Original articleA posttreatment evaluation of direct bonding in orthodontics
Abstract
A long-term evaluation was made of results achieved in direct bonding of metal attachments with a chemically polymerized composite material. A total of 705 attachments were bonded to different teeth, including premolars and molars, in forty-six children. Slim bracket bases, small quantities of adhesive paste, and trimming of the excess material were used to improve esthetics and to benefit in respect of gingival condition. The same person bonded all brackets and performed the orthodontic treatment by a friction-free edgewise light-wire technique. Mean treatment time was 17 months. The clinical appearance before, during, and after treatment is shown in Figs. 3 to 5.
The failure rates for the whole treatment period were 4 to 10 per cent for central and lateral incisors, canines, and first premolars in both dental arches. The second premolars, which were often in various stages of eruption at the time of bonding, and the molars had higher failure rates (Table I). An evident individual variation was noted, as a few children had a high number of loose brackets.
Clinical and scanning electron microscopic studies of tooth surfaces following removal of the brackets demonstrated normal surface appearance when plain-cut tungsten carbide burs rotated at low speed were used to remove remnants of adhesive that could not easily be scraped off. Precoating etched enamel with sealant, in combination with daily fluoride mouth rinses and good oral hygiene, virtually eliminated the caries problem, but regular inspection for interproximal cavities was needed. There were no signs of enamel damage or discoloration for periods of up to 12 months subsequent to bracket removal.
Further details of the technical operative procedure, failure analysis, bracket type and design, gingival health, and other aspects of direct bonding were also discussed.
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Cited by (223)
Evaluation of the effects of 2 different adhesive-coated bracket systems on white spot lesion formation
2023, American Journal of Orthodontics and Dentofacial OrthopedicsThis study evaluated the effects of 2 different adhesive-precoated (APC) bracket systems on white spot lesions (WSLs).
The study had a split-mouth design, and 34 patients were included. The APC Flash-Free (FF) and APC II system brackets were used. At the end of the treatment, digital photographs of each tooth were taken, the WSLs were scored, and lesion areas were calculated. In the same session, the mineralization level of the teeth was measured by DIAGNOdent. The 2 bracket systems were compared in terms of bonding time.
There was no difference between the 2 groups regarding the number of WSLs or the size of the lesion areas. In the maxillary arch, 55.3% of the teeth in the FF group and 61.2% in the control group were healthy. In the mandibular arch, no lesions occurred in 61.2% of the teeth in the FF group and 64.7% of the control group. In the evaluation of DIAGNOdent measurements, WSL formation was detected in 3 teeth in the FF group and 4 in the control group. No statistically significant difference was found between the 2 groups. There was a significant difference between the 2 groups in the evaluation of bonding times.
The effects did not differ between FF and conventional brackets in patients undergoing fixed orthodontic treatment. The use of FF brackets significantly shortened the bonding time.
A comparison between RMGIC and composite with acid-etch preparation or hypochlorite on the adhesion of a premolar metal bracket by testing SBS and ARI: In vitro study
2020, International OrthodonticsA bonding material can be acceptable in orthodontics when Shear Bond Strength (SBS) is higher than 5.9 Mpa. The aim of our study was to compare the bonding of a metal orthodontic bracket “in vitro” under different types of healthy enamel surface preparations and with two bonding products: the composite and the Resin Modified Glass Ionomer Cement (RMGIC).
Premolars preserved in 1% thymol water were bonded on their vestibular and palatal/lingual surfaces with different techniques of bonding and surface preparation: Group 1: Etching + Bonding + Composite, Group 2: Etching + Fuji Ortho LC, Group 3: V-prep + Fuji Ortho LC, Group 4: V-prep + Fuji Ortho LC + Thermocycling. The SBS was measured in Newton on the universal testing machine and the sample was observed under an optical microscope with 10-fold magnification to note the adhesive remnant index score (ARI), before and after thermocycling.
120 premolars were used in this study. RMGIC bonding was significantly increased when the surface was prepared at V-prep (P < 0.001). In these conditions, RMGIC bonding on the buccal surface was similar to that of the composite and superior on the palatal/lingual surface (P = 1). After 2 years of aging using a thermocycling machine for simulation, RMGIC bonding significantly decreased (P < 0.001). The ARI score was significantly lower for the RMGIC group than the composite group (P < 0.001).
RMGIC bonding with V-prep preparation is recommended for palatal/lingual surfaces and for hard-to-dry surfaces. For vestibular surfaces, studies are still needed to recommend bonding with RMGIC instead of composite.
Un produit de collage peut être accepté en orthodontie quand sa capacité d’adhérence est supérieure à 5,9 MPa. Le but de notre étude est de comparer le collage d’une attache orthodontique métallique « in vitro » avec différents types de préparation de surface de l’émail sain et deux produits de collage: le composite et le ciment au verre ionomère modifié par adjonction de résine (RMGIC). Leur adhérance (SBS) a été testée avec une machine de test universelle et leur indice d’adhésif résiduel (ARI) a été évalué sous microscope, avant et après thermocyclage.
Des prémolaires préservées dans l’eau de thymol à 1 % ont été collées sur leurs faces vestibulaires et palatines/linguales avec différentes techniques de collage et de préparation de surface: Groupe 1 : Etching + Liand + Composite, groupe 2 : Etching + Fuji Ortho LC, groupe 3 : V-prep + Fuji Ortho LC, groupe 4 : V-prep + Fuji Ortho LC + thermocyclage. La résistance à la force de cisaillement ou SBS a été mesuré en Newton avec la machine de test universelle et l’indice d’adhésif résiduel ARI a été évalué au microscope optique (avec un grossissement: 10 fois)
Cent vingt prémolaires ont été utilisées. Le collage avec RMGIC a été amélioré de façon significative quand la surface est préparée au V-prep (p < 0,001). Le collage sur la face vestibulaire était proche celui du composite et était supérieur à celui du composite sur la face palatine/linguale. Après 2 ans de vieillissement, le collage à la RMGIC avait significativement diminué (p < 0,001). Le score ARI était significativement inférieur avec RMGIC qu’avec le composite (p < 0,001).
Le collage avec le RMGIC et la préparation V-prep est recommandé pour les surfaces palatines/linguales et les surfaces difficiles à déshydrater. Pour les surfaces vestibulaires, des études sont encore nécessaires pour recommander le collage au RMGIC à la place du composite.
Evaluation of shear bond strength of orthodontic molar tubes bonded using hydrophilic primers: An in vitro study
2019, International OrthodonticsTo evaluate and compare the shear bond strength (SBS) of orthodontic molar tubes bonded using two hydrophilic primers along with a moisture tolerant adhesive system to dry and saliva-contaminated enamel surfaces; and to assess the mode of their bond failure.
A total of 60 extracted human mandibular molars were randomly divided into three major groups according to the primer used, each consisting of 20 molars: XT group acts as a control and bonded with the conventional hydrophobic Transbond XT primer, OS group bonded with the hydrophilic Ortho Solo primer, AP group bonded with the hydrophilic Assure Plus all surface bonding resin. Each major group was further divided into two subgroups, of 10 molars each, according to presence or absence of saliva. All the specimens were thermocycled 500 cycles between 5̊ and 55 °C. Shear forces were applied to the specimens with a universal testing machine at a crosshead speed of 1 mm/min and SBS was measured in megapascals (MPa). The mode of failure was determined using the adhesive remnant index (ARI). Data were analysed using two-way analysis of variance (ANOVA) followed by univariate analysis and Bonferroni post hoc tests.
The three tested primers did not show a significant difference in the mean SBS in dry conditions (P = 0.137); the mean SBS of OS and AP primers were 15.60 ± 5.879 MPa and 12.51 ± 2.583 MPa respectively which were comparable to that of the hydrophobic XT primer (12.76 ± 2.952 MPa). In saliva-contaminated conditions, the mean SBS values were 10.41 ± 4.457 MPa and 9.22 ± 3.422 MPa for OS and AP primers respectively, which were significantly higher than that of XT primer (4.82 ± 2.050 MPa) (P = 0.004). When comparing the mean SBS for each group according to the bonding condition, it was significantly higher in dry bonding compared to saliva-contaminated bonding for the three primers; XT (P < 0.001), OS (P = 0.003) and AP (P = 0.011). In the dry field, most of the bond failures of the three primers were adhesive (score 3), whereas in the saliva-contaminated field, most of the failures were cohesive (score 1).
Dry bonding yielded the highest SBS for the three primers. Saliva contamination significantly decreased the bond strength of both hydrophilic primers; however, the values were above the clinically acceptable limit. The hydrophilic primers tested in the present study can be successfully used for bonding orthodontic molar tubes under dry and saliva-contaminated enamel surface conditions.
Évaluer et comparer la résistance au cisaillement (SBS) des tubes molaires orthodontiques collés à l’aide de deux agents de couplage hydrophiles et d’un système adhésif tolérant à l’humidité sur des surfaces émaillées sèches et contaminées par la salive, et évaluer le mode de décollement.
Un total de 60 molaires mandibulaires humaines extraites ont été réparties au hasard en trois grands groupes selon l’agent de couplage utilisé, chaque groupe était composé de 20 molaires : le groupe XT a servi de témoin et a été collé avec l’agent de couplage hydrophobe conventionnel Transbond XT ; le groupe OS a été collé avec l’agent de couplage hydrophile Ortho Solo ; le groupe AP a été collé avec la résine hydrophile toutes surfaces Assure Plus. Chaque grand groupe a été divisé en deux sous-groupes, de 10 molaires chacun, selon la présence ou l’absence de salive. Tous les échantillons ont été thermocyclés 500 fois entre 5 et 55 °C. Les forces de cisaillement ont été appliquées aux échantillons à l’aide d’une machine d’essais universelle dont la tête se déplace à la vitesse de 1 mm/min et le SBS a été mesuré en mégapascals (MPa). Le mode de décollement a été déterminé à l’aide de l’index des résidus d’adhésifs (ARI). Les données ont été analysées à l’aide d’une analyse de variance bidirectionnelle (ANOVA) suivie d’une analyse univariée et du test post hoc de Bonferroni.
Les trois agents de couplage testés n’ont pas montré de différence significative dans le SBS moyen dans des conditions sèches (p = 0,137) ; le SBS moyen des agents de couplage OS et AP était respectivement de 15,60 ± 5,879 MPa et 12,51 ± 2,583 MPa et était comparable à celui de l’agent de couplage hydrophobe XT (12,76 ± 2,952 MPa). Dans des conditions de contamination salivaire, les valeurs SBS moyennes étaient de 10,41 ± 4,457 MPa et de 9,22 ± 3,422 MPa respectivement pour les agents de couplage OS et AP, elles étaient significativement supérieures à celles des agents de couplage XT (4,82 ± 2,050 MPa) (p = 0,004). Lorsque l’on compare le SBS moyen pour chaque groupe selon les conditions de collage, il était significativement plus élevé pour le collage à sec que pour le collage contaminé par la salive pour les trois agents de couplage : XT (p < 0,001), OS (p = 0,003) et AP (p = 0,011). En milieu sec, la plupart des décollements des trois agents de couplage étaient adhésifs (score 3), tandis qu’en milieu contaminé par la salive, la plupart des décollements étaient cohésifs (score 1).
Le collage à sec a donné le SBS le plus élevé pour les trois agents de couplage. La contamination salivaire a réduit de façon significative l’adhérence des deux agents de couplage hydrophiles ; toutefois, les valeurs étaient supérieures à la limite acceptable sur le plan clinique. Les agents de couplage hydrophiles testés dans la présente étude peuvent être utilisés avec succès pour le collage des tubes molaires orthodontiques dans des conditions de surface d’émail sèche et contaminée par la salive.
Comparative assessment of bonding time and 1-year bracket survival using flash-free and conventional adhesives for orthodontic bracket bonding: A split-mouth randomized controlled clinical trial
2018, American Journal of Orthodontics and Dentofacial OrthopedicsA new flash-free adhesive promises to eliminate the flash removal step in bonding and to reduce bonding time by as much as 40% per bracket, with a bond failure rate of less than 2%. The aim of this trial was to compare bonding time and bracket failure rate over a 1-year period between the flash-free adhesive and a conventional adhesive for orthodontic bracket bonding.
Forty-five consecutive patients had their maxillary incisors, canines, and premolars bonded with ceramic brackets (Clarity Advanced; 3M Unitek, Monrovia, Calif) using a flash-free adhesive (APC Flash-Free Adhesive Appliance System; 3M Unitek) on 1 side and a conventional adhesive (APCII Adhesive Appliance System; 3M Unitek) on the other side. The side allocation was randomized. Bonding was timed to the nearest second. Bond failure was recorded at standardized intervals of 4 weeks. The primary outcome was bonding time (average per tooth for each patient and per quadrant). Secondary outcomes were bracket failure rate within 1 year, time to first-time failure of a bracket, and bond failure type (adhesive remnant index score). Bonding times and adhesive remnant index scores upon bond failure were compared using paired t tests, with P <0.05 considered statistically significant. The adhesives were considered equivalent if the confidence interval for the difference between bracket failure rates fell within a margin of equivalence of ±5%.
The bonding times were significantly shorter with the flash-free adhesive than with the conventional adhesive, both per tooth (P <0.001) and per quadrant (P <0.001). Compared with the conventional adhesive, the average bonding times per tooth and per quadrant with the flash-free adhesive were 37.3% and 32.9% shorter, respectively. The bracket failure rates at 1 year were 3.7% for the flash-free adhesive and 0.9% for the conventional adhesive. This was statistically equivalent. The average times to first-time failure of a bracket were 25 weeks for the flash-free adhesive and 11 weeks for the conventional adhesive. Although there were no significant differences in the adhesive remnant index scores upon failure (P >0.05), the flash-free adhesive tended to fail more often at the enamel-adhesive interface than did the conventional adhesive.
The use of the flash-free adhesive may result in bonding time savings of approximately one third compared with the conventional adhesive. With regard to bracket survival, a statistically significant difference was not found between the 2 adhesives when ceramic brackets were bonded.
This trial was registered on December 3, 2013 (ClinicalTrials.gov ID, NCT02030002).
The protocol was not published before trial commencement.
Evaluation of failure rate of molar tubes with a modified bonding technique: a randomized clinical trial
2023, European Journal of OrthodonticsEffect of bleaching treatments on the adhesion of orthodontic brackets: a systematic review
2023, BMC Oral Health