The effect of etch duration on the microstructure of molar enamel: an in vitro study

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.

Bonded molar tubes: a survey of their use by specialist orthodontists

OBJECTIVE

To investigate the use of bonded molar tubes (BMTs) by specialist orthodontists.

DESIGN

Prospective postal questionnaire.

SETTING

Ireland.

PARTICIPANTS

Registered members of the Orthodontic Society of Ireland.

METHODS

A questionnaire was posted to registered members of the Orthodontic Society of Ireland. It investigated demographics, pattern of use, reasons for use and techniques for placement of BMTs.

RESULTS

A 74% response rate was obtained. In more than 80% of cases, BMTs were used on first and second permanent molars by 52% and 33% of orthodontists respectively. BMT usage was adopted by 97% of respondents in the previous decade. Direct bonding was used by all for BMT placement. Etch times for molars, compared to other teeth, increased from 15 to 30 seconds by 51% of orthodontists. Of the respondents, 97% used light-cured adhesives and 17% used self-etching primers. Molar tube holders were preferred by 54% for placement. Only with a history of epilepsy, were bands preferred to BMTs. BMTs were regarded as more cost-effective than molar bands by 66% of responding clinicians.

CONCLUSIONS

Specialist orthodontists preferred BMTs to bands on first permenent molars. Direct bonding was favoured using a 30-second etch, a light-cured primer and adhesive with specialized molar tube holders. BMTs were perceived to be more cost-effective than molar bands.

Characterization of the porosity of human dental enamel and shear bond strength in vitro after variable etch times: initial findings using the BET method

OBJECTIVES

(1) To quantitatively characterize human enamel porosity and surface area in vitro before and after etching for variable etching times; and (2) to evaluate shear bond strength after variable etching times. Specifically, our goal was to identify the presence of any correlation between enamel porosity and shear bond strength.

MATERIALS AND METHODS

Pore surface area, pore volume, and pore size of enamel from extracted human teeth were analyzed by Brunauer-Emmett-Teller (BET) gas adsorption before and after etching for 15, 30, and 60 seconds with 37% phosphoric acid. Orthodontic brackets were bonded with Transbond to the samples with variable etch times and were subsequently applied to a single-plane lap shear testing system.

RESULTS

Pore volume and surface area increased after etching for 15 and 30 seconds. At 60 seconds, this increase was less pronounced. On the contrary, pore size appears to decrease after etching. No correlation was found between variable etching times and shear strength. Samples etched for 15, 30, and 60 seconds all demonstrated clinically viable shear strength values.

CONCLUSIONS

The BET adsorption method could be a valuable tool in enhancing our understanding of enamel characteristics. Our findings indicate that distinct quantitative changes in enamel pore architecture are evident after etching. Further testing with a larger sample size would have to be carried out for more definitive conclusions to be made.

In vitro evaluation of an alternative method to bond molar tubes

Despite the advances in bonding materials, many clinicians today still prefer to place bands on molar teeth. Molar bonding procedures need improvement to be widely accepted clinically.

Bond strength comparison and scanning electron microscopic evaluation of three orthodontic bonding systems

This study sought to assess the efficacy of two self-etching primer systems (Transbond Plus and Beauty Ortho Bond) on orthodontic brackets. Therefore, shear bond strengths and bracket-adhesive failure modes (ARI scores) were determined and compared against an etch-and-rinse adhesive system (Transbond XT) under two experimental conditions (dry and saliva application). Shear bond strength test was performed at a crosshead speed of 0.5 mm/min, while enamel surfaces and enamel-adhesive interfaces were examined with SEM. There were no significant differences between Transbond XT (9.15 MPa) and Transbond Plus (9.74 MPa) under the dry condition, whereas that of Beauty Ortho Bond (6.47 MPa) was significantly lower than these two systems. Under SEM examination, both self-etching primers showed a milder etching effect and decreased depth of resin penetration into intact enamel than Transbond XT. In conclusion, results of this study showed that both self-etching systems seemed to offer more merits than conventional acid etching because of fewer irreversible changes to enamel.

Surface Analysis of Etched Molar Enamel by Gas Adsorption

Much research has been devoted to the study of etched enamel, since it is critical to bonding. Currently, there are no precise data regarding the etched-enamel specific surface area. The aim of this study was to characterize, by two different methods, the surface of human dental enamel in vitro after being etched. It was hypothesized that differences would be observed between specimens in terms of specific surface area and grade of etching. Sixteen third molar enamel samples were etched for 30 sec with 37% phosphoric acid prior to being viewed by SEM. Etched enamel surfaces were graded according to the Galil and Wright classification. The total surface area of etched samples was determined by the BET gas absorption method. A substantial variability in total surface area was observed between and among samples. A Pearson’s Correlation Coefficient showed a lack of relationship between etch pattern and total surface area.

Effect of impression technique on bond strength

If the effects of surface preparation (eg, acid etching, laser preparation, crystal growth) are to be investigated on the same tooth from which the bond strength is recorded, a method of surface replication is required that does not affect the subsequent bond. This study investigated the effect of 2 different methods of taking impressions on bond strength. Three groups of 11 mandibular incisors were used. The labial enamel was etched with 37% phosphoric acid for 30 seconds. Group A (control) had no impression taken; in group B (silicone), impressions were taken with silicone impression material before bonding; in group C (polyether), an impression was taken with polyether before bonding. After the impressions were taken, GAC brackets (A Company, San Diego, Calif) were bonded to the labial surfaces of the etched enamel with Transbond XT light-cured composite (3M Unitek, Monrovia, Calif). Teeth with bonded brackets were stored in water at 37 degrees C for 24 hours, and then bond strength was measured on a testing machine. The adhesive remnant index (ARI) was also recorded. The lowest bond strength was found after silicone replication (mean [standard deviation]: 8.6 [1.7] MPa) and the highest in the control group (21.2 [4.0] MPa). There was no significant difference between the control group and the polyether replication group (19.1 [4.7] MPa). The surface detail replications of polyether and silicone were found to be identical. It was concluded that polyether had no significant effect on bond strength and was suitable for surface replication before bonding. Polyether allows replication of the enamel surface without a significant effect on bond strength, and this technique could be used to examine the relationship between enamel preparation techniques and subsequent bond strength between composite and enamel.

Acid-etch patterns on the buccal surface of human permanent teeth

Since the introduction of acid etching to aid adhesion to enamel, there has been much research into dental materials to improve bond strength, but little into the surface topography of etched enamel, particularly regarding possible variations between tooth types. This study was a systematic investigation into the quality and quantity of etch patterns found on the buccal surfaces of different human permanent teeth. Twenty-nine orthodontic patients had high-resolution silicone impressions taken of the buccal surface of incisor, canine, premolar and molar, upper and lower teeth, following etching for 30s with 37% phosphoric acid. Impressions (n=266) were replicated in epoxy resin and examined under high magnification in a scanning electron microscope. A modification of the classification of Galil and Wright was used, with histometric techniques, to quantify the quality of etch patterns on enamel surfaces where orthodontic brackets are typically bonded. There was no difference between right and left or between upper and lower teeth of the same type (P>0.05). There was a general trend toward the increasing occurrence of no etch (type D) from anterior to posterior teeth, and a trend toward fewer good-quality etches (types A and B) in the same direction. Etch types A and B were found to occupy the smallest area on the etched buccal surface enamel. The greatest amount of type A etch 'ideal' was found on the lower incisors, yet it occupied less than 5% of the etched buccal surface enamel. The greatest area of etched enamel surface was occupied by type C (etched, but enamel prisms not evident). It was concluded that there is a significant difference in the acid-etch patterns achieved on different tooth types, which suggests that bond-strength studies should be performed with a single tooth type or that an equal number of different tooth types be included.

Variations in acid-etch patterns with different acids and etch times

Research has shown that mandibular premolars have the highest rate of orthodontic bracket bond failure. Bond strength is thought to depend on the quality and quantity of enamel etch produced by the acid. Phosphoric acid is the most commonly used acid for etching before bonding. Nitric acid is also commercially available for etching enamel; however, it has not been studied specifically for etching in orthodontic bonding. This ex vivo study compared the enamel etch patterns achieved on the orthodontic bonding area of extracted mandibular premolars treated with 37% wt/wt phosphoric acid and 2.5% wt/wt nitric acid applied for 15, 30, or 60 seconds. The etch patterns were viewed with a scanning electron microscope and assessed with a 5-point etch scale. Statistical analysis showed that increasing the duration of acid application (irrespective of acid type) significantly increased the amount of better quality etch. Phosphoric acid at 37% concentration was more effective at producing a good-quality etch than was nitric acid at 2.5% for all 3 application times. The quantity of good-quality etch produced by phosphoric acid at 37% was time specific, with 15 seconds being significantly less effective than 30 or 60 seconds. However, 60 seconds was not significantly better than 30. Comparing the upper half of the orthodontic bonding area with the lower half showed no statistically significant differences for either acid type or length of application (P >.005). These findings support the use of 37% wt/wt phosphoric acid and indicate an optimum application time of 30 seconds.

Bonded molar tubes: a retrospective evaluation of clinical performance

This study investigated time to first failure of stainless steel orthodontic first permanent molar tubes (Ormco Corp) bonded with a light-cured resin adhesive (Transbond) and assessed whether this was related to patient gender, age of the patient at the start of treatment, the presenting malocclusion, or the operator. All first molar tubes were bonded to intact buccal enamel, free of any restoration. Survival analysis was carried out on data from 483 patients with 1190 bonded first molar tubes. For each case, a single molar tube, either that which was first to fail or had the shortest follow-up time, was chosen for analysis. The median time until first bonded tube failure was 699 days with an overall failure rate of 21% recorded. There was no significant difference in time to first failure of molar tubes with respect to patient gender or presenting malocclusion but significant differences were recorded with respect to the patients' age at the start of treatment and the operator. Age at the start of treatment and operator were identified as independently useful predictors of bonded molar tube survival.

Dental materials: 1996 literature review. Part 2

This critical review of the published literature on dental materials for the year 1996 has been compiled by the Dental Materials Panel of the UK. It continues the series of annual reviews started in 1973 and published in the Journal of Dentistry. Emphasis has been placed upon publications which report upon the materials science or clinical performance of the materials. The review has been divided by accepted materials classifications (fissure sealants, glass polyalkenoate cements, dentine bonding, dental amalgam, endodontic materials, casting alloys, resin-bonded bridges and ceramo-metallic restorations, ceramics, denture base resins and soft lining materials, impression materials, implants materials, orthodontic materials, biomechanics and image processing, resin composites and casting investment materials and waxes). Three hundred and thirteen articles have been reviewed.

Orthodontic adhesives and bond strength testing

A bracket bond failure is a frustrating occurrence in orthodontic practice. Because the location of the bond failure may indicate the probable cause, it is important to understand the significance of "bond strength" in a clinical application. Bonding in orthodontics can be studied using controlled clinical models or in vitro using simulated clinical models or more fundamental, isolated substrate models, in which bonding of an adhesive to tooth structure or a bracket is studied independently. With numerous adhesives and orthodontic band and bracket materials available as well as other orthodontic substrates besides enamel, such as esthetic ceramic restorations, in vitro models play an important role in characterizing the bonding potential of new systems. This article reviews bonding of orthodontic brackets and bands using various orthodontic adhesives to dental substrates from the perspective of bond strength and its measurement.