An ex vivo study to investigate bond strengths of different tooth types

The best method of reconditioning ceramic brackets to get an optimum shear bond strength compared with new ceramic brackets - Systematic review and meta-analysis of in vitro studies

PURPOSE

Bracket debonding is an undesirable problem during fixed orthodontic treatment. As ceramic brackets have no flexibility, there is no change in the slot dimension. So, reconditioning a ceramic bracket can be done without compromising the quality of treatment and could be a cost-effective measure. The objective of this systematic review is to deduce and validate the best method of reconditioning ceramic bracket in order to get optimum clinical shear bond strength.

MATERIAL AND METHODS

Studies such as randomized controlled trials (RCTs); In vitro studies comparing different interventions with control group, cross sectional studies were included. Electronic databases such as Cochrane database, PubMed, Web of Science, Embase were searched up to July 2022. Grey literature search and cross-referencing/snowballing methods were also used. Two reviewers independently selected studies and assessed the risk of bias using amalgamation of five tools for in vitro studies. Then meta-analysis was performed using random effects model.

RESULTS

Eleven studies were included in which ten studies were considered as good quality studies. According the meta-analysis performed, the best performance in terms of shear bond strength was of new brackets. Among the different reconditioning methods, the meta-analysis showed that the method with the closest bond strength to the new brackets was silicatisation with a mean difference of 6.35MPa (95% CI between 2.39 and 10.31) followed by sandblasting+silane application with a mean difference of 3.36MPa (95% CI between 0.3 and 6.96) compared to other methods.

CONCLUSIONS

Due to the lack of in vivo studies, only in vitro studies were evaluated. The data available from the in vitro studies was considered to be of good quality, leading to the conclusion that the best method for reconditioning debonded ceramic brackets is silicatisation followed by sandblasting and silane application.

Effect of using different component combinations for orthodontic bracket bonding with self-etch primers

PURPOSE

To evaluate bonding quality for orthodontic bracket bonding with different component combinations of self-etch primers in vitro.

METHODS

Metallic brackets were bonded to bovine lower incisors and assigned to groups. Group 1: comparison of self-etch (Transbond™ Plus, 3M™ Unitek, Neuss, Germany, n = 30; BrackFix® primer SE, VOCO®, Cuxhaven, Germany, n = 20) and etch-and-rinse bonding systems (Transbond™ XT, n = 20; BrackFix®, n = 20); group 2: comparison of different self-etch primer (Transbond™ Plus; BrackFix® primer SE) and adhesive (Transbond™ XT, n = 20; BrackFix®, n = 20) product combinations; group 3: testing cyclic fatigue bond strength of self-etch bonding systems (Transbond™ Plus, n = 20; BrackFix® primer SE, n = 20). All teeth were tested for shear bond strength according to the DIN-13990 standard, the adhesive remnant index (ARI) and enamel fractures were determined microscopically (10 × magnification).

RESULTS

The mean shear bond strength of the self-etch (Transbond™ Plus: 16.38 ± 3.68 MPa; BrackFix® primer SE: 16.24 ± 1.73 MPa) and etch-and-rinse bonding systems (Transbond™ XT: 18.45 ± 2.56 MPa; BrackFix®: 17 ± 5.2 MPa) were of a clinically adequate order of magnitude (≥ 6-10 MPa) and were not statistically different. The component combination BrackFix® primer SE/Transbond™ XT adhesive led to a significantly lower shear bond strength (11.99 ± 3.68 MPa). There were no significant differences between static and fatigue shear bond strengths of self-etch bonding systems. Mean ARI scores mostly ranged between 4 and 5. The combination of the self-etch primer Transbond™ Plus with the BrackFix® adhesive led to a significantly increased enamel fracture rate.

CONCLUSIONS

Based on the present findings bond strength of self-etch primers was equal to etch-and-rinse primers for bracket bonding. Combining different self-etch bonding systems might alter the clinical performance.

The effect of diabetes mellitus on the shear bond strength of composite resin to dentin and enamel

Diabetes mellitus might be linked to the deterioration of certain physical properties of dentin and enamel. This study aimed to determine the effect of two types of diabetes on the shear bond strength of enamel and dentin, by using the single bond universal bonding system. Sixty specimens [from 15 teeth; 5 from each group-non-diabetic (ND), Diabetic type I (D1), and Diabetic type II (D2)], were prepared with equal amounts of dentin (n = 5) and enamel (n = 5). Enamel specimens (E20) were etched with 37% phosphoric acid, for 20 s, and dentin specimens (D15) were etched for 15 s. A standard shear bond strength test was performed on all specimens. Their failure modes were also studied under a scanning electron microscope, and the data were analyzed by using ANOVA and Post Hoc Tukey's test (a = 0.050). For the enamel groups, significant differences were only noticed between the ND and D1 (P < 0.050) groups, and between the ND and D2 (P < 0.050) groups. In the dentin groups, there was a significant difference only between the ND and D1 (P < 0.050) groups. The micrographs showed that the ND group had the highest number of specimens with cohesive failure and D1 had the highest number of specimens with adhesive failure. It can be concluded that both types of diabetes reduce the shear bond strength of composite resin on dentin and enamel. However, it seems that the negative effect of diabetes on shear bond strength of dental composite resin is more drastic in individuals with type I diabetes as compared with type II.

Comparison of Orthodontic Bracket Debonding Force and Bracket Failure Pattern on Different Teeth In Vivo by a Prototype Debonding Device

Objective

To compare the orthodontic bracket debonding force and assess the bracket failure pattern clinically between different teeth by a validated prototype debonding device. Materials and Method. Thirteen (13) patients at the end of comprehensive fixed orthodontic treatment, awaiting for bracket removal, were selected from the list. A total of 260 brackets from the central incisor to the second premolar in both jaws were debonded by a single clinician using a validated prototype debonding device equipped with a force sensitive resistor (FSR). Mean bracket debonding forces were specified to ten (10) groups of teeth. Following debonding, Intraoral microphotographs of the teeth were taken by the same clinician to assess the bracket failure pattern using a 4-point scale of adhesive remnant index (ARI). Statistical analysis included one-way ANOVA with post hoc Tukey HSD and independent sample t-test to compare in vivo bracket debonding force, Cohen's kappa (κ), and a nonparametric Kruskal-Wallis test for the reliability and the assessment of ARI scoring.

Results

A significant difference (p < 0.001) of mean debonding force was found between different types of teeth in vivo. Clinically, ARI scores were not significantly different (p = 0.921) between different groups, but overall higher scores were predominant.

Conclusion

Bracket debonding force should be measured on the same tooth from the same arch as the significant difference of mean debonding force exists between similar teeth of the upper and lower arches. The insignificant bracket failure pattern with higher ARI scores confirms less enamel damage irrespective of tooth types.

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.

Orthodontic Bond Strength Comparison between Two Filled Resin Sealants

Objective

Sealants are used in orthodontics to help prevent demineralization during treatment. This study aimed to determine if there is a difference in the shear bond strength (SBS) between 2 different resin sealants bonded to teeth.

Methods

Extracted human premolars (n=20/group) were randomly divided and prepared by acid etching, followed by application of primer or sealant. Group 1, the control group, used Transbond XT Primer (3M Unitek). Groups 2 and 3 were prepared with the sealants L.E.D. Pro Seal (Reliance Orthodontic Products) and Opal Seal (Opal Orthodontics) as the respective primers. Transbond XT Adhesive was applied to a stainless steel bracket and bonded to each tooth. Each group was stored in distilled water at 37°C for 48 hours before. SBS was measured using a universal testing machine, and the adhesive remnant index (ARI) was scored.

Results

The SBS (MPa) of the groups was as follows: Group 1 (Transbond): 20.1±6.0; Group 2 (Pro Seal): 16.5±4.8; and Group 3 (Opal Seal): 15.7±3.9. The SBS of Transbond XT Primer was significantly greater than that of Opal Seal (p<0.05/analysis of variance-Tukey), while Pro Seal and Opal Seal sealants were not significantly different from each other (p<0.05). The Opal Seal group had significantly greater ARI scores, indicating that more adhesive remained on the teeth after debonding.

Conclusion

Opal Seal and Pro Seal sealants have similar SBS but generally exhibit lower bond strengths than an adhesive primer.

Assessment of in vivo bond strength studies of the orthodontic bracket-adhesive system: A systematic review

The aim of this study was to systematically review the available studies measuring the bond strength of orthodontic bracket-adhesive system under different experimental conditions in vivo. Literature search was performed in four different databases: PubMed, Web of Science, Cochrane, and Scopus using the keywords – bond strength, orthodontic brackets, bracket-adhesive, and in vivo. A total of six full-text articles were selected based on the inclusion and exclusion criteria of our study after a careful assessment by the two independent reviewers. Data selection was performed by following PRISMA 2009 guidelines. Five of the selected studies were clinical trials; one study was a randomized clinical trial. From each of the selected articles, the following data were extracted – number of samples, with the type of tooth involved materials under experiment methods of measurement, the time interval between bonding and debonding orthodontic brackets, mode of force application, and the bond strength results with the overall outcome. The methodological quality assessment of each article was done by the modified Downs and Black checklist method. The qualitative analyses were done by two independent reviewers. Conflicting issues were resolved in a consensus meeting by consulting the third reviewer (MKA). Meta-analysis could not be performed due to the lack of homogenous study results. The review reached no real conclusion apart from the lack of efforts to clinically evaluate the bonding efficiency of a wide range of orthodontic bracket-adhesive systems in terms of debonding force compared to laboratory-based in vitro and ex vivo studies.

Shear bond strength of two 2-step etch-and-rinse adhesives when bonding ceramic brackets to bovine enamel

AIM

The present study assessed a fracture analysis and compared the shear bond strength (SBS) of two 2-step etch-and-rinse (E&R) adhesives when bonding ceramic orthodontic brackets to bovine enamel.

MATERIALS AND METHODS

Thirty healthy bovine mandibular incisors were selected and were equally and randomly assigned to 2 experimental groups. Ceramic brackets (FLI Signature Clear^®, RMO) were bonded onto bovine enamel using an adhesive system. In group 1 (n=15), the conventional E&R adhesive (OrthoSolo^®+Enlight^®, Ormco) was used, and in group 2 (n=15), the new E&R adhesive limited to ceramic bracket bonding (FLI ceramic adhesive^®: FLI sealant resin^®+FLI adhesive paste^®, RMO) was used. In order to obtain appropriate enamel surfaces, the vestibular surfaces of mandibular bovine incisors were flat ground. After bonding, all the samples were stored in distilled water at room temperature for 21 days and subsequently tested for SBS, using the Instron^® universal testing machine. The Adhesive Remnant Index (ARI) scores were evaluated. Failure modes were assessed using optical microscopy at magnification ×40. A statistic data analysis was performed using the Mann-Whitney U-test (P<0.05).

RESULTS

The test showed a significant difference (P=0.00155) between the two groups for the SBS values. Group 1 had significantly higher SBS values (9.79 to 20.83MPa) than group 2 (8.45 to 13.94MPa). Analysis of the ARI scores revealed that most of the failures occurred at the enamel/adhesive interface. A statistically significant difference was found for the ARI scores between the two groups (P=0.00996). Only two fractured brackets, which remained bonded onto the bovine enamel, were reported. Both occurred in group 1.

CONCLUSION

When bonded to ceramic brackets, FLI ceramic adhesive^® (RMO) was demonstrated to be very predictable and safe for clinical application in enamel bonding, whereas the results obtained with the conventional adhesive system (OrthoSolo^®+Enlight^®, Ormco) were less reproducible and revealed slightly excessive shear bond strength values.

Validity of bond strength tests: A critical review: Part I

Adhesive systems are selected based on their bond strengths achieved while testing in laboratories. These bond strengths can predict the longevity of a restoration to some extent. There were several discrepancies in the reported bond strengths. To critically review the reliability of macro-bond strength tests used to evaluate resin-tooth interface. Relevant literature published between January 1983 and May 2013 was collected from PubMed database, Google scholar, and hand-searched journals of Conservative Dentistry, Endodontics and Dental materials. Variables that influence the test outcome are categorized into substrate-related factors, factors related to specimen properties, preparation of specimens, and test methodology. Impact of these variables on the test outcome is critically analyzed. There is lack of a standard format for reporting the bond strength tests, which could lead to misinterpretation of the data and bonding abilities of adhesives.

Effects of buccal and lingual enamel sandblasting on shear bond strength of orthodontic brackets bonded with a self-etching primer

The purpose of this study was to evaluate the effects of sandblasting on the initial shear bond strength (SBS) and on the bracket/adhesive failure mode of orthodontic brackets bonded on buccal and lingual enamel using a self-etching primer (SEP). The brackets were bonded using a SEP and composite resin on the buccal and lingual surfaces of 30 premolars with intact enamel and 30 premolars pretreated by sandblasting with 50 μm aluminum-oxide. Student's paired t-test was used to compare the groups for differences in SBS and a multiple Chi(2) test was performed to compare the bond failure mode. It was shown that sandblasting increases significantly SBS of the SEP on the buccal surfaces but the increase on the lingual surfaces is not statistically significant. A comparison of the adhesive remnant index scores indicated that there was more residual adhesive remaining on the teeth that were treated by sandblasting than on the teeth with intact enamel. Besides, there is no statistical difference between SBS of the SEP on buccal and lingual surfaces with intact enamel. Therefore, we can conclude that sandblasting improves the bond between buccal and lingual enamel and resin ant that the SEP provides the same SBS on buccal and lingual intact surfaces.

In vitro evaluation of an alternative method to bond molar tubes

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

In-vitro orthodontic bond strength testing: a systematic review and meta-analysis

INTRODUCTION

The aims of this study were to systematically review the available literature regarding in-vitro orthodontic shear bond strength testing and to analyze the influence of test conditions on bond strength.

METHODS

Our data sources were Embase and Medline. Relevant studies were selected based on predefined criteria. Study test conditions that might influence in-vitro bond strength were independently assessed by 2 observers. Studies reporting a minimum number of test conditions were included for meta-analysis by using a multilevel model with 3 levels, with author as the highest level, study as the second level, and specimens in the study as the lowest level. The primary outcome measure was bond strength.

RESULTS

We identified 121 relevant studies, of which 24 were included in the meta-analysis. Methodologic drawbacks of the excluded studies were generally related to inadequate reporting of test conditions and specimen storage. The meta-analysis demonstrated that 3 experimental conditions significantly affect in-vitro bond strength testing. Although water storage decreased bond strength on average by 10.7 MPa, each second of photopolymerization time and each millimeter per minute of greater crosshead speed increased bond strength by 0.077 and 1.3 MPa, respectively.

CONCLUSIONS

Many studies on in-vitro orthodontic bond strength fail to report test conditions that could significantly affect their outcomes.

Bond failure of gingivally offset mandibular premolar brackets: a randomized controlled clinical trial

INTRODUCTION

The purpose of this randomized controlled clinical trial was to examine the clinical bond failure rate of gingivally offset mandibular premolar brackets and compare it with that of standard mandibular premolar brackets.

METHODS

Eighty-three patients were enrolled in this trial. A total of 240 brackets--120 standard and 120 offset--were bonded in a split-mouth design.

RESULTS

Ten standard brackets and 1 offset bracket debonded during the trial period. Survival times were analyzed by using the Kaplan-Meier nonparametric test, and comparisons between bracket types were made with the Mantel-Haenszel log rank test. These tests showed that the failure rate between the bracket types was statistically significant (P <0.0058).

CONCLUSIONS

Gingivally offset mandibular premolar brackets have a lower bond failure rate than standard mandibular premolar brackets.

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.