Effect of erbium family laser etching on shear bond strength of enamel surfaces: A meta-analysis-PRISMA

BACKGROUND

Recently, laser etching has appealed to people's attention. It is meaningful to compare the effect of erbium-doped yttrium-aluminum-garnet (Er:YAG) and erbium-chromium; yttrium-scandium-gallium-garnet (Er,Cr:YSSG) laser etching parameters with acid etching on bond strength of enamel surfaces. As far as we know, there still remains no related meta-analysis. To evaluate the efficacy of Er:YAG and Er,Cr:YSSG lasers etching on shear bond strength (SBS) of brackets bonded to enamel. The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, conducted with literature search.

METHODS

Twelve relevant randomized controlled trials (RCTs) were included.

RESULTS

The pooled analysis of SBS showed that there were no significant differences between erbium family lasers and acid etching. In the mass, we noticed they did not achieve statistical significance in the lasers etching and acid etching. However, pooled analysis of 5 studies showed the SBS bonding to enamel was lower in Er,Cr:YAG laser group compared with acid group. As a whole, there were statistical significance between erbium lasers groups and acid etching group in adhesive remnant index (ARI) aspects, which less adhesives remained can reduce damage to enamel. With regard to the rate of teeth with ARI score ≤2, the results in Er:YAG laser etching group were obviously higher than acid etching group.

CONCLUSION

Our data indicated that erbium lasers may be considered bonding of brackets to enamel instead of acid etching bonding to enamel.

Effect of sandblasting on the shear bond strength of recycled metal brackets: A systematic review and meta-analysis of in-vitro studies

INTRODUCTION AND OBJECTIVE

Sandblasting is an efficient and economic method of rebonding brackets. Literature is divided regarding the Shear Bond Strength (SBS) associated with sandblasted brackets. Hence this systematic review was conducted to obtain conclusive evidence on the same. The aim was to compare the SBS between sandblasted brackets bonded to extracted human teeth and new brackets bonded on extracted teeth that have not been previously bonded.

MATERIALS AND METHODS

The following databases were searched up to April 30, 2021: PubMed via Medline, Web of Science, LILACS, Cochrane, EMBASE and Scopus. Articles comparing SBS of a new bracket with that of a rebonded bracket following sandblasting were included. Two reviewers independently selected the studies, extracted the data and assessed the risk of bias which was based on a modification of the Risk Of Bias In Nonrandomized Studies of Interventions Tool (ROBINS-I). SBS data generated from the systematic review was summarized and a meta-analysis using random effects inverse-generic model was done.

RESULTS

Sixteen studies generated 521 samples for the new bracket group and 391 samples for the sandblasted group. These sixteen studies showed a low risk of bias. Meta analysis reported the mean difference between the SBS of new and sandblasted brackets to be 0.85. (95 CI of -0.24 to 1.94). This difference can be clinically disregarded. The high degree of heterogeneity indicated by an I² of 87% led to a subgroup analysis.

CONCLUSIONS

With the studies showing a high quality of evidence, it can be concluded that sandblasting is an efficient means of recycling debonded brackets without affecting SBS. The inherent deficiencies of in vitro bond strength studies should be borne in mind when making this conclusion. The study protocol was registered on the International Prospective Register of Systematic Reviews (Reg no: CRD42020193616).

Effect of surface treatments on the adhesive properties of metallic brackets on fluorotic enamel

OBJECTIVE

To compare the effectiveness of the pretreatment with sandblasting and deproteinization with NaOCl on bond strength (SBS), in situ conversion degree (CD) of brackets in fluorotic enamel, and enamel etching pattern.

METHODS

A total of 90 non-carious maxillary premolars were used. The teeth were then assigned to six experimental groups according to: enamel surface (sound and fluorotic enamel); surface treatment (Regular etch with 37% phosphoric acid [RE]; 5.2% sodium hypochlorite + phosphoric acid [NaOCl + RE]; sandblasting + phosphoric acid [sandblasting + RE]). After storage in distilled water (37°C/24h), the specimens were tested at 1 mm/min until failure (SBS). Enamel-resin cement interfaces were evaluated for CD using micro-Raman spectroscopy. The enamel-etching pattern was evaluated under a scanning electron microscope. Data from SBS and in situ CD values were analyzed using ANOVA two-away and Tukey test (α=0.05). The enamel etching pattern was evaluated only qualitatively.

RESULTS

For sound enamel, RE showed the highest SBS values, when compared to NaOCl + RE and Sandblasting + RE groups (p< 0.01). Regarding CD, only NaOCl + RE significantly compromised the mean DC, in comparison with other groups (p= 0.002). For fluorotic enamel, the Sandblasting + RE group significantly increased the mean SBS values, in comparison with RE group (p= 0.01) and no significant change was observed for CD (p> 0.52).

CONCLUSIONS

The application of NaOCl or sandblasting associated to phosphoric acid improved the SBS of the brackets in fluorotic enamel without compromising the CD of the resin cement, with improving of enamel interprismatic conditioning.

Analysing the potential of hydrophilic adhesive systems to optimise orthodontic bracket rebonding

Introduction

Bond failure during fixed orthodontic treatment is a frequently occurring problem. As bracket rebonding is associated with reduced shear bond strength, the aim of the present investigation is to analyse the effect of different innovative rebonding systems to identify optimised rebonding protocols for orthodontic patient care.

Methods

Metallic brackets were bonded to the frontal enamel surfaces of 240 bovine lower incisors embedded in resin bases. Teeth were randomly divided into two major experimental groups: in group 1 a hydrophilic primer (Assure™ PLUS) was compared to commonly used orthodontic adhesives (Transbond XT™, BrackFix®, Grengloo™) and a zero control. In group 2 different rebonding systems were analysed using a hydrophilic primer (Assure™ PLUS), a methyl methacrylate-consisting primer (Plastic Conditioner) and a conventional adhesive (Transbond XT™). All teeth were tested for shear bond strength according to the DIN-13990 standard, the Adhesive Remnant Index and enamel fracture rate.

Results

The hydrophilic primer enhanced shear bond strength at first bonding (Assure™ PLUS 20.29 ± 4.95 MPa vs. Transbond XT™ 18.45 ± 2.57 MPa; BrackFix® 17 ± 5.2 MPa; Grengloo™ 19.08 ± 3.19 MPa; Meron 8.7 ± 3.9 MPa) and second bonding (Assure™ PLUS 16.76 ± 3.71 MPa vs. Transbond XT™ 13.06 ± 3.19 MPa). Using Plastic Conditioner did not seem to improve shear bond strength at rebonding (13.57 ± 2.94). When enamel etching was left out, required shear bond strength could not be achieved (Plastic Conditioner + Assure™ PLUS 8.12 ± 3.34 MPa; Plastic Conditioner: 3.7 ± 1.95 MPa). Hydrophilic priming systems showed decreased ARI-scores (second bonding: 2.63) and increased enamel fracture rates (first bonding: 55%; second bonding 21,05%).

Conclusions

Based on the present study we found that rebonding strength could be compensated by the use of hydrophilic priming systems. The additional use of a methyl methacrylate-consisting primer does not seem to enhance shear bond strength. No etching approaches resulted in non-sufficient bond strength.

Staining protocols to improve the detection of composite restorations in human identification

INTRODUCTION

The improvement of aesthetic properties of dental materials has hampered the work of forensic experts in cases of identification. Even in dental practice, the identification of the margins of restorations has become a challenge.

OBJECTIVE

To establish protocols to improve the visual contrast between teeth and composites using dyes.

METHOD

Anterior and premolar human teeth were chosen (n = 40) and class V cavities were made in the lingual/palatal and buccal surfaces. Ten commercially available dyes were dissolved in distilled water. Three protocols were proposed using phosphoric acid (Gphos) and hydrofluoric acid (Ghydro) for 60 s followed by application of the dye for 20 s. The control group (Gcontrol) was acid free, i.e. only distilled water was applied. Data was analysed using Kruskal-Wallis and Dunn´s tests.

RESULTS

Analyses showed that darker dyes, such as crystal violet, methylene blue, malachite green and neutral red, had better results (p < 0.001). The composite brand did not influence the results (p > 0.05). Both Gphos and Ghydro were effective in discriminating restorations when compared to Gcontrol (p > 0.001). No differences were detected between Gphos and Ghydro protocols (p > 0.05). In Gphos, the enamel surface was stained leaving the restoration without pigmentation. Oppositely, in Ghydro the composite filling was coloured, but not the enamel. In Gcontrol, both enamel and restoration were stained indistinctively.

CONCLUSION

Tooth etching with either phosphoric or hydrofluoric acids was suitable to discriminate the presence of aesthetic dental fillings.

Deproteinization of Fluorosed Enamel with Sodium Hypochlorite Enhances the Shear Bond Strength of Orthodontic Brackets: An In vitro Study

Context:

Improving bonding strength to fluorosed teeh.

Aims:

To determine the effect of deproteinization using 5.25% sodium hypochlorite (NaOCl) prior to acid etching on shear bond strength of orthodontic brackets bonded to fluorosed teeth.

Settings and Design:

In vitro experimental study.

Methods and Material:

Forty freshly extracted human mandibular first premolars with TFI 4 were selected and divided into two groups of 20 each. In Group I the teeth were acid etched with 37% phosphoric acid and bonded with composite. In Group II the teeth were deproteinized with 5.25% NaOCl prior to acid etching with 37% phosphoric acid and were bonded with composite. Samples were then subjected to shear bond test by Instron Universal Testing machine. The sample from each group were selected for the SEM study (prior to bonding) to analyze the etching patterns achieved.

Statistical Analysis Used:

Data was checked for normality by Shapiro Wilk Test, to compare the two groups unpaired t test was used. P value was predetermined at ≤ 0.05.

Results:

The S BS of Group II (11.75 ± 2.83 MPa) was higher than Group I (7.44 ± 2.43 MPa) and the difference was statistically significant (P = 0.000). On SEM the etching pattern was more of type 1 and 2 in Group II.

Conclusions:

Deproteinization using 5.25% NaOCl prior to acid etching significantly increases the shear bond strength of brackets bonded to fluorosed teeth and can be used as a convenient and effective option in orthodontic bonding to fluorosed teeth.

Effects of silver nanoparticles on the bonding of three adhesive systems to fluorotic enamel

The objective was to evaluate the effect of adding silver nanoparticles into three commercial adhesive systems (Excite™, Adper Prompt L-Pop™ and AdheSE™). Nanoparticles were prepared by a chemical method then mixed with the commercial adhesive systems. This was later applied to the fluorotic enamel, and then micro-tensile bond strength, contact angle measurements and scanning electron microscopy observations were conducted. The commercial adhesive systems achieved the lowest micro-tensile bond strength (Excite™: 11.0±2.1, Adper Prompt L-Pop™: 14.0±5.4 and AdheSE™: 16.0±3.0 MPa) with the highest adhesive failure mode related with the highest contact angle (46.0±0.6º, 30.0±0.5º and 28.0±0.4º respectively). The bond strength achieved in all the experimental adhesive systems (19.0±5.4, 20.0±4.0 and 19.0±3.5 MPa respectively) was statistically higher (p<0.05) than the control and showed the highest cohesive failures related to the lowest contact angle. Adding silver nanoparticles in order to decrease the contact angle improve the adhesive system wetting and its bond strength.

Effects of adhesion promoter on orthodontic bonding in fluorosed teeth: A scanning electron microscopy study

Introduction:

The objectives of the present study were to elucidate the effects of fluorosis in orthodontic bonding and to evaluate the efficiency of an adhesion promoter (Assure Universal Bonding Resin) in bonding to fluorosed teeth.

Materials and Methods:

Extracted premolars were divided into two groups on the basis of Thylstrup and Fejerskov Index. Ten samples from each group were etched and evaluated for etching patterns using scanning electron microscope (SEM). The remaining samples were subdivided into four groups of 20 each on the basis of adhesives used: IA, IIA - Transbond XT and IB, IIB - Transbond XT plus Assure Universal Bonding Resin. Shear bond strength (SBS) was measured after 24 h using the universal testing machine. Adhesive remnant index (ARI) scores were recorded using SEM. Statistical analysis was conducted using a two-way analysis of variance, and Tukey's post hoc test was performed on SBS and ARI scores.

Results:

Similar etching patterns were observed in both fluorosed and nonfluorosed teeth. No significant differences were found in the SBS values observed in both groups (8.66 ± 3.19 vs. 8.53 ± 3.44, P = 1.000). Increase in SBS was observed when Assure Universal Bonding Resin was used. Higher ARI scores were observed when adhesion promoter was used for bonding.

Conclusions:

Mild-moderately fluorosed teeth etch in a manner similar to the nonfluorosed teeth. Similar bond strengths were achieved in fluorosed and nonfluorosed teeth when conventional composite was used. Use of adhesion promoter increases the bond strengths in both groups of teeth.

Evaluation of enamel damages following orthodontic bracket debonding in fluorosed teeth bonded with adhesion promoter

Objective:

To evaluate shear bond strength (SBS) of the orthodontic brackets bonded to fluorosed and nonfluorosed teeth using Light Bond with and without adhesion promoters and compare their enamel damages following debonding.

Materials and Methods:

In this study, 30 fluorosed (Thylstrup and Fejerskov Index = 4–5) and 30 nonfluorosed teeth were randomly distributed between two subgroups according to the bonding materials: Group 1, fluorosed teeth bonded with Light Bond; Group 2, fluorosed teeth bonded with adhesion promoters and Light Bond; Group 3, nonfluorosed teeth bonded with Light Bond; Group 4, nonfluorosed bonded with adhesion promoters and Light Bond. After bonding, the SBS of the brackets was tested with a universal testing machine. Stereomicroscopic evaluation was performed by unbiased stereology in all teeth to determine the amount of adhesive remnants and the number and length of enamel cracks before bonding and after debonding. The data were analyzed using two-way analysis of variance, Kruskal–Wallis, Wilcoxon Signed Rank, and Mann–Whitney test.

Results:

While fluorosis reduced the SBS of orthodontic bracket (P = 0.017), Enhance Locus Ceruleus LC significantly increased the SBS of the orthodontic bracket in fluorosed and nonfluorosed teeth (P = 0.039). Significant increasing in the number and length of enamel crack after debonding was found in all four groups. There were no significant differences in the length of enamel crack increased after debonding among four groups (P = 0.768) while increasing in the number of enamel cracks after debonding was significantly different among the four groups (P = 0.023). Teeth in Group 2 showed the highest enamel damages among four groups following debonding.

Conclusion:

Adhesion promoters could improve the bond strength of orthodontic brackets, but conservative debonding methods for decreasing enamel damages would be necessary.

Efficacy of New Adhesion Promoters on Compromised Hypocalcified Enamel

INTRODUCTION

The amount of technological progress occurred in the last few years has brought an add up to the benefits of bonding in Orthodontics. Research-based findings have constantly led to the development of new materials that are aimed to simplify the clinical procedures like bonding of brackets to compromised enamel surfaces. Hence, the present study is aimed to assess the bond strength of orthodontic brackets on fluorosed enamel using adhesion promoters.

AIM

To evaluate the shear bond strength (SBS) of orthodontic brackets bonded on fluorosed enamel using conventional Transbond XT and new adhesion promoters such as Enhance LC and All Bond 3.

MATERIALS AND METHODS

The study involved 90 non carious, extracted teeth with mild to moderate fluorosis randomly divided into 3 Groups. In Group - I (control group) the teeth were bonded with conventional Transbond XT and cured with LED light. In Group - II Enhance LC was applied to fluorosed enamel before bonding and in Group - III All Bond 3 was used. Shear bond strength was tested by using Universal testing Instron machine. ANOVA and Post-Hoc Tukey's tests were used to compare shear bond strength. Adhesive remnant on the tooth was assessed and scored using adhesive remnant index (ARI).

RESULTS

Results showed a reduced SBS values (9.43MPa ±3.03) with conventional Transbond XT on fluorosed enamel. Among the adhesion boosters used Enhance LC illustrated lesser SBS values (12.03 MPa ± 4.42) compared with All Bond 3 (14.38MPa ±4.92). ARI showed bond failure at bracket resin interface in group I & group II and at enamel resin interface in group III although statistically insignificant.

CONCLUSION

It was concluded that using adhesion boosters on fluorosed enamel showed higher bond strength compared to the control group. Among the two adhesion promoters used All Bond 3 expressed highest bond strength compared to Enhance LC although statistically insignificant.

Effects of long-term repeated topical fluoride applications and adhesion promoter on shear bond strengths of orthodontic brackets

Objective:

The purpose of this study was to assess the effects of long-term repeated topical application of fluoride before bonding and an adhesion promoter on the bond strength of orthodontic brackets.

Materials and Methods:

A total of 76 bovine incisors were collected and divided equally into four groups. In group 1, the brackets were bonded without topical fluoride application or adhesion promoter. In group 2, before bonding, the adhesion promoter was applied to nonfluoridated enamel. In group 3, the brackets were bonded without the application of the adhesion promoter to enamel, which had undergone long-term repeated topical fluoride treatments. Teeth in group 4 received the long-term repeated topical applications of fluoride, and the brackets were bonded using the adhesion promoter. All the brackets were bonded using BeautyOrtho Bond self-etching adhesive. The shear bond strength was measured and the bond failure modes were evaluated with the use of the adhesive remnant index (ARI) after debonding.

Results:

The mean shear bond strength was significantly lower in group 3 than in groups 1, 2, and 4, and there were no significant differences between the groups except for group 3. There were significant differences in the distribution of ARI scores between groups 2 and 3, and between groups 3 and 4.

Conclusions:

The adhesion promoter can recover the bond strength reduced by the long-term repeated topical applications of fluoride to the prefluoridation level and had a significantly great amount of adhesives left on either fluoridated or nonfluoridated enamel.

Effect of 980-nm diode laser-aided circumferential supracrestal fiberotomy on fluorosed root surfaces

OBJECTIVE

To evaluate and compare the root surface morphological changes after 980-nm diode laser-aided circumferential supracrestal fiberotomy (CSF) on fluorosed and non-fluorosed teeth.

MATERIALS AND METHODS

The sample comprised 27 orthodontic patients (14 males and 13 females; mean age  =  17.3 years) with and without fluorosis, from whom 40 fluorosed and 40 non-fluorosed premolar teeth were extracted for orthodontic reasons. Conventional (control group) and laser-aided (experimental group) CSF was performed on fluorosed and non-fluorosed teeth indicated for orthodontic extraction, using a scalpel and a 980-nm diode laser at 2.5 W power, respectively. Subsequently, teeth were extracted, sectioned, and examined by scanning electron microscope to assess the ultrastructural changes.

RESULTS

There were differences in surface morphology among fluorosed and non-fluorosed roots in the control group. The root specimens of both fluorosed and non-fluorosed teeth irradiated by diode laser exhibited no evidence of smear layer, laser-induced pitting or cavitation, linear cuts/markings, carbonization of surface, and heat-induced surface cracking. However, a glazed or slightly melted appearance was observed in root specimens of fluorosed teeth after diode laser irradiation.

CONCLUSIONS

These findings suggest that the diode laser-aided CSF procedure is free from thermal hazard on non-fluorosed root surfaces but may provoke some thermal changes on fluorosed root surfaces.

Shear bond strength evaluation of bonded molar tubes on fluorotic molars

OBJECTIVE

To study the shear bond strength (SBS), sites of failure, and micromorphology of bonded molar tubes used on teeth affected by dental fluorosis.

MATERIALS AND METHODS

This in vitro study included 140 first molars classified according to Dean's index for dental fluorosis. Samples were divided into seven groups: (1) healthy teeth etched for 15 seconds, (2) teeth with moderate fluorosis (MOF) etched for 15 seconds, (3) teeth with MOF etched for 150 seconds, (4) teeth with MOF microabrasion etched for 15 seconds, (5) teeth with severe fluorosis (SEF) etched for 15 seconds, (6) teeth with SEF etched for 150 seconds, and (7) teeth with SEF microabrasion etched for 15 seconds. All samples were incubated and were then submitted to the SBS test and evaluated with the modified adhesive remnant index (ARI) and analyzed by using a scanning electronic microscope.

RESULTS

The SBS mean value for healthy enamel was 20 ± 10.2 MPa. For the group with MOF, the etched 150-second mean value was the highest (19 ± 7.6 MPa); for the group with SEF treated with microabrasion and etched for 15 seconds, the mean value was (13 ± 4.1 MPa). Significant differences (P ≤ .05) were found in the ARI between healthy and fluorosed groups.

CONCLUSIONS

Fluorotic enamel affects the adhesion of bonded molar tubes. The use of overetching in cases of MOF and the combination of microabrasion and etching in SEF provides a suitable adhesion for fixed appliance therapy.

Enamel roughness and depth profile after phosphoric acid etching of healthy and fluorotic enamel

BACKGROUND

Dental fluorosis requires aesthetic treatment to improve appearance and etching of enamel surfaces with phosphoric acid is a key step for adhesive restorations. The aim of this study was to evaluate surface roughness and a depth profile in healthy and fluorotic enamel before and after phosphoric acid etching at 15, 30 and 60 seconds.

METHODS

One hundred and sixty enamel samples from third molars with no fluorosis to severe fluorosis were evaluated by atomic force microscopy.

RESULTS

Healthy enamel showed a statistically significant difference (p < 0.05) between mean surface roughness at 15 seconds (180.3 nm), 30 seconds (260.9 nm) and 60 seconds (346.5 nm); depth profiles revealed a significant difference for the 60 second treatment (4240.2 nm). For mild fluorosis, there was a statistically significant difference (p < 0.05) between mean surface roughness for 30 second (307.8 nm) and 60 second (346.6 nm) treatments; differences in depth profiles were statistically significant at 15 seconds (2546.7 nm), 30 seconds (3884.2 nm) and 60 seconds (3612.1 nm). For moderate fluorosis, a statistically significant difference (p < 0.05) was observed for surface roughness for 30 second (324.5 nm) and 60 second (396.6 nm) treatments.

CONCLUSIONS

Surface roughness and depth profile analyses revealed that the best etching results were obtained at 15 seconds for the no fluorosis and mild fluorosis groups, and at 30 seconds for the moderate fluorosis group. Increasing the etching time for severe fluorosis decreased surface roughness and the depth profile, which suggests less micromechanical enamel retention for adhesive bonding applications.

Effects of fluorosis on the shear bond strength of orthodontic brackets bonded with a self-etching primer

The aim of this study was to compare the shear bond strength (SBS) of brackets bonded to fluorosed and non-fluorosed teeth with self-etching primer (SEP) and phosphoric acid (PA). The study involved 40 mildly fluorosed [Thylstrup-Fejerskov (TFT) Index = 1-3] and 40 non-fluorosed human premolar teeth. The fluorosed and non-fluorosed teeth were randomly divided into two subgroups. In the first subgroup, 37 per cent PA was applied for 30 seconds and in the second, a SEP (Transbond Plus) was used. The brackets were bonded with light-cure adhesive paste (Transbond XT) and cured for 20 seconds. The SBSs were measured after 1000 thermocyclies. Two-way analysis of variance, Tukey's multiple comparison test, and Weibull analysis were used for the evaluation of SBS values. Bond failure locations were determined with the adhesive remnant index (ARI) and were compared with the Kruskal-Wallis and Mann-Whitney U-tests. The mean SBS was 9.01 MPa for the fluorosed teeth bonded with SEP. This value was significantly different from those of fluorosed teeth etched with PA (15.22 MPa) and non-fluorosed teeth conditioned with SEP (12.95 MPa) and PA (15.37 MPa). The ARI scores of the fluorosed teeth conditioned with SEP were significantly lower than those of non-fluorosed teeth conditioned with SEP or PA. The results of this in vitro study suggest that there are no differences in the SBS of orthodontic brackets between mildly fluorosed and non-fluorosed enamel etched with 37 per cent PA for 30 seconds. The SEP showed lower SBS values for orthodontic brackets bonded to mildly fluorosed enamel. The findings provide some evidence that routine clinical use of a SEP to bond brackets to mildly fluorosed teeth cannot be supported.

Effects of adhesion promoters on the shear bond strengths of orthodontic brackets to fluorosed enamel

The aims of this in vitro study were to evaluate the effect of enamel fluorosis on the shear bond strength (SBS) of orthodontic brackets and to determine whether adhesion promoter, Enhance LC, increases the bond strength of brackets to fluorosed enamel. Forty-five (30 fluorosed and 15 non-fluorosed) non-carious fresh human premolar teeth, extracted for orthodontic reasons and without any caries or visible defects, were used in this study. The fluorosed teeth were selected according to the modified Thylstrup and Fejerskov index, which is based on the clinical changes in fluorosed teeth. In groups 1 (fluorosed teeth) and 3 (control), the brackets were bonded with Light Bond composite resin and cured with a halogen light. In group 2, Enhance LC was applied to fluorosed enamel before bonding. After bonding, the SBS of the brackets was tested with a universal testing machine. One-way analysis of variance and Tukey multiple comparison tests were used to compare the SBS of the groups. Any adhesive remaining after debonding was assessed and scored according to the modified adhesive remnant index. The results showed that while fluorosis significantly reduced the bond strengths of the orthodontic brackets (mean 13.94 +/- 3.24 MPa; P < 0.01), Enhance LC significantly increased bond strength on fluorosed enamel (mean 18.22 +/- 5.97 Mpa; P < 0.05). Groups 1 and 3 had greater bond failures at the composite-bracket interface, whereas group 2 showed bond failure primarily at the enamel-composite interface.