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.

Orthodontic bonding to silicate ceramics: impact of different pretreatment methods on shear bond strength between ceramic restorations and ceramic brackets

Objective The study aims to investigate the shear bond strength (SBS) between silicate ceramic restorations and ceramic brackets after different pretreatments and aging methods. Material and methods Leucite (LEU) and lithium disilicate (LiSi) specimens were pretreated with (i) 4% hydrofluoric acid + silane (HF), (ii) Monobond Etch&Prime (MEP), (iii) silicatization + silane (CoJet), and (iv) SiC grinder + silane (SiC). Molars etched (phosphoric acid) and conditioned acted as comparison group. SBS was measured after 24 h (distilled water, 37 °C), 500 × thermocycling (5/55 °C), and 90 days (distilled water, 37 °C). Data was analyzed using Shapiro–Wilk, Kruskal–Wallis with Dunn’s post hoc test and Bonferroni correction, Mann–Whitney U, and Chi2 test (p < 0.05). The adhesive remnant index (ARI) was determined. Results LEU pretreated with MEP showed lower SBS than pretreated with HF, CoJet, or SiC. LiSi pretreated with MEP resulted in lower initial SBS than pretreated with HF or SiC. After thermocycling, pretreatment using MEP led to lower SBS than with CoJet. Within LiSi group, after 90 days, the pretreatment using SiC resulted in lowest SBS values. After HF and MEP pretreatment, LEU showed lower initial SBS than LiSi. After 90 days of water storage, within specimens pretreated using CoJet or SiC showed LEU higher SBS than LiSi. Enamel presented higher or comparable SBS values to LEU and LiSi. With exception of MEP pretreatment, ARI 3 was predominantly observed, regardless the substrate, pretreatment, and aging level. Conclusions MEP pretreatment presented the lowest SBS values, regardless the silicate ceramic and aging level. Further research is necessary. Clinical relevance There is no need for intraoral application of HF for orthodontic treatment.

Effect of extended application time of universal adhesives on bond strength of brackets and enamel integrity

The objective of this study to evaluate the effect of universal adhesives application time to enamel through shear bond strength (SBS), adhesive remnant index (ARI), and morphological enamel integrity. Bovine incisors were divided into four groups according to bonding system protocol (n=20): (1) conventional etch-and-rise adhesive – Transbond XT Primer (P-XT); (2) one-step self-etching adhesive –­ Transbond Self Etching Primer (T-SEP); (3) one universal adhesive – Single Bond Universal, which were rubbed for 20s (SBU-20) or (4) 40s (SBU-40). Transbond XT composite was used to bond the brackets to enamel. SBS was evaluated in a universal test machine at 0.5mm/minute. ARI was determined under x12.5 magnification and enamel damage was evaluated through scanning electron microscope (SEM) after debonding (n=10). SBS data were compared using one-way ANOVA and Tukey’s test. The Kruskal–Wallis test was used to compare the ARI scores (α =0.05). The P-XT and T-SEP groups showed significantly higher bond strength than SBU-20 and SBU-40 (p<0.05). The ARI was similar for all groups (p>0.05). SEM showed enamel damage only in T-SEP and P-XT groups. Conventional ‘etch and rinse’ and ‘self-etch’ adhesives had the highest shear bond strength, but they were associated with more enamel damage compared to universal adhesives. The application of universal adhesives with the time recommended by the manufacturer — ensure satisfactory bond strength and enamel integrity.

The effect of aluminum oxide sandblasting and discs on shear bond strength of metal brackets rebonded in eroded enamel

This research aimed to assess the effect of aluminum oxide sandblasting and discs on the bond strength of metal brackets rebonded on artificially eroded enamel. Fifty-four bovine incisors were divided into groups: Control (Artificial Saliva), AlOx (Aluminum oxide sandblasting), and SL (Aluminum oxide discs). They had their enamel surface flattened with Al2O3 discs and a metallographic polisher, then Knoop microhardness was assessed. AlOx and SL specimens were eroded with Coca-Cola™ for 1 minute, 3 times a day for 7 days. Metal brackets were bonded to the tooth. Shear strength was measured by an EMIC universal testing machine (0.5 mm/min). The Adhesive Remnant Index (ARI) was performed after shearing through magnifying glass (10X). Kolmogorov-Smirnov, Levene, homoscedasticity and ANOVA tests were applied to assess microhardness and shear strength (p=0.163). All groups presented shear bond strength with no significant differences. The ARI showed statistically significant difference between the groups. The prevalence for the control group was ARI 3. However for AlOx and SL, ARI 1 and 2 prevailed. The aluminum oxide sandblasting and aluminum oxide discs did not positively increase the bond strength of brackets when bonded to artificially eroded enamel. The ARI indicated that eroded teeth present higher resin adhesion to enamel.

Safe Debonding of Fixed Appliances: A Comparison of Traditional Techniques and LODI Devices on Different Bracket Types in Terms of Enamel Cracks, Site of Bond Failure, and Bracket Reusability

The objective of this study was to compare the effects of the debonding of three different bracket types by means of three popular debonding methods. A total of 180 human third molars was divided into six groups, consisting of 20 teeth each. Three bracket types were bonded to the enamel (metal brackets with an integral base and a foil mesh base, and ceramic brackets) and three methods of bracket debonding were employed (bracket removal pliers, Weingart pliers, and Lift-Off Debonding Instrument). The samples were examined with scanning electron microscopy to assess the number of enamel cracks, measure the area of adhesive remaining on the enamel, and calculate the adhesive remnant index (ARI). There were no statistically significant differences between the groups in terms of the number of enamel cracks after bracket debonding. The amount of adhesive remaining on the teeth after the brackets were removed was significantly different between the groups. LODI and Weingart pliers are considered to be the safest methods of debonding brackets with an integral base, while LODI is the best tool for brackets with foil mesh. Bracket removal pliers are considered to be the preferred method for ceramic bracket debonding.

Influence of Pre-Etched Area and Functional Monomers on the Enamel Bond Strength of Orthodontic Adhesive Pastes

This study was performed to investigate the influence of pre-etching area and functional monomers in orthodontic adhesive pastes on enamel bond strength. Bovine enamel was partially pre-etched with phosphoric acid for 30 s over areas with a diameter of 1.0, 2.0 or 3.0 mm, and metal brackets were then bonded with or without functional monomers in the orthodontic adhesive paste. For the baseline groups, the whole adherent area was pre-etched. The shear bond strength (SBS) and adhesive remnant index (ARI) were determined. The adhesive paste/enamel interfaces were observed by scanning electron microscopy (SEM). Although the adhesive paste with functional monomers showed higher SBS than the functional monomer-free adhesive paste in all groups, there were no significant differences in SBS between them regardless of the pre-etched area. The SBS increased with increasing pre-etched area in both orthodontic adhesive pastes. In SEM images of adhesive paste/enamel interfaces, although adhesive with functional monomers showed excellent adaptation, the functional monomer-free adhesive paste showed gap formation at the interface. These findings suggested that the pre-etching area greatly influenced bond strength, regardless of the presence or absence of the functional monomer in the orthodontic adhesive paste.

Evaluation of enamel roughness after the removal of brackets bonded with different materials: In vivo study

The aims of this in vivo study were to evaluate the effect of bonding with resin-modified glass ionomer cement (RMGIC) and to assess enamel surface roughness before and after the removal of brackets bonded with composite or RMGIC from the maxillary central incisors. Fifteen orthodontic patients were selected for the study. For each patient, the teeth were rinsed and dried, and brackets were bonded with composite (Transbond XT) and RMGIC (Vitremer Core Buildup/Restorative). At the conclusion of orthodontic treatment, their brackets were removed. Dental replicas were made of epoxy resin in initial conditions (before bonded) and after polishing with an aluminum oxide disc system. Adhesive remnant index (ARI) and surface roughness was measured on the dental replicas and data were evaluated statistically by Mann-Whitney and paired t-test, respectively. No bracket debonding occurred during patients’ treatment periods. It was verified that the ARI values of the two maxillary central incisors were similar (p = 0.665). For both bonding materials, the ARI value of 3 was predominant. After polishing, surface roughness was similar in the composite and RMGIC groups (0.245 μm and 0.248 μm, respectively; p = 0.07). In both groups, enamel surface roughness values were significantly lower after polishing compared with the initial condition (p < 0.001). RMGIC promoted efficiency in cementing brackets without fail during treatment; the choice of composite or RMGIC materials was not a factor that influenced the roughness of the enamel surface, however, polishing led to smoother surfaces than those found at the beginning of the treatment.

Effects of Composite Resin on the Enamel after Debonding: An In Vitro Study—Metal Brackets vs. Ceramic Brackets

Fixed orthodontic therapies include several procedures that can affect the enamel surface. The aim of this study was to assess the action of composite resin on the surface of the tooth through variation of enamel changes after debonding metal and ceramic brackets, by means of scanning electron microscopy. An in vitro study was conducted on 48 human premolar specimens, which were extracted within a period of two months for orthodontic purposes. On half of them, metal brackets were bonded, and on the other half, ceramic brackets (Al2O3) were bonded, using light cure adhesive paste and a two-step, etch-and-bonding technique. The brackets were debonded after 24 h using a straight debonding plier. The adhesive remnant index (ARI) was determined by visual observation of the specimen. Post-debonding scans were aligned with the baseline, and the surfaces’ changes were quantified. A quantitative analysis was made on the debonded brackets to determine the presence or absence of enamel on the base pad. Evaluation of pre-bonded and post-clean-up enamel surface revealed no crack and increased roughness in both ceramic and metal brackets, which was higher for the ceramic ones. The enameled band (perikymata), artificial caries, or the superficial fissures revealed in the pretreatment stage were replaced with the loss of the prismatic structure and the presence of remnant adhesive. No enamel substance was found on the base pad. The ARI tooth was higher for metallic brackets than for ceramic ones. Metallic brackets and ceramic brackets have undergone mechanical changes by showing fractures in their structure. According to our present investigation, we can conclude that the adhesive composite resin is safe for use on both metal and ceramic brackets in orthodontic treatments, with no iatrogenic enamel damages.

Evaluation of Dental Surface after De-Bonding Orthodontic Bracket Bonded with a Novel Fluorescent Composite: In Vitro Comparative Study

The use of a new fluorescent composite can reduce some of the problems related to procedures of de-bonding orthodontic bracket (enamel damage, dentine lesions, and composite residuals). The aim of the presented study was to compare the effect of fluorescent and conventional non-fluorescent composite on dental surface and composite remnants by in vitro de-bonding tests. De-bonding of florescent composite (DFC) and the de-bonding of standard composite (DSC) were performed by operators on an in vitro sample of 48 teeth under UV light (360–370 nm min 20 mW/cm2). Modified ARI (Adhesive Remnant Index), scored under 5.0×/235 magnification, was used for evaluation of dental surface after the procedure, and the duration required for de-bonding was measured. Significant differences in ARI between the two groups were observed (Pearson two-tailed p = 0.006 1.4 ± 0.1 95% C.I.), and the average duration of de-bonding was 38 s (DFC) and 77 s (DSC) per tooth, respectively (Mann–Whitney test p = 0.015; 57.7 ± 19.9 95% C.I.). The use of fluorescent composite could significantly improve the quality of de-bonding by reducing the quantity of composite residuals and visible enamel damage, while reducing time needed for successful procedure performance.