Effect of multiple debonding sequences on shear bond strength of new stainless steel brackets

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.

Structural and Color Alterations of Teeth following Orthodontic Debonding: A Systematic Review

AIM

The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and alterations in color.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of online databases was conducted using the keywords 'enamel' AND 'orthodontic debonding'. Eligibility criteria included both in vivo and ex vivo clinical trials conducted on human teeth.

RESULTS AND DISCUSSION

A total of 14 relevant papers were analyzed. Various instruments and techniques were utilized across different studies to assess surface roughness, color change, and surface fractures.

CONCLUSIONS

The findings of this study suggest that ceramic brackets may lead to an increase in enamel fractures, particularly during bracket removal. The surface roughness of enamel exhibits variability depending on the adhesive substance and polishing methods used post-removal. Fixed orthodontic appliances could induce changes in enamel color, which may be alleviated by the use of nano-hydroxyapatite or specific polishing techniques. Further research is necessary to identify effective strategies for managing these color changes and improving the overall outcomes of fixed orthodontic treatment.

Influence of different acid etching times on the shear bond strength of brackets bonded to bovine enamel

Introduction

The most used product for surface acid conditioning for enamel is 37-40% phosphoric acid, which promotes greater mechanical retention.

Aim

The objective of this study was to compare the shear bond strength (SBS) of brackets bonded to bovine enamel with different acid conditioning protocols and to analyze the surface morphology.

Materials and methods

169 teeth (n = 13) were divided into 4 groups: control group without conditioning (G1), Dental Gel 37% phosphoric acid (Dentsply) (G2), Ultra Etch 35% (Ultradent) (G3) and Attaque gel 37% (Biodinâmica) (G4). Groups G2, G3 and G4 were subdivided according to the conditioning time into: 10 s (a), 15 s (b), 30 s (c) and 60 s (d). The superficial enamel morphology (n = 3) was analyzed using a scanning electron microscopy (SEM) to analyze the depth of the microporosities. The samples were submitted to the shear test (SBS) with the aid of a universal testing machine (INSTRON) with a speed of 1 mm/min. The enamel after debonding was analyzed to determine the adhesive remnant index (ARI) in a stereoscopic magnifying glass.

Statistical analysis used

The SBS data were analyzed using two-way ANOVA. ARI data were analyzed using generalized linear models and SEM measurements were analyzed using Kruskal Wallis and Dunn tests. The 95% significance level was used.

Results

The SBS within G2, G3 and G4 ranged from 11.11 to 12.66 MPa. ARI score 3 was observed in 35% of the samples. The samples analyzed in the SEM showed microporosity depth rangingfrom 1.28 to 2.48 μm.

Conclusions

There was no difference between the acids and times evaluated for SBS. The ARI analysis showed that the studied acids provide protection to the enamel surface, keeping the adhesive attached to the buccal surface after debonding. The increase in conditioning time is directly proportional to the deterioration of the prismatic and interprismatic content.

The orthodontic bonding properties of human enamel after cryopreservation

The aim was to investigate the effect of cryopreservation on the enamel bonding properties of orthodontic brackets. Sixty-six human premolars were randomly allocated to a control group or a cryopreserved group. Conventional stainless-steel orthodontic brackets were bonded with a light cure adhesive on the buccal side of the premolars. The shear bond strength (SBS) was determined at a crosshead speed of 1 mm/min. The SBS and adhesive remnant index (ARI) were evaluated respectively by an independent samples t test and Fisher's exact test (α≤0.05). The mean failure load was lower in the cryopreserved group. However, this difference in SBS was not significant (p=0.443). In both groups, the ARI mostly indicated a failure at the enamel-adhesive interface. The mean ARI scores for both groups were not significantly different (p=0.099). Within the limitations of this macro bond strength testing, it can be concluded that cryopreservation does not significantly affect the bonding properties of enamel.

Analysing the potential of hydrophilic adhesive systems to optimise orthodontic bracket rebonding

Introduction

Bond failure during fixed orthodontic treatment is a frequently occurring problem. As bracket rebonding is associated with reduced shear bond strength, the aim of the present investigation is to analyse the effect of different innovative rebonding systems to identify optimised rebonding protocols for orthodontic patient care.

Methods

Metallic brackets were bonded to the frontal enamel surfaces of 240 bovine lower incisors embedded in resin bases. Teeth were randomly divided into two major experimental groups: in group 1 a hydrophilic primer (Assure™ PLUS) was compared to commonly used orthodontic adhesives (Transbond XT™, BrackFix®, Grengloo™) and a zero control. In group 2 different rebonding systems were analysed using a hydrophilic primer (Assure™ PLUS), a methyl methacrylate-consisting primer (Plastic Conditioner) and a conventional adhesive (Transbond XT™). All teeth were tested for shear bond strength according to the DIN-13990 standard, the Adhesive Remnant Index and enamel fracture rate.

Results

The hydrophilic primer enhanced shear bond strength at first bonding (Assure™ PLUS 20.29 ± 4.95 MPa vs. Transbond XT™ 18.45 ± 2.57 MPa; BrackFix® 17 ± 5.2 MPa; Grengloo™ 19.08 ± 3.19 MPa; Meron 8.7 ± 3.9 MPa) and second bonding (Assure™ PLUS 16.76 ± 3.71 MPa vs. Transbond XT™ 13.06 ± 3.19 MPa). Using Plastic Conditioner did not seem to improve shear bond strength at rebonding (13.57 ± 2.94). When enamel etching was left out, required shear bond strength could not be achieved (Plastic Conditioner + Assure™ PLUS 8.12 ± 3.34 MPa; Plastic Conditioner: 3.7 ± 1.95 MPa). Hydrophilic priming systems showed decreased ARI-scores (second bonding: 2.63) and increased enamel fracture rates (first bonding: 55%; second bonding 21,05%).

Conclusions

Based on the present study we found that rebonding strength could be compensated by the use of hydrophilic priming systems. The additional use of a methyl methacrylate-consisting primer does not seem to enhance shear bond strength. No etching approaches resulted in non-sufficient bond strength.

SEM Analysis of Enamel Abrasion after Air Polishing Treatment with Erythritol, Glycine and Sodium Bicarbonate

The aim of this in vitro study was to evaluate the enamel surface topography after treatment with three air polishing powders: Glycine (A), erythritol (B), and sodium bicarbonate (C) (Air Flow Soft, Plus and Classic powders, EMS Electro Medical Systems S.A., Nyon, Switzerland). Fifteen extracted incisors were randomly divided into three groups of five teeth each, A, B and C, respectively. The teeth were blocked in plaster bases, washed, dried and half-covered with polytetrafluoroethylene strips before treatment. In this way, each half-treated dental element became test and control of itself. Comparative statistical analysis of Rq (geometric average of the deviations occurring in roughness profile) was performed. The scanning electron microscope (SEM) analysis showed different degrees of surface roughness between the groups, decreasing after treatment. In addition, a statistically significant reduction p < 0.05 was present in group C (Rq mean non-treated 108.17 µm, 95% CI: 97.29–124.01 and Rq mean treated 86.78 µm, 95% CI: 80.63–93.70). A decrease in surface roughness post-treatment was not observed in group A and B. Therefore, it may be concluded that the air flow powders tested herein can be used on dental enamel to reduce the surface roughness due to function and the action of dental therapies.

Debonding force and shear bond strength of an array of CAD/CAM-based customized orthodontic brackets, placed by indirect bonding- An In Vitro study

Based on three-dimensional scanning and computer-aided design and computer-aided manufacturing (CAD/CAM) techniques, customized bracket systems are increasingly used. However, data remain limited regarding customized bracket design, characteristics, and stability. This study was undertaken to evaluate the design, bond strength, and residual adhesives of four different CAD/CAM customized brackets that were attached to human tooth specimens by indirect bonding. Thirty extracted human upper premolars were divided into five groups: Group 1, preadjusted self-ligating labial metal bracket; Group 2, lingual self-ligating metal injection molding customized bracket; Group 3, gold-casted lingual customized bracket; Group 4, labial self-ligating milled customized bracket; Group 5, labial customized resin base bracket. Except in Group 1, premolar specimens were scanned via model scanner, and the images were sent to each manufacturing company to fabricate customized brackets and transfer trays/jigs. Debonding force (DF; N) was measured by Instron universal testing machine and shear bond strength (SBS; MPa) was calculated via dividing DF by bonding area. Adhesive remnants were analyzed via stereo microscopic images. Group 2 (196.90±82.75 N) exhibited significantly higher DF than Group 1 (62.77±12.65 N); other groups exhibited similar DFs, compared with Group 1. No customized bracket groups exhibited significant differences in SBS, relative to Group 1 (6.73±1.36 MPa). However, SBS in Group 5 (11.46±7.22 MPa) was significantly higher than in Group 3 (3.58±2.14 MPa). Group 3 had significantly lower ARI scores than other groups (P<0.05). Customized brackets exhibited large deviations in DF and SBS; all customized bracket systems exhibited DF that was equivalent or superior to that of preadjusted brackets, even when placed by indirect bonding.

Enamel Resistance to Demineralization After Bracket Debonding Using Fluoride Varnish

The aim of this study was to evaluate the elemental content and morphology of enamel subjected to demineralization cycles after bracket debonding, adhesive remnant removal, and application of a fluoride varnish. 125 bovine teeth were divided into five groups (n = 25): 1) Intact enamel; 2) Intact enamel + demineralization cycles (DC); 3) Enamel after adhesive removal; 4)Enamel after adhesive removal + DC; 5) Enamel after adhesive removal + Profluorid + DC. The weight percentages of calcium (Ca), phosphorous (P) and fluoride (F) were calculated using energy dispersive X-ray spectroscopy (EDX). Samples were observed under scanning electron microscopy (SEM). Data were analyzed using Kruskal-Wallis and Mann-Whitney test. The weight percentages of Ca and P in Group 1 were significantly higher than Groups 2, 4, and 5. The weight percentages of Ca and P in Group 2 were significantly higher than Groups 4 and 5. Group 3 presented significantly higher percentages of Ca and P than Group 4. Group 5 showed a significantly higher percentage of Ca than Group 4. The presence of F was detected in Group 5. SEM images showed more signs of demineralization in Group 4 than Group 5. Fluoride varnish application may protect enamel from demineralization after bracket debonding.

Effects of various debonding and adhesive clearance methods on enamel surface: an in vitro study

Background

The purpose of this study was to evaluate orthodontic debonding methods by comparing the surface roughness and enamel morphology of teeth after applying two different debonding methods and three different polishing techniques.

Methods

Forty eight human maxillary premolars, extracted for orthodontic reasons, were randomly divided into three groups. Brackets were bonded to teeth with RMGIC (Fuji Ortho LC, GC, Tokyo, Japan) (two groups, n = 18 each) after acid etching (30s), light cured for 40 s, exposed to thermocycling, then underwent 2 different bracket debonding methods: debonding pliers (Shinye, Hangzhou, China) or enamel chisel (Jinzhong, Shanghai, China); the third group (n = 12) comprised of untreated controls, with normal enamel surface roughness. In each debonded group, three cleanup techniques (n = 6 each) were tested, including (I) diamond bur (TC11EF, MANI, Tochigi, Japan) and One-Gloss (Midi, Shofu, Kyoto, Japan), (II) a Super-Snap disk (Shofu, Kyoto, Japan), and (III) One-Gloss polisher. The debonding methods were compared using the modified adhesive remnant index (ARI, 1–5). Cleanup efficiencies were assessed by recording operating times. Enamel surfaces were qualitatively and quantitatively evaluated with scanning electron microscopy (SEM) and surface roughness tester, respectively. Two surface roughness variables were evaluated: Ra (average roughness) and Rz (10-point height of irregularities).

Results

The ARI scores of debonded teeth were similar with debonding pliers and enamel chisel (Chi-square = 2.19, P > 0.05). There were significant differences between mean operating time in each group (F = 52.615, P < 0.01). The diamond bur + One-Gloss took the shortest operating time (37.92 ± 3.82 s), followed by the Super-Snap disk (56.67 ± 7.52 s), and the One-Gloss polisher (63.50 ± 6.99 s). SEM appearance provided by the One-Gloss polisher was the closest to the intact enamel surface, and surface roughness (Ra: 0.082 ± 0.046 μm; Rz: 0.499 ± 0.200 μm) was closest to the original enamel (Ra: 0.073 ± 0.048 μm; Rz: 0.438 ± 0.213 μm); the next best was the Super-Snap disk (Ra: 0.141 ± 0.073 μm; Rz: 1.156 ± 0.755 μm); then, the diamond bur + One-Gloss (Ra: 0.443 ± 0.172 μm; Rz: 2.202 ± 0.791 μm).

Conclusions

Debonding pliers were safer than enamel chisels for removing brackets. Cleanup with One-Gloss polisher provided enamel surfaces closest to the intact enamel, but took more time, and Super-Snap disks provided acceptable enamel surfaces and efficiencies. The diamond bur was not suitable for removing adhesive remnant.

Epidemiological survey of different clinical techniques of orthodontic bracket debonding and enamel polishing

Objectives:

To conduct an epidemiological survey of the orthodontic debonding techniques in Italy, and describe the most commonly used methods to remove the brackets and adhesive from the tooth surfaces.

Materials and Methods:

A survey consisting of 6 questions about bracket debonding methods and instruments used was emailed to 1000 orthodontists, who were members of the Italian Orthodontics Society (SIDO. Clinicians were characterized by different sex, age, origin, and professional experience.

Results:

Overall, 267 surveys were returned, representing a response rate of 26.7% of the participants interviewed. The 0.2% of the orthodontists responded, via email, confirming that they were not interested, while 3% of the questionnaires were sent back not completed. The 70.1% of the clinicians interviewed did not return any response. Overall, 64% of SIDO members (orthodontists) did not detect any enamel damage after debonding. The brackets used most frequently (89.14%) in clinical practice were the metal ones. The most commonly used pliers for bracket removal were cutters (37.08%) and bracket removal pliers (34.83%). For adhesive removal, low speed tungsten carbide burs under irrigation were the most widely utilized method for adhesive removal (40.08%), followed by high speed carbide burs (14.19%), and diamond burs (14.19%). The most frequently used instruments for polishing after debonding were rubber cups (36.70%) and abrasive discs (21.35%). The 31.21% of the orthodontists found esthetic enamel changes before bonding versus after debonding.

Conclusions:

This survey showed the high variability of different methods for bracket debonding, adhesive removal, and tooth polishing. The collected answers indicate that most orthodontists have developed their own armamentarium of debonding and polishing, basing their method on trials and errors.

Effect of acid etching on bond strength of nanoionomer as an orthodontic bonding adhesive

AIMS

A new Resin Modified Glass Ionomer Cement known as nanoionomer containing nanofillers of fluoroaluminosilicate glass and nanofiller 'clusters' has been introduced. An in-vitro study aimed at evaluating shear bond strength (SBS) and adhesive remnant index (ARI) of nanoionomer under etching/unetched condition for use as an orthodontic bonding agent.

MATERIAL AND METHODS

A total of 75 extracted premolars were used, which were divided into three equal groups of 25 each: 1-Conventional adhesive (Enlight Light Cure, SDS, Ormco, CA, USA) was used after and etching with 37% phosphoric acid for 30 s, followed by Ortho Solo application 2-nanoionomer (Ketac(™) N100, 3M, ESPE, St. Paul, MN, USA) was used after etching with 37% phosphoric acid for 30 s 3-nanoionomer was used without etching. The SBS testing was performed using a digital universal testing machine (UTM-G-410B, Shanta Engineering). Evaluation of ARI was done using scanning electron microscopy. The SBS were compared using ANOVA with post-hoc Tukey test for intergroup comparisons and ARI scores were compared with Chi-square test.

RESULTS

ANOVA (SBS, F = 104.75) and Chi-square (ARI, Chi-square = 30.71) tests revealed significant differences between groups (P < 0.01). The mean (SD) SBS achieved with conventional light cure adhesive was significantly higher (P < 0.05) (10.59 ± 2.03 Mpa, 95% CI, 9.74-11.41) than the nanoionomer groups (unetched 4.13 ± 0.88 Mpa, 95% CI, 3.79-4.47 and etched 9.32 ± 1.87 Mpa, 95% CI, 8.58-10.06). However, nanoionomer with etching, registered SBS in the clinically acceptable range of 5.9-7.8 MPa, as suggested by Reynolds (1975). The nanoionomer groups gave significantly lower ARI values than the conventional adhesive group.

CONCLUSION

Based on this in-vitro study, nanoionomer with etching can be successfully used as an orthodontic bonding agent leaving less adhesive remnant on enamel surface, making cleaning easier. However, in-vivo studies are needed to confirm the validity of present findings.

Three-dimensional analysis of enamel surface alteration resulting from orthodontic clean-up -comparison of three different tools

Background

The present study aimed at 3D analysis of adhesive remnants and enamel loss following the debonding of orthodontic molar tubes and orthodontic clean-up to assess the effectiveness and safety of One-Step Finisher and Polisher and Adhesive Residue Remover in comparison to tungsten carbide bur.

Materials and methods

Thirty human molars were bonded with chemical-cure orthodontic adhesive (Unite, 3M, USA), stored 24 h in 0.9 % saline solution, debonded and cleaned using three methods (Three groups of ten): tungsten carbide bur (Dentaurum, Pforzheim, Germany), one-step finisher and polisher (One gloss, Shofu Dental, Kyoto, Japan) and Adhesive Residue Remover (Dentaurum, Pforzheim, Germany). Direct 3D scanning in blue-light technology to the nearest 2 μm was performed before etching and after adhesive removal. Adhesive remnant height and volume as well as enamel loss depth and volume were calculated.

An index of effectiveness and safety was proposed and calculated for every tool; adhesive remnant volume and duplicated enamel lost volume were divided by a sum of multiplicands. Comparisons using parametric ANOVA or nonparametric ANOVA rank Kruskal-Wallis tests were used to compare between tools for adhesive remnant height and volume, enamel loss depth and volume as well as for the proposed index.

Results

No statistically significant differences in the volume (p = 0.35) or mean height (p = 0.24) of adhesive remnants were found (ANOVA rank Kruskal-Wallis test) between the groups of teeth cleaned using different tools. Mean volume of enamel loss was 2.159 mm³ for tungsten carbide bur, 1.366 mm³ for Shofu One Gloss and 0.659 mm³ for Adhesive Residue Remover - (F = 2.816, p = 0.0078). A comparison of the proposed new index between tools revealed highly statistically significant differences (p = 0.0081), supporting the best value for Adhesive Residue Remover and the worst – for tungsten carbide bur.

Conclusions

The evaluated tools were all characterized by similar effectiveness. The most destructive tool with regards to enamel was the tungsten carbide bur, and the least was Adhesive Residue Removal.