compared separately with the control.

Long-term fluoride release of some orthodontic bonding resins: a laboratory study

OBJECTIVES

The present study compared the amounts and profiles of long term fluoride release from four commercial direct bonding resins (Light-Bond, Reliance Orthodontic Products; Rely.a. Bond, Reliance Orthodontic Products; Orthon, Orthon Dental Inc.; Fluor Ever, Macro-Chem Corporation) and one glass ionomer cement (Ketac-Cem, Espe).

METHODS

The specimens were equilibrated in double-deionized water at 37 degrees C. At predetermined intervals, and up to 560 days, the fluoride concentration of the equilibrated solution was determined with a fluoride ion selective electrode. For Light-Bond and Rely.a. Bond two batches were studied and the amount of fluoride released in a 0.1 mol/L NaCl solution was also determined. Differences in the fluoride release profiles due to batch, type of solution and time were determined with a three-factor mixed design ANOVA with repeated measures on one factor.

RESULTS

The fluoride release profiles of the orthodontic adhesives studied differ markedly. Initially, Fluor Ever and Ketac-Cem release comparable amounts of fluoride which are greater than those released by Orthon. After a few weeks the amounts of fluoride released by Ketac-Cem and Orthon become comparable, but are considerably higher than those released by Fluor Ever. During the first days of the elution, the amount of fluoride released by Light-Bond equals that of Orthon, but then decreases below the determination limit of the analytical method within half a year. No difference was found between the fluoride release profiles in water and the NaCl solution. However, the fluoride release profiles apparently depend on the batch. For Rely.a. Bond, the amount of fluoride released is smaller than the detection limit for the fluoride analysis.

SIGNIFICANCE

The fluoride release of the orthodontic adhesives investigated markedly depends on the mechanisms responsible for the fluoride release process.

In vitro dentine fluoride uptake from three fluoride-containing composites and their acid resistance

OBJECTIVES

The purpose of this study was to determine the dentine fluoride uptake from three fluoride-containing composites (FluorEver, FluoroCore and Pertac-Hybrid) and to investigate their ability to affect the resistance of dentine to an artificial caries challenge.

METHODS

Three dentine slabs were prepared from each tooth. The baseline, total and bound fluoride concentrations of each tooth were determined by three successive abrasion biopsies performed on each slab followed by adjusting to standardized depths of 10 microns. Next, dentine slabs ligated with the composites were suspended in synthetic saliva for 1 week. After removal of the composites, these specimens and controls were immersed in an artificial caries medium (pH 4.5) for 5 days. Each slab was sectioned and analysed by quantitative microradiography.

RESULTS

The results indicate that dentine acquired significantly different amounts of fluoride from the three composites. The acid resistance of dentine in contact with the composites was also significantly different among the composites and followed the same order as for fluoride uptake.

CONCLUSIONS

Dentine fluoride uptake and artificial caries inhibition were significantly greater with FluorEver followed by FluoroCore and Pertac-Hybrid.

In vitro evaluation of matrix-bound fluoride-releasing orthodontic bonding adhesives

Sustained fluoride-releasing composite resins have the potential to prevent decalcification of enamel that may occur during the course of orthodontic treatment. The purpose of this study was to evaluate the potential of matrix-bound fluoride-releasing adhesives (MBF) for orthodontic use by comparing the shear bond strengths (in MPa) and remnant adhesive on debonding (ARI scores) of these resins with commercially available orthodontic adhesives. Two types of resins were evaluated in separate groups: The light-cured resins (group I) consisted of two light-cured MBF, designated resins LA and LB, and five nonfluoride releasing resins, designated LC, LD, LE, LF, and LG. The self-cured resins (group II) consisted of one MBF, designated resin SA, and six nonfluoride releasing resins, designated resins SB, SC, SD, SE, SF, and SG. These resins were used to attach upper right central incisor metal (foil mesh based) orthodontic brackets to 210 freshly extracted bovine incisors in groups of 15 each. Student-Newman-Keuls multiple comparison tests were performed at p < 0.05 to determine significant differences among the resin types. Resin LA was significantly higher in bond strength (mean = 27.4 MPa) compared with LD and LG (mean = 18.9, 10.7 MPa, respectively). Further, LA demonstrated a higher mean bond strength compared with LB, LC, LE, and LF (mean = 21.9, 24.1, 24.3, and 20.8 MPa, respectively). Resin LB had significantly lower ARI scores (mean = 0.33) compared with LF and LG (mean = 1.20 and 1.80). LA, LB, LC, LD, and LE (mean = 0.47, 0.33, 0.60, 0.73, and 0.73, respectively) were not significantly different in their ARI scores. Resin SB demonstrated significantly lower bond strength (mean = 17.2 MPa) compared with SC, SD, SE, SF, and SG (mean = 23.9, 23.7, 23.4, 23.8, and 22.9 MPa, respectively). Resin SA (mean = 19.0 MPa) was not significantly different in bond strength from SB, SC, SD, SE, SF, and SG. Resin SA demonstrated significantly lower ARI scores (mean = 0.73) compared with SD and SE (mean = 2.13 and 1.87). Resin SA had lower mean ARI scores compared with SB, SC, SF, and SG (mean = 1.00, 1.27, 1.13 and 0.87, respectively). Sustained fluoride-releasing (matrix-bound) orthodontic adhesive systems demonstrated bond strength and ARI scores that compared favorably with commercially available orthodontic adhesives.

In vitro measurement of enamel demineralization in the assessment of fluoride-leaching orthodontic bonding agents

The aim of this study was to measure in vitro demineralization around orthodontic brackets, bonded with five different bonding agents. Two conventional bonding agents, two fluoride-leaching agents, and a glass ionomer were tested. A sixth group utilized a fluoride varnish after bonding. The amount of dissolved enamel mineral was determined from increases in the phosphorus concentration in the demineralizing solution and measurements were made over a 4 week period. The results confirmed that when fluoride is present in the form of a fluoride-leaching bonding agent or a fluoride varnish, resistance to demineralization is enhanced. Analysis of variance showed that Ketac-cem, Concise with Duraphat, and Pulpdent O.B.A. performed statistically significantly better than Concise, Bond-fast, and Rely-a-bond, in resisting enamel demineralization.

Fluoride released from orthodontic bonding agents alters the enamel surface and inhibits enamel demineralization in vitro

In this study, we examined two fluoride-releasing orthodontic agents in respect to fluoride release, enamel demineralization inhibition, as well as alterations observed on the enamel surface after their use. Fluoride release was found to occur in the highest concentrations within the first 24 hours for both materials examined. After this period, a dramatic decline in fluoride release was observed in both adhesives, and after 90 days no fluoride was detectable. Both fluoride-releasing materials showed significant differences on enamel demineralization around the brackets when compared with a conventional adhesive, and the agent with the initial higher amounts of fluoride release showed the best results. Scanning electron microscopy of the enamel surface revealed particle depositions of microglobular form, after the examined adhesives were used. These particles most likely represent deposition of calcium fluoride, a salt with clearly cariostatic properties. The results of this in vitro study show that certain fluoride-releasing orthodontic bonding systems may provide an additional degree of safety against caries susceptibility in patients with fixed appliances for a limited period.

The application of in vitro models to research on demineralization and remineralization of the teeth

Progress in in vivo and in situ experimentation has led many researchers to speculate as to the relevance and importance of in vitro testing protocols in caries research. A Medline/Biosis search for the present review revealed well over 300 citations (since 1989) documenting in vitro tests associated with caries research on mineralization and fluoride reactivity. The present survey documents these recent applications of in vitro test methods in both mechanistic and 'profile' caries research. In mechanistic studies, in vitro protocols over the past five years have made possible detailed studies of dynamics occurring in mineral loss and gain from dental tissues and the reaction dynamics associated with fluoride anticaries activity. Similarly, in profile applications, in vitro protocols make possible the inexpensive and rapid--yet sensitive--assessment of F anticaries efficacy within fluoride-active systems, and these tests represent a key component of product activity confirmation. The ability to carry out single variable experiments under highly controlled conditions remains a key advantage in in vitro experimentation, and will likely drive even further utilization, as advances continue in physical-chemical and analytical techniques for substrate analysis in these protocols. Despite their advantages in vitro testing protocols have significant limitations, most particularly related to their inability to simulate the complex biological processes involved in caries.

An ex vivo investigation into the release of fluoride from fluoride-containing orthodontic bonding composites

This study was concerned with an evaluation of fluoride release from commercially available orthodontic bonding composite resins, known as Reliance and Mirage Dual Cure, which are claimed to release ionic fluoride. Forty-eight premolar teeth had brackets bonded with four different composite resins--Mirage Dual Cure, Reliance, Right-on and Heliosit. They were then immersed in a demineralizing solution. The amount of fluoride released from the composites into the solution was measured. The results indicated that Mirage Dual Cure released statistically significant amounts of fluoride over the first 2 days. A similar pattern was noted with Reliance albeit releasing a lesser amount. From the third day onwards, fluoride release levelled out to concentrations similar to those of the two control materials, Right-on and Heliosit (i.e. 0.09 ppm). Fluoride-releasing composite resins, therefore, failed to demonstrate any potential long-term fluoride release within the ex vivo model. Even in the short term, the amount of fluoride released was very small.

Tensile bond strength of orthodontic brackets bonded with a fluoride-releasing light-curing adhesive. An in vitro comparative study

A light-curing, fluoride-releasing adhesive (VP 862, Vivadent, Liechtenstein) for bonding of brackets has been produced for inhibition of white spot lesions during orthodontic treatment. The tensile bond strength after 24 hours and 6 months was investigated and compared with two other light-curing adhesives (Transbond, 3M Corp., Monrovia, Calif., and Heliosit-Orthodontic, Vivadent, Liechtenstein) and two chemical-curing adhesives (Concise, 3M, Monrovia Calif., and Saga Bond, Saga Orthodontics, Kongsvinger, Norway). All adhesives produced adequate strength to be recommended for clinical use. The light-curing adhesives produced slightly lower bond strengths after 24 hours and 6 months, except Transbond, which showed an increase in bond strength in this period approaching the two chemical adhesives.

Decalcification during orthodontic treatment with fixed appliances--an overview

The prevalence and aetiology of decalcification during orthodontic treatment with fixed appliances is discussed and consideration given to the methods of reducing this problem.

Cariostatic effect and fluoride release from a visible light-curing adhesive for bonding of orthodontic brackets

This study was designed to investigate the cariostatic potential in vivo of a visible light-curing adhesive for the bonding of orthodontic brackets. The fluoride release of the adhesive in water and saliva was also measured. Ten orthodontic patients with premolars to be extracted participated. One bracket with Heliosit-Orthodontic (no fluoride) was positioned on the buccal surface of one premolar (control), and another bracket with Orthodontic cement VP 862 (containing fluoride) was positioned on the experimental contralateral premolar. The adhesives were cured with a Heliolux II lamp, and the teeth were extracted after 4 weeks. The patients used a fluoride toothpaste during the experiment. The mineral content of the enamel adjacent to the brackets was determined by quantitative microradiography. The fluoride release from disk-shaped plates of the fluoride adhesive was measured in water for a 6-month period and in human saliva for 24 hours. The fluoride adhesive reduced lesion depths by about 48% than the nonfluoride adhesive (P less than 0.05, t test). The largest release of fluoride from the plates in water was observable within the first week. However, a significant amount of fluoride was still released after 6 months. The fluoride release in saliva was significantly lower in human saliva at pH 7 than in water (P less than 0.01, t test). When salivary pH was lowered to 4, to mimic a cariogenic challenge, the amount of fluoride released increased up to the value measured in water. It was concluded that the regular use of fluoride toothpastes is insufficient to inhibit lesion development around orthodontic brackets.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of fluoride release from an orthodontic bonding system

Decalcification around brackets is sometimes observed after orthodontic treatment. Fluoride-releasing orthodontic adhesives have been developed in an attempt to reduce the frequency and severity of decalcification. This study evaluated, in vitro, a light-activated, fluoride-releasing composite resin adhesive, FluorEver OBA. The findings indicate that FluorEver OBA released small concentrations of fluoride ions over time. A mean of 2.6 ppm was released on day 1, decreasing to a mean of 0.42 ppm by day 2 and to 0.04 ppm by day 43. The clinical implications of these findings are discussed.