Bond strength: a comparison between chemical coated and mechanical interlock bases of ceramic and metal brackets

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.

The effect of different mechanical retention forms on shear bond strength of rebonding of ceramic brackets

The objective of this study is to compare the shear bond strength (SBS) and the morphological characteristics and chemical compositions of the base surface of newly bonded and rebonded ceramic brackets with different mechanical retention bases. Sixty extracted human premolars were divided into the newly bonded and rebonded groups. Ceramic brackets with patterned, laser-etched, and particle-coated patterned bases were randomly bonded to the tooth samples in each group (n=10 per base type). The rebonded brackets exhibited significantly lower SBS than the newly bonded brackets (p<0.05). The main chemical composition of the brackets in both groups was aluminum on the energy-dispersive X-ray spectroscopy. Scanning electron microscopy imaging showed the presence of regular-shaped undercuts or irregular micro-undercuts on the bracket bases which mostly remained intact even after debonding and sandblasting, while coated particles disappeared. The rebonded ceramic brackets with mechanical retention bases exhibited clinically acceptable bond strength regardless of retentive forms.

Comparison of tensile bond strength of new and rebonded Symetri Clear™ ceramic brackets with Transbond™ XT or BluGloo™, with or without surface treatment: An in vitro study

OBJECTIVES

This study sought to determine the bond strength of the Symetri Clear™ bracket after rebonding (reused) for a second and third time.

MATERIALS AND METHODS

Symetri Clear™ mandibular incisor brackets were bonded to bovine incisors and divided into six experimental groups. Two groups underwent tensile bond strength testing, and the remaining four groups were debonded using the manufacturer's recommended plier. Two groups were rebonded twice following surface preparation with Ortho SoloTM and two groups were rebonded twice without surface preparation. The rebonded brackets also underwent tensile bond strength testing after each rebonding event as well as receiving an Adhesive Remnant Index score.

RESULTS

One-way ANOVA found a statistically significant difference in bond strength among the six groups (P<0.0001). Tukey's Studentized Range (HSD, honestly significant difference) Test found significant differences in tensile bond strength of groups which did not undergo surface preparation prior to rebonding. One-way ANOVA found a P-value of 0.2563 and thus no significant difference in ARI among the different groups.

CONCLUSIONS

There was no significant difference in the tensile bond strength of Symetri ClearTM brackets initially bonded with either Transbond™ XT or BluGloo™ and no significant difference between the initial tensile bond strength and the first or second rebond tensile bond strength. Rebonding Symetri Clear™ brackets without surface treatment did show significantly reduced tensile bond strength.

The use of the laser confocal scanning microscopy to measure resin remnants on customized lingual bracket

Background

The study aimed to evaluate the permanence of resin and enamel remains on lingual brackets at the end of orthodontic treatment and after the debonding procedure. The evaluation of resin remnants on customized lingual brackets bases has never done before in other studies because they are curved, and traditional techniques are not applicable.

Methods

The sample consisted of 100 lingual brackets (25 incisors, 25 canines, 25 premolars, 25 molars) scanned with a confocal laser microscope (OLS4000). We measured the brackets' surface and the area of resin remnants with the software of the microscope. Median and quartiles were presented to describe the data. ARI calculation was indirect for each tooth, measuring the resin remnants to the total surface of the bracket. The Kruskal-Wallis test and Fisher test were applied respectively to compare the percentages of remnants and the frequencies of the ARI between the four groups.

Results

After the analyses, 13 brackets had no adhesive remnants (ARI 0), 29 brackets had less than 50% of resin remnants (ARI 1), 50 brackets had more than 50% of resin remnants (ARI 2), and 8 brackets had 100% of adhesive (ARI 3). Canines brackets presented the lower amount of resin followed by premolars, incisors, and molars.

Conclusion

Lingual brackets showed a high frequency of ARI = 2. The median percentage of the bracket surface covered by resin was 41%. We observed a slight tendency of more resin remnants on molar brackets, due to half-pad configuration. The authors suggest paying attention during the debonding procedure of molar brackets since a stronger connection between the adhesive and the bracket mesh means a higher risk of enamel damage.

Priming and bonding metal, ceramic and polycarbonate brackets

Objective: To investigate if primers can be used to modify bonding characteristics of orthodontic brackets.

Materials and methods: Stainless steel, zirconia-alumina ceramic and polycarbonate brackets were bonded to enamel with and without universal and bracket material specific primers on the bracket base. Orthodontic adhesive cement (Transbond™XT) was used for bonding. The primers in each group (n = 10) were silane based (RelyX™ Ceramic Primer) and universal primer (Monobond Plus) for ceramic and metal brackets, and adhesive resin (Adper™ Scotchbond™ Multi-Purpose Adhesive) and composite primer (GC Composite Primer) for polycarbonate brackets. Controls with no primer were used for all bracket types. Teeth with bonded brackets were stored in distilled water in 37 °C for 7 days and debonded with static shear loading. Debonding forces were recorded and analyzed with ANOVA. Adhesive remnant index (ARI) was determined and enamel damage examined.

Results: The bond strength without primers was 8.14 MPa (±1.49) for metal, 21.9 MPa (±3.55) for ceramic and 10.47 MPa (±2.11) for polycarbonate brackets (p < .05). Using silane as primer increased the bond strength of ceramic brackets significantly to 26.45 MPa (±5.00) (p < .05). ARI-scores were mostly 2–3 (>50% of the adhesive left on the enamel after debonding), except with silane and ceramic brackets, ARI-score was mostly 0–1 (>50% of the adhesive left on the bracket). Debonding caused fractured enamel in four specimens with ceramic brackets.

Conclusions: Bond strength was highest for ceramic brackets. Silane primer increased bond strength when used with ceramic brackets leading to enamel fractures, but otherwise primers had only minor effect on the bond strength values.

Er:YAG Laser for Metal and Ceramic Bracket Debonding: An In Vitro Study on Intrapulpal Temperature, SEM, and EDS Analysis

OBJECTIVE

To evaluate the effects of bracket removal using an erbium laser on the pulp temperature and enamel surface.

BACKGROUND

Removal of orthodontic brackets with conventional debonding pliers may result in enamel cracks. To avoid damage to the enamel surface and effectively remove metal or ceramic brackets, different types of lasers, such as Nd:YAG, CO₂, TM:YAP, diode laser, or Er:YAG, have been introduced for debonding.

MATERIALS AND METHODS

A total of 55 brackets (n = 55; 20 metal and 35 ceramic ones) were bonded to 55 caries-free premolars extracted for orthodontic indications. Brackets were irradiated with Er:YAG laser (Morita, Irvine, CA) with a wavelength of 2940 nm at a power of 3.4 W, energy 170 mJ, frequency 20 Hz, pulse duration 300 μs, tip diameter 0.8 mm, air/fluid cooling 3 mL/s, and time of irradiation: 6 sec. Debonding was made by scanning (n = 15; 6 sec irradiation at distance of 2 mm from the bracket with an "S" shape movement) and circular (n = 15; 6 sec irradiation at distance of 1 mm from the bracket) motion technique in ceramic brackets or the circular motion technique in metal brackets (n = 15). The number of 10 nonirradiated teeth with ceramic (n = 5) or metal brackets (n = 5) was used as a control in SEM test and EDS analysis. The damage in tooth enamel surface and the calcium percentage were analyzed by means of scanning electron microscope (JEOL 6610LV, JEOL, Japan) and energy dispersive X-ray spectroscopy (EDS, Oxford, United Kingdom). Temperature changes in the pulp were measured by K-type thermocouple. Evaluation of the Adhesive Remnant Index (ARI) on the enamel surface of each tooth was examined after bracket debonding.

RESULTS

The scanning method has caused significantly lower temperature increase (mean: 0.83°C) compared with circular motion technique around the ceramic brackets (mean: 1.78°C; p = 0.0001) or the metal brackets (mean: 1.29°C; p = 0.015). ARI score showed no differences between the study groups (p = 0.57). SEM analysis revealed no cracks on enamel surface after laser-assisted debonding in comparison with the control samples where cracks were found. EDS showed a higher mean percentage of the calcium (30.7-85.8%) for all test groups compared with control samples (mean: 7%; p = 0.0002). The amount of the calcium elements was higher for metal brackets in comparison with ceramic ones (p = 0.0002).

CONCLUSIONS

Er:YAG laser-assisted debonding causes a minor increase in the pulp temperature and reduced the risk of enamel damage compared with conventional bracket removal.

Enamel defects during orthodontic treatment

Background/Aim: Orthodontic treatment has an inherent potential for causing defects to enamel in the course of bonding and debonding procedures, interproximal enamel stripping and induce the presence of white spot lesions, enamel discoloration or wear. The aim of this study is to present the stages of orthodontic therapy associated with potential damage to enamel and list the enamel alterations observed in each stage. Material and Methods: A literature search was carried out in MEDLINEPubMed database for papers published up to and including February 2015. Results: Enamel loss is induced by cleaning with abrasives before etching, the acid etching process itself, forcibly removing brackets, and mechanical removal of composite remnants with rotary instruments. Loss of enamel or topographic changes in the form of cracks, scarring and scratches may occur. Clinicians may cause structural damage of enamel by interproximal enamel stripping. Additionally, the enamel surface may become demineralized due to plaque accumulation around the orthodontic attachments. Additional complications are enamel color alterations due to its microstructural modifications or discoloration of adhesive remnants and enamel wear due to contact with the brackets of the opposing teeth. Conclusions: Therapeutic procedures performed in the course of orthodontic treatment may cause irreversible physical damage to the outermost enamel. To avoid this, the orthodontic practitioner should take great care in every stage of the treatment and manage the enamel surface conservatively. Moreover, patients should follow an effective oral hygiene regimen. Given these conditions enamel damage during orthodontic therapy is eliminated and longevity of the dentition is promoted.

Comparison of Shear Bond Strength of Four Types of Orthodontic Brackets with Different Base Technologies

Objectives

The aim of this study was to compare the shear bond strength (SBS) of brackets systems with four different base technologies.

Materials and Methods

Maxillary first premolars were randomly divided into four groups of thirty specimens each: (1) Master Series™ conventional twin, (2) T3™ self-ligating, (3) Victory series™ conventional twin, and (4) H4™ self-ligating brackets. Maxillary first premolars were bracketed using an acid-etch composite system, and the SBS measured using an Instron Universal Testing Machine at a crosshead speed of 2 mm/min. The ANOVA and Tukey’s multiple comparison tests were performed with significance predetermined at P ≤ 0.05.

Results

The overall mean bond strengths were 8.49 ± 2.93, 10.85 ± 3.34, 9.42 ± 2.97, and 9.73 ± 2.62 for the Groups 1, 2, 3, and 4 brackets, respectively. One-way ANOVA test gave an F = 3.182 with a P = 0.026. The Group 1 and Group 2 were observed to have statistically significant difference with a P = 0.014.

Conclusions

The T3 self-ligating one-piece design with microetched Quadra Grip™ base brackets had the highest bond strength. The SBS difference between Group 2, Group 3, and Group 4 was not significant, but the difference between Group 2 and Group 1 was statistically significant.

Effect of Er:YAG Laser and Sandblasting in Recycling of Ceramic Brackets

Introduction: This study was performed to determine the shear bond strength of rebonded mechanically retentive ceramic brackets after recycling with Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) laser or sandblasting. Methods: Twenty-eight debonded ceramic brackets plus 14 intact new ceramic brackets were used in this study. Debonded brackets were randomly divided into 2 groups of 14. One group was treated by Er:YAG laser and the other with sandblasting. All the specimens were randomly bonded to 42 intact human upper premolars. The shear bond strength of all specimens was determined with a universal testing machine at a crosshead speed of 0.5 mm/min until bond failure occurred. The recycled bracket base surfaces were observed under a scanning electron microscope (SEM). Analysis of variance (ANOVA) and Tukey tests were used to compare the shear bond strength of the 3 groups. Fisher exact test was used to evaluate the differences in adhesive remnant index (ARI) scores. Results: The highest bond strength belonged to brackets recycled by Sandblasting (16.83 MPa). There was no significant difference between the shear bond strength of laser and control groups. SEM photographs showed differences in 2 recycling methods. The laser recycled bracket appeared to have as well-cleaned base as the new bracket. Although the sandblasted bracket photographs showed no remnant adhesives, remarkable micro-roughening of the base of the bracket was apparent. Conclusion: According to the results of this study, both Er:YAG laser and sandblasting were efficient to mechanically recondition retentive ceramic brackets. Also, Er:YAG laser did not change the design of bracket base while removing the remnant adhesives which might encourage its application in clinical practice.

Shear Bond Strength of Ceramic Brackets with Different Base Designs: Comparative In-vitro Study

INTRODUCTION

Knowledge about the Shear Bond Strength (SBS) of ceramic brackets with different base design is essential as it affects bond strength to enamel.

AIM

The aim of the present study was to evaluate and compare the effect of base designs of different ceramic brackets on SBS, and to determine the fracture site after debonding.

MATERIALS AND METHODS

Four groups of ceramic brackets and one group of metal brackets with different base designs were used. Adhesive precoated base of Clarity Advanced (APC Flash-free) (Unitek/3M, Monrovia, California), microcrystalline base of Clarity Advanced (Unitek/3M, Monrovia, California), polymer mesh base of InVu (TP Orthodontics, Inc., La Porte, IN, United States), patented bead ball base of Inspire Ice (Ormco, Glendora, California), and a mechanical mesh base of Gemini Metal bracket (Unitek/3M, Monrovia, California). Ten brackets of each type were bonded to 50 maxillary premolars with Transbond XT (Unitek/3M). Samples were stored in distilled water at room temperature for 24 hours and subsequently tested in shear mode on a universal testing machine (Model 3382; Instron Corp., Canton, Massachusetts, USA) at a cross head speed of 1mm/minute with the help of a chisel. The debonded interface was recorded and analyzed to determine the predominant bond failure site under an optical microscope (Stereomicroscope) at 10X magnification. One way analysis of variance (ANOVA) was used to compare SBS. Tukey's significant differences tests were used for post-hoc comparisons. The Adhesive Remnant Index (ARI) scores were compared by chi-square test.

RESULTS

Mean SBS of microcrystalline base (27.26±1.73), was the highest followed by bead ball base (23.45±5.09), adhesive precoated base (20.13±5.20), polymer mesh base (17.54±1.91), and mechanical mesh base (17.50±2.41) the least. Comparing the frequency (%) of ARI Score among the groups, chi-square test showed significantly different ARI scores among the groups (χ² = 34.07, p<0.001).

CONCLUSION

Different base designs of metal and ceramic brackets influence SBS to enamel and all were clinically acceptable.

Physical and adhesive properties of dental enamel after radiotherapy and bonding of metal and ceramic brackets

INTRODUCTION

The increasing success rates for cancer patients treated with radiotherapy and the frequent occurrence of tooth loss during treatment have led to an increased demand for orthodontic treatment after radiotherapy. The aim of this study was to evaluate tooth enamel of irradiated teeth after the bonding and debonding of metal and ceramic brackets.

METHODS

Ten permanent molars were cut into enamel fragments measuring 1 mm(2) and divided into an irradiated group (total dose of 60 Gy) and a nonirradiated group. The fragments were subjected to microshear testing to evaluate whether radiotherapy altered the strength of the enamel. Furthermore, 90 prepared premolars were divided into 6 groups and subgroups (n = 15): group 1, nonirradiated and nonaged; group 2, nonirradiated and aged (thermal cycled); group 3, irradiated and aged; each group was divided into 2 subgroups: metallic and ceramic brackets. After thermal cycling and radiotherapy, the brackets were bonded onto the specimens with Transbond XT (3M Unitek, Monrovia, Calif). After 24 hours, the specimens were subjected to the shear tests. Images of the enamel surfaces were classified using the adhesive remnant index. The composite resin-enamel interface was also evaluated.

RESULTS

Enamel fragments subjected to radiation had lower strength than did the nonirradiated samples (P <0.05). The groups and subgroups submitted to radiation and bonded ceramic brackets had the lowest strength values. Groups 1 and 2 with metallic brackets had less adhesive on the surface, whereas groups 1 and 2 with ceramic brackets and group 3 with both metallic and ceramic brackets had more adhesive on the surfaces. On the images of the composite resin-enamel interface, resin tags were more extensive on irradiated tooth enamel.

CONCLUSIONS

Radiation decreased tooth enamel strength, and the specimens treated with radiotherapy had higher frequencies of adhesive failure between the bracket and the composite resin as well as more extensive tags.

Current Products and Practice

Due to an increasing demand for superior aesthetics during fixed appliance treatment, the use of aesthetic brackets has grown in popularity over recent years. Although often requested by patients, aesthetic brackets are not without their disadvantages. This article presents the currently available plastic and ceramic brackets and discusses the potential problems associated with each. Recent advances, introduced by manufacturers in an attempt to overcome their clinical disadvantages, are described.

Invisible orthodontics part 3: aesthetic orthodontic brackets

In this, the third part of the series, aesthetic orthodontic treatment will be considered. The previous two articles have looked at invisible orthodontics with Invisalign and lingual brackets. This article will discuss the properties and use of aesthetic brackets, along with examples of orthodontic treatment cases using the aesthetic brackets.

CLINICAL RELEVANCE

Increasing demand for aesthetics during orthodontic treatment has resulted in a significant increase in the use of aesthetic brackets. Clinicians need to be aware of the benefits and drawbacks of aesthetic brackets.

Bracket base remnants after orthodontic debonding

OBJECTIVE

To evaluate whether the debonding procedure leads to restitutio ad integrum of the enamel surface by investigating the presence of enamel within the bracket base remnants after debonding.

MATERIALS AND METHODS

Sixty patients who completed orthodontic treatment with fixed appliances were included. A total of 1068 brackets were microphotographed; the brackets presenting some remnants on the base (n = 818) were selected and analyzed with ImageJ software to measure the remnant area. From this population a statistically significant sample (n = 100) was observed under a scanning electron microscope to check for the presence of enamel within the remnants. Energy dispersive x-ray spectrometry was also performed to obtain quantitative data.

RESULTS

Statistically significant differences in the remnant percentage between arches were observed for incisor and canine brackets (P < .0001 and P = .022, respectively). From a morphologic analysis of the scanning electron micrographs the bracket bases were categorized in 3 groups: group A, bases presenting a thin enamel coat (83%); group B, bases showing sizable enamel fragments (7%); group C, bases with no morphologic evidence of enamel presence (10%). Calcium presence was noted on all evaluated brackets under energy dispersive x-ray spectrometry. No significant difference was observed in the Ca/Si ratio between group A (16.21%) and group B (18.77%), whereas the Ca/Si ratio in group C (5.40%) was significantly lower than that of the other groups (P < .323 and P = .0001, respectively).

CONCLUSION

The objective of an atraumatic debonding is not achieved yet; in some cases the damage could be clinically relevant.

Quantitative analysis of mechanically retentive ceramic bracket base surfaces with a three-dimensional imaging system

OBJECTIVE

To investigate the three-dimensional structural features of three types of mechanically retentive ceramic bracket bases.

MATERIALS AND METHODS

One type of stainless steel (MicroArch, Tomy, Tokyo, Japan) and three types of ceramic maxillary right central incisor brackets-Crystaline MB (Tomy), INVU (TP Orthodontics, La Porte, Ind), and Inspire Ice (Ormco, Glendora, Calif)-were tested to compare and quantitatively analyze differences in the surface features of each ceramic bracket base using scanning electron microscopy (SEM), a three-dimensional (3D) optical surface profiler, and microcomputed tomography (micro-CT). One-way analysis of variance was used to find differences in bracket base surface roughness values and surface areas between groups according to base designs. Tukey's honestly significant differences tests were used for post hoc comparisons.

RESULTS

SEM revealed that each bracket exhibited a unique surface texture (MicroArch, double mesh; Crystaline MB, irregular; INVU, single mesh; Inspire Ice, bead ball). With a 3D optical surface profiler, the stainless steel bracket showed significantly higher surface roughness values. Crystaline MB had significantly higher surface roughness values than Inspire Ice. Micro-CT demonstrated that stainless steel brackets showed significantly higher whole and unit bracket base surface areas. Among ceramic brackets, INVU showed significantly higher whole bracket base surface area, and Crystaline MB showed a significantly higher unit bracket base surface area than Inspire Ice.

CONCLUSION

Irregular bracket surface features showed the highest surface roughness values and unit bracket base surface area among ceramic brackets, which contributes to increased mechanically retentive bracket bonding strength.

Evaluation of shear bond strength of different treatments of ceramic bracket surfaces

OBJECTIVE: To evaluate the bonding strength of the ceramic bracket and composite resin restoration interface, using four types of treatment on the base of the bracket. METHODOLOGY: 48 photoactivated composite resin discs were used (FiltekTM Z250) contained in specimens and divided into 4 groups of 12 specimens for each group according to the type of treatment performed on the base of the brackets. Once the brackets were bonded, the specimens were subjected to shear stress carried out in a universal testing machine (MTS: 810 Material Test System) calibrated with a fixed speed of 0.5 mm / minute. The values obtained were recorded and compared by means of appropriate statistical tests - analysis of variance and then Tukey's test. RESULTS AND CONCLUSIONS: The surfaces of ceramic brackets conditioned with 10% hydrofluoric acid for 1 minute, followed by aluminum oxide blasting, 50µ, after silane application and primer application, was considered the best method to prepare surfaces of ceramic brackets prior to orthodontic esthetic bonding.

Does ultra-pulse CO(2) laser reduce the risk of enamel damage during debonding of ceramic brackets?

This study seeks to evaluate the enamel surface characteristics of teeth after debonding of ceramic brackets with or without laser light. Eighty premolars were bonded with either of the chemically retained or the mechanically retained ceramic brackets and later debonded conventionally or through a CO(2) laser (188 W, 400 Hz). The laser was applied for 5 s with scanning movement. After debonding, the adhesive remnant index (ARI), the incidence of bracket and enamel fracture, and the lengths, frequency, and directions of enamel cracks were compared among the groups. The increase in intrapulpal temperature was measured in ten extra specimens. The data were analyzed with SPSS software. There was one case of enamel fracture in the chemical retention/conventional debonding group. When brackets were removed with pliers, incidences of bracket fracture were 45% for the chemical retention, and 15% for the mechanical retention brackets. No case of enamel or bracket fracture was seen in the laser-debonded teeth. A significant difference was observed in ARI scores among the groups. Laser debonding caused a significant decrease in the frequency of enamel cracks, compared to conventional debonding. The increase in intrapulpal temperatures was below the benchmark of 5.5 °C for all the specimens. Laser-assisted debonding of ceramic brackets could reduce the risk of enamel damage and bracket fracture, and produce the more desirable ARI scores without causing thermal damage to the pulp. However, some augmentations in the length and frequency of enamel cracks should be expected with all debonding methods.

Rebonding performance of different ceramic brackets conditioned with a new silane coupling agent

The objective of this study was to investigate the rebonding effect of a new silane coupling agent on various ceramic brackets bonded to ceramic specimen. Different ceramic brackets (Fascination 2, Clarity SL, and In-OvationC) were assigned to three groups: rebonding with new silane coupling agent, rebonding with conventional silane coupling agent, or regular bonding as control (n = 16). Bracket adhesion was calculated with a shear test in a universal testing machine. The bracket-composite-ceramic interface was evaluated using the adhesive remnant index score. One-way analysis of variance was applied for inferential statistics. Rebonding with the new silane coupling agent resulted in high shear bond strengths (SBSs; mean values: 37.44-41.24 MPa) and ceramic specimen fractures. Rebonding with the conventional silane coupling agent resulted in significantly (P < 0.001) lower clinically adequate SBS (mean values: 20.20-29.92 MPa) with the least ceramic specimen fractures. Regularly bonded ceramic brackets resulted in clinically adequate to high SBS (mean values: 17.06-41.56 MPa) depending on their bracket base design. Rebonded ceramic brackets showed sufficient SBS to ceramic specimen surfaces. However, increased bracket adhesion was associated with a risk of ceramic specimen surface damage. Therefore, ceramic brackets rebonded with the new silane coupling should be debonded cautiously using alternative debonding methods.

Finite element sub-modeling analyses of damage to enamel at the incisor enamel/adhesive interface upon de-bonding for different orthodontic bracket bases

This study investigates the micro-mechanical behavior associated with enamel damage at an enamel/adhesive interface for different bracket bases subjected to various detachment forces using 3-D finite element (FE) sub-modeling analysis. Two FE macro-models using triangular and square bracket bases subjected to shear, tensile and torsional de-bonding forces were established using μCT images. Six enamel/adhesive interface sub-models with micro- resin tag morphology and enamel rod arrangement were constructed at the corresponding stress concentrations in macro-model results. The boundary conditions for the sub-models were determined from the macro-model results and applied in sub-modeling analysis. The enamel and resin cement stress concentrations for triangular and square bases were observed at the adhesive bottom towards the occlusal surface under shear force and at the mesial and distal side planes under tensile force. The corresponding areas under torsional force were at the three corners of the adhesive for the triangular base and at the adhesive bottom toward/off the occlusal surface for the square base. In the sub-model analysis, the concentration regions were at the resin tag base and in the region around the etched holes in the enamel. These were perfectly consistent with morphological observations in a parallel in vitro bracket detachment experiment. The critical de-bonding forces damaging the enamel for the square base were lower than those of the triangular base for all detached forces. This study establishes that FE sub-modeling can be used to simulate the stress pattern at the micro-scale enamel/adhesive interface, suggesting that a square base bracket might be better than a triangular bracket. A de-bonding shear force can detach a bracket more easily than any other force with a lower risk of enamel loss.

Assessment of enamel damage after removal of ceramic brackets

INTRODUCTION

Since the introduction of ceramic brackets, research has been performed to evaluate enamel damage caused during their removal. One problem in comparing treated and control groups is the absence of assurance that the surfaces were undamaged before the brackets were bonded and debonded, or that superficial treatment applied to the enamel could hinder damage detection. The aim of this in-vitro study was to evaluate enamel injuries during debonding of 3 types of ceramic brackets.

METHODS

Forty-five premolars, extracted for orthodontic purposes, were divided into 3 groups of 15. The enamel surfaces were photographed with a magnifying loupe (60 times) in an optical stereomicroscope (Stemi 2000-C, Zeiss, Oberkochen, Germany) with a digital camera. A different type of backet was bonded and debonded in each group: mechanical retention, mechanical retention with a polymer base, and chemical retention. After debonding, the surfaces were again photographed. The photographs were evaluated for quality of enamel surface according to a predetermined scale. The results were tested by method error and the chi-square test.

RESULTS

The damage evaluation comparing the same surface before bonding and after debonding showed no significant statistical difference between the mechanical retention group and the polymer base retention group. There was a significant statistical difference (P <0.05) for the chemical adhesion ceramic bracket group.

CONCLUSIONS

The difference between the enamel surfaces before bonding and after debonding brackets with chemical retention was statistically significant; bonding and debonding these brackets resulted in enamel damage.

Effects of different debonding techniques on the debonding forces and failure modes of ceramic brackets in simulated clinical set-ups

INTRODUCTION

The objectives of this study were to evaluate the effects of different debonding techniques on the in-vitro mean debonding forces and failure modes of ceramic brackets bonded to enamel with clinically simulated setups.

METHODS

Three kinds of ceramic brackets (Clarity; 3M Unitek, Monrovia, Calif; Inspire and Inspire Ice; Ormco, Orange, Calif) were bonded to extracted premolars with the same bonding system. Thirty ceramic brackets, 10 of each type, were removed by hand; 60 ceramic brackets, 20 of each type, were tested on a universal testing machine with the pliers according to the manufacturers' recommendations. To simulate clinical debonding conditions, specially designed setups were used to debond the ceramic brackets. Debonding forces and failure modes were investigated. Fractographic evaluations were performed by using scanning electron microscopy.

RESULTS

Most brackets failed at the bracket-adhesive interface. Cohesive bracket fractures were noted in all 3 types of ceramic brackets (debonded by hand: 70% of Inspire, 20% of Inspire Ice, and 10% of Clarity; debonded by machine: 75% of Inspire, 30% of Inspire Ice, and 25% of Clarity). The cohesive ceramic fractures of the Clarity brackets were located at the junction between the wings and the body, and at the slot. However, for the Inspire and the Inspire Ice brackets, the cohesive ceramic fractures were located at the occlusal aspect of the base. The mean debonding forces of Inspire, Inspire Ice, and Clarity brackets were 25.72 +/- 11.98, 17.92 +/- 5.03, and 76.89 +/- 23.47 N, respectively. No enamel damage was found after the brackets were removed.

CONCLUSIONS

The results of the failure modes showed that the new designs with a ball reduction band in the Inspire Ice bracket and the vertical debonding slot in the Clarity bracket significantly reduced the risk of ceramic bracket fracture during debonding. The force required to debond the Inspire Ice bracket was significantly lower than that of the Inspire bracket.

Comparison of debonding characteristics of metal and ceramic orthodontic brackets to enamel: an in-vitro study

INTRODUCTION

The objectives of this study were to compare the debonding strengths of 1 metal and 2 types of ceramic orthodontic brackets with different retention mechanisms bonded to enamel and to determine the risk of enamel damage after debonding.

METHODS

In this interventional in-vitro study, 36 maxillary premolars were divided into 3 groups. Three types of orthodontic brackets (metal, ceramic with chemical retention, and ceramic with mechanical retention) were bonded to the teeth with a luting resin composite. The brackets were debonded with a sharp-edged debonding pliers in a universal testing machine. Enamel cracks were evaluated with a stereomicroscope. The amount of residual adhesive on the enamel surfaces was evaluated with the adhesive remnant index.

RESULTS

The mean bond strength for the metal brackets was significantly higher than that of the 2 ceramic brackets (P <.001). No significant difference between the mean bond strengths for the 2 ceramic brackets was observed (P = .238). There was no statistically significant difference in the number (P = .871) or length (P = .188) of enamel cracks among the 3 groups. There were significant differences in the adhesive remnant index scores between metal and chemically retained ceramic brackets (P = .007), and between chemically and mechanically retained ceramic brackets (P = .002).

CONCLUSIONS

The risk of enamel damage when debonding ceramic brackets is not greater than the risk when debonding metal brackets.

In vivo debonding strength and enamel damage in two orthodontic debonding methods

Bracket debonding strength related to diverse debonding methods and enamel damage has not been assessed in vivo. The study hypothetized a direct relationship between these three parameters. Debonding strength was measured clinically in the wings method and base method on 50 patients in a split mouth method using a calibrated debonding plier. Brackets from 30 of these patients were scanned in SEM and EDAX for adhesive remnant index and enamel calcium remnants. Base method debonding force was significantly greater than wings method (163.5+/-68.7 N, 106.1+/-66.2 N, respectively, p < 0.001). A positive adhesive remnant index score was found in both methods (68.7%, 66.7%, respectively). Debonding strength vs. adhesive remnant index or calcium index scores were not correlated. However, the latter two were significantly correlated (0.524 < R < 0.895, p < 0.031). Half of the debonding failures developed at the adhesive enamel interface. The results warnts the potential of enamel damage during debonding.

Shear bond strength of rebonded mechanically retentive ceramic brackets

The purpose of this study was to evaluate the bond strength of rebonded mechanically retentive ceramic brackets. Twenty new and 100 sandblasted rebonded ceramic brackets (Clarity, 3M Unitek, Monrovia, Calif) were bonded to 120 extracted human premolars with composite resin and divided into 6 equal groups according to how the bracket bases were treated: (1) new brackets, (2) rebonded/sandblasted, (3) rebonded/sandblasted/sealant, (4) rebonded/sandblasted/hydrofluoric acid (HF), (5) rebonded/sandblasted/HF/sealant on bracket base, and (6) rebonded/sandblasted/silane. Shear bond strength of each sample was tested with a testing machine. Results showed that the new brackets group had the highest mean strength (15.66 +/- 7.05 megapascals [MPa]), followed by the rebonded/sandblasted/sealant group (7.65 +/- 5.62 MPa), the rebonded/sandblasted/silane group (5.94 +/- 5.33 MPa), the rebonded/sandblasted group (2.97 +/- 2.29 MPa), the rebonded/sandblasted/HF group (1.22 +/- 1.66 MPa), and the rebonded/sandblasted/HF/sealant group (0.82 +/- 1.16 MPa). Statistical analysis showed that only the rebonded/sandblasted/sealant group was comparable with the new brackets group in bond strength (P >.05). It was concluded that in the process of rebonding mechanically retentive ceramic brackets, (1) new brackets have the highest mean bond strength when compared with rebonded brackets, (2) the bond strength of sandblasted rebonded brackets with sealant is not significantly different from new brackets, (3) silane does not increase bond strength of rebonded brackets significantly, and (4) HF treatment on sandblasted rebonded brackets significantly decreases bond strength.

Comparison of bond strength between simple foil mesh and laser-structured base retention brackets

The aims of the current study were to evaluate the bond strength of a new metallic orthodontic bracket with a laser structured base (Discovery, Dentaurum, Ispringen, Germany), and its effects on the site of bond failure and on the behavior of the enamel after debonding. One hundred and twenty recently extracted human premolars were bonded with 1 of 2 types of mechanical interlock base metal brackets: a standard system with a simple foil mesh pad (Minitrim, Dentaurum) and the Discovery bracket. A resin-based, chemically activated bonding system, No-mix (Dentaurum), was used as the adhesive system in this trial. The teeth were immersed in normal saline solution at 37 degrees C for 7 days before debonding and were randomly assigned to different subgroups. A testing machine was used to evaluate tensile and fatigue bond strengths for both brackets. After debonding, the amount of residual adhesive on the bracket and enamel detachment were assessed according to the adhesive remnant index (ARI) and the enamel detachment index (EDI) with a scanning electron microscope and an energy dispersive X-ray spectrometer. The scores obtained from the ARI and the EDI showed that the laser structured base brackets had a significantly higher bond strength (mean +/- SD: 17.1 +/- 0.7 MPa) that was 2 times higher than that observed with the simple foil mesh brackets (mean +/- SD: 8.7 +/- 1.4 MPa) (P <.001). Bond failure with the laser structured base was at the enamel-adhesive interface with an ARI score of 3 in 80% of the teeth, and bond failure with the simple foil mesh base was at the bracket-adhesive interface with an ARI score of 0 in 75% of the teeth. A small area, with less than 10% of the enamel damaged (1 on the EDI) and 1.5 microm in thickness, was observed for both brackets. The laser structured base bracket's bond strength was double that of the simple foil mesh bracket but was equally safe and did not induce significant enamel detachment.

Dental materials citations: Part A, January to June 1997

OBJECTIVE

A search was conducted in biomedical journals published from January 1997 to June 1997 to identify all dental materials publications and sort them into major categories.

METHODS

Tables of contents for 79 journals for the period of January to June, 1997 were inspected and divided into 17 categories. Citations were analyzed by both frequency in journals and in categories, as well as compared to frequencies for previous years.

RESULTS

A total of 445 citations were detected in 79 journals for the period January 1997 to June 1997. Certain journals (n = 19) demonstrated a higher citation frequency (> or = 10 citations for 6 months) and represented 77.8% of all citations. The greatest number of citations continued to involve bonding (n = 97), resin-based restorative materials (composites; glass ionomers) (n = 95), prosthodontic materials (n = 51), and pulp protection/luting materials (n = 48). Frequencies by category were very similar to those for the last four years.

SIGNIFICANCE

The compiled literature citations provide a supplement for researchers and academicians seeking information in existing electronic databases.