Effect of Simplified Bonding on Shear Bond Strength between Ceramic Brackets and Dental Zirconia

Enamel Deproteinization or Sandblasting for Enamel Reconditioning Before Acid Etching to Enhance the Shear Bond Strength of Metallic Brackets in a Third Bonding: An In Vitro Study

BACKGROUND

Enamel conditioning with 37% phosphoric acid is the most common technique during orthodontic bracket bonding procedures. However, due to the repeated de-bonding of the orthodontic brackets during treatment, other methods were needed to condition the enamel surface and increase the bond strength. This study aimed to compare the effect of conditioning the enamel surface by sandblasting with aluminum oxide particles or 5.25% sodium hypochlorite gel in combination with acid etching compared to acid etching alone on shear bond strength (SBS).

MATERIAL AND METHODS

One hundred eight extracted upper premolars were randomly divided into three groups according to the conditioning enamel surface method. After the first and second bonding of metal brackets, new metal brackets were bonded with a total-etching adhesive after enamel conditioning using different methods: acid etching only (37% phosphoric acid for 30 seconds) (AE group), sodium hypochlorite associated with acid etching (5.25% NaOCl gel for 60 seconds and then acid etching for 30 seconds) (NaOCl-AE group), and sandblasting associated with acid etching (sandblasting for five seconds and then acid etching for 30 seconds) (SB-AE group). The shear bond strengths of the brackets were tested with a universal testing machine. One-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) tests were used to detect significant differences in shear bond strength among groups at the third bonding. Repeated-measure ANOVA and Bonferroni's tests were used to detect significant differences in shear bond strength among the bonding attempts within each group.

RESULTS

5.25% sodium hypochlorite associated with the acid etching method produced significantly greater shear bond strength than sandblasting associated with acid etching and acid etching only methods at the third bonding (16.40 ± 5.80 MPa, 13.60.47 ± 6.40 MPa, and 9.90 ± 4.40 MPa, respectively; P < 0.001). However, there was no significant difference between the AE and SB-AE groups (P = 0.247). In addition, we found a significant decrease in the shear bond strength within each group after each bonding attempt.

CONCLUSION

Conditioning the enamel surface with 5.25% sodium hypochlorite associated with acid etching produced greater bond strength than conditioning by sandblasting associated with acid etching and acid etching only at the third bonding. The bond strength of the metal bracket decreased with increasing bonding attempts, even with the application of enamel surface conditioning methods.

Shear bond strength of orthodontic brackets bonded with primer-incorporated orthodontic adhesives and unpolymerized 3-dimensional printing materials on 3-dimensional-printed crowns

INTRODUCTION

The use of 3-dimensional (3D) printing techniques in fabricating crowns has increased the demand for bracket bonding onto these surfaces. The objective was to evaluate the shear bond strength (SBS) of orthodontic brackets bonded onto 3D-printed crowns using primer-incorporated orthodontic adhesives and 3D printing materials as orthodontic adhesives.

METHODS

A total of 160 crowns were printed with two 3D printing materials, DentaTOOTH (Asiga, Sydney, Australia) (group A) and NextDent C&B Micro Filled Hybrid (3D Systems, Soesterberg, Netherlands) (group N). Each group was randomly divided into 4 adhesive subgroups (n = 20): Transbond XT (for groups A [ATX] and N [NTX]; 3M Unitek, Monrovia, Calif), Ortho Connect (for groups A [AOC] and N [NOC]; GC Corporation., Tokyo, Japan), Orthomite LC (for groups A [AOM] and N [NOM]; Sun Medical, Co Ltd, Moriyama, Shiga, Japan), and unpolymerized liquid state of 3D printing resin (for groups A [AA] and N [NN]). SBS was measured with a universal testing machine at a crosshead speed of 0.5 mm/min. The adhesive remnant index and the mode of failure were analyzed under the microscope. Statistical analysis was performed at a significance level of α = 0.05.

RESULTS

When used as adhesives (AA and NN), 3D printing materials showed no statistically significant difference in SBS compared with Transbond XT (ATX and NTX, respectively). In group N, NN showed a significantly higher SBS than primer-incorporated orthodontic adhesives (NOC and NOM; P <0.001). Adhesive failures were only observed in primer-incorporated orthodontic adhesives (AOC, NOC, AOM, and NOM).

CONCLUSIONS

Primer-incorporated orthodontic adhesives, as well as unpolymerized 3D printing materials employed as orthodontic adhesives on 3D-printed crowns, exhibited comparable bonding strength to Transbond XT without surface modification. Despite variations in adhesive-related factors, all measurements stayed within clinically acceptable ranges, highlighting the potential of these materials for orthodontic bonding on 3D-printed crowns, simplifying clinical procedures without compromising bond strength.

The possibility of clinical bonding between metal/ceramic brackets to zirconia: in vitro study

Objective: The present study aimed to assess the bond strength and durability of six bonding agents concerning their application to metal or ceramic brackets and zirconia. Materials and Methods: Six resin cement bonding agents (XT, XTS, RSBU, RGBU, SBPM, and GMP) were chosen for this investigation. Specimens were either stored in distilled water at 37°C for 24 h or subjected to 5,000 thermocycles before conducting a Shear Bond Strength (SBS) test. Statistical analysis of the SBS data was performed using three-way ANOVA and Games-Howell tests (α = 0.05). The Adhesive Remnant Index was examined, and the debonding surface details on brackets and zirconia were observed. Results: For metal brackets, all groups demonstrated clinically acceptable bond strength, irrespective of storage conditions, except for the XT group. Regarding ceramic brackets, all groups displayed acceptable bond strength after 24 h of water storage. However, following thermocycling, a significant decrease in SBS was noted across all groups (p < 0.05), with SBPM exhibiting a higher bond strength. Three-way ANOVA analysis indicated that SBS values were notably influenced by each factor, and an interaction among the three independent variables was observed (p = 0.000). Conclusion: The reliable bond strength between ceramic brackets and zirconia was significantly lower after thermocycling compared to that of metal brackets and zirconia. SBPM exhibited consistent and robust bond strength between ceramic/metal brackets and zirconia across various storage conditions. Furthermore, the HEMA-free adhesive demonstrated a potentially more consistent bonding performance compared to the HEMA-containing adhesive employed in this study.

Effects of Acidic Environments on Dental Structures after Bracket Debonding

Brackets are metallic dental devices that are very often associated with acidic soft drinks such as cola and energy drinks. Acid erosion may affect the bonding between brackets and the enamel surface. The purpose of this study was to investigate the characteristics of brackets' adhesion, in the presence of two different commercially available drinks. Sixty human teeth were divided into six groups and bonded with either resin-modified glass ionomer (RMGIC) or resin composite (CR). A shared bond test (SBS) was evaluated by comparing two control groups with four other categories, in which teeth were immersed in either Coca-Cola^TM or Red Bull^TM energy drink. The debonding between the bracket and enamel was evaluated by SEM. The morphological aspect correlated with SBS results showed the best results for the samples exposed to artificial saliva. The best adhesion resistance to the acid erosion environment was observed in the group of teeth immersed in Red Bull^TM and with brackets bonded with RMGIC. The debonded structures were also exposed to Coca-Cola^TM and Red Bull^TM to assess, by atomic force microscopy investigation (AFM), the erosive effect on the enamel surface after debonding and after polishing restoration. The results showed a significant increase in surface roughness due to acid erosion. Polishing restoration of the enamel surface significantly reduced the surface roughness that resulted after debonding, and inhibited acid erosion. The roughness values obtained from polished samples after exposure to Coca-Cola^TM and Red Bull^TM were significantly lower in that case than for the debonded structures. Statistical results evaluating roughness showed that Red Bull^TM has a more erosive effect than Coca-Cola™. This result is supported by the large contact surface that resulted after debonding. In conclusion, the prolonged exposure of the brackets to acidic drinks affected the bonding strength due to erosion propagation into both the enamel-adhesive interface and the bonding layer. The best resistance to acid erosion was obtained by RMGIC.

Orthodontic shear bond strength and ultimate load tests of CAD/CAM produced artificial teeth

OBJECTIVES

To investigate whether artificial CAD/CAM processed (computer-aided design/manufacturing) teeth could be a feasible option for the production of dental in vitro models for biomechanical testing.

MATERIAL AND METHODS

Disks (n = 10 per group) made from two different CAD/CAM-materials, one fiber-reinforced composite (FRC; Trinia, Bicon) and one polymethylmethacrylate-based resin (PMMA; Telio CAD, Ivoclar Vivadent), as well as bovine teeth (n = 10), were tested for their shear bond strength (SBS) and scored according to the adhesive remnant index (ARI). In addition, CAD/CAM-manufactured lower incisor teeth were tested for their ultimate load (F_u).

RESULTS

With regard to SBS, both PMMA (17.4 ± 2.2 MPa) and FRC (18.0 ± 2.4 MPa) disks showed no significant difference (p = 0.968) compared to bovine disks (18.0 ± 5.4 MPa). However, the samples differed with regard to their failure mode (PMMA: ARI 4, delamination failure; FRC: ARI 0 and bovine: ARI 1.6, both adhesive failure). With regard to F_u, FRC-based teeth could withstand significantly higher loads (708 ± 126 N) than PMMA-based teeth (345 ± 109 N) (p < 0.01).

CONCLUSION

Unlike PMMA-based teeth, teeth made from FRC showed sufficiently high fracture resistance and comparable SBS. Thus, FRC teeth could be a promising alternative for the production of dental in vitro models for orthodontic testing.

CLINICAL RELEVANCE

CAD/CAM-processed teeth made from FRC enable the use of standardized geometry and constant material properties. Using FRC teeth in dental in vitro studies has therefore the potential to identify differences between various treatment options with rather small sample sizes, while remaining close to the clinical situation.

Cytotoxicity and Bonding Property of Bioinspired Nacre-like Ceramic-Polymer Composites

For clinical applications, non-cytotoxicity and good bonding property of dental restorative materials are the most essential and important. The aim of this study was to evaluate the potential for clinical applications of two novel bioinspired nacre-like ceramic (yttria-stabilized zirconia)-polymer (polymethyl methacrylate) composites in terms of the cytotoxicity and bonding property. The relative growth rates (24 h) of the Lamellar and Brick-and-mortar composites measured by CCK8 were 102.93%±0.04 and 98.91%±0.03, respectively. According to the results of cytotoxicity and proliferation experiments, the two composites were not cytotoxic to human periodontal ligament fibroblasts (HPDLFs) in vitro. Both composites exhibited improved bonding strength as compared to the Control group (Vita In-Ceram YZ). As the polymer content in the composite material increases, its bonding strength also increases, which enhances the application potential of the material in the field of dental restoration. Meanwhile, by controlling the direction of loading force in the shear test, the effect of microstructure on the bonding strength of anisotropic composites was studied. After sandblasted, the bonding strengths of the Lamellar group in the longitudinal and transverse shear directions were 17.56±1.56 MPa and 18.67±1.92 MPa, respectively, while of the Brick-and-mortar group were 16.36±1.30 MPa and 16.99±1.67 MPa, respectively. The results showed that the loading direction had no significant effect on the bonding strength of the composites.

Impact of different pretreatments and attachment materials on shear bond strength between monolithic zirconia restorations and metal brackets

To investigate the influence of different pretreatment methods, attachment materials and artificial aging on shear bond strength (SBS) between monolithic zirconia and metal brackets. Zirconia substrates were pretreated with silica coated alumina (CoJet) and (1) clearfill ceramic primer plus (CF), (2) RelyX ceramic primer (RXP), (3) Futurabond U (FU). The brackets were bonded with (1) Transbond XT Adhesive (TB), (2) BrackFix Adhesive (BF), (3) bracepaste adhesive (BP). SBS was tested after 24 h, 500 thermal cycles, 90 d at 37 °C with a universal testing machine. SBS values reached from 8.3 to 16.9 MPa. The Weibull moduli ranged between 0.37 (RXP combined with BP after 90 d) and 7.42 (CF combined with TB after 24 h). The pretreatment with FU after 90 d, independent of the attachment material, and RXP with BF resulted in the lowest SBS values 8.3–9.9 MPa, the combination of RXP or CF with TB showed the highest (13.2–16.9 MPa) independent of aging. After FU pretreatment the proportion of ARI 1 and 0 was higher, of ARI 3 lower as after CF and RXP pretreatment. All tested combinations showed sufficiently high SBS values for clinical use. Pretreatment with FU presented the lowest values after 90 days.

The effect of surface treatment and thermocycling on the shear bond strength of orthodontic brackets to the Y-TZP zirconia ceramics: A systematic review

INTRODUCTION

Various surface pre-treatment methods have been adapted to optimize the bonding between the zirconia ceramics and the orthodontic brackets.

OBJECTIVE

This review is aimed at systematically analyzing the relevant data available in the literature, to find out the most effective and durable bonding protocol.

METHODS

Database search was conducted in PubMed, Scopus, and ScienceDirect, during September 2020. The review was conducted according to the PRISMA guidelines.

RESULTS

Based on the inclusion criteria, 19 articles were selected for qualitative analysis. Meta-analysis could not be performed due to the heterogeneity of the methodology among the studies. Most of the studies scored medium risk of bias. Compared to the untreated surface, surface pretreatments like sandblasting and lasers were advantageous. Primers and universal adhesive were mostly used as an adjunct to the mechanical pretreatment of the zirconia surface. In most studies, thermocycling seemed to lower the shear bond strength (SBS) of the orthodontic brackets.

CONCLUSION

Based on this qualitative review, surface pretreatments with lasers and sandblasting can be suggested to optimize the bracket bond strength. To clarify this finding, meta-analysis is anticipated. Hence, high heterogeneity of the included studies demands standardization of the methodology.

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.

In Vitro Study of Shear Bond Strength in Direct and Indirect Bonding with Three Types of Adhesive Systems

This study aimed to compare the shear bond strength (SBS) and adhesive remaining index (ARI) using one conventional and two novel adhesive systems with clinical step reduction and direct and indirect bonding. A sample of 72 human premolars were divided into six groups of 12 samples. The first three groups (G1, G2, G3) were bonded with a direct technique, while the remaining groups (G4, G5, G6) were bonded by the indirect technique. Groups G1 and G4 used conventional acid-etching primer composite (XT); groups G2 and G5 used self-etching bonding (BO), and groups G3 and G6 had an acid-etching treatment followed by a self-adhesive composite (OC). All groups were exposed to thermocycling. Shear bond strength was analyzed with a universal test machine, and the ARI was examined with 4× magnification. The results showed statistically significant differences between the three adhesive systems. The highest strength values were observed in the XT group G1 (13.54 ± 4 MPa), while the lowest were shown in the BO G2 samples (5.05 ± 2 MPa). There was no significant difference between the direct or indirect bonding techniques on the three compared groups. The type of primer and bonding material significantly influenced the SBS. Values with self-etching bonding were below the minimum recommended for clinical use (5.9-7.8 MPa). There was no difference between indirect and direct bonding techniques. The lowest ARI scores (0-1) were observed in both self-etching and BO groups. Further clinical studies are needed to compare in vivo results.

The effect of various mechanical and chemical surface conditioning on the bonding of orthodontic brackets to all ceramic materials

Background/purpose

Increasing the bond strength between the orthodontic brackets and all-ceramic materials is one of the challenges facing orthodontists. The purpose of this study is to assess the shear bond strength (SBS) of metal brackets to two types of all ceramic materials using various surface mechanical and chemical conditioning methods.

Materials and methods

Sixty ceramic blocks were prepared using two types of all ceramic materials (IPS e.max and VITA Suprinity® PC) and treated with 3 surface treatments; surface etching with 9.6% hydrofluoric acid (HFA) for 2 mins; surface roughening with Sof-Lex finishing discs; and surface roughening with Sof-Lex finishing discs and etching with HFA. Metal brackets were attached to the surface of the ceramic blocks using light cure orthodontic adhesive. Samples were subjected to 2000 thermo-cycles (5-50 °C) and the SBS was assessed using Instron machine. The adhesive remnant index (ARI) was evaluated under light microscope. Descriptive and group comparison were calculated using Two-way ANOVA, Post-hoc Tukey's and Chi-square tests and significance level set at (P < 0.05).Results: surface roughening of both ceramic materials with Sof-Lex discs and HFA resulted in a significant increase in SBS compared to other experimental groups (P < 0.05). However, VITA Suprinity ceramic prepared with Sof-Lex discs only showed the lowest SBS. The distribution of the ARI scores was significantly different between the groups (P < 0.05).

Conclusion

Surface preparation of all ceramic materials with Sof-Lex discs and hydrofluoric acid combination produces the highest SBS to metallic orthodontic brackets.

Bond Strength and Failure Pattern of Orthodontic Tubes Adhered to a Zirconia Surface Submitted to Different Modes of Application of a Ceramic Primer

The aim of this study was to evaluate the shear bond strength of orthodontic tubes adhered to ceramics with the Transbond™ XT bonding resin (3M, Maplewood, MN, USA) while varying the surface treatment. Then, the adhesive remaining index (ARI) was verified, and the representative fracture patterns were evaluated via scanning electron microscopy. Forty-eight zirconia blocks were divided into three groups, varying the number of layers of the 10-methacryloyloxy-decyl dihydrogen phosphate (MDP) primer: one, two, or three applications. In addition, 16 lithium disilicate IPS E.max ceramic disks (Ivoclar Vivadent, Schaan, Liechtenstein) were conditioned with 10% hydrofluoric acid for 20 s and underwent a single-layer primer application regimen. The four groups were further stratified to undergo bond testing after either 24 h (control) or 5000 cycles in a thermocycling machine. A shear bond strength test was performed (0.5 mm/min), and the MPa values obtained were submitted to a two-way analysis of variance and Tukey’s test. There was no statistical difference among the control group ceramics that received the varying surface treatments. After thermocycling, it was verified that both the E.max disks and the zirconia ceramics with three primer applications obtained the highest bond strength values. In the 24 h groups, a total displacement of the resin from the orthodontic tubes was observed (ARI of 1). After thermocycling, the highest prevalence of an ARI of 5 (adhesive failure) was observed among the zirconia ceramics with single-coat primer application, followed by those with triple-coat primer application (mixed failure). Three applications of the MDP-containing ceramic primer achieved the best result in the present study. Zirconia surface should be treated with three coats of MDP primer to achieve a level of bond strength similar to silica-rich phase ceramic.