Bonding brackets to porcelain--in vitro study

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.

Comparison of feldspathic veneer surface treatments on ceramic bracket SBS, ARI and surface roughness after different debonding/polishing methods: An in vitro study

OBJECTIVES

To analyse, in vitro, surface properties and the shear bond strength after debonding and polishing procedures of ceramic brackets directly bonded to 0.3-0.5-mm thick feldspathic veneers.

MATERIALS AND METHODS

Fifty six feldspathic ceramic veneers samples (0.3 to 0.5-mm thick) were allocated into groups according to veneers surface treatment procedures: (S) glaze layer was retained; (SHF) hydrofluoric (HF) acid etch; (SOXA) Al2O3 sandblasting; and (SB) diamond burs roughening. Specimens were treated with silane Monobond N® and ceramic brackets bonded with Transbond XT^®. Shear bonding strength (SBS) was assessed with a universal testing machine and ARI evaluated under a stereomicroscopic coupled to a digital camera. Remaining bonding composite was removed using a porcelain polishing kit and surface roughness assessed with a stylus profilometer.

RESULTS

No statistically significant differences were identified for SBS among the study groups (S, SHF, SOXA and SB) (P>0.05). The majority of the specimens presented ARI scores 3 and 2 (P>0.05). All of the study groups presented increased surface roughness after debonding and polishing procedures (P<0.05), with significant greater values observed in SB group (RaF: 1.27±0.41; RzF: 6.23±1.82), (P<0.05).

CONCLUSIONS

Surface treatment with hydrofluoric acid etch, Al₂O₃ sandblasting and diamond bur did not enhance SBS of orthodontic brackets bonded to ceramic veneers. Ceramic surfaces treated with diamond burs presented significantly increased roughness after adhesive removal.

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 new and rebonded orthodontic brackets to the enamel surfaces

OBJECTIVES

The objective of this study was to compare the shear bond strength (SBS) of new and rebounded orthodontic brackets bonded to the buccal sound and cleaned enamel surfaces using two orthodontic adhesives: resin-modified glass-ionomer (RMGI) and resin-composite.

MATERIALS AND METHODS

Forty premolars were randomly allocated into four groups, 10 teeth/group. New and rebonded brackets were bonded to sound and cleaned enamel surface, and then were subjected to thermocycling. The bond strength was determined using a universal testing machine at a crosshead speed of 1 mm/min. Remaining adhesives on enamel after bracket debonding was scored independently by two investigators who were not aware of the four different groups, using adhesive remnant index (ARI).

RESULTS

There was a statistical significant difference in SBS of the four groups (P = 0.005). SBS values were significantly higher with cleaned enamel surfaces after adhesive removal compared to sound enamel. SBS was significantly higher for rebonded brackets, when compared with the new brackets. No significant difference was found between the two adhesives types. The level of agreement between the two raters was higher toward the classification of higher categories of ARI (scores 5 and 6) with agreement percentage 91.7% and 100%, respectively. There was more adhesive remained among resin-composite groups.

CONCLUSIONS

The bond strength of debonded sandblasted stainless-steel brackets was higher than new brackets. Resin-composite and RMGI orthodontic adhesives used in this study exhibited sufficient SBS values for bonding brackets to sound and cleaned enamel and comparable to each other.

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.

Effect of bonding material, etching time and silane on the bond strength of metallic orthodontic brackets to ceramic

The purpose of this study was to evaluate the bond strength of metallic orthodontic brackets to feldspathic ceramic with different etching times, bonding materials and with or without silane application. Cylinders of feldspathic ceramic were etched with 10% hydrofluoric acid for 20 or 60 s. For each etching time, half of the cylinders received two layers of silane. Metallic brackets were bonded to the cylinders using Transbond XT (3M Unitek) or Fuji Ortho LC (GC). Light-activation was carried out with total exposure time of 40 s using UltraLume 5. Shear bond strength testing was performed after 24 h storage. Data were submitted to three-way ANOVA and Tukey's test (α=0.05). The adhesive remnant index (ARI) was used to evaluate the amount of adhesive remaining on the ceramic surface at ×8 magnification. Specimens etched for 60 s had significantly higher bond strength compared with 20 s. The application of silane was efficient in increasing the shear bond strength between ceramic and both fixed materials. Transbond XT showed significantly higher (p<0.05) bond strength than Fuji Orth LC. There was a predominance of ARI score 0 (clean ceramic failure surface) for all groups, with an increase in scores 1, 2 and 3 (adhesive material increasingly present on ceramic failure aspect) for the 60-s etching time. In conclusion, 60-s etching time, silane and Transbond XT improved significantly the shear bond strength of brackets to ceramic.

Shear bond strength of orthodontic buccal tubes to porcelain

BACKGROUND

Bonding of molar tubes is becoming more popular in orthodontics. Occasionally, these bonding are done on posterior porcelain crowns or bridges. The purpose of this study was to evaluate the shear bond strength of buccal tubes on feldspathic porcelain crowns with two different methods.

MATERIALS AND METHODS

Forty porcelain right molar crowns were fabricated for this study. The crowns were randomly divided into two groups. In group 1, the crowns were etched with 9.6% hydrofluoric acid, silane coupling agent applied, coated with bonding primer and bonded with Transbond XT (3M Unitek, Monrovia, Calif). In group 2, the crowns were etched with phosphoric acid 37%, silane coupling agent applied, coated with bonding primer and bonded with Transbond XT. All the crowns were stored for 24 hours at 37°C and thermo-cycled before the shear bond test. The analysis of variance (ANOVA) was used to determine whether significant difference were present between the groups.

RESULTS

The results of the analysis of variance (F = 0.23) indicated the shear bond strength of group 1 (3.57 ± 0.87 MPa) was not significantly different (P > 0.05) from group 2 (3.46 ± 0.65 Mpa). Fisher's exact test for the adhesive remnant index (ARI) revealed significant difference between both groups (P < 0.05). Eighty percent of group 1 buccal tubes failed at buccal tube/resin interface and eighty percent of group 2 mostly failed at porcelain/resin interface.

CONCLUSION

Etching with phosphoric acid with the use of silane coupling agent would be safer and should make it easier for clinicians to clean the adhesive on the porcelain surface after debonding.

Evaluation of shear bond strength of different treatments of ceramic bracket surfaces

OBJECTIVE: To evaluate the bonding strength of the ceramic bracket and composite resin restoration interface, using four types of treatment on the base of the bracket. METHODOLOGY: 48 photoactivated composite resin discs were used (FiltekTM Z250) contained in specimens and divided into 4 groups of 12 specimens for each group according to the type of treatment performed on the base of the brackets. Once the brackets were bonded, the specimens were subjected to shear stress carried out in a universal testing machine (MTS: 810 Material Test System) calibrated with a fixed speed of 0.5 mm / minute. The values obtained were recorded and compared by means of appropriate statistical tests - analysis of variance and then Tukey's test. RESULTS AND CONCLUSIONS: The surfaces of ceramic brackets conditioned with 10% hydrofluoric acid for 1 minute, followed by aluminum oxide blasting, 50µ, after silane application and primer application, was considered the best method to prepare surfaces of ceramic brackets prior to orthodontic esthetic bonding.

Influence of surface conditioning on ceramic microstructure and bracket adhesion

The objective of this study was to investigate the influence of different conditioning procedures on various ceramic microstructures and bracket adhesion. Ceramic specimens (feldspathic, leucite, leucite-free, and fluorapatite) were mechanically conditioned (n = 20 per ceramic type) with conventional hydrofluoric acid (5 per cent HF; 60/30 seconds), buffered hydrofluoric acid (9.6 per cent BHF; 60/30 seconds), or sandblasting (Al(2)O(3)/SiO(2) particles). Silane coupling agents were added for chemical conditioning before bracket bonding. Bracket adhesion was calculated with a shear test in a universal testing machine. The bracket-composite-ceramic interface was further evaluated using the adhesive remnant index (ARI). One specimen of each ceramic/conditioning combination was subjected to qualitative electron microscopy investigation. One-way analysis of variance followed by Tukey's honestly significant difference test were applied for inferential statistics. Conditioning with conventional 5 per cent HF or sandblasting resulted in significantly (P < 0.001) higher bond strengths (mean values: 34.11 and 32.86 MPa, respectively) than with 9.6 per cent BHF (mean value: 12.49 MPa). Etching time or sandblasting particles had no statistical (P > 0.001) influence on bond strength. Higher ARI scores were found in the conventional 5 per cent HF and sandblasted groups, when compared with the 9.6 per cent BHF group. Microscopic examination of the conditioned ceramic surfaces showed that leucite and leucite-free ceramics differed most with respect to their surface roughness, though without an influence on shear bond strength (SBS; P < 0.001). Bracket adhesion was mostly influenced by the conditioning procedure itself. Sandblasted ceramic surfaces showed sufficient conditioning and bracket adhesion; however, the increased bracket adhesion was associated with a risk of ceramic surface damage.

Avaliação da resistência ao cisalhamento de braquetes da técnica lingual colados sobre superfície cerâmica

OBJETIVO: avaliar a resistência ao cisalhamento de braquetes metálicos (American Orthodontics) utilizados na técnica lingual, colados em facetas de cerâmica. MÉTODOS: foram utilizados 40 corpos de prova divididos em quatro grupos de 10, de acordo com o material de colagem e do preparo da porcelana: Grupo I -resina Sondhi Rapid-Set e ácido fluorídrico; Grupo II -resina Sondhi Rapid-Set e óxido de alumínio; Grupo III -resina Transbond XT e ácido fluorídrico; e Grupo IV -resina Transbond XT e óxido de alumínio. Previamente à colagem, os braquetes foram preparados com base de resina de carga pesada (Z-250) e as facetas de cerâmica receberam aplicação de silano. O teste de cisalhamento foi realizado por uma máquina de ensaios Kratos à uma velocidade de 0,5mm/min. RESULTADOS: os resultados obtidos foram analisados estatisticamente através do teste de Tukey (p<0,05) e demonstraram diferença significativa entre os grupos I (2,77MPa) e IV (6,00MPa), e entre os grupos III (3,33MPa) e IV. CONCLUSÕES: concluiu-se que a colagem de braquetes da técnica lingual em superfície de cerâmica foi mais resistente ao cisalhamento com o uso de óxido de alumínio associado às duas resinas utilizadas neste estudo, porém a resina Transbond XT apresentou maior resistência que a Sondhi Rapid-Set.

Effect of etching time and light source on the bond strength of metallic brackets to ceramic

This study evaluated the bond strength of brackets to ceramic testing different etching times and light sources for photo-activation of the bonding agent. Cylinders of feldspathic ceramic were etched with 10% hydrofluoric acid for 20 or 60 s. After application of silane on the ceramic surface, metallic brackets were bonded to the cylinders using Transbond XT (3M Unitek). The specimens for each etching time were assigned to 4 groups (n=15), according to the light source: XL2500 halogen light, UltraLume 5 LED, AccuCure 3000 argon laser, and Apollo 95E plasma arc. Light-activation was carried out with total exposure times of 40, 40, 20 and 12 s, respectively. Shear strength testing was carried out after 24 h. The adhesive remnant index (ARI) was evaluated under magnification. Data were subjected to two-way ANOVA and Tukey's test (α=0.05). Specimens etched for 20 s presented significantly lower bond strength (p<0.05) compared with those etched for 60 s. No significant differences (p>0.05) were detected among the light sources. The ARI showed a predominance of scores 0 in all groups, with an increase in scores 1, 2 and 3 for the 60 s time. In conclusion, only the etching time had significant influence on the bond strength of brackets to ceramic.

Shear bond strength of orthodontic brackets to enamel under different surface treatment conditions

The purpose of the present study was to evaluate the shear bond strength to enamel and the adhesive remnant index (ARI) of both metallic and polycarbonate brackets bonded under different conditions. Ninety bovine permanent mandibular incisors were embedded in acrylic resin using PVC rings as molds and assigned to 6 groups (n=15). In Groups 1 (control) and 3, metallic and polycarbonate orthodontic brackets were, respectively, bonded to the enamel surfaces using Transbond XT composite according to the manufacturer's recommendations. In Groups 2 and 4, both types of brackets were bonded to enamel with Transbond XT composite, but XT primer was replaced by the OrthoPrimer agent. In Groups 5 and 6, the polycarbonate bracket bases were sandblasted with 50-μm aluminum-oxide particle stream and bonded to the enamel surfaces prepared under the same conditions described in Groups 3 and 4, respectively. After bonding, the specimens were stored in distilled water at 37°C for 24 hours and then submitted to shear bond strength test at a crosshead speed of 0.5 mm/min. The results (MPa) showed no statistically significant difference between Groups 4 and 6 (p>0.05). Likewise, no statistically significant differences (p>0.05) were found among Groups 1, 2, and 5, although their results were significantly lower than those of Groups 4 and 6 (p<0.05). Group 3 had statistically significant lower bond strength than Groups 2, 4, and 6, but no statistically significant differences were found on comparison to Groups 1 and 5. A larger number of fractures at the bracket/composite interface were evidenced by the ARI scores. OrthoPrimer bonding agent yielded higher bond strength in the groups using either conventional or sandblasted polycarbonate brackets, which was not observed in the groups using metallic brackets.

Ceramic Surface Polishing Techniques After Removal of Orthodontic Adhesive

Objective: Verify the in vitro effectiveness of different porcelain surface polishing systems used after orthodontic debonding.

Materials and Methods: Restorations were simulated by 52 metallic samples covered with glazed feldspathic porcelain. Four of these intact samples composed the control group (C). The remaining samples were divided into four groups (n = 12), according to the surface preparation they were to receive: no surface treatment (G1); roughened with a diamond bur (G2); etched with 10% hydrofluoric acid (G3); and sandblasted with aluminum oxide (G4). All experimental samples were treated with silane and bonded with a primer and standardized amount of adhesive. After composite removal, each group was divided into subgroups randomly (n = 4), according to the porcelain polishing system used: Edenta (P1); Identoflex (P2); and Komet (P3). All 52 sample-surfaces were evaluated quantitatively with a profilometer, and a mean roughness profile (Ra) value was determined for each sample. Both control and experimental specimens were evaluated qualitatively using a scanning electron microscope (SEM) to assess surface morphology.

Results: Statistical analysis with analysis of variance (ANOVA) and post-hoc Tukey multiple comparisons test showed statistical differences between surface preparation groups (G1 ≠ G2 = G3 = G4), at α = .05 level of significance; as for polishing protocols, no statistical difference was found.

Conclusions: The surface preparation was the determinant for final surface texture. No combination between surface preparation and polishing system was able to reestablish the original glazed porcelain smoothness.

Effects of surface conditioning on bond strength of metal brackets to all-ceramic surfaces

The aim of this study was to determine the effectiveness of bonding brackets to ceramic restorations. Sixty feldspathic and 60 lithium disilicate ceramic specimens were randomly divided into six groups. Shear bond strength (SBS) and bond failure types were examined with six surface-conditioning methods: silane application to glazed surface, air particle abrasion (APA) with 25- and 50-microm aluminium trioxide (Al(2)O(3)), etching with 9.6 per cent hydrofluoric acid (HFA), and roughening with 40- and 63-microm diamond burs. Silane was applied to all roughened surfaces. Metal brackets were bonded with light cure composite, then stored in distilled water for 1 week and thermocycled (x500 at 5-55 degrees C for 30 seconds). The ceramic surfaces were examined with a stereomicroscope at a magnification of x10 to determine the amount of composite resin remaining using the adhesive remnant index. The lowest SBS values were obtained with HFA for feldspathic (5.39 MPa) and lithium disilicate (11.11 MPa) ceramics; these values were significantly different from those of the other groups. The highest SBS values were found with 63-microm diamond burs for feldspathic (26.38 MPa) and lithium disilicate (28.20 MPa) ceramics, and were not significantly different from 40-microm diamond burs for feldspathic and lithium disilicate ceramics (26.04 and 24.26 MPa, respectively). Roughening with 25- and 50-microm Al(2)O(3) particles showed modest SBS for lithium disilicate (22.60 and 26.15 MPa, respectively) and for feldspathic ceramics (17.90 and 14.66 MPa, respectively). Adhesive failures between the ceramic and composite resin were noted in all groups. Damage to the porcelain surfaces was not observed. The SBS values were above the optimal range, except for feldspathic ceramic treated with HFA and silane. With all surface-conditioning methods, lithium disilicate ceramic displayed higher SBS than feldspathic ceramic.

Shear bond strength of new and recycled brackets to enamel

The purpose of this study was to evaluate in vitro the shear bond strength of recycled orthodontic brackets. S2C-03Z brackets (Dental Morelli, Brazil) were bonded to the buccal surfaces of 50 extracted human premolars using Concise Orthodontic chemically cured composite resin (3M, USA). The teeth were randomly assigned to 5 groups (n=10), as follows. In group I (control), the bonded brackets remained attached until shear testing (i.e., no debonding/rebonding). In groups II, III and IV, the bonded brackets were detached and rebonded after recycling by 90-microm particle aluminum oxide blasting, silicon carbide stone grinding or an industrial process at a specialized contractor company (Abzil-Lancer, Brazil), respectively. In group V, the bonded brackets were removed and new brackets were bonded to the enamel surface. Shear bond strength was tested in an Instron machine at a crosshead speed of 0.5 mm/min. Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. There was no statistically significant difference (p>0.05) between the control brackets (0.52 kgf/mm2), brackets recycled by aluminum oxide blasting (0.34 kgf/mm2) and new brackets attached to previously bonded teeth (0.43 kgf/mm2). Brackets recycled by the specialized company (0.28 kgf/mm2) and those recycled by silicon carbide stone grinding (0.14 kgf/mm2) showed the lowest shear strength means and differed statistically from control brackets (0.52 kgf/mm2) (p<0.05). In conclusion, the outcomes of this study showed that bracket recycling using 90-microm aluminum oxide particle air-abrasion was efficient and technically simple, and might provide cost reduction for orthodontists and patients alike.