Failure rates among metal brackets cured with two high-intensity LED light-curing lamps: an in vivo study

OBJECTIVE

The objective of this split-mouth clinical trial was to compare bonding failure rates of metal brackets bonded with two different light-emitting diode (LED) light-curing lamps with different high-intensity power outputs.

MATERIALS AND METHODS

Forty patients were included for a total of 800 brackets that were randomly bonded (left and right sides in a 1:1 ratio) in maxillary and mandibular arches using two different LED devices. An LED of 3200 mW/cm2 and an LED of 5000 mW/cm2 were used in this split-mouth clinical trial. Bonding failures during the initial 6 months of orthodontic treatment were recorded as maxillary versus mandibular, anterior teeth versus posterior teeth, and left side versus right side.

RESULTS

Five dropouts were recorded for discontinuing orthodontic treatment and 700 brackets were analysed in total. The bonding failure rates for 3200 and 5000 mW/cm2 LEDs were 6.0 and 7.4 per cent, respectively (P = 0.450), which were not statistically significantly different. There were no significant differences in bracket survival rates between the LEDs used (P = 0.866). The posterior teeth presented a higher index of bond failures (odds ratio, 3.14; 95% confidence interval, 1.68-5.87; P < 0.001).

LIMITATIONS

Direct comparison was only done between two high-intensity LED lights rather than against conventionally used halogen lights.

CONCLUSION

Similar bonding failures were recorded using both LED devices (3200 and 5000 mW/cm2). Significantly more bonding failures occurred in premolar teeth than in anterior teeth.

Factors influencing treatment efficiency

OBJECTIVES

The purpose of this cohort study was to evaluate the effect of self-ligating brackets (SB) and other related factors that influence orthodontic treatment time.

MATERIALS AND METHODS

This was a two-armed prospective study. Consecutively treated patients who were recruited from a private practice were enrolled and asked to choose between SB and conventional brackets (CB). If the patient did not have a preference, that patient was randomly allocated. An identical archwire sequence was used, and all patients were treated by a single orthodontist. Treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, whether or not to orthodontic mini-implants (OMI) were used, OMI failure, extraction, American Board of Orthodontics Discrepancy Index, and arch length discrepancy were measured and statistically analyzed using t-tests, correlation analysis, and analysis of covariance (ANCOVA). Stepwise regression analysis was conducted to generate an equation to predict treatment duration.

RESULTS

A total of 134 patients with an average age of 22.73 years were included. The average treatment duration was 28.63 months. ANCOVA showed no significant difference in treatment duration between CB and SB. Stepwise regression analysis could explain 64.6% of the variance in treatment duration using five variables.

CONCLUSIONS

SB did not exhibit a significant reduction in treatment time as compared with CB. Patient cooperation, extractions, and malocclusion severity had a significant impact on treatment duration.

Predicting the bracket bond failure rate in orthodontic patients: A retrospective cohort study

The aim of this study was to determine the risk factors associated with orthodontic bracket bond failure and to develop a prediction equation for orthodontic bracket bond failure rate using the risk factors. This was a retrospective cohort study conducted on a sample of 690 brackets in orthodontic patients aged 10 to 28 years old (mean age 17.97±5.11 years old) visiting a dental hospital. The effect of various parameters of orthodontic bond strength was assessed on bracket failure rate using survival analysis. Parametric (exponential) regression analysis was used to determine the risk factors associated with bracket failure and a prediction equation was formulated to predict the bracket failure rate. The overall mean survival time for the brackets was 3.04 (2.9-3.17) years. The univariate analysis showed a statistically significant (P<0.05) association of bracket material, site, overjet, overbite, incisor and molar classification and age. The multivariate analysis showed a significant interaction between site and side along with bracket material, jaw, overjet and overbite in the model. The risk of bracket failure on the right posterior region is 7.7 times that in the right anterior region when adjusted for all other variables in the model (HR: 7.7; 95% CI: 4.3-13.6). The model including bracket material, jaw, overjet, overbite and interaction between site and side can be used as a predictor of hazard rate for orthodontic bracket failure. Care should be taken in bonding brackets in the posterior region, as their debonding rate is higher as compared to anterior region.

Clinical long-term success of contemporary nano-filled resin composites in class I and II restorations cured by LED or halogen light

OBJECTIVES

The use of LED light-curing units (LED LCUs) for polymerising resin-based composite restorations has become widespread throughout dentistry. Unfortunately, there is a paucity of clinical longitudinal studies that evaluate the comparative efficacy of LED-based polymerisation in direct posterior composite restorations. The aim of the present study was to investigate the performance of class I and II resin composite restorations for two successful composite restorative materials cured with LED versus halogen LCUs.

METHODS

One hundred restorations were placed using the nano-filled composites Grandio® or Filtek™ Supremé. The following test groups were established: LED-Grandio® n = 23 (LG), LED-Filtek™ Supremé n = 21 (LS). As controls were used: Halogen-Grandio® n = 28 (HG), Halogen-Filtek™ Supremé n = 28 (HS). All restorations were evaluated according to the clinical criteria of the CPM index (C-criteria) at baseline and after 6, 12 and 36 months.

RESULTS

After 12 and 36 months, there were no significant differences between restorations polymerised with LED or halogen light. At the end of the study, 97% of the restorations showed sufficient results regardless of the employed LCU or composite. Globally, after 36 months, 56% of all restorations were assessed with code 0 (excellent) and 41% with code 1 (acceptable). In detail, excellent results (code 0) among the criteria surface quality; marginal integrity and marginal discoloration were assigned in 72, 70 and 69%.

CONCLUSIONS

For the current limitations in the clinical trial design, the results showed that LED-polymerisation is appropriate to ensure clinical success of direct posterior resin composite restorations in a range of 3 years.

CLINICAL SIGNIFICANCE

The choice of LCU has no significant influence on the clinical performance of posterior direct resin composite restorations within 3 years of wear.

Clinical effect of reducing curing times with high-intensity LED lights

OBJECTIVE

To evaluate the clinical performance of brackets cured with a high-intensity, light-emitting diode (LED) with a shorter curing time.

MATERIALS AND METHODS

Thirty-four patients and a total of 680 brackets were examined using a randomized split-mouth design. The maxillary right and mandibular left quadrants were cured for 6 seconds with a high-intensity LED light (3200 mW/cm(2)) and the maxillary left and mandibular right quadrants were cured for 20 seconds with a standard-intensity LED light (1200 mW/cm(2)). Alternating patients had the quadrants inverted for the curing protocol. The number and date of each first-time bracket failure was recorded from 199 to 585 days posttreatment.

RESULTS

The bracket failure rate was 1.18% for both curing methods. The proportion of bracket failure was not significantly different between curing methods (P  =  1.000), genders (P  =  1.000), jaws (P  =  .725), sides (P  =  .725), or quadrants (P  =  .547). Posterior teeth exhibited a greater proportion of failures (2.21%) relative to anterior teeth (0.49%), although the difference was not statistically significant (P  =  .065).

CONCLUSIONS

No difference was found in bond failure rates between the two curing methods. Both methods showed bond failure rates low enough to be considered clinically sufficient. The high-intensity LED light used with a shorter curing time may be considered an advantage due to the reduced chair time.

A 15-month evaluation of bond failures of orthodontic brackets bonded with direct versus indirect bonding technique: a clinical trial

Background

The purpose of this clinical longitudinal study was to investigate the effectiveness of indirect bonding technique evaluating the number of bond failures which occurred during treatment.

Methods

Fifty-two patients were selected and divided into two groups: group A (33 patients) bonded with the direct technique and group B (19 patients) bonded with the indirect technique. The number and date of bracket failure were recorded for over 15 months. Moreover, also the effect of crowding level on bracket failures was calculated. Statistical analysis was performed by means of t-test, Kaplan-Meier survival estimates and chi-squared test.

Results

No statistically significant differences were found in the total bond failure rate between direct and indirect techniques, also when comparing the upper and lower arches. The only significant difference was found comparing the posterior segment of the lower arches, in which a higher percentage of detachments were recorded in group B, bonded with the indirect technique. Moreover, no significant differences between direct and indirect bonding were found when evaluating crowding level.

Conclusions

Orthodontic practitioners can safely use the indirect bonding technique, even in patients with severe crowding, because it does not influence the adhesive quality and the bracket survival rate.

Survival analysis of brackets and tubes: A twelve-month assessment

OBJECTIVE

To compare the clinical performance of brackets bonded to anterior and posterior teeth, including second molars.

MATERIALS AND METHODS

One operator, using the straight-wire technique, bonded metallic brackets to the teeth of 127 consecutive patients. All patients were observed for 12 months during their regular orthodontic appointments. Bracket failures were recorded and summarized for statistical analysis. The Cox proportional hazards regression analysis was performed to evaluate bracket failure rates.

RESULTS

Statistically significant differences in survival rates were observed between molar tubes and anterior brackets (P < .05). Twelve-month failure rates of incisor, canine, premolar, and molar brackets were 3.6, 1.6, 4.8, and 11.6%, respectively. The first and second molar did not show significant difference in bond failure. Young patients (age <18 years) showed a higher failure rate than old patients (≥18 years).

CONCLUSIONS

Brackets directly bonded to the buccal surfaces of molars failed significantly more often than those directly bonded to anterior teeth or premolars, but showed acceptable failure rate especially in adult patients. Bonding on second molars seems to be as reliable as bonding on the first molars.

Does a reduction of polymerization time and bonding steps affect the bond strength of brackets?

High bond strengths are required in order to avoid bracket failure during treatment while brackets should be removable. In addition, chair time should be kept at a minimum. Therefore, the aim of this study was to investigate any differences in bracket's bond strength to enamel by reducing the polymerization time and the steps of bonding procedure. Five hundred teeth were randomly allocated into 20 groups. The groups were established considering the investigated curing units (quartz-tungsten-halogen (QTH) and light-emitting diode (LED), each with two different polymerization times) and the used bonding agents (Clearfil SE Bond, Transbond Plus, Ideal1, iBond, and Transbond XT Primer following acid etching). The brackets were debonded using a shear-peel load and used to calculate the bond strength. The location of adhesive failure was registered by using the modified adhesive remnant index (ARI). The influence of the parameters curing unit, curing time, and bonding agent as well as their interaction products on bond strength showed that the bonding agent influenced the bond strength most followed by curing time. The parameter curing unit as well as all the generated interaction products of it showed a lower impact. Regarding the ARI, the bonding agent exhibited also the highest influence. Using a LED resulted in comparable bond strengths as the QTH curing device also at shorter exposure times. Additionally, the two-component self-etching primers showed similar bond strengths compared to the acid-etching method. Chair time can be reduced by using two-component self-etching primers and LED without decrease of bond strength.