The force levels required to mechanically debond ceramic brackets: an in vitro comparative study

Comparative Study of Transmission of 2940 nm Wavelength in Six Different Aesthetic Orthodontic Brackets

Background: Previous studies have confirmed the superiority of using erbium lasers (2940, 2780 nm) over other lasers in the debonding of ceramic brackets due to their safety and effectiveness. The most important factor in the debonding of aesthetic brackets is the transmission of the erbium laser through the aesthetic bracket to the adhesive resin. Objective: To identify the transmission of the 2940 nm wavelength through different types of aesthetic brackets. Materials and methods: A total of 60 aesthetic brackets were divided into six equal groups (10 monocrystalline sapphire brackets—Radiance, AO; 10 monocrystalline sapphire brackets—Absolute, Star Dentech; 10 polycrystalline brackets—20/40, AO; 10 polycrystalline brackets—3M Unitek Gemini Clear Ceramic; 10 silicon brackets—Silkon Plus, AO; 10 composite brackets—Orthoflex, OrthoTech). The aesthetic brackets were mounted in a Fourier transform infrared spectrophotometer (FTIR IRPrestige-21, SHIMADZU) following the typical spectroscopy lab procedure for such samples. The transmission ratio for the 2940 nm wavelength was obtained using IRsolution software. The mean transmission values of the tested groups were compared using a one-way analysis of variance (ANOVA) test followed by a Bonferroni test (post-hoc test). Results: The highest transmission ratio was observed for the Radiance sapphire brackets (64.75%) and the lowest was observed for the 3M polycrystalline brackets (40.48%). The differences among the Aesthetic brackets were significant (p < 0.05). Conclusions: The thick polycrystalline and composite brackets have the lowest transmissibility, whereas the monocrystalline sapphire brackets have the highest transmissibility for the 2940 nm wavelength, meaning that there is a higher possibility of debonding them with a hard tissue laser through thermal ablation.

Bond Strength of Metallic or Ceramic Orthodontic Brackets to Enamel, Acrylic, or Porcelain Surfaces

Bonding strategies within different brackets and dental materials are still a challenge concerning adhesion and dental surface damage. This study compared the shear and tensile bond strength of orthodontic ceramic and metallic brackets to enamel, acrylic, and ceramic surfaces after thermal cycling. Dental surfaces were divided into three groups: enamel, ceramic, and acrylic. Each group received stainless-steel and ceramic brackets. After thermal cycling, specimens were randomly divided into two subgroups considering tensile (TBS) or shear bond strength (SBS) test. After the mechanical testing, scanning electron and optical microscopy were performed, and the adhesive remnant index (ARI) was determined. The two-way ANOVA full factorial design was used to compare TBS, SBS, and ARI on the surface and bracket type (α = 0.05). There were significant differences in TBS, SBS, and ARI values per surface (p < 0.001 and p = 0.009) and type of bracket (p = 0.025 and p = 0.001). The highest mean SBS values were recorded for a ceramic bracket bonded to an acrylic surface (8.4 ± 2.3 MPa). For TBS, a ceramic bracket bonded to acrylic showed the worst performance (5.2 ± 1.8 MPa) and the highest values were found on a metallic bracket bonded to enamel. The adhesion of metallic or ceramic brackets is enough for clinical practice although the damage of the enamel surface after debonding is irreversible and harmful for the aesthetic outcome of the teeth.

Effect of different debonding techniques on shear bond strength and enamel cracks in simulated clinical set-ups

OBJECTIVE

The aim of this study was to evaluate the relationship between debonding forces and enamel cracks length change between different debonding techniques.

METHODS

80 extracted premolar teeth with intact buccal enamel were divided into five groups. In each group, enamel cracks were evaluated by stereomicroscope before and after debonding. All teeth were bonded with metal brackets by self-cure adhesive (3M, USA) and then debonded by bracket debonding plier, fixed on the UTM machine, through five methods based on location of plier on brackets: OGwing (occlusogingival), MDwing (mesiodistal), Oblique, OGbase (occlusogingival) and Cusp-base.

RESULTS

Based on non-parametric distribution of data, there was no significant difference between groups in ARI and enamel cracks length change. The highest shear bond strength for debonding presented in OG base method (25.25 ± 8.4) and the difference was statistically significant (P-value = 0.029). There was no linear relationship between shear bond strength and cracks length change and also between ARI and cracks length change.

CONCLUSION

Despite the lower cracks length change in Cusp-base method than other groups, there wasn't significant difference between debonding methods. Also the amount of debonding forces and ARI do not affect the changes of cracks length.

Assessment of microcracks and shear bond strength after debonding orthodontic ceramic brackets on enamel priorly etched by different Er,Cr:YSGG and Er:YAG laser settings without acid application: An in vitro study

BACKGROUND DATA

Enamel microcrack formation has a high incidence after mechanical debonding of ceramic brackets. This may be due to high delivered shear bond strength values when enamel is priorly etched by phosphoric acid. It is still not well elucidated in the literature if laser etching affects enamel the same way. The aim of the research was to analyze different Er,Cr:YSGG and Er:YAG laser etching settings as an alternative to phosphoric acid, in an attempt to prevent enamel microcrack formation during laser etching and mechanical debonding, while reducing the shear bond strength to the minimal clinical acceptable value.

MATERIALS AND METHODS

One hundred and thirty-three teeth were randomly divided into 7 experimental groups according to their etching modalities. Settings used for enamel etching were in Er,Cr:YSGG groups: Er,Cr:YSGG (1.5Watt, W/20Hertz, Hz); Er,Cr:YSGG (1.5W/15Hz) and Er,Cr:YSGG (2W/20Hz) and settings used for enamel etching in Er:YAG groups were: Er:YAG (60 millijoules, mJ), Er:YAG (80mJ) and Er:YAG (100mJ). Group C etched with 37% phosphoric acid served as control. Microscopic analysis was performed to assess presence of enamel microcracks. Shear bond strength was evaluated after thermocycling using Weibull survival analysis.

RESULTS

All groups showed a reduction in additional microcracks after debonding when compared to control, but only group Er:YAG (60mJ) exhibited a statistically significant difference. Groups Er:YAG (80mJ), control and Er:YAG (100mJ) showed respectively the highest probability of survival at various stress levels followed by groups Er:YAG (60mJ); Er,Cr:YSGG (1.5W/15Hz); Er,Cr:YSGG (2W/20Hz) and Er,Cr:YSGG (1.5W/20Hz) that presented a relatively considerable risk of failure, even at low stress levels.

CONCLUSIONS

When considering reduction of enamel microcrack formation and clinical acceptable shear bond strength, none of the groups succeeded both. Etching by Er:YAG (60mJ) and Er,Cr:YSGG (1.5W/15Hz), showed the least overall microcrack incidence between groups, but Er:YAG (60mJ) displayed significant reduction compared to phosphoric acid. However, etching by Er:YAG (80mJ) had the most predictable results in term of shear bond strength.

Detection of residual resin-based orthodontic adhesive based on light-induced fluorescence

INTRODUCTION

This study evaluated the fluorescence of orthodontic adhesives using quantitative light-induced fluorescence-digital (QLF-D) images, and compared differences in the color characteristics of the fluorescence between adhesive and the adjacent tooth with that under white-light illumination in specimens containing residual adhesive of various thicknesses.

METHODS

Disc-shaped adhesive samples and samples comprising adhesive attached to extracted human teeth were prepared using Transbond XT, Blugloo, and Enlight, and they were ground to thicknesses ranging from 800 to 20 μm. Fluorescence and white-light images of the two types of specimens were taken with a QLF-D system. The color parameters for the fluorescence from the discs and the color difference (ΔE) between residual adhesive and the adjacent tooth were quantified in images using the CIE L*a*b* system.

RESULTS

The fluorescence color values of the discs differed significantly among the three adhesive products (P <  0.05). The ΔE values in fluorescence (ΔE_F) and white-light (ΔE_W) images for all three adhesives were lower for thinner residual adhesive specimens. The thickness of the adhesive could be perceived over a range of 50-100 μm for fluorescence images and 400-800 μm for white-light images (ΔE > 3.3). ΔE_F was significantly larger than ΔE_W for all of the residual adhesives, Blugloo specimens thicker than 100 μm, and Transbond XT and Enlight specimens thicker than 50 μm (P <  0.05).

CONCLUSIONS

Detecting and analyzing fluorescence signals can improve the ability to detect residual adhesive on a tooth and also provide thickness information.

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.

CO2 laser as auxiliary in the debonding of ceramic brackets

This study evaluated the temperature in the bonding composite and in the pulp chamber, the shear bond strength after the irradiation of CO2 lasers, and the Adhesive Remnant Index (ARI) after debonding of ceramic bracket. A hundred and five premolars were used: 30 to evaluate the temperature and 75 to test the resistance to shear and the ARI. To assess the temperature, different irradiation times (3 and 5 s), pulse duration (0.001 and 0.003 s), and output power (5, 8, and 10 W) were tested (total of 12 groups). During all the irradiation, specimens were immersed in thermal bath water at 37 °C. In the test and ARI evaluation, premolars were divided into five groups (n = 15) and were submitted to the following regimens of CO2 laser irradiation: I (5 W, pulse duration = 0.01 s, application time = 3 s), II (5 W, 0.03 s, 3 s), III (8 W, 0.01 s, 3 s), and IV (1 0 W, 0.01 s, 3 s). Group C (control) was not subjected to irradiation. ARI was measured after debonding of the bracket. Following irradiation of the lasers, the pulpal temperature was not higher than 5.5 °C in four of the study groups. Results were submitted to the ANOVA and Duncan's test. CO2 laser irradiation regimen IV was one in which the strength of debonding is 7.33 MPa. Therefore, CO2 laser may aid removal of ceramic brackets; it decreased the bond strength without increasing the excessive temperature excessively.

Comparison of the Debonding Characteristics of Conventional and New Debonding Instrument used for Ceramic, Composite and Metallic Brackets - An Invitro Study

BACKGROUND

Debonding procedure is time consuming and damaging to the enamel if performed with improper technique. Various debonding methods include: the conventional methods that use pliers or wrenches, an ultrasonic method, electrothermal devices, air pressure impulse devices, diamond burs to grind the brackets off the tooth surface and lasers. Among all these methods, using debonding pliers is most convenient and effective method but has been reported to cause damage to the teeth. Recently, a New Debonding Instrument designed specifically for ceramic and composite brackets has been introduced. As this is a new instrument, little information is available on efficacy of this instrument. The purpose of this study was to evaluate the debonding characteristics of both "the conventional debonding Pliers" and "the New debonding instrument" when removing ceramic, composite and metallic brackets.

MATERIALS AND METHODS

One Hundred Thirty eight extracted maxillary premolar teeth were collected and divided into two Groups: Group A and Group B (n = 69) respectively. They were further divided into 3 subGroups (n = 23) each according to the types of brackets to be bonded. In subGroups A1 and B1{stainless steel};A2 and B2{ceramic};A3 and B3{composite}adhesive precoated maxillary premolar brackets were used. Among them {ceramic and composite} adhesive pre-coated maxillary premolar brackets were bonded. All the teeth were etched using 37% phosphoric acid for 15 seconds and the brackets were bonded using Transbond XT primer. Brackets were debonded using Conventional Debonding Plier and New Debonding Instrument (Group B). After debonding, the enamel surface of each tooth was examined under stereo microscope (10X magnifications). Amodifiedadhesive remnant index (ARI) was used to quantify the amount of remaining adhesive on each tooth.

RESULTS

The observations demonstrate that the results of New Debonding Instrument for debonding of metal, ceramic and composite brackets were statistically significantly different (p = 0.04) and superior from the results of conventional debonding Pliers.

CONCLUSION

The debonding efficiency of New Debonding Instrument is better than the debonding efficiency of Conventional Debonding Pliers for use of metal, ceramic and composite brackets respectively.

A novel bracket base design: biomechanical stability

The aim of this research was to investigate the retention of a bracket equipped with a novel base, the R-system. The design of the bracket base is characterized by concentric grooves. The behaviour of this bracket was compared with a bracket with a conventional mesh base from the same manufacturer. Thirty lower adult bovine incisors were selected and metallic brackets were bonded using the Concise adhesive system. Each bracket-adhesive-enamel interface was investigated according to torsion debonding. One-way analysis of variance was used for statistical evaluation. Finite element analysis was also undertaken. In order to assess if the technique was detrimental to the enamel, the mode of failure was determined using the Adhesive Remnant Index (ARI). The debonded surfaces were analysed using scanning electron microscopy (SEM) and electron dispersion spectrometry (EDS). The R-system provided a bond strength greater than that of the mesh-base bracket. EDS showed that the amount of calcium on the novel base was higher than that on the conventional base, which allowed transfer of torsional stress more uniformly to the substrate, resulting in higher bond values for the R-system. On the other hand, as debonding of the R-system occurred at the enamel-composite interface, lesions to the enamel substrate are possible.

Influence of different tooth types on the bond strength of two orthodontic adhesive systems

The aim of this investigation was to evaluate the effects of different tooth types on the shear bond strength (SBS) of two orthodontic resin adhesive systems in vitro.

Two hundred extracted sound human teeth were used in the study. Ten teeth of each tooth type were the mounted in acrylic resin leaving the buccal surface of the crowns parallel to the base of the moulds. In each experimental group, the adhesives (Transbond XT™ and Light Bond™) were applied to the etched enamel surfaces. The orthodontic composite resins were then applied to the surface in cylindrical-shaped plastic matrices. For SBS testing, a force transducer (Ultradent™) was applied at a crosshead speed of 1 mm/minute at the interface between the tooth and composite until failure occurred. Data were analysed using two-way analysis of variance (ANOVA), Kruskal–Wallis one-way ANOVA, a Bonferroni adjusted Mann–Whitney U-test, and an independent t-test.

Generally, it was found that tooth type had a significant effect on SBS (P < 0.05) with Light Bond™ showing a higher SBS than Transbond XT™ (P < 0.05). The highest bond strengths were observed for the upper central incisor and lower molars with Light Bond™ (P < 0.05) and the lowest mean bond strengths for the upper molars and lower canine with Transbond XT™ (P <0.05). The results demonstrated that enamel SBS was significantly altered by both tooth type and adhesive system. Thus, the findings of this study confirm that enamel bond strength is not uniform for all teeth. These results may also explain the variability in the enamel-bonding efficacy of adhesives.

Enamel Cracks and Ceramic Bracket Failure during Debonding In Vitro

Objective: To test the null hypothesis that no difference in bracket failure characteristics is noted when use of a new ceramic bracket debonding instrument is compared with the use of conventional pliers.

Materials and Methods: Thirty maxillary premolars were randomly assigned to one of two groups. In group 1, Clarity collapsible ceramic brackets (3M Unitek, Monrovia, Calif) were debonded with the use of conventional Utility/Weingart (3M Unitek, Monrovia, Calif) pliers. In group 2, Clarity brackets were debonded with a new Debonding Instrument (3M Unitek). For all teeth, the same bracket bonding system was used. Following debonding, teeth and brackets were examined under 10× magnification for assessment of bracket failure (fracture) and of residual adhesive on the enamel surface. Enamel surfaces were visualized with transillumination prior to bonding and after removal of the residual adhesive, so the effect of the debonding forces could be determined.

Results: The results of Adhesive Remnant Index comparisons indicated that a statistically significant difference (χ2 = 8.73; P = .013) in bond failure patterns was apparent when the two groups were compared. Brackets debonded with the new instrument showed a greater tendency for the adhesive to be removed from the tooth during debonding.

Conclusions: The hypothesis is rejected. Although the incidence of enamel damage following debonding was similar in the two groups, the use of the new Debonding Instrument decreased the incidence of bracket fracture.

The effect on shear bond strength of different antimicrobial agents after acid etching

The aim of the present study was to determine whether the application of different primers containing antibacterial agents (Micro Prime, Seal&Protect, and Gluma Desensitizer) can affect the shear bond strength (SBS) of an orthodontic resin composite. Seventy-two crowns of extracted lower human incisors were mounted in acrylic resin leaving the buccal surface of the crowns parallel to the base of the moulds. The teeth were randomly distributed into three experimental and one control group, each containing 18 teeth. In each experimental group, the primers were applied to the etched enamel surfaces. In the control group, no antibacterial primer was used. An orthodontic composite resin was applied to the surface into cylindrical-shaped plastic matrices after application of an orthodontic adhesive primer (Transbond XT). For shear bond testing, a stubby-shaped force transducer apparatus (Ultradent) was applied at a crosshead speed of 1 mm/minute to each specimen at the interface between the tooth and the composite until failure occurred. A Kruskal-Wallis one-way ANOVA and a Mann-Whitney U-test with a Bonferroni adjustment were used for statistical analysis. There was no significant difference between Seal&Protect (27.98 +/- 8.73 MPa) and the control (35.15 +/- 7.85 MPa) (P > 0.05). However, Gluma (21.61 +/- 7.96 MPa) and Micro Prime (14.89 +/- 5.55 MPa) caused a decrease in bond strength (P < 0.05). No statistically significant difference was observed between Seal&Protect and Gluma (P > 0.05). As triclosan containing Seal&Protect did not cause a significant decrease in bond strength, it can potentially be used under an orthodontic resin composite to obtain an antibacterial effect. However, further in vivo studies are required.

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.