A Clinical Comparison of Failure Rates of Metallic and Ceramic Brackets: A Twelve-Month Study

The Effect of MRI Exposure on the Shear Bond Strength and Adhesive Remnant Index of Different Bracket Types

Background/Objectives: Magnetic resonance imaging (MRI) is widely used in diagnostics, but its effects on orthodontic materials remain a concern. This study aimed to evaluate the impact of MRI exposure at 1.5 T and 3 T on the shear bond strength (SBS) and adhesive remnant index (ARI) of different orthodontic bracket types (metal, self-ligating, and ceramic). Methods: A total of 90 extracted human premolars were divided into three groups (control, 1.5 T, and 3 T MRI exposure). The three bracket types were bonded using Transbond XT adhesive and subjected to standardized polymerization. MRI scans were conducted using 1.5 T and 3 T machines with clinically relevant sequences. SBS was measured using a universal testing machine, and the ARI was assessed under a stereomicroscope. Statistical analysis was performed using Kruskal-Wallis and chi-square tests. Results: MRI exposure influenced SBS and the ARI differently across bracket types. Firstly, 3 T MRI exposure significantly reduced SBS in self-ligating (p = 0.017) and ceramic brackets (p = 0.014) compared to the control, whereas metal brackets showed no significant changes. ARI scores varied across MRI conditions, with metal and self-ligating brackets showing increased adhesive retention at higher field strengths. No significant differences were observed in ARI scores for ceramic brackets across MRI conditions. Conclusions: The clinical importance of understanding these results is that both patients and clinicians must be aware of inevitable changes that occur in SBS during MRI, since exposure to high-field MRI, particularly 3 T, may alter bond strength and adhesive failure characteristics.

The impact of temperature on the shear bond strength of conventional multi-step and self-adhesive orthodontic adhesive systems: an in-vitro study

BACKGROUND

A recurring issue during orthodontic treatment is the detachment of brackets from the tooth surface, which proves problematic for both the patient and the orthodontist. This study aimed to evaluate the impact of various temperatures on the shear bond strength of metal molar tubes, using conventional multi-step and self-adhesive orthodontic adhesive systems.

METHODS

A total of 112 extracted human molars were randomly divided into eight groups (n = 14) for bonding tubes with two orthodontic adhesive systems (Transbond XT and GC Ortho Connect) at different temperatures: refrigeration temperature (4 °C), room temperature (20 °C), human body temperature (37 °C), and high temperature (55 °C). The shear bond strength (SBS) test was conducted using a universal testing machine set to a crosshead speed of 0.5 mm/min. The adhesive remnant index (ARI) was used to evaluate the amount of adhesive remnants on the molar surfaces. ARI scores were assessed under Carl Zeiss Stemi 2000-CS stereomicroscope with image recording camera AxioCam Mrc5 at ×10 magnification. The data were analyzed using Student's t-test, parametric analysis of variance (ANOVA), the intra-class correlation coefficient (ICC), the Kruskal-Wallis test, and the chi-square test.

RESULTS

Higher mean SBS values were obtained with Transbond XT compared to GC Ortho Connect resin; however, the difference was not statistically significant (p > 0.05). The SBS results were lowest at 20 °C and highest at 55 °C in the Transbond XT group, and lowest at 37 °C and highest at 20 °C in the GC Ortho Connect group with no statistically significant difference (p > 0.05). The distribution of the ARI scores between the two materials showed a statistically significant difference (p = 0.002), with higher ARI scores found in the Transbond XT group.

CONCLUSIONS

Pre-heating orthodontic adhesives prior to bonding does not affect the shear bond strength.

Metallic vs Ceramic Bracket Failures After 12 Months of Treatment: A Prospective Clinical Trial

INTRODUCTION

Orthodontic treatment with fixed vestibular appliances is still widely used worldwide. When choosing the aesthetic alternative of ceramic brackets, the possibility of failure and cracking of braces should be considered. Therefore, the aim of the present study was to compare the failure rates of ceramic and metal brackets in a 12-month clinical study.

METHODS

Eighty patients undergoing fixed orthodontic treatment with vestibular appliances were enrolled and divided into 2 equal groups: MET for metal brackets and CER for ceramic brackets. After bonding, bracket failures were recorded for 12 months, along with the archwire placed at the time of failure. Angle's dental class, skeletal class, Wits appraisal, Little's irregularity index, overjet, overbite, age, and gender of the patients were recorded from pretreatment cephalometric tracings and study casts. The data were statistically analysed (P < .05).

RESULTS

Significantly higher failure rates were found for ceramic brackets in the overall analysis, in the mandibular arch, and in the posterior region. Regression analysis revealed a significant influence of round nickel-titanium archwires on higher failure rates, whilst a significant influence of rectangular archwires was found on lower failure rates.

CONCLUSIONS

Ceramic brackets showed higher failure rates. Patients should be aware that orthodontic treatment with ceramic brackets may involve delays and inconvenience due to the higher failure rate compared to metal brackets.

A difference in application time between two direct orthodontic bonding methods: A prospective randomized clinical trial

OBJECTIVE

This clinical study aimed to evaluate the difference in the time of application phase, employing the conventional and modified direct orthodontic bonding method.

MATERIALS AND METHODS

Thirty patients who needed orthodontic therapy with fixed appliances were randomly divided into two equal groups (n = 15): the control and experimental group, according to the bonding method applied. A total of 600 metal brackets inch slot 0.022 (Mini Sprint®, Forestadent, Germany) were bonded to incisors, canines, and premolars using the light-cured adhesive Transbond XT (3M Unitek, Monrovia, CA, USA). The failure rates of the brackets were evaluated within 12 months. The independent samples t-test was applied. The Chi-square test and Fisher exact test were used for statistical analysis.

RESULTS

The initial bonding time using the modified method was significantly shorter (3.27 min or 17.1% per patient) compared with the conventional bonding method (p < 0.001). Number of failed brackets between the two methods did not differ significantly (p = 0.226).

CONCLUSION

The time of the application phase in initial bonding using the modified method (experimental group) was shorter than in control group. There was no statistically significant difference in the number of bond failures between the two methods.

CLINICAL SIGNIFICANCE

The modified application phase of direct orthodontic bracket placement shortens the total bonding time and facilitates the manual work of orthodontists.

The Effect of Various Lasers on the Bond Strength Between Orthodontic Brackets and Dental Ceramics: A Systematic Review and Meta-Analysis

Background/objective: This systematic review and meta-analysis aimed to assess how laser conditioning affected brackets bonded to dental ceramics' shear bond strength (SBS). Materials and methods: The study was conducted by searching Pubmed/Medline, Scopus, Embase, Web of Science, the Cochrane Library, and Google Scholar up to September 14, 2022. In addition, the reference lists of the relevant articles were checked manually. Articles that compared SBS of laser-treated feldspathic, lithium disilicate, or zirconia surfaces with other standard techniques for bonding metal or ceramic orthodontic brackets were considered. Using a random-effects model, data pooling was carried out as the weighted mean difference (WMD). Results: This study initially contained 1717 reports, and following review, 32 articles were deemed suitable for our meta-analysis. The pooling results showed that the treatments with lasers such as "Er:YAG" [WMD = -1.12 MPa; 95% confidence interval (CI): -1.93 to -0.31], "Er:YAG + Silane" (WMD = -3.08 MPa; 95% CI: -4.77 to -1.40), and "Nd: YAG + Silane" (WMD = -2.58 MPa; 95% CI: -3.76 to -1.40) had statistically significant lower adhesion values compared with controls. Contrarily, "Ti:Sapphire femtosecond" demonstrated significantly higher bonding values (WMD = 0.94 MPa; 95% CI: 0.29-1.60). In contrast, other interventions obtained no statistically significant difference in SBS. Conclusions: Most of the laser groups showed results comparable with those of conventional approaches. Although more research is necessary for definitive conclusions, laser treatment may be an effective option for treating the surfaces of ceramic materials.

Comparative evaluation of bracket bond failure rates of a novel non-primer adhesive with a conventional primer-based orthodontic adhesive - a pilot study

Background

Bonding is an important step in fixed orthodontic therapy and evaluation of bracket bond failures while using different bonding systems is required. The aim of the present study was to evaluate and compare bracket failure rates of a novel no primer adhesive with conventional primer-based orthodontic adhesives.

Methods

This split mouth study was conducted among fifteen patients who underwent therapy with fixed orthodontic appliances using metal brackets. Total of 300 brackets were bonded and the bracket bond failure rates were assessed at the end of 3 months. The difference in bond failure rates between the two groups were assessed in different teeth. Descriptive statistics and chi-square test was performed.

Results

Evaluation of bracket bond failure rates showed a higher incidence of bond failures in the group bonded with the primerless adhesive (6.3%) compared to conventional adhesive (2.3%) but there was no statistically significant difference (P>0.05). No intergroup difference was found in the bracket failure rates of individual teeth (P>0.05).

Conclusion

Higher incidence of bond failures were noted with brackets bonded with primerless adhesive when compared to primer-based adhesive but no significant difference was noted over a period of 3 months. Mandibular canine and premolars had a higher bracket failure rate with no significant difference between the adhesives.

Bracket Bond Failures: Incidence and Association with Different Risk Factors-A Retrospective Study

BACKGROUND

Bracket bonding failure is one of the relevant problems in fixed orthodontics therapy, which affects the total treatment and quality of treatment results. The purpose of this retrospective study was to evaluate the frequency of bracket bond failure and find out risk factors.

METHODS

A total of 101 patients with an age range of 11-56 years were included in this retrospective study and treated for a mean period of 30.2 months. Inclusion criteria were: males and females with permanent dentition and completed orthodontic treatment in both fully bonded dental arches. Risk factors were calculated using binary logistic regression analysis.

RESULTS

The overall bracket failure rate was 14.65%. The bracket failure rate was significantly higher in the younger patients' group (p = 0.003). In most cases, patients experienced bracket failures in the first month of the treatment. Most of the bracket bond failures occurred on the left lower first molar (29.1%) and were twice as common in the lower dental arch (66.98%). Patients with increased overbite had an increased likelihood of bracket loss (p = 0.042). Class II malocclusion increased the relative risk of bracket failure, while Class III decreased the rate of bracket failure, but the difference was not statistically significant (p = 0.093).

CONCLUSIONS

The bracket bond failure rate was higher in younger patients than in older patients. Brackets placed on mandibular molars and premolars had the highest failure rate. Class II was associated with an increased bracket failure rate. Increased overbite statistically significantly increases bracket failure rate.

Evaluation of the shear bond strength and adhesive remnant index of color change, fluorescent, and conventional orthodontic adhesives: An in vitro study

AIMS

To investigate the in vitro performance of colour change orthodontic adhesive (CCOA) or fluorescent orthodontic adhesive (FOA), conventional orthodontic adhesives (COA), and the mixed CCOA and FOA utilizing the shear bond strength (SBS) and adhesive remnant index (ARI).

MATERIAL AND METHODS

Ninety extracted first premolars were used in the study. Four manufacturers of orthodontic adhesive were used, including Transbond™ XT (TBXT) and Transbond™ plus (TBP) (3M™ Unitek™, CA, United States), Ormco Enlight™ (OE) and Greengloo™ (GG) (Ormco™, CA, United States), Light Bond Medium™ (LBM), and GoTo™ (GT) (Reliance orthodontic products®, IL, United States), and BracePaste® Adhesive (BPA) and BracePaste® Colour Change (BPCC) (American orthodontics®, WI, United States). The mixed orthodontic adhesive of Transbond™ plus and GoTo™ (TBPGT) was prepared to evaluate the combined effect of colour change and fluorescent orthodontic adhesives. Peak SBS was recorded using a universal testing machine. ARI was measured using a stereomicroscope under 10x magnification. Descriptive statistical analysis and comparative tests were used to evaluate the results.

RESULTS

All CCOA and FOA had higher mean SBS than COA. The highest value of SBS was obtained in BPCC (23.56MPa), and the lowest value in TBPGT (11.41Mpa). One-way ANOVA multiple comparisons and Duncan's multiple range test showed that TBXT and TBPGT significantly differed in SBS with GT, GG, TBP, and BPCC, respectively (P=0.016). Kruskal-Wallis multiple comparisons test showed no significant differences in ARI among the tested adhesives (P=0.089).

CONCLUSIONS

Colour Change Orthodontic Adhesive (CCOA) and Fluorescent Orthodontic Adhesive (FOA) showed a higher SBS than conventional orthodontic adhesives. Greengloo^TM had the lowest ARI among the groups tested. All adhesives tested can be safely used in orthodontic practice, and both CCOA and FOA showed better performance than COA. The Transbond^TM plus and GoTo^TM (TBPGT) mixed adhesives showed the lowest performance in terms of SBS and ARI.

Effects of Magnesium Oxide Nanoparticles Incorporation on Shear Bond Strength and Antibacterial Activity of an Orthodontic Composite: An In Vitro Study

This study aimed to evaluate the effects of magnesium oxide (MgO) nanoparticle (NP) incorporation on shear bond strength (SBS) and antibacterial property of orthodontic composites. A total of 100 mounted premolar teeth were randomly divided into five groups. In group 1 (control), the brackets were bonded to the teeth using the GC Ortho Connect orthodontic composite, while the brackets of groups 2 to 5 were bonded by the GC Ortho Connect orthodontic composite that contained 0.5%, 1%, 2%, and 4% weight percentages (w/w) of MgO NPs, respectively and then the SBS was measured. In the following, we evaluated the antibacterial properties of the MgO NP-containing composite on Streptococcus mutans (S. mutans) bacteria by the direct contact test method. According to results, there were no significant changes in the SBS as the MgO NP concentration was increased up to 1%, while the SBSs of the 2% and 4% MgO NPs were decreased when compared to the other three groups. The outcomes of the direct contact test indicated the case of 1% as being the minimum ratio of MgO NPs, which almost caused the entire annihilation of the S. mutans bacteria. In conclusion, the orthodontic composite containing 1% MgO NPs can display a significant antibacterial effect against S. mutans bacteria without inducing any negative effect on the SBS.

Effect of different enamel pretreating agents on bonding efficacy and survival rates of orthodontic brackets: In vitro study and split-mouth randomized clinical trial

INTRODUCTION

This double in vitro study and randomized clinical trial aimed to investigate the bonding failure rates of orthodontic brackets after enamel pretreatment with agents showing different particle sizes.

METHODS

For the in vitro study, 80 bovine teeth were randomly divided into 4 groups according to the pretreating method used and their particle sizes: erythritol (14 μm), glycine (18-22 μm), sodium bicarbonate (70 μm), and no pretreatment. Scanning electron microscopy microphotographs were performed after pretreatment. Then, brackets were bonded, and shear bond strength was calculated. For the clinical study, agents with low (erythritol) and high (sodium bicarbonate) particle sizes were chosen. Twenty consecutive patients willing to start fixed orthodontic treatment with vestibular stainless steel brackets were enrolled. Patients were randomly divided into 2 groups following a split-mouth design. Group A underwent a 5-second enamel pretreatment procedure with erythritol for teeth belonging to maxillary left and mandibular right quadrants, whereas the remaining quadrants were pretreated for 5 seconds with sodium bicarbonate powder. In group B, quadrants were inverted. Then, brackets were bonded on the vestibular surfaces of teeth, and patients were visited monthly for 12 months to assess bond failures. Periodontal evaluation of probing pocket depth, bleeding on probing, plaque index, and papilla bleeding index was conducted before bonding and after 1, 3, 6, and 12 months.

RESULTS

The in vitro study showed that erythritol and control presented significantly higher shear bond strength values for other agents. Bicarbonate showed the lowest values. In the clinical study, 20 patients (aged 16.4 ± 3.9 years) were enrolled, and all completed the study. Erythritol showed a significantly lower failure rate (3%) than sodium bicarbonate (7.5%). Kaplan-Meier survival plots showed statistically significant differences in risk of failure between the 2 groups during the 12-month follow-up.

CONCLUSIONS

Enamel pretreatment with erythritol can be a viable technique to reduce failure rates of orthodontic brackets.

REGISTRATION

The trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

No funding or grant was received for this research.

Effect of Enamel Pretreatment with Pastes Presenting Different Relative Dentin Abrasivity (RDA) Values on Orthodontic Bracket Bonding Efficacy of Microfilled Composite Resin: In Vitro Investigation and Randomized Clinical Trial

Bonding failure is a clinical issue frequently encountered in orthodontic practice. The aim of this study was to evaluate enamel pretreatment both in vitro and clinically using agents with different RDA values before brackets' bonding, to assess if RDA can affect the Shear Bond Strength (SBS), Adhesive Remnant Index (ARI) and clinical failure rate of orthodontic brackets. For the in vitro study, 220 bovine teeth were pretreated with agents with different RDA values. Subsequently, brackets were bonded. For the clinical study, 20 patients underwent bonding of 20 brackets each with a split-mouth design. Low and high RDA toothpastes were used for enamel pretreatment. SBS, ARI and failures were recorded. Higher SBS values were found for teeth pretreated with lower RDA agents; conversely, lower SBS values were found for teeth pretreated with higher RDA agents (p < 0.05). For high ARI values, RDA increased too (p > 0.05). In the clinical study, a significantly lower failure rate was reported for teeth pretreated with low RDA toothpaste (2.5% in low RDA group, 7.0% in high RDA group; p < 0.05). No significant differences were assessed comparing the two dental arches and anterior and posterior sites. Enamel pretreatment with low RDA toothpastes could increase brackets' survival rate. Further in vitro and clinical studies would be welcomed to confirm these findings.

Use of optical coherence tomography in orthodontics

Optical coherence tomography (OCT) is a modern imaging method with applicability in orthodontics. In recent years, there has been an increasing trend in the use of ceramic brackets. The aim of the present study was to investigate the effects of bonding metallic and ceramic brackets on tooth enamel, using optical coherence tomography. For this purpose, 20 permanent teeth we bonded and were subsequently debonded using a side cutter or anterior bracket removal pliers. Using the OCT technique, the enamel, the amount of adhesive remaining and the bracket fragments remaining on the tooth surface were analyzed following the debonding procedure. It was demonstrated that enamel cracks were present only in the samples bonded with ceramic brackets. At the same time, it was noted that the type of pliers did not affect the incidence and extent of damage to the enamel. The type of debonding technique (using the side cutter or the anterior removal pliers) used did not markedly affect the amount of adhesive remaining on the teeth. Thus, as demonstrated herein, by analyzing the enamel structure through the use of OCT, the quality of the processes and the materials used for manufacturing brackets can be increased.

Shear bond strength of APC Plus adhesive coated appliance system to enamel in wet and dry conditions: An in vitro study

OBJECTIVE

It is claimed that a hydrophilic primer, called the moisture insensitive primer (MIP), can be used with both dry and wet enamel surfaces. This study sought to assess the shear bond strength (SBS) of APC Plus adhesive coated appliance system to enamel using MIP in wet and dry conditions.

MATERIALS AND METHODS

This in vitro experimental study evaluated 24 extracted maxillary premolars with intact buccal enamel. The teeth were randomly divided into two groups (n=12), and APC Plus premolar brackets were bonded to their buccal surface using moisture insensitive primer (MIP) under wet and dry enamel conditions. The SBS values were measured by a universal testing machine. The adhesive remnant index (ARI) score was also determined under a stereomicroscope. Data were analyzed using t-test and Mann-Whitney test at P<0.05 level of significance.

RESULTS

The SBS in wet condition was significantly lower than that in dry condition (mean value of 18.37MPa versus 25.5MPa, P<0.001). The two groups had no significant difference regarding the ARI scores (P>0.05). However, in both groups, less adhesive was left on the tooth surface. This suggests that bond failure occurred at the adhesive-enamel interface.

CONCLUSIONS

APC Plus adhesive coated appliance system in combination with hydrophilic MIP can be effective in clinical conditions with high risk of moisture contamination.

Nanomaterials Application in Orthodontics

Nanotechnology has gained importance in recent years due to its ability to enhance material properties, including antimicrobial characteristics. Nanotechnology is applicable in various aspects of orthodontics. This scientific work focuses on the concept of nanotechnology and its applications in the field of orthodontics, including, among others, enhancement of antimicrobial characteristics of orthodontic resins, leading to reduction of enamel demineralization or control of friction force during orthodontic movement. The latter one enables effective orthodontic treatment while using less force. Emphasis is put on antimicrobial and mechanical characteristics of nanomaterials during orthodontic treatment. The manuscript sums up the current knowledge about nanomaterials' influence on orthodontic appliances.