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Presented By, Dr. Girish G. Sarada 1ST year P.G. Department Of Orthodontics & Dentofacial Orthopedics K.L.E. society`s Institute of dental sciences, Bangalore
EVOLUTION OF BONDING For the orthodontic treatment to carry out, force is to be applied to the teeth, to apply force we need some form of attachment over the teeth, so this can be done in two ways 1. Banding 2. Bonding BANDS - Bandless dentistry had been dream of orthodontists for many years. These bands were introduced by W.E. Magill in 1871 & have been in existence for more than 100 years.
DISADVANTAGES OF BANDING
Laborious, time-consuming Skilled work is required Difficulty in banding partially erupted teeth Decalcification /discoloration with loose or un-contoured bands Gingival irritation Unaesthetic Need of separators Closure of band spaces after completion of treatment
For the patient to whom esthetics being prime consideration even during treatment ,metallic look of fixed orthodontic appliance , has always been the bone of contention. A survey of the developments in the field of orthodontics over last 50 years would indicate that successful bonding of brackets to teeth, replacing conventional system of cementing stainless steel bands with welded attachments is most significant achievement. Since breakthrough of bandless dentistry in 1955, when buonocore described acid technique to achieve to achieve micromechanical retention of resin to enamel, bonding had come to stay.
3 major developments that made bonding of attachments to teeth possible 1. BUONOCORE 1955 – improved retention of methyl methacrylate to enamel – 85% phosphoric acid for 30 seconds 2. BOWEN 1962 – bis Glycidyl methacrylate – more stable and greater strength 3. NEWMAN 1965 – first to acid etch and bond orthodontic brackets with epoxy resin
ACID ETCHING -Michael Buonocore in 1955 • The first bonding agent for restorative dentistry, Sevriton Cavity Seal introduced in 1949 by Oskar Hagger, a Swiss chemist working in London, using glycerophosphoric acid dimethacrylate, an unfilled acrylic resin. • In 1955, Buonocore, borrowing the techniques of industrial bonding, enhanced the adhesion with the phosphoric acid etch. Micahel Buonocore was first to demonstrate that bonding of acrylic material was substantially increased by conditioning enamel surface with 85% phosphoric acid for 30 seconds. Monomer of acrylic wet etched surface, flowed into each pits aided by capillary action & generated retentive resin tags. Mainly used to seal pits & fissures. This procedure has expanded the use of resin bonded restorative materials as it provides a strong bond between resin & enamel, forming basis for many innovative dental procedures like resin bonded metal retainers, porcelain laminates & bonded orthodontic brackets.
Newmann in 1965Was first to apply these findings & bonded plastic brackets with an epoxy resin after etching with 40% phosphoric acid for 60 seconds. Mitchell in 1967 Described a successful although limited, clinical trial using black copper cement & gold copper attachment. Smith in 1968Introduced zinc polycarboxylate cement & bracket bonding with this cement. Miura et al in 1971Described an acrylic resin ORTHOMITE using a modified trialkyl borane catalyst, that proved to be particularly successful for bonding plastic brackets & for enhanced adhesion in presence of moisture. In 1975, Silverstone Three patterns of enamel etching.
called direct bonding system for enamel.C. The adhesives used introduced in early 1970‘s were primarily those of powder-liquid type of methyl methacrylate that did not incorporate a filler. As time passed however the weakness of plastic brackets became apparent & metal brackets begin to be used.1979 Maijer R. first detailed post-treatment evaluation of direct bonding over a full period orthodontic treatment was published. OIS Adhesive system – OIS company in 1969. 2. From mid 1970‘s the paste type of adhesives emerged in which both base materials & catalyst were dispensed as pastes to be to be mixed before being used for bonding.Tri–N–Butyl Borane (catalyst) • Increased adhesive strength • Coupling agent – ‗silane‘ methacryloxypropyltrimethoxysilane • Increased adhesive penetration • Chemically bonded to adhesive Affinity to enamel . Bonding materials strong enough for clinical use did not become routinely available until mid 1970‘s before that experimental bonding system based on epoxy & acrylic resin had been proposed & evaluated clinically with success. The reason for change from powder & liquid type to paste was mainly due to change in type of brackets used in bonding. Fujio Miura and associates in 1971 – • Introduced – ORTHOMITE • MMA . During this period. Bracket Bond – GAC in 1970 3.The crystal growth on the enamel surface. so it was not possible to place arch wires at same visit the bonded attachments were placed. In survey by Gorlick in 1979 in U. The greatest difficulty with epoxy resin was slow development of full strength. => Masuhara introduced -. introduced an alternative to acid etching. It was one of the first dental adhesive commercially introduced after Buonocore proposed the concept of acid-etching enamel. all adhesives introduced had to adhere to plastic brackets that were made up of polycarbonate. It was in 1977. and Smith D.S. it was seen that 93% of orthodontist preferred bonding for bracket placement First commercially available orthodontic adhesives 1. The early resin materials suffered from their different thermal coefficient of expansion relative to enamel extended to weaken bonds.
Plastic brackets 2. Poor mechanical interlocking to metal bracket bases BOWEN 1962 : Bisphenol Glycidyl Dimethacrylate (Bis-GMA) • • • Greater strength • Lower water absorption • Less polymerization shrinkage 2-paste system Strongest adhesives for metal brackets MERIT AND DEMERIT OF BIS-GMA • Poor penetration due to increased viscosity – dilution reqd. • Plastic brackets could not be used – primer for partially dissolving added • Active life less than powder liquid system . Elimination of sealant . Fluctuating proportion of powder-liquid depending on operator 2.good penetration into enamel surface 5.BPO (Benzoyl peroxide) Difficulty in adhesion • Polymerization shrinkage Pulpal irritation Merits of MMA adhesives: 1. Increased working time – brush-on / dip-in 4. Less damage during debonding Demerits of MMA adhesives: 1.Methyl Methacrylate – 1st used adhesive Catalyst . Good storage stability 3.
which are made up of zirconium/silica or nanosilica particles.In 1974 – ORTHOMITE II 20% more HNPM – hydroxy napthoxy propyl methacrylate • Eliminated silane ORTHOMITE SUPER BOND 4 . Bond strength less than manual application Nanotechnology has led to the development of a new composite resin characterised by containing nanoparticles measuring approximately 25 nm and nanoaggregates of approximately 75 nm.META – methacryloxyethyl trimellitate anhydride 4 .META • • • • • • Bonds to Plastic & metal PRE-PRIMED brackets Base was primed with adhesive Bracket base covered with PMMA powder Base dipped in monomer and pressed onto etched surface. .
Arch length not increased by band material 5. Interproximal caries can be detected & treated. 11. Interproximal areas are accessible for composite buildup. Most important – Improved appearance Hygiene Ease of application Decreased discomfort for the patient . Allows more precise bracket placement 6. Esthetically superior. 13. Faster & simpler. deceased discomfort for patient & ease of application for clinician. No band spaces to close at end of treatment.Advantages of bonding1. 10. Improved appearance. Brackets may be recycled further reducing the cost. Lingual brackets ‗Invisible Braces‘ may be used when esthetics important. There is less discomfort for patient 4. Partially erupted or fractured teeth can be controlled. 12. Mesiodistal enamel reduction is possible during treatment. No large supply of bands needed. Improved gingival condition is possible & there is better access for cleaning. 9. 8. 3. 14. 7. Caries under loose bands is eliminated. 15. 2.
Almost every case of dental adhesion is based primarily on mechanical bonding. 3. • Types1. specially if excess adhesive extends beyond bracket base. It is the type of bonding seen when surfaces smooth & chemically dissimilar. ADHESION- . 7. 5. Rebonding a loose bracket requires more preparation than rebanding a loose band. Debonding is more consuming than debanding since removal of adhesive is more time consuming. Few bracket adhesives are not strong. Better access for cleaning does not necessarily guarantee better oral hygiene & improved gingival condition. Protection against interproximal caries of well contoured cemented band is absent. Chemical bonding Involves bonds between atoms are formed across the interface from adhesive & adherand. 2.Disadvantages1. A bonded bracket has weaker attachment than a cemented band. 4. 2. Mechanical bonding – Result of an interface that involves undercuts & other irregularities that produce interlocking of the material. overall contribution to bond strength low.the extent to which bonding is possible is limited. 6. • TERMINOLOGY Bonding Process of joining 2 materials by means of an adhesive agent that solidifies during bonding process. Bonding in not indicated on teeth where lingual auxillaries are required or where headgear are attached. Physical bonding Involves Vander wall / electrostatic interactions that are relatively weak. Since materials are dissimilar.
Tolerate/dissolve impurities 5.Contact angle – It is angle formed between interface of adhesive & adherent.A molecular attraction between 2 contacting surfaces promoted by interfacial force of attraction between molecules or atoms of two different species. Can be chemical. Allow air to escape as air if present acts as. It should be zero for proper wetting of surface. Set hard and tough 4. Resist ambient temperature 2.Decreases cohesion . ADHESIVESubstance that promotes adhesion of one substance or material to another Requirements1. Water absorbing tendency . Not cure slowly. Fluid enough to penetrate tooth surface but viscous enough to enable good bracket positioning. 7. No change on solidification 9. Must wet tooth surface & flow into surface pores & valleys.Polymerisation inhibitor . 8. unduly shrink or allow discontinuities 6. It should be Clean & Firm 2.minimal SUBSTRATE / INTERFACE 1. mechanical or combination. 3.
No regenerative capacity • Morphologically – It has enamel prisms which results in Keyhole/ Fishlike appearance.Topical fluorides Plaque/pellicle • Above all factors decreases enamel solubility Classification of Bonding MaterialsA) Based on basic bonding Materials 1. Enamel rod has 2 parts. Light curing 3. Hardest 2.Nature of Enamel – Unique characters are 1.Glass ionomer Basic difference between is acrylics are linear polymers where as diacrylates are cross linked 3-D polymers. Only clinically visible mineralized tissue 3. Self curing 2.infection of primary teeth Excessive ingestion of fluoride Post-eruptive.Bis GMA/ Bowen‘s resin 3. Thermocured C) Based on Fluoride system 1. Non-fluoride releasing .Diacrylate based.Self curing acrylic 2.Acrylic based. • B) Based on curing system 1.Head & tail Each prism contains hydroxyapatite crystals which are parallel to long axis in head region & perpendicular in tail region Crystal dissolves faster – Head region Factors affecting Enamel solubility Pre-eruptive-Hypoplasia/hypocaicification. Dual curing 4. Fluoride releasing 2.
Methyl methacrylate Cross linking agent .15 Water sorption. Directon. Smartbond Unfilled Acrylic ResinsWidely used as adhesives in beginning but its use is limited due to its few properties. Bondeze.can bond in presence of water . MOISTURE-RESISTANT . Available in powder & liquid form.5%.Cyanoacrylate – no liquid. are based on self curing acrylics Properties Unfilled Compressive strength.ex. MOISTURE-ACTIVE .Methyl hydroquinone 0.8ppm/ºC KHN.Benzoyl Peroxide approximately 0.polymethyl methacrylate Initiator.006% Orthimite.microleakage .Ethylene dimethacrylate Inhibitor.enamel surface intentionally made wet . Monomer.ex. gingival fluid – contaminants .92.3 to 0.saliva.need water for bonding . Geine etc.1.7 Curing shrinkage-2-3vol% Disadvantages Low hardness & strength Inferior resistance to abrasion High coefficient of thermal expansion .70MPa Tensile strength –24MPa Elastic modulus-2. only paste .4GPa Thermal coefficient of expansion.Adhesives acting in the presence of water 1. Transbond MIP 2. CompositionPowder .
Filler Coupling agent MATRIX – It is made up any of the following BisGMA Urethane dimethacrylate Triethylene Glycol Dimethacrylate (TEGMA) High molecular weight that reduces polymerization shrinkage but increases viscosity.Benzoyl peroxide Accelerators .N.CompositesComposite is a solid formed from two or more distinct phases that have been combined to produce properties superior to or intermediate to those of individual components.Tertiary aromatic amines Eg.0. • There are 3 structural componentsMatrix – Plastic resin that forms continuous phase & binds filler particles. Dental Composite .N dihydroxy ethyl-p-toludine Two pastes are mixed. Viscosity Controller Methyl methacrylate (MMP) Ethylene glycol Dimethacrylate (EDMA) Triethylene Dimethacrylate (TEGDMA) Diethylene glycol Dimethacrylate (DEGMA) • Inhibitors Butylated Hydroxytolune (BHT) . glass. Photochemical Activators Initiator .amine reacts with BP forming free radicles & polymerization is initiated. crystalline or organic resin filler particles &/ short fibers bonded to matrix by a coupling agent.It is a highly cross linked polymeric material reinforced by dispersion of amorphous silica.01wt% Functions 1.N-Dimethyl-p-toluidine N.benzion ethyl ether . Ensures sufficient working time Chemical Activation Initiators . For adequate storage life 2.UV light of 365nm Activator .
Initiator . Reinforcement of matrix resin . decreased wear.Controlled working time Optical Modifiers Titanium oxide & aluminum oxide . 4.007wt% Visual shading & translucency DISPERSED PHASE/ REINFORCING PHASE Quartz. Reduction in water sorption. COUPLING AGENT Filler particles bonded to resin matrix Titanates & Zirconates Organosilanes like γ-emethacryloxypropyl-trimethoxy-silane Improves physical & mechanical properties Inhibits leaching by preventing water from penetrating along resin-filler interface • Bonding agents.increased hardness. strength.Physical properties .2 to 0. 6. glasses & glass ceramics. Solo-Tach.Diaketone such as camphoroquinone . Reduction of polymerization shrinkage.Visible light of 420-450nm.0.2wt% Advantages of Visible light over UV light. Increased radiopacity & diagnostic sensitivity through incorporation of strontium & barium glass & other heavy metals. Nuva-Tach -3 to 20 µm impart abrasion resistance properties. Reduction in thermal expansion & contraction. Endur. • Concise.001-0. barium aluminum or strontium aluminum silicates. 2. 5. 3. Activator . The glass or glass ceramic may be lithium aluminum.0.0.3µm smoother surface that retains less plaque & is prone to abrasion. fluorosilicates.Greater depth of cure . Improved workability by increasing viscosity. Dynabond . Purpose1. softening & staining.
8-12µm Filler loading 70-80wt% Compressive strength.Classification – based on particle size 1.4-1µm Filler loading – 75-80wt% Compressive strength.50-60ppm/ºC KHN.50-60 Curing shrinkage-2-3vol% • 3.25-35 Curing shrinkage-2-3vol% .350-400MPa Tensile strength – 75-90MPa Elastic modulus-15-20GPa Thermal coefficient of expansion. Hybrid (all purpose) Filler size – 0. Hybrid (small particle) – Filler size – 0. Microfilled Filler size – 0.30-40ppm/ºC KHN.250-300MPa Tensile strength – 50-65MPa Elastic modulus. Traditional/macrofilled Filler size – 1-50µm Average.55 • 2.300-350MPa Tensile strength – 40-50MPa Elastic modulus-11-15GPa Thermal coefficient of expansion.250-350MPa Tensile strength – 30-50MPa Elastic modulus-3-6GPa Thermal coefficient of expansion.8-15GPa Thermal coefficient of expansion.04-4µm Filler loading – 35-67wt% Compressive strength.25-35ppm/ºC KHN.19-26ppm/ºC KHN.5-3µm Filler loading – 80-90wt% Compressive strength.50-60 Curing shrinkage-2-3vol% • 4.
• Flowable composites – Modification of small particle filled & hybrid composites. They have reduced filler level so as to provide a consistency that enables the material to flow readily, spread uniformly, intimately adapt to tooth surface. Properties Filler size – 0.6-1µm Filler loading – 40-60wt% Elastic modulus-4-8GPa Curing shrinkage-3-5vol% Packable composites Filler size –fibrous Filler loading – 65-81wt% Elastic modulus-3-13GPa Curing shrinkage-2-3vol%
e. an electron is extracted. leaving the other electron of the double bond unpaired . Ethylene C2H4 A free radical I* When the free radical & its unpaired electron approach a monomer with its high electron density double bond. Addition polymerization 2.g. Monomers may be joined by either: 1. the structure of monomer is repeated many times in polymer Requirement :An unsaturated group (having double bond) e. or the polymer. add polymerization can produce giant molecules of almost unlimited size. is formed from large number of molecules known as monomers. Polymerization occurs through a series of chemical reactions by which the macromolecule. Step. & it pairs with the electron to form a bond between the radical & the monomer molecule . Also there is no change in composition i.Chemistry Basic • • Dental resins solidify when they polymerize.growth or condensation polymerization Addition polymerization • • • • Most dental resins are polymerized by this mechanism in which monomers add sequentially to the end of a growing chain Compared with condensation polymerization.
- Thus the original free radical bonds to one side of the monomer molecule & forms a new free radical site at the other end. Induction Propagation Chain transfer Termination Induction Activation of monomer molecules Free Radicals In light activated system Camphoroquinone & Dimethyleaminoethylemethacrylate will generate free radicals. can add successively to a large no. - TERMINATION 1. Direct coupling Ii Mm*+ IiMn* => Ii Mm MnIi It become deactivated by an exchange of energy. of molecules so that the polymerization process continues through the propagation of the reactive center. which also becomes a free radical.monomer complex then acts as a new free radical center when it approaches another monomer to form a dimer. 2. Visible light => 470 nm wavelength Propogation The resulting free radical. Exchange of hydrogen atom The hydrogen atom is transferred from one growing chain to another. 4. 2. The reaction is now initiated. The double bond is created in this transfer . 3. STAGES IN ADDITION POLYMERIZATION 1. This in turn.
Raw materials are fused at 1100 -1500ºC to a uniform glass. aluminum oxide .86 Tensile strength –6. It is used routinely for cementing bands because they are stronger than zinc phosphate & zinc polycarboxylate cement with less demineralization at the end of treatment. • CompositionPowder It is an acid soluble calcium fluroaluminosilicate Silica.1. sodium fluoride & aluminum phosphate Lanthanum. Liquid Polyacrylic acid. calcium fluoride.40-50% Itaconic / Maleic acid . reaction follows step wise pattern i. aluminum fluoride.STEP GROWTH POLYMERIZATION The polymerization is accompanied by repeated elimination of small molecules (byproducts) • Functional groups are repeated in the polymer chain.2MPa Elastic modulus -7.so for • Glass ionomer cement Glass Ionomer is generic name of group of materials based on reaction of silicate glass powder & polyacrylic acid.improves handling characterstics & increases working time Rexn.Acid base Glass + Polyelectrolyte = Polysalt hydrogel + silica gel Porperties ST – 7 min Film thickness – 24 Compressive strength. strontium. Slow process.25wt% . monomer – dimer – trimer.3GPa Solubility in water. barium.Increase reactivity & reduce viscosity Tartaric acid . This acquires its name from its formulation of glass powder & an ionomer that contains carboxylic acids GIC were introduced in 1972 primarily as luting agent & direct restorative properties with unique properties for bonding chemically to enamel dentin being able to release fluoride ions for caries protection.e. or zinc oxide – provides radiopacity.
as well as during rebonding procedures (Thompson and Way. Resistance to acid erosion 6. Enamel may be lost during prophylaxis. 1981) and the loss of this surface material is therefore of concern. 1980). 1981. Adhesion to enamel & metallic bases Limitations Short working time Initial sensitivity to moisture & dehydration Slow development of strength & elastic modulus Low fracture toughness Low abrasion resistance Need for GIC for bonding • • • The use of composites for bracket attachment has a number of disadvantages. Pus and Way. acid etching and at the time of clean up of residual resin at debond.Advantages 1. Silverston. Ease of debonding 2. Fluoride release 5. Controllable working time 3. Advantages Faster setting Show higher initial & sustained shear bond strength Types 1. They reported failure rate of approx 3% comparable to that of bonding resins which indicate its clinical satisfactory. Modified composite . The concentration of fluoride is greatest at the enamel surface (Thompson and Way. No iatrogenic enamel damage 4. They have recommended a no etch technique for bonding & claims it to bond satisfactory in presence of moisture.Compomer or polyacid modified composite resin 2. Silverman et al introduced in 1995 a light curing GIC for orthodontic bonding Fuji ortho LC. The earlier chemically cured GIC typically took 24 hours to reach optimal bond strength therefore arch wires had to be deterred or else very light force generating arch wires could be only placed. 1974. Larry White in 1986 described method of bonding orthodontic brackets with GIC. True resin modified / Hybrid ionomer .
Wieczkowski. Joynt. Advantages -Better early strength compared to conventional GIC. Ketac-cem and Chelon) with Rely-A-Bond (no-mix autopolymerising) which served as a standard in a clinical study.leachable fluoroaluminosilicate glass particles Initiators for light & / chemical curing. -Reduce moisture sensitivity -Improvement of translucency -Higher bond strength compared to conventional GIC.105 Tensile strength –20 KHN-40 Increased early strength Less moisture sensitivity Literature Bond strength and durability of glass ionomer cements used as bonding agents . • .Filler replaced by ion leachable aluminosilicate . CompositionPowderIon. Results: • Bond strength of GICs was significantly less when compared to Rely-A-bond. It consists of silicate glass particles. Because of absence of water cement mixture is not self adhesive. It incorporates acid base reaction. sodium fluoride & polyacid modified monomer without any water.AJO July 1989 -Klockowski. Compressive strength.No acid base reaction during setting . LiquidWater Polyacrylic acid or Polyacrylic acid modified with methacrylate & hydroxyethyl methacrylate (HEMA) monomers. But polymerization shrinkage on setting can increase microleakage. Davis. • Less reduction of bond strength of GICs on recycling – lesser than Rely-A-bond on recycling • Failures involved cohesion within cement or adhesion involving the enamel easily scraped off from the enamel surface without causing much damage. . True Resin modifiedReplacing part of polyacrylic acid with hydrophilic monomer.CompomerEssentially resin matrix composite.Light activated free radicals polymerization of methacrylate groups. and MacDo Compared GICs (Ketac-fil.
. Kyoto.1990 evaluated the bond strength of three glass ionomer cements against a composite resin in vitro Fricker .Silverman. Eliminates etching and priming enamel surfaces.).AJO-DO SEP 1995 . Eliminates working in a dry field. worked with Fuji II LC glass ionomer cement (GC Corp. Japan) Same rate of success bonding brackets to enamel surfaces as he did with composite cements.1994. Ketac (ESPE Premier Denbol Products. Pa. with a composite resin bonding agent – 12% failure rate • • • • Fajen et al. Increased patient and operator comfort. resin-reinforced glass ionomer cement 3 mechanisms of setting • • • • • • Advantages: Saves significant amount of chair time.• Cook -1990 compared the in vivo bond strength of a glass ionomer cement. Norristown. highest is achieved by conventional chemically cured composite followed by RMGIC & least by GIC . EJO 2004 April according to S. Fluoride release protects teeth against decalcification. Cohen • Used a new Resin modified GIC • Fuji Ortho LC • Light-cured. Aug 2004 AJO-DO by Andrew Summers et al • bond strength.B. Dentine conditioner was utilized for ten seconds A new light-cured glass ionomer cement that bonds brackets to teeth without etching in the presence of saliva . So RMGIC is a viable alternative when used with light & medium arch wires. Oliveria et al • There is no significant bond strength difference occurred when compared to composite resin when used with light and medium arched wires. Repairs are quick and easy.
4. Different preparations used are Methantheline bromide (Banthine). Whenever indicated Banthine tablets 50mg per 100 lb(45kg) in sugar free drink 15 min indicated. 2. Propanthaline bromide(Probanthine ). Gadgets that combine several of these.000rpm) than pumiced for 10 secs before acid etching. Excellent & rapid saliva flow restriction is obtained by Propanthaline bromide injections. While bonding mandibular second molar use of double hygoformic saliva ejector & T tube is indicated. 6. atropine sulfate. 2. A bristle brush cleans effectively after cleaning rinse. Reisner et al found more consistent results when Buccal tooth surfaces were abraded lightly with a tungsten carbide bur(#1172) at slow speed (25.For simultaneous premolar to premolar bonding in both arches.tongue holder to remove moisture from mouth. 8. Antisialogogues are generally not recommended. Dri-Angles to restrict flow of saliva from parotid duct. Moisture ControlAfter the rinse. Some measures are1. Cleaning is done using rotary instruments either a rubber cup or polishing brush.BONDING PROCEDURE DIRECT BONDING1. Lip Expander. Cheek retractors 7. Combined saliva ejector. 3. salivary control & maintenance of a completely dry working field is absolutely essential.Cotton or gauze rolls. 5. ENAMEL CONDITIONINGa. CLEANINGThorough cleaning of teeth with pumice is essential to remove plaque & the organic pellicle that normally covers all teeth. Various means for moisture control• • Dri angle Salivary duct obstructor .
. Carter reported that 50 mg per 100 lb in a sugar free drink 15 min before bonding is adequate. bite block High speed evacuator • ANTISIALOGOGUES – They help to decrease salivary release from glands & ducts unlike other devices that control released saliva.4 mg) Banthine tablets –In JCO 1981 Richard . The conditioning solution or gel usually 30% to 50% phosphoric acid typically 37% is preferred Calcium monophosphate & ca. Crystal growth 2.foam pellet. Sand blasting/air abrasion 3. brush for approximately 15-30 seconds.In JCO-1981 Sidney brant Showed this is a safe drug with few complication & can be used as an sublingual injection (Dose-0. sulfate byproducts – removed by water rinse Concentration greater than 50% . tongue holder.Saliva ejector. b.N.Enamel Pretreatment• Acid etching • Other alternatives to acid etching 1. • • Atropine sulphate .Deposition of adherent layer of monocalcium phosphate monohydrate on etched surface which inhibits further dissolution Concentration less than 27% creates dicalcium phosphate monohydrate precipitate that cannot be easily removed & may interfere with adhesion Apply over enamel surface . Laser etching Acid EtchingProcess of roughning a solid surface by exposing it to an acid & thoroughly rinsing the residue to promote micromechanical bonding of an adhesive to the surface.
frosty appearance. Gels are prepared by adding colloidal silica or polymer beads to acid. Provides even nicely demarcated white frosted appearance Alternative acids for etching traditionally :30 – 40 % Phosphoric acid . Gel Bond Strength 37% phosphoric acid – highest bond strength – 28 MPa 10% maleic acid – 18 MPa Wang and colleagues ( Angle 1994) evaluated several phosphoric acid concentrations from 2% to 80% and found that best bond strength was achieved with 30%-40% concentrations . Mostly used gel -Ultra Etch 37% phosphoric acid blue gel Advantages1.10 % Maleic acid . Thoroughly wash with moisture & oil free surface to obtain dull.higher total surface energy which ensures that a resin will readily wet surface & penetrate into resulting microporosity. To avoid damaging delicate enamel rods care should be taken not to rub liquid onto tooth. Once resin penetrates into porosity it can be polymerized to form resin tags that produce mechanical bond to enamel. Etchant is washed with abundant water spray. Smooth consistency 3.increased efficiency in collecting etchant water rinse & reduce moisture contamination. Adequate contrast 2. Liquid B.2.5 % Nitric acid Type and concentration of Acid A. Etched enamel . Fluoridated phosphoric acid solutions and gel provides same morphological etching pattern. Cervical enamel due to its different morphology usually looks different from central & incisal portion of tooth. Ideal viscosity 4. & have adequate strength.10 % Phosphoric acid . If contamination occurs re-etch again. High evacuator . Etching entire facial surface is harmless but logically etch an area only slightly larger than pad Acid in gel or solution Gel provides better control.
canine.60 secs Premolars.Sandblast with 50 µm Aluminum oxide for 30 secs to remove outermost aprismatic enamel & etch for 30 secs with 35% phosphoric acid gel. Matsui & Buonocore Primary mechanism of attachment of resin Resin tags to etched surface MICROMECHANICAL BOND Acid etch removes 10 microns of enamel Creates porous surface Increases wettability Timing Young permanent teeth -15-30 secs.Rationale of etching Gwinnett. anteriors. Adult. Deciduous teeth.15 secs First molar.30 secs 10.Decreased bond strength .30 secs – No effect on bond strength Less than 5 secs.
Max enamel loss takes place in this stage . Scanning electron microscopy.Short etching time . Patterns of etching Gwinnett & Silverstone Type I. at the same time should facilitate easy & a traumatic debonding attachments & minimum clean up procedure of enamel subsequent to removal of appliances. . Honeycomb pattern – ( Initially periphery of prism head is delineated by micro.Core etching A. Various studies have been carried out to define optimal concentration of acid used for etching with phosphoric acid.1-0. test of shear bond strength of a bonded attachment to a correlated etchant concentration & duration of etching & trauma to enamel & amount of adhesive on surface of enamel subsequent to debonding.clefts (0.30 secs produces optimal etching than 15 secs • Normal thickness of enamel is 1000.2000µm Etching removes 3-10µm of surface enamel Histological alteration of 25 µm Deeper – 100 µm Care taken while etching acquired & developmental demineralization.Use bonding agents with extra care not to have any adhesive deficiency Study of Etched Enamel Under Scanning Electron MicroscopeBonding should have sufficient strength to resists application of orthodontic force to move teeth.Apply sealer / primer . These investigations include study of etched enamel surface pattern under scanning electron microscope highlighting the loss of enamel . Diedrich typed action of etchant on enamel in 3 stagesThe above mentioned etched patterns of etched enamel surface given by Silverstone et al.2Mm) continued action of acid leads to loss of substance predominantly in area of prism cores with simultaneous conservation of marginal areas Least amount of enamel is lost in this etch pattern.. Type II – Periphery etching Peripheral etching pattern is an advanced stage in which fragile prism peripheries break off.
better etch for all 3 applications • 15 < 30 & 60 • 30 = 60 • Supported use of 37% .30 secs to get optimum bond strength The continuous brush acid technique BAHARAV .90 TBS decreased – 120 secs Debonding – fewer enamel fragments with shorter etching times • • • • • ALASTAIR GARDNER . Iatrogenic effects of acid etching Fracture & cracking of enamel on bonding Increased surface porosity.discoloration Rougher surface if overetched Bond strength with various etching times WEI NAN WANG ET AL AJO 1991 Compared the tensile bond strength at various etching times 15. 60.60. ROSS HOBSON AJO 2001 • Compared quality and quantity of enamel etch produced by 37 % phosphoric acid and 2.5% nitric acid for 15 .staining Loss of acquired fluoride in outer 10 µm of enamel surface Resin tags retained. Enamel surface is extremely flat & smooth & they lack micro-irregularities for resin penetration.Type III – Mixed pattern As action of acid proceeds there is dissolution of crest like marginal ridges.& 60 secs Concluded • 37 % phosphoric acid . 30 .Etch pattern commonly seen in cervical areas. LANGSAM J PROSTH DENT 1987 • Aim was to determine whether mechanical agitation of etchant would enhance decalcification of enamel . This transitional zone of central & peripheral etching pattern in which existing marginal ridges are elevated to 3µm Galil & Wright desribed Type IV & V Type IV. 120 secs 37 % phosphoric acid TBS was not statistically different for 15. 90. 30.30. Type V – Shows no prism outline. It shows irregular pattern & displays no rod or prism pattern. while marginal clefts continue to widen.
Distal half – 35% po4 acid [30 secs] continuously painted • • • • Results Continuous brushing of etchant .more efficient dissolution of enamel Reduction of size of remaining crystals Hence increasing the potential space between them for retention Alternatives to acid etching • • • CRYSTAL GROWTH SAND BLASTING/ AIR ABRASION LASER ETCHING Crystal growth SMITH Polyacrylic acid – chemical bonding Purified polyacrylic acid.resin interface n Other sol – sulphuric acid anion[more reliable and uniform growth Procedure • • • • • • One drop of viscous liquid placed on tooth surface Left undisturbed for 30 secs Brush / swab should not be agitated as in etching as it may affect crystal/enamel interface Rinsed for 20 secs Forceful water spray to be avoided as it will break crystals Look out for a dull whitish deposit .• Non carious pre molars 1. Mesial half – 35% P04 acid[30 secs] left undisturbed 2.slight etching Polyacrylic acid + sulfate ion – crystalline deposit CALCIUM SULPHATE DIHYDRATE Depends on concentration of sulfate ions MAIJER AND SMITH AJO 1982 Crystalline interface produced tensile bond strength equivalent to conventional acid etched surface Debonding => fracture at crystal .
sulphuric acid + sodium sulphate Soln B – 10% po4 acid +dil. S. sulphuric acid Failure rates recorded – 6 months A > B > ACID ETCH Sand blasting / air abrasion Also referred as Micro etching in which particles of aluminum oxide are propelled against suefrace of enamel by high air pressure causing abrasion of surface. BERGLAND AJO 1984 • • • • Soln A – dil.crystals not as long and needle like as with polyacrylic acid but were rounder and flatter Hence debonding was easier Advantages of crystal growth • • • • • Debonding easier and quicker Little damage to enamel Minimal effect on outer fluoride containing enamel No resin tags left behind Possibility of incorporating fluoride in crystal interface – anticariogenic action Crystal growth JOHN ARTUN . .• • • • • • Bracket bonded in usual way These crystals grow in so called spherulitic habit MECHANISM OF RETENTION Calcium sulfate crystals must enucleate from bound calcium To achieve this some etching is required Enamel solubility ~ crystal enucleation Mechanical attachment is created around the crystalline interface and superficially etched enamel Phosphoric acid etched enamel surface Crystal growth on enamel surface ARTUN AND BERGLAND • Sulphuric acid .
2. 4. • So it is not recommended. Robert Black. Used for cavity preparation Preparation of enamel /dentin • 1.Resultant bond strength is 50% of those to conventional acid etching. Factors affecting bond strength Particle size Air pressure Exposure time Microstructure of enamel surface 37% H3PO4 acid 90 um AlO2 air abrasion WENDALA VAN WAVERAN. It uses abrading with 50 µm or 90 µm particles of aluminium oxide for 3 sec at 10 mm distance.E. . Olsen et al reported that air abrasion significantly decreases bond strength & on debonding leaves no adhesive on enamel surface. Its a older technique of enamel pretreatment introduced as early as 1940 by Dr. ALBERT FEILZER AJO 2000 Compared bond strength and enamel loss between sand blasting and conventional acid etching at varying exposure times and air pressure Bond strength Sand blasting < acid etching Enamel loss Sand blasting < acid etching AJO-DO 1997 Marc . 3.
• He used Nd/ YAG as laser source.A. Mode of excitation ( Continuous or Pulsed) Wavelength UV range(Krypton Flouride. Classification • • 1. Removal of enamel primarily occurs by micro-expulsion of entrapped water in the enamel. YSGG as the hydrokinetic laser system for acid etching & came to the same conclusion. Monochromaticity When laser strikes an object it may be • Reflected • Transmitted • Scattered • Absorbed • Combination of above This new concept was proposed in 1993. There may be melting of hydroxyapatite crystals Laser etching with Nd : Yag M. Argon Flouride) Visible Light ( Helium . Nd:Yag) Application of laser causes localized melting & ablation. • Serder Usumuz et al in AJO-DO 2002 used ErCr . • At 3 watts for 12 sec laser etching = acceptable bond strength though significantly less than conventional acid etching. Neon ) Infra Red range ( carbon dioxide. Collimation 3. 2. by J.Laser etching LASER • Light Amplification By Stimulated Emission Of Radiation 3 elements • Lasing medium [ solid/liquid/gas] • Energy source[xenon flash lamp/electrical discharge] • Optical resonator 1. 3.Von Fraunhofer.A WILSON ET AL • Studied the surface effects of dentin following laser etching with Nd:Yag and evaluated the shear bond strength of composite between treated and untreated laser etched dentin • Surface roughness . Coherence 2.
75-W laser produced lower shear bond strengths than the other methods • No difference for enamel characteristics • ARI scores no diff. and adhesive remnant index (ARI) scores of bonding with laser irradiation. enamel surface characteristics. • 0. phosphoric-acid etching. bond strength. 460. except for 0.laser etched > unlased dentin • Bond strength Laser treated >unlased dentin LYDON COOPER ET AL • Shear bond strength of composite to laser pre treated dentin increased by 300 % localized melting + recrystallization Fungiform projections • The composite adapted to undercuts & space between the dentin projections SEM picture of enamel after 37% after phosphoric acid etching SEM picture of enamel laser etching of 2 W output Pulsed krypton fluoride excimer laser Dr Francis M Compared surface morphology.75 W laser group. Results • Irradiation with the 0.75 W group => not suitable . and ARI between acid etching and 3 different energy densities of pulsed krypton fluoride laser 440. 480 MJ/cm2 Concluded : TBS 460> 480 >A E >440 SBS 480 > A E > 460 > 440 SEM regular etch pattern similar to acid etch seen with 460 & 480 MJ/cm2 Törün Özer et al (AJODO Aug 2008) • compared shear bond strengths. and SEP systems.
Some investigations conclude that intermediate resin is necessary to achieve proper bond strength.Light polymerized sealants protects enamel adjacent to brackets from dissolution & surface lesions. a thin layer of sealant is applied over entire etched enamel surface with a small foam pellet or brush with a single gingivoincisal stroke. low viscosity resin that promotes bonding to substrate such as dentin Coated in thin layer. Sealer is a hydrophilic . Permit easier bracket removal Chemical curing primers Poor polymerization Drift Low resistance to abrasion . It is thinned with gentle air burst for 1-2 secs. Research is going on to determine the exact function of intermediate resin in acid etch procedure.LASER ETCHING UNIT 3. .Sealing permits a relaxation of moisture control. . SEALING After teeth are completely dried & appear frosty white.They protect against enamel tear outs at Debonding Light polymerizing resins Permits relaxation of moisture control Provides cover over adhesive voids . .indirect bonding Ceen & Gwinnet. .Sealants permits easier bracket removal.
Acid groups attach to monomer are neutralized by forming a complex with calcium from hydroxyapatite. The mixed component then ejected into 3rd to wet applicator tip. 3.Applicator microbrush Sqeeze & fold first compartment over second activates system. Active ingredient of self etching primer is a methacrylated phosphoric acid ester that dissolves calcium from hydroxyapatite. Solvent is removed from primer during airburst step. 2. Liquid itself has component that conditions enamel. Removed calcium forms complex & is incorporated into network when primer polymerizes.Methacrylated phosphoric acid ester Photosensitizers Stablizers nd 2 compartment. transport of acid groups to interface is stopped. Bond bracket with Transbond XT & cure with light Scanning electron microscopy shows following etching pattern Acid etching • SEP treated Study by Helen Grubisa et al – shear bond strength with SEP‘s is less than conventional acid etching. Clinical procedure1. Primer is cured & monomer are polymerized.Water soluble fluoride 3rd compartment. They contain hydrophilic methacrylated monomer Transbond MIP. Etching & monomer penetration to exposed enamel rods are simultaneous. 2.Self Etching Primers (SEP‘s) Main feature of single step Etch/primer bonding system is that no separate acid etching of enamel & subsequent rinsing with water & air spray required. Dry tooth surface. 3 mechanisms for self etching process1. AJO 2004 Moisture Insensitive PrimersReduce bond failure under moisture contamination hydrophilic primers that bond in wet condition. viscosity rises showing transport of acid groups to enamel interface. 3M/Unitek . Rub thoroughly atleast 3 secs & always wet surface with new solution to ensure monomer penetration 3. Apply Transbond Plus 1st compartment.
. Literature 1.Conventional etchant with separate primer Group B a. Bonding of stainless steel brackets to enamel with new self etch primer Ryan Arnold et al AJO sep 2002 • Bond strength of stainless steel brackets using Transbond self etch primer Four groups A.Indications Second molar bonding When there is risk of blood contamination on half erupted teeth or on impacted teeth Hydrophilic resins polymerize in presence of slight amount of water but will not routinely compensate for saliva contamination.2 min bonding c-Self etch . 2. • Comparison of ARI scores – More residual adhesive remained with self etch primer.Self etch .10 min Conclusion – • No significant difference in bond strength between the two groups. Asgari et al (JCO 2002) did a clinical study of Transbond SEP in 20 patients => the bond failure rate using Transbond Plus Self Etching Primer was significantly less than the bond failure rate in those quadrants where a 37% phosphoric acid etchant was used.Self etch –15 sec Before b. Effect of self etch primer on shear bond strength of orthodontic brackets Samir Bishara & Leigh Von Wald AJO 2001 • Their study concluded that use of self etch primer resulted in low but clinically acceptable shear bond strength. • 10 min delay in bonding after application of self etch primer might not be deleterious for adhesion 3.
For Vertical positioning-Height gauges/boon‘s gauge is used where as for horizontal positioning mouth mirror can be used. Bracket pushed against the surface firmly.Little material for debonding . Disadvantages of this technique includes Extensive chair time Frequent screening for caries Periodontal – leaching of cements • PositioningPlacement scaler can be used to place bracket on tooth surface.• 4. 3. 4. . BONDING STEPS Four steps Transfer Positioning Fitting Removal of excess 1. 2. Earlier brackets were welded to band. Instruments- • TransferBracket is gripped with pair of cotton pliers or reverse action tweezer & mixed adhesive is applied to back of bonding base.Good bond strength .Optimal adhesive penetration at bracket base. Tight fit is very important as it results in .
Prevents Decalcification .Once excess is removed it is cured. Small & large TC burs are used to remove excess set adhesive Curing .Prevent or minimize gingival irritation & plaque build up .Reduced slide Undisturbed setting-optimal bond strength • • Removal of excess. To reduce periodontal damage To prevent possibility of decalcifications.. Facilitate debonding.Improve aesthetic appearance • Removing excess adhesive why? • • • • • • To minimize gingival irritation by preventing plaque accumulation around the periphery of bracket base. .Reduces periodontal damage . It avoids bridging when tooth are crowded Improves esthetics.
Curing lights • • • • • Tungsten quartz halogen light Argon laser Xenon plasma arc light light emitting diode curing units[LED] Pulsed xenon plasma arc light Tungsten quartz halogen curing light when electric energy is passed Halogen bulb Tungsten filament is heated HEAT LIGHT Selective filters – blue light [ 400-500 microns] • 40 seconds per bracket • 15 minutes – both arches Disadvantages • Time consuming • Light output < 1% of consumed electricity • Lifetime – 100hrs • High heat .degrades components of bulb Argon laser • • • • Introduced in the late 80‘s & early 90‘s Promised to reduce the curing time dramatically 480 microns wavelength Curing time .
• LED – junction of doped semi conductors. & 9 secs – xenon plasma light • Bond strength xenon light > with longer exposure time • To equal bond strength of conventional curing light the exposure time with xenon had to be 6 –9 seconds Light emitting diode curing units Mills –1995 • Instead of hot filament – Halogen bulb. • Lifetime 10. 000 hrs • Requires no filters • Resist shock and vibration • Little power to operate • Newer –GALLIUM NITRIDE ( LED ) 400-500microns .• • 3 secs – per bracket 1 min – both arches • KELSEY . 6 .POWELL To equal bond strength of 40 sec exposure by conventional curing light argon laser must cure for 10 seconds Disadvantages • Laser unit large • expensive Xenon plasma arch light • • • Introduced in the late 1990‘s Short exposure time at lower cost Curing time 3 – 5 secs per bracket Comparison of efficiency of xenon plasma light and conventional curing light Sheldon Newman et al AJO 2001 • Exposure time 40 secs .conventional curing light 3 . Advantages.
Angle Orthod 2006) where it is concluded that exposure time beyond 5 sec and power setting beyond 150mW has no cumulative effect on the shear bond strength of stainless steel orthodontic brackets. There seems to be an . An exposure time of less than 4 seconds. plasma arc and LED light sources for polymerization of an orthodontic adhesive and concluded that polymerization as effective as conventional bulb light sources was obtained with short exposure times recommended for plasma arc or LED Similar results have been got for Argon laser (Bryan S. • • The concept of ―total energy. cannot guarantee sufficient bracket bond strength. irrespective of the power density.unit light is a series of pulse to polymerize the adhesive Facts • In the study by Eliades et al the DC value for a light cured adhesive bonded to a metal bracket and irradiated from incisal & cervical edges was comparable to DC values for a chemically cured adhesive & its light cured counterpart bonded to ceramic brackets J Dent Res 1992 (sp Issue) 71:169 • Bikram S Thind & David R Stirrups ( EJO 2006) compared tungsten quartz halogen.‖— the reciprocity between power density and exposure The concept of ―total energy‖ does not hold for orthodontic light-cure bracket bonding.• Optimum curing time ? • Replace halogen bulbs ? Mills et al ( BJO 1997 ) • Compared light source containing LED to Halogen units • Concluded – LED curing units cured composites to significantly greater depths when tested at 40 & 60 sec Polymerization of resin cement with LED curing unit William Dunn & Louis Taloumis AJO sep 2002 • Compared the shear bond strength of orthodontic brackets bonded to teeth with conventional halogen light and LED curing units .LED curing units bonded brackets to enamel as well as Halogen based curing lights Pulsed Xenon Plasma Arc Light Polymerization shrinkage – Over come -Curing composite in layers -Pulsed curing light Pulsed curing light. • Concluded.
Zachrisson (EJO 2007) overall failure rate = 11 per cent The brackets most prone to come loose. Reynolds and von Fraunhofer (1976) investigated the minimum bond strength values required in direct orthodontic bonding systems with bracket placement and confirmed that bond strengths of 5. maxillary first molars =27% mandibular first molars = 24% Mandi. European Journal of Orthodontics 30 (2008) 407–412 • • • • • • A post-treatment evaluation. 6. 4. 3.8 MPa are clinically acceptable. the type of etchant used 5. Linklater and Gordon (2001) and Hobson et al.advantage of power density over exposure duration in the context of metallic bracket bonding. Various Factors Can Affect Bond Failure 1. 2. the adhesive Influence of different tooth types on the bond strength • • • • Mattick and Hobson (2000) showed that the etched enamel surface varied between different tooth types => influence bond strength. (2001) => significant differences in the bond strength of different tooth types no significant differences between upper and lower teeth of the same type ( Linklater and Gordon. 2001 ). its duration of application. Am J Orthod Dentofacial Orthop Oct 2008. operator technique and manual dexterity.9 – 7. • The light-initiated bonding resins under metal brackets may take as long as 3 days to reach maximum polymerization or strength. all other teeth = lower than 10 % canines = lowest debonding rates (4-6%) . second molars = 18% molars. • The polymerization only begins at the edges of the bracket base and then continues as a chain reaction. variation in the enamel surface. after 9-20 months of routine orthodontic therapy Bjorn U. for an efficient light-cure bracket bonding.134:543-7 These results show that. patient behaviour. there is an absolute lower limit of exposure duration (4 seconds) and an upper limit of useful power density (3000 mW/cm2).
019×0. c.bond to saliva contaminated enamel surface without phosphoric acid etching Liquid.SPEED system Advantagesa. Steel ties are safer than elastomers & definitely are more hygienic. ligature can be retied at next visit.1 min ST. This tightens ligature when end is tucked under arch wire.2-4 min • Acid Etching.Bonding to MolarIn young patients second molars bonding is advantageous. Resin modified GIC (chemical & light cured).ligature wire should be twisted with the strand that crosses arch wire closest to bracket wing. Disadvantages 1. Bond strength is lower. Rule of Thumb . b. .Arch wires placed in next visit . -Newly erupted mandibular premolar gingivally offset brackets are recommended. self ligating. 2. Saves time.mouth mirror is recommended.025 inch slot were used Adhesive was Plastic resin base with liquid monomer of methyl-2-cyanoacrylate & silicate filler Working time. Do not create micromechanical retention as good as 37% phosphoric acid.Polyacrylic acid.If full engagement is not possible. maleic acid It removes contaminants & change surface mechanically It do not produce micromechanical retention. Increases patient comfort • First Direct bonding It was done in Eastman Dental Center in 1966 Round metal brackets with single groove 0. • Ligature less. Reduces friction. Bonding to Premolar-Most difficult technical problem -Visibility . • Ligation of Bonded Brackets Bonded brackets will not withstand heavy pull on arch wires.50% phosphoric acid & 7% zinc oxide.45 secs .Only 4 upper anterior teeth bonded . low friction brackets are available now. .In few cases canines were bonded .Push arch wire into bottom of slot using fingers for flexible wires & plier or ligature director for stiffer wire & make passive ligation.
Surface is more rougher & more porous attracts plaque & stains surrounding enamel. Both of them resists staining & discoloration. Frictional resistance between orthodontic wire & ceramic bracket is greater & less predictable than with steel brackets therefore optimal force levels & anchorage control are difficult to determine. Ceramic BracketsTheoretically porcelain brackets made of aluminum oxide could combine esthetics of plastic & reliability of metal brackets. Debonding is difficult. Added bulk required to provide adequate strength makes oral hygiene difficult. Photoetched recessions or machined undercuts are also available. Drawbacks1. discoloration. whereas chemical bonding may produce excessive bond strength with stress at debonding shifted towards enamel-adhesive interface. 6. Chemical bonding by means of silane coupling agent. 4. small metal attachments are improvement over bands metal brackets rely on mechanical retention for bonding & mesh gauge is conventional method of providing retention. Pure plastic brackets lack strength to resist distortion & breakages.BRACKETS1. Metal BracketsAlthough not as esthetically pleasing as ceramic & plastic brackets .GAC Allure. Such brackets may be useful in minimal force situation & for treatment of short duration. New types of reinforced plastic brackets with or without steel slot inserts have presently being introduced. 2. . With mechanical retention the stress of debonding is generally at adhesive bracket interface. 2. Corrosion of metal is a problem & black & green stains appeared with bonded stainless steel attachments. wire slot wear.Made of sintered or fused aluminum oxide particles. Eg. Not as durable as steel brackets & brittle by nature( break easily) 3. The base of the bracket must be small ( not smaller than bracket wings therefore of danger of demineralization around periphery) as it avoids gingival irritation & should be designed to follow tissue contour along gingival margin. uptake of water.wing fractures easily. Single crystal form-‗A‘ company starfire. 3. Harder than steel & induce enamel wear of any opposing teeth. & need for compatible bonding resin. 2. Ceramic brackets bond to enamel by 2 mechanismsa. Hence increased interest fore corrosion resistant & biocompatible brackets like titanium. Polycrystalline. Unitek 3M Transcend 2000. Two forms currently available are1. Plastic BracketsThey are made up of polycarbonate & are used mainly for esthetic purpose. b. 5. Mechanical retention via indentation &b undercuts in the base.
ARI at debonding was recorded. Requiring fixed mechanotherapy. mandibular anterior & posterior teeth. Brackets can be placed more accurately. 4. 3. al.4. in ARI scores b/w the 2 groups. Clinical chair time is decreased. Better resin hygiene 5. Better control over flash removal 2. . Risk of adhesive leakage to interproximal gingival areas. transferred to mouth with some sort of tray into brackets become incorporated & then bonded simultaneously. Better slot orientation 3. INDIRECT BONDINGSeveral techniques for indirect bonding are available. 2.Verstrynge et. 2. Most are based on procedures based on procedures described by Silverman & Cohen. Results No significant diff. Technique sensitive 5. Chairside procedure very crucial. In these techniques brackets are attached to teeth on patients models.Used particularly for maxillary premolar.Corrosion is not found clinically Adhesive Precoated Brackets Advantages 1. Risk for adhesive deficiency under brackets is greater. Advantages1.Gold coated Brackets. The 2 groups performed identically. Convenience Clinical comparison of APC bracket v/s uncoated ceramic bracket system .More hygienic & neater. Disadvantages1. OCFR 04 Materials & methods RCT with APC Clarity® v/s Clarity® + Transbond XT® 20 pts. Moisture tolerant 4. Removal of excessive is more difficult & more time consuming. . 6. Failure rates are high. . Most current indirect bonding techniques are based on based on modification introduced by Thomas.
immerse model & tray in hot water to release the brackets from stone. load it in syringe. 7. Trim tray & mark midline 8. Seat tray on the prepared arch & hold with firm & steady pressure for about 3 mins. 4. Make an impression & pour a stone model 2. Reposition if needed.Reasons for difference in bond strength between direct & indirect techniques1. Apply a small portion of water soluble adhesive on each base or tootrh. 5. . Remove any adhesive under running water. Form a tray allowing sufficient thickness for strength. Prepare patients teeth as for direct bonding 9. acrylic with transfer arms) . A totally undisturbed setting is obtained more easily with direct bonding. Apply a sufficient portion to bonding bases. Several indirect bonding techniques have proved reliable in clinical practice. For silicone tray fabrication . Press the putty onto cemented brackets. mix material . They differ in way brackets are attached temporarily to model ( caramel candy. 6. the type of transfer tray (silicone. 2. After silicone has set. Select brackets for each tooth 3. Mix adhesive.BISGMA[ UV light activated] Increased operator working time as polymerization did not occur THOMAS TECHNIQUE 1979 • • • • • • • • • • • Filled BISGMA resin placed into the bracket bases Attached to the stone model Before setting all excess material is removed from the cast around the brackets Transfer tray made of flexible material Tray + brackets removed from the cast as single unit Teeth of one arch isolated +etched Liquid unfilled resin formed the interface between etched enamel and filled resin Liquid catalyst – tooth Base resin – brackets Unfilled resin not pre mixed – working time increased tray seated held till polymerization is complete Silicone Tray technique1. bonding resin). SILVERMAN AND COHEN – 1972 • • • • • • MMA and UV light activated unfilled BISGMA MMA was applied to the plastic bracket base on the patient‘s model BISGMA –intermediary adhesive between the patients etched enamel & pre set adhesive on the bracket base Updated technique – 1974 by same authors Used perforated metal bracket bases and only one adhesive. Bracket bases may be fitted closer to tooth surface with one point fitting by placement scaler than when a transfer tray is placed over teeth. laboratory adhesive. Position brackets on model. 10. Check all measurements & alignments.
12. The tray may be cut transversly or longitudinally to reduce the risk of bracket debonding when peeled.11.Complete bonding by careful removal of excess flash.etched & isolated Enamel surface is sealed with mixture of universal & catalyst sealant bracket base is covered with the adhesive tray is seated Use of sticky wax-corrections can easily &readily be made until optimal bracket alignment is obtained Previously used Adhesive tape .bracket displacement Bonding resin – cleaning of bracket base prior to bonding difficult and time consuming . Remove the tray after 10 mins. Use a scaler & oval or tapered TC bur to clean tray properly around bracket Above steps are shown in following figure- Indirect bonding Moin & Dogon technique AJO 1977 • Pour impression in stone • A drop of sticky wax is placed on teeth surfaces of cast Brackets are warmed over flame and set on the cast • Impression made with polyether material • • • • • • • • • • • Tray separated from cast but brackets remain in situ Bracket is removed from the cast &warmed to remove residual wax They are placed into the impression Teeth are pumiced.
AJO-DO 1997 . failed procedures • • Modifies the fabrication of transfer tray Provides direct visualization & access to the brackets .Paul Kasrovi et al Conventional indirect bonding – Non-transparent trays Poor visualization Self-cure resin – difficult to clean-up on setting Time lost in removing set flash Improperly seated tray revealed only after removal – misplaced brackets.A new approach to indirect bonding technique using light-cure composites .during both lab and clinical procedures STEPS • Lab adhesive for IDB .
Technique is highly predictable & reproducible Visibility and accessibility from start to finish Ability to remove composite flash before curing .
12. thermoplastics or similar. 10. Clean up is simple 2. 6.Double sealant techniqueSteps1. After 10 min. Midline marked 7. Bonding adhesive paste – attach brackets to model 2. Remove excess flash of resin with scaler or contrangle handpiece & tungsten carbide bur. Oral prophylaxis. Tooth.Check all measurements & alignments. Material can be putty silicone. Prepare patient teeth for a direct application. Seat tray on prepared arch & apply equal pressure to occlusal. 2.Universal sealant resin Bracket base. Tray seated . Above steps are shown in following figure- . 9. If Custom IQ is used. labial & buccal surface for 30 secs & allow 2 mins or more of curing. Apply acetone to base to dissolve remaining separating medium. Tray separated and trimmed with gingival edge within 2mm of brackets 6. Little flash • Composite Custom bracket base1.Make transfer tray for brackets. 7. 8. Remove excess Advantages1.held for 3 mins 11.Isolate stone model with a separating medium.catalyst sealant resin 10. Trays with model placed in water 5. 3.Attach brackets to teeth on model 5. apply resin B to teeth & resin A to bases 11. isolation & etching 9. Apply Sondhi Rapid Set resin A to teeth surface & resin B to bracket base.Remove transfer tray & gently sandblast adhesive base with microetching unit. Reposition if needed. Excessive adhesive removed 3. 4. Bonding base lightly abraded with stone point 8. placement tray is vaccum formed 4.Select brackets for each tooth. Peel it from lingual towards buccal 12.Make an impression & pour up a stone model.
Use light separating spray to fascilitate easy removal of tray from brackets Silicon/ light cooking spray like PAM. Soak tray for 1 hour. Tray sectioned with bur 12.separating medium dissolves 11.Place Transbond XT adhesive on base 4.easier removal 10. Spray for less than 1 secs 9.30secs which allows rapid removal of tray in 2mins • Indirect bonding technique.Vaccum formed tray with 1. Tray is made Biostar unit.cure for 1 min 8. If APC brackets. Place all brackets 5. Working models from accurate alginate impression remove air voids 2.place directly If non-coated.ANUP SONDHI • Lab procedure1. Apply thin layer of diluted separating medium Dry for 1 hr 3.rigidity Inner layer. Cure for 10 minutes If clear esthetic brackets. Check for final bracket placement 6.Resin used for Indirect Bonding contains fine particle fumed silica filler which avoid voids It has quick set time. Place models in TRIAD 2000 curing unit 7. Once trimmed place in TRID unit to ensure curing of uncured resin .75mm thick layer of Biocryl Outer layer.5 mm thick layer of bioplast . overlayed with 0.
Dry teeth 6. Tray can either Single tray / segmented depending on the type of malocclusion Segmented tray is used in case of crowding 4. Apply resin A on tooth surface & resin B on bracket base • 9. Polish teeth with pumice 3. Apply equal pressure for 30 secs. air dry for 2secs 8. Water sprayed 30secs 7. Remove outer layer using scaler 11. Position tray & seat it in hinge motion. It is cured for 2 mins 10. Isolation 5. Scale excess resin & floss interproximal areas . Apply primer. Remove inner layer using scaler & fingers 12. Etching. Antisialagogue.15secs Suction gel off.13. Resin poured in wells. Clean tray with ultrasonic cleaner with dishwashing detergent for 10 mins then with water-for 5 mins Microetching is done to remove any adhesive remnant • Clinical steps1.atropine/ propantheline is given to decrease salivation 2.
.S. MILES JCO2002 Apc brackets used A Thermal-Cured. for 20 minutes. Remove the model from the oven. Sinha JCO 1995 • Heat the cast with the brackets in place in a countertop toaster-oven.K.Flowable Light-Cured Adhesive • PETER G. P. . Fluoride-Releasing Indirect Bonding System • R . This process will cure the composite resin. Calibrate the oven thermostat monthly with an oven thermometer. and let it cool. Nanda. set at 325°F.
reaches its initial set in 60 second* and therefore no time should be wasted once n has been mixed. Reprosil—a vinyl polysiloxane impression material (PVS) as a highly accurate but flexible inner tray that can be easily removed. Thermally cured composite material. Mix Maxicure* sealants \ and B Th sealant. We prefer the silicone material. Moskowitz • modification of the Thomas technique 1. 2. which contains hydrogen fluoride m >S monomer. . Indirect Bonding with a Thermal Cured Composite Elliott M.Make a transfer tray from silicone impression material or a vacuum-formed plastic sheet. which is manipulated to encapsulate the brackets and make an impression of the model. This allows all the brackets to be bonded simultaneously in their predetermined positions.
Vacuum-form Essix (trademark of Raintree Essix.75 mm) clear thermoplastic material over the cast. brackets.5 mm) clear material tray that covers the PVS inner tray Place the ThermaCure composite resin on the pad of each bracket.020 inch (0.3.030 inch (0. Vacuum-form Essix 0. and undertray complex .. taking care to cover all of the pad surfaces. Apply the Reprosil impression material with a syringe over the thermally cured brackets 3. The ThermaCure provides virtually unlimited working time Casts placed in toaster oven for curing at 325°F for 15 minutes 2.5 mm) or 0. Inc. New Orleans. LA) 0.020 inch (0.
IL) A and B primer. Bonding area. • Bond Strength- Ratio of debonding force by interfacial area of adhesive or bracket base.5 MPa Able to withstand stress of 6-8 MPa .120N Bond Strength. Itasca. lightly abrade the composite back of each bracket base with a Micro Etcher Mix 2 drops each of Enhance (Reliance Orthodontic Products.To remove the air-inhibited layer of adhesive.7.16mm2 Debonding force. The flexible undertray is teased away with an explorer or scaler without dislodging the brackets.5 N/mm2 or 7. Apply the mixture to the composite bases and the tooth surfaces.
Linklater and Gordon (2001) and Hobson et al.Various Factors Can Affect Bond Failure 1. patient behaviour. second molars = 18% molars. the adhesive Influence of different tooth types on the bond strength • • • Mattick and Hobson (2000) showed that the etched enamel surface varied between different tooth types => influence bond strength. . Although it appears possible to treat malocclusion successfully from lingual side. variation in the enamel surface. all other teeth = lower than 10 % canines = lowest debonding rates (4-6%) • • • • • • • Lingual Orthodontics LINGUAL BRACKET POSITIONING ( INVISIBLE RETAINERS) Lingual orthodontics has added a new dimension to bonding spectrum. The technique rapidly gained popularity in early 1980‘s.More precision is necessary for adjustment of lingual arch wires with reduced bracket distance. the type of etchant used 5. Kelley & more recently by Creekmore. additional improvements in bracket design & technical aids are needed. 4. The development was pioneered in Japan by Fujita who worked on mushroom arch. 6. operator technique and manual dexterity. if at all they should differ from labial bonding procedures. . . 2001 ). but most clinicians experienced considerable difficulties particularly in finishing stages & abandoned the technique for routine use. however questions have arisen with regard to lingual bonding procedures & how. its duration of application. 3. 2. maxillary first molars =27% mandibular first molars = 24% Mandi. (2001) => significant differences in the bond strength of different tooth types no significant differences between upper and lower teeth of the same type ( Linklater and Gordon. Zachrisson (EJO 2007) overall failure rate = 11 per cent The brackets most prone to come loose. a combined lingual & buccal segmental approach may offer a number of options with no great esthetic compromises n most patients. & by several American orthodontists: Kurz. after 9-20 months of routine orthodontic therapy Bjorn U. European Journal of Orthodontics 30 (2008) 407–412 A post-treatment evaluation.If lingual treatment is to become more important in future.
Working position awkward. • BONDING TO OTHER METALS- Many adult patients have crown & bridge restorations fabricated from porcelain & nonprecious metals or gold. Sandblasting & silane (Scotchprime) 3. Others- . In vitro studies have shown that bond strength to porcelain equals or surpassed that obtained after bonding to acid etched enamel which suggested possible damage to porcelain tooth surface during debonding. Recent advances in materials & techniques indicate however that effective bonding of orthodontic attachments to surface other than enamel may now be possible . Two different techniques1. Difficult & time consuming. adding a porcelain primer & using a highly filled adhesive resin when bonding to glazed porcelain added progressively to bond strength. BONDING TO PORCELAINIn 1986 Wood et al showed that roughening the porcelain surface. Intraoral SandblastingMicroetcher .- Pronunciations difficulty occur immediately after insertion. Customized brackets are formed after scanning malocclusion model using a high resolution optical 3-D scanner.Uses 50µm white or 90µm tan aluminum oxide at 7kg/cm2 pressure Uses-Rebonding loose bracket -Increases retentive area inside molar band -Create retention for bonded retainers . Brackets then designed in computer using computer aided manufacturing technology. High end rapid prototyping machines are used to convert virtual bracket series into wax analog that is then casted into alloy with high gold content. Hydrofluoric acid gel – Excellent result 2.Bonding to decidous teeth.
5.Etch porcelain with 9. rinsing with high volume suction & immediate drying & bonding.γ-methacryloxy-propyltrimethoxysilane which provides reactive sites for inorganic & organic components. several porcelain etchants have been developed. phosphoric acid & hydrofluoric acid may provide equivalent bond strength. • Debonding Gentle 45 degree outward pull applied to gingival tie wings Residual adhesive. Use barrier gel such as Kool-Dam to prevent flow of gel in gingiva or soft tissues. Immediately dry with air & bond bracket.But diamond roughening & microetching produce only surface peeling. 4. cautious removal of gel with cotton roll.remove with tungstun carbide bur Smoothing.23% or 4% Acidulated Phosphate Fluoride(APF) for 10 mins solution or gel containing sodium fluoride. 6.Diamond polishing paste in rubber cup • Surface preparation for orthodontic bonding to porcelain ZACHRISSON et al AJO 1996 HF acid gel = sand blasting + silane • Some authors feel Sand blasting + silane = high failure rates AJO-DO 1998 Zachrisson showed HF produce extensive in depth penetrating pattern . Methacrylate groups. Etchant produces microporosities on porcelain surface that achieves mechanical retention.6% Hydrofluoric acid. 2. 3. Other studies indicate that 1. However . Deglaze area slightly larger than bracket by sandblasting with 50Mm aluminum oxide for 3 secs. 2.Silicon carbide Silane coupling .slow speed polishing rubber wheel Polishing.oxide.6% hydrofluoric acid gel for 2 mins. Etchant porcelain will have frosted appearance similar to etched enamel. . Porcelain surface is sandblasted with aluminum oxide to create rough surface If allergic to Al. Remove gel with cotton roll & rinse using high volume suction. The most commonly used etchant is 9. Hydrofluoric acid is strong & requires careful isolation of working area. Conventional acid etching is ineffective in preparation of porcelain surfaces for mechanical retention of brackets. Isolate working field adequately.Roughninig with diamonds or stones 1. Procedure1. In gel form for 2 to 4 mins.covalent bond with polymer matrix Hydrofluoric acid cannot be used for high alumina porcelain & glass ceramics where silica coating can be used.
.6 MPa particularly with polycarbonate brackets. Apply a uniform coat of Reliance metal primer & wait for 30 secs. The micro etcher which uses 50 micron while aluminum oxide or silicon carbide particles approximately 7kg/cm2 pressure has been most advantageous for bonding to gold & other metals. 2.AJO –DO 2004 Mutlu Ozean et al superior bond strength is obtained when ceramic surface is pretreated with silica coating & silanization giving about 13.All Bond 2 3) Adhesive resin that bond chemically to metals. For Large amalgam fillings1. Apply sealant & bond with composite. 3. Sandblast amalgam with 50Mm aluminum oxide for 3 secs. A hand piece abraded surface may look rough eye. In 1980‘s some adhesives ( Enamelite 500. • BONDING TO AMALGAMTechniques for bonding to amalgam includes1) The method of choice for bonding to hardened amalgam with any orthodontic adhesive is to increase surface by sand blasting.4-methacryloxtethyl trimellitate anhydride (4-META) & 10-MDP /Bis-GMA resins. • • BONDING TO GOLDUntil recently bonding to gold & other metals was considered difficult. Sandblast amalgam with 50Mm aluminum oxide for 3 secs. Condition surrounding enamel with 37% phosphoric acid for 15 secs. Strongest bond to amalgam were obtained with 4-META adhesive9Superbond C & B) ProcedureFor small amalgam fillings1. 3. but SEM studies indicate that micromechanical retention of metals can be increased by atleast 300% using intraoral sandblasting. Roughening gold surface with green stone was found by Wood et al to significantly increase bond strength to a highly filled resin system. 2) Intermediate resin that improves bond strength. Bond failure site is at bracket / adhesive interface. During a quick 3 second blast with fingertip control & high speed evacuation the abrasives creates a retentive surface to which bonding & composite resin (Concise) is greatly enhanced. Apply sealant & bond with composite. However the breakthrough came with intraoral sandblasting. Goldlink) & primers (Fusion) were designed to allow such bonding however published reports & clinical experience do not support their effectiveness. 2.
Bonding • BONDING TO ACRYLICS.Bond using unfilled resin & composite Deciduous teeth • • • • • The outer prismless enamel layer lacks the characteristic prism markings of enamel no well-developed etch pattern with well-defined prisms The enamel crystallite diameter of deciduous teeth is relatively larger than permanent teeth The chemical compositions of calcium and phosphorus => similar • • A recommended procedure for conditioning deciduous teeth == sandblast with 50-μm aluminum oxide for 3 seconds to remove some outermost aprismatic enamel .37% phosphoric acid 3. Gloria Nollie et al in ANGLE 1997 reported that Type –1V gold treated with adlloy has increased bond strength & gives twice as strong as those found in microetched gold. Tin plating is not approved by Food & Drug administration for intraoral use.Outer layer removed with diamond /carbide bur 2. Super bond C & B is activated by combining 4-META & tributyl borane monomers & then adding polymer powder to activated liquid. Etch. The deposition of layer of tin on gold surface permits a chemical & mechanical bond between resin & metal. 2. Most commonly the tin is electrolytically deposited with a unit such as Micro Tin or Kura Ace Mini. Bond strength of any adhesive can be greatly increased by with intermediate resins like All-Bond 2+ and Scotchbond MP (multipurpose). Apply silane coupling agent 4. Alternative that bond chemically to Metal1. BONDING TO COMPOSITES1.Tin PlatingNew voltage tin plates also facilitate intraoral bonding to noble metals. 3. Alternative method is to rub on a solution of gallium Or tin alloy with a pure tin bar. Two different types of adhesives 4-META resins ( Methacryloethyl trimellitate anhydro) & 10-MDP bisGMA have been recently developed to improve adhesion to metals.Wet surface with MMA for 3 mins .
Permanent teeth – SEP Deciduous teeth – acid etch Deciduous teeth – SEP Results = The shear bond strengths of the brackets bonded to the deciduous teeth with either adhesive system were lower than those to the permanent teeth SBS for all groups exceeded the clinically sufficient SBS i. The failure rate = less than 5%. . Enhance LC. 6 to 8 MPa a. b. • • • Results = fluorosis significantly reduced the bond strengths Enhance LC significantly increased bond strength on fluorosed enamel • Fluorosed enamel = an outer hypermineralized and acid-resistant layer difficult to attach bonds because a reliable etched enamel surface cannot be produced. increases the bond strength of brackets to fluorosed enamel. Enamel Fluorosis • • • • As • colour from white to brown • as pits and irregular white opaque lines • striations cloudy areas Effects of adhesion promoters on the shear bond strengths of orthodontic brackets to fluorosed enamel Necdet Adanir et al EJO Dec 2008 evaluate the effect of enamel fluorosis on the SBS of orthodontic brackets and to determine whether adhesion promoter. Comparison of shear bond strengths of orthodontic brackets bonded to deciduous and permanent teeth Toshiya Endo AJO 2008 Aug 4 groups: Permanent teeth – acid etch tech.• • • etch for 30 seconds with the Ultraetch 35% phosphoric acid gel.e. c. Fluorosis manifests itself as defects in the subsurface enamel In Vivo Bonding of Orthodontic Brackets to Fluorosed Enamel using an Adhesion Promotor James Noble et al AO 2008 • the success of bracket retention using an adhesion promoter with and without the additional microabrasion of enamel. d.
Remove adhesive from tooth surface with tungstun carbide bur . then bond a new bracket (5) (5) Remove residual resin using pliers alone. (6) results => the light-cured system produced higher shear bond strength in the initial bond than the self-cured system. re-etch enamel surface. then bond a new bracket (4) (4) Remove residual resin using a rubber cup and pumice.It can be avoided by following rules for bonding Procedure.Remove from archwire .8 MPa.better to replace with new for optimal bond strength. then bond a new bracket (2) ) Remove resin from the base mesh with micro-etching then rebond the same bracket (3) (3) Remove residual resin from the enamel surface using resin-removing pliers. Loose ceramic bracket. p<0. recondition the enamel with an air-powder polisher. then bond a new bracket. . Optimization of a procedure for rebonding dislodged orthodontic brackets B. Miller JCO 1995 reported that microabrasion of fluorosed enamel concomitantly with acid etching improves bond strength • Rebonding -Consumes more chair time .Re-etch tooth surface for 15 secs.01) and clinically favorable fracture characteristics.Sandblast bracket . Reconditioning the enamel surfaces using a tungsten carbide bur and acid-etching gave the highest SBS (difference 5. Mui et al AO 1999 Compared shear bond strength (SBS) of bonded and rebonded orthodontic brackets Brackets debonded were rebonded after the removal of residual resin from enamel surfaces using five different treatments (1) Remove residual resin using a tungsten carbide bur.• • • • group 1 – microabrasion + acid etching + Scotchbond Multipurpose Plus Bonding Adhesive Group 2 – acid etching + Scotchbond Multipurpose Plus Bonding Adhesive Conclusion Bonding orthodontic attachments to fluorosed enamel using an adhesion promoter is a viable clinical procedure that does not require the additional micromechanical abrasion step.
It is directly proportional to force at which contacting surfaces are pressed together.Light load. Brackets Steel –smooth Titanium – sliding difficult Ceramic – Rough & hard Can penetrate steel wires during sliding . • RecyclingGoal.Changes in torque angle & slot size after 1/2 recycling were below significance. acid-etch the enamel. Heat (above 450) to burn resin followed by electropoloshing to remove oxide build up 2. Only 4% of orthodontists in US use recycled brackets Methods 1. Surface qualities of wiresNiTi. and use a new or re-use an old bracket after microetching. Solvent striping with high frequency vibrations & flash electropolishing Electropolishing.cause appreciable plastic deformation When force is applied. • Frictional Effects between bracket & arch wireFriction at interface between wire & bracket produces resistance to movement.• The optimal procedure for rebonding dislodged orthodontic brackets is to resurface the enamel using a tungsten carbide bur.remove adhesive from bracket without damaging bracket backing /distorting dimensions of slot.junctions shears as sliding takes place When soft material slides against harder.Remove tarnish or oxide Buchman. Affected by nature of surfaceRough/smooth Reactive/passive Though surface appears to be smooth microscopic irregularites present Real contact occurs only at limited no of spots at peak of irregularity ASPERITES which -Carry all loads . small fragments of soft material adheres to hard one • Friction depends on 1. 2.greater surface roughness Beta-Ti – greater frictional resistance Cold weld to steel bracket – sliding impossible.
More the angle. Reduced need for long term patient co-operation.Produces nicks & cuts in wire To reduce friction metal slot can be used • 3. Based on evaluation ofPre-treatment records Habits Patient cooperation Growth pattern Age • TypesMandibular canine to Canine retainers Mandibular premolar to premolar retainer Direct contact splinting Flexible spiral wire retainers Hold retainers for individual tooth • Made of . Prolonged semi permanent as well as even permanent retention when conventional retainers do not provide same degree of stability • Differential RetentionIntroduced by James L. Completely invisible from front 3.If tooth pulled along arch wire-initial tipping . more is the friction. • Self ligating .effective sliding-better anchorage control APPLICATIONS OF BONDING1.Force of contact. Reduced caries risk 4. BONDED RETAINERSAdvantages1. 5. Jensen. Differential retention 2. implies special attention is directed towards the strongest or most important predilection site for relapse in each & every case.Friction based on contact angle at which corner of the bracket meets arch wire.reduced friction.
Use of acid etched retainers cast appliances has been expanded to include other appliances including posterior tooth replacement & tooth contouring. Long term results on a group of patients are not available for any design. They are made of 0.0. With round wire on either side & thus frequently out of occlusion. It can be attached to canine or second premolar for better esthetics to avoid empty – looking spaces in adults when premolar extractions are needed & invisible lingual appliances are used. simpler & more durable than cast variant for anterior tooth replacement is by using acrylic prosthetic tooth & inserting into it 2 flexible braided rectangular (0. steel wire/ 0. Short clinical crowns can be utilized since rectangular braided wire is placed along gingival margin.030/0.Toothpicks to avoid interdental flow of adhesive . replacement is made mainly by removable appliance. This type of replacement can be used during orthodontic treatment.022) & one round spiral wire (0.032 inch Thin wire.Prevent post orthodontic space opening & stability against traumatic jigging .032 inch s.0215 inch DIRECT CONTACT SPLINTING.016×0.0195) for support.0.Absolute moisture control is very important. Such appliances are sometimes damaging to periodontal tissues & an inconvenience to patient. Utility wire design was used to reduce the influence of occlusal forces BONDED SINGLE TOOTH REPLACEMENT – For most children having missing anterior teeth.Need for independent physiological tooth movement during function • BONDED SPACE MAITAINERS – Several studies regarding bonded space maintainers have been described with varying degree of short term success.030 gold coated wire.Bond breakage high. Thick wire. • . Another method which is cheaper.rubber dam .
• DEBONDING- Definition: To remove the attachment and all the adhesive resin from the tooth and restore the surface as closely as possible to its pre-treatment condition without inducing iatrogenic damage. Objectives Remove attachment & all adhesive resin from tooth surface . Several types of traumatic splinting devices are conventionally used including band – acrylic splint. As shown in below figure restoration of peg lateral to normal size & shape..032 inch stainless steel spiral wire. Eg.carious teeth during or after orthodontic treatment may be indicated as an alternative to capping on single or multiple teeth to solve tooth shape & / size problems.SPLINTING OF TRAUMATIC INJURIESThe goal of splinting traumatized teeth is to stabilize & to allow healing & prevent further damage to pulp & periodontal structures. contact splinting with composite & orthodontic bonded bracket plus arch wire. COMPOSITE BUILDUPSThe addition of composite resin to non.small or peg shaped lateral. In certain situations this buildup technique may be provide esthetic improvement of the orthodontic results. It has been demonstrated that clinical success has been achieved by using bonded plastic wire and thick 0. congenitally missing lateral.
Cutting -Tips of twin beaked plier against mesial & distal edges of bracket & cut bracket off with peel force • 2. Sqeezing. Remaining adhesive cleaned-up 5. Minimum damage to enamel – fracture • Within bonding material itself • Between bracket – resin – most desirable • Between resin – enamel .Useful on brittle. mobile or endodontically treated teeth Disadvantages Brackets easily deformed Break at adhesive-bracket interface. Debonding ceramic brackets problematic 6. Distorting metal bracket base – non-reusable 4. • Bond strength= the force of debonding the area of the bonded interface.Sqeeze bracket wing mesiodistally & lift it with peeling force Adv.adhesive remnant on enamel • 3.undesirable 2. Restore surface as closely as possible to its pre treatment condition DEBONDING OF BRACKETS: Principles: 1. kilograms (kg). Failure has to be induced between bracket and resin 3. Unit . for easy removal – electrothermal / lasers Debonding Force • In units Newton's (N). An adhesive-bracket system should be able to withstand a stress of at least 6-8MPa PROCEDURE Steel brackets1. Bracket bases cannot be distorted • Grind brackets – rotary instruments • Mechanical instead of chemical bond between base and resin • Heat to soften resin.megapascals grams per square centimeter. Peeling- . or pounds (lb).
022-inch wire embedded in a plastic handle) In either case. • The clinical significance (increase in slot dimension) => loss of effective torque from an arch wire. Method B— A shear force is applied with the blades of the debonding pliers or ligature cutters positioned at the enamel/composite or composite/bracket interface. the presence of a wire in the bracket should help to maintain the slot dimensions. • Method A => All parts equally affected • Method C => wing distortion only. • Results : • Method B => most distortion (majority on the base). the greatest being an increase of 0. This method distorts the brackets the least and is preferred if recycling is a consideration. • Method C— Use of LODI. • • • Oliver and Pal (AJODO July 1989) compared three methods of debonding: Method A— The mesial and distal wings of an edgewise twin bracket are squeezed together with pliers. • Most of the debonded brackets had increased slot dimensions compared with control brackets.-Brackets gripped with removing plier & lifted outwards at 45 angle -It creates Peripheral stress concentration -Advantage includes bracket remains intact & fit for recycling • • • • Lift-off Debonding Instrument: A tensile force is placed on the adhesive bond through a wire loop hooked over the bracket tie wings pulling the wings of the bracket directly away from the tooth surface.032 mm.018 ´ 0. This may be used in two ways: the arch wire – in situ the slot keeper (a length of 0. .
Mechanical PliersETM 346 direct bond bracket removing plier Transcend debonding wrench .fracture occurs at Enamel –Adhesive interface Chemical.20% under stress before fracture Ceramic . • Results : • LODI produced few slot closures • Bracket removing pliers used after removal of the archwire produced significantly greater numbers of slot closures and distorted brackets.Bracket . • After debond brackets were tested for slot closure by the fit of rectangular test wires from 0·016X 0·022 to 0·021X 0·025 inch in size. • • Coley-Smith and Rock (BJO 1999) compared two methods of debonding (bracket removing pliers or a lift off debonding instrument) in 507 metallic brackets.< 1% before fracture Common site of fracture . then use of the lift off debracketing instrument for bracket removal is most advantageous. with and without the archwire in place during debonding. the archwire should be left in place at the time of debond since this reduces the number of distortions • Ceramic bracketsCeramic – low fracture toughness Metal deform.Conclusion – Recycling of brackets is considered.fracture occurs at Adhesive interface • Reasons for failure during debonding isStress incorporated duringLigation & arch wire activation Force of mastication & occlusion Stress applied during debonding It creates cracks resulting in failure • Methods of Debonding1.If retention is Chemical & mechanical. • 10% of the brackets debonded using bracket removing pliers had distorted bases • No base damage – LODI When bracket removing pliers are used.enamel-adhesive interface but metal bracket –adhesive interface Ripley.
2 secs Composite softens – 300-392ºF • . Bishara et al (AJODO 1999) compared the debonding characteristics of the two brackets.Flash.Given by Sheridan et al in 1986 .Rocking motion applied to break bond Advantages No bracket breakage Can be used for metal brackets Less time • 3.When heat applied.Width of tip is equal to width of vertical slot / saddle between M & D tie wings of bracket .6 MPa).Tip moved in MD direction until purchase pt / groove of 0. • Clinically acceptable • The Clarity brackets – greater rate of partial bracket failure with the Weingart pliers compared the to the MXi brackets in which no failures were seen. • 2.it deforms Adhesive.Rechargable direct current power unit connected to cylindrical handpiece which ngets activated at 450ºF . • The mean shear bond strength Clarity bracket (10.4MPa) > MXi ceramic bracket (7.5 mm made between bracket base & enamel surface .Straight chisel tip with bevel of chisel towards bracket .Bracket interface & bracket can be gently separated Time. eye irritation hence safety glass should be worn. using their appropriate pliers. Ultrasonic.Heat used 3-0 joules total energy . The most efficient method of debonding the Clarity bracket is to use the Weingart pliers and apply pressure to the tiewings The most efficient method to debond the MXi ceramic bracket is to place the blades of the ETM 346 plier between the bracket base and the enamel surface.3. Electrothermal debonding (ETD) .Debondig tip maintains constant temperature .remove it before bracket removal .-Sharp torsional force applied in downward direction -Very painful -Risk of bracket failure hence Bracket remains on tooth surface where removal in high speed handpiece -Time consuming -Ceramic dust – itching.
Peppermint oil Peppermint oil – viscous gel in 2ml syringe Apply around bracket base & left for 2 min Promotes failure at Enamel –Adhesive interface No damage tooth Reduces mean & maximal debond force from 103. • Advantages Better bracket removal without damage to enamel/ distortion of bracket Failure site.7.Bracket failure Complete.E.tie wing break at bracket base within body of bracket Partial. No signs of pulpal inflammation were seen. the teeth were extracted and histologically examined. After 4 weeks. Ethanol.inflammation to pulpal fibrosis persists No discomfort except for burning smell 5 secs application – irreversible pulpal disease.intraoral use difficult • • • Jost-Brinkmann et al (EJO 1997) did an in vivo study in which 12 human premolars scheduled for extraction were bonded with ceramic brackets which were subsequently debonded using ETD. .fracture of bracket component in which part of bracket remains on tooth surface • Paul Takle et al –Studied pulpal response.A interface Recyling of bracket Comfortable Disadvantages Pulpal damage Adhesive remains on tooth surface Burning smell Straight handpiece. Chemical debonding Various chemicals used are-Acetone. • 4. debonding time & pt response to ETD AJO 1995 Conclusions were Pulpal hyperemia occurs 24 after debonding Upto 30 days. 200N to 77 & 114N respectively.
bracket slides off Slow • 2.91ºC.5ºC raise can result in necrosis but results shows that there is increase of 0.Polycrystalline & monocrystalline brackets Results.heating is very fast to raise the temperature of resin into vapours It is rapid as bracket blown off 3.1ºC Shear force to debond is less if MMA is used than BisGMA • Study by Samir Bishara .little more time Pulp.after 1 sec of lasing 1.heat propagation can result in pulp damage It is found that 5.2 at 7 watts & Bracket cracked along slot in 2 of 10 cases • Advantages Heat is localized & controlled Debracketing tool is cold Can be used for various types of brackets.2 secs 2. Bracket-blown off from tooth surface. Thermal ablation.degrades adhesive by 3 ways 1.67ºC.force decreased by factor by 25.Polycrystalline.48 MPa of tensile load with CO2 laser at 18 W for 2 secs Intrapulpal temp raise of 1. Thermal softening. Laser debonding Ruby laser – first introduced in 1960‘s Widely used in dentistry Tocchio et al.Monocrystalline.• 5.2W for .force decreased by factor of 5. • CO2 laser timing Super pulse.High energy laser interact with adhesive & energy level bonds between resin rises rapidly above their dissociation energy level resulting in decomposition of adhesive.all designs Atraumatic & safer . <4 secs Normal pulse.CO2 laser at 14 watts for 2 secs & there was complete bracket removal .AJO 1992 Studied the 2 types of lasers-CO2 & Nd:YAG Laser . Photoablation.74ºC.3 secs • Ma et al – Debonding at 1.
Debonding With rubber dam.bracket removed with flat beaked plier • Advantages Safe Can be used for both metal & ceramic brackets No pulpal reactions RESIDUAL ADHESIVE REMOVAL Difficult.color similarity between adhesive & tooth. beveled.A.• 6.Light painting movements .Used Small wood burning pen which has cool cork handle.C.Isolation Disadvantages.Water cooling is not recommended as it lessen contrast . Arthur WoolHe suggested hot water rinse before debonding .000 rpm – rapid removal .Less use on flat anteriors .Fast & more useful on curved teeth . generates 600ºC of heat .30.Prevents inhalation/ingestion of fragments . Suitable bur with contrangle .chate et al.Flat . plugs into a 110 volt outlet . Abrasive wear minimal Remnants gets discolored over period of time • Methods of removal1.Gingival trauma due to inappropriate clamp application .Tip placed flat against facial aspect of bracket for 6-8 secs .Respiratory distress – cannot be used in atopic individuals • • 7.Dome shaped tungstun carbide .Patient indicates first feel of warmth. angled working tip .Creates scratches • 2.21 watts. Scrape with supersharp band/band removing plier/ scaler .R.safeguard during debonding as it .
1/3 – 2/3 surface At 13 yrs.000 rpm satisfactory appearane Score 0 – None of instruments kept perikymata intact • Clinical implication No instrument left surface intact TC spiral fluted bur.medium sand paper disks & green rubber wheel Similar coarse appearance • Score 2 – fine sand paper disks Marked deeper scratches Surface resembles adult tooth • Score 1 – plain cut & spiral fluted TC bur At 25. 2.pits.25-50% ridges remains Normal wear.0-2µm/year • Enamel characterstics after debondingZachrisson & Artun in 1979 – Enamel surface index which is based on Scanning electron microscopy Different instruments for debonding • Score 4 . parallel to each other which considered as external manifestation of incremental lines of retzius. wavelike grooves. Perikymata – transverse.diamond instruments Not acceptable Coarse scratches Marred appearance • Score 3 . Open enamel prism ends appear as small holes Ridges get worn off. fissures Lingual surfaces .Oval TC bur .reduced to 70-80% At 18 yrs.• Characterstics of Normal enamel – 1.finest scratch pattern & has ability to reach difficult areas.scratched pattern • As per Mannerberg At 8 yrs.
suggested that enamel tearouts are localized & are seen specially with filled resins -Comparison between macro(10-30µm) & micro(0.5-8µm • Pus & Way.average enamel loss of 7.abrades 5µm Brawn & Way.Patient comfort .26µm loss as a result of prophylaxis • Type of adhesive Filled resin – clean up with rotary instruments enamel loss.10-25µm Unfilled resin – clean up hand instruments enamel loss.Water coolant results in poor contrast .• Ultrasonic scaler.4µm with tungstun carbide bur • Enamel Tearouts Brobakken & Zachrisson.Slow • Amount of enamel lost in debondingBased on Instrument used for prophylaxis Method of debonding Type of adhesive • Instrument used for prophylaxis – Bristle brush for 10-15 secs.high speed bur & green rubber wheel removes 20µm & low speed tungstun carbide bur.alternative to burs .30) .20-0.10µm Van Waes et al.During debonding – small fillers reinforce adhesive tags Macrofillers forms natural breakpoint at enamel-adhesive interface Unfilled resins.chemical retention – more damage • Clinical implications To use brackets that have mechanical retention .abrades 10µm Rubber cup.Size of hole after etching of prism core is 3-5µm so small filler particles penetrates etched enamel .no breakpoint Ceramic brackets.
Sharp sound on debonding – creation of crack • Zachrisson et al –Studied 3000 teeth in 135 adolescents using fiberoptic light occurrence of cracks in debonded. All composite remains on tooth surface along with impression of bracket 2. Avoid scraping of adhesive remnants with hand instruments • Enamel cracks. > 90% on tooth surface 3.debonding techniques needs improvement Pretreatment examination of cracks if pronounced cracks are present. debanded & untreated teeth Findings are Vertical cracks common.did not wear • Adhesive Remnant IndexGiven by Artun & Bergland 1. <10% but >90% on tooth surface 4.They are Split lines which are often overlooked .>50% Few oblique & horizontal cracks No significant difference in 3 groups in relation to prevalence & relation of cracks Most notable cracks – maxillary centrals & canine • Clinical implications Several distinct cracks after debonding on maxillary centrals & canines Cracks in horizontal direction.abrade easily • Study by Brabakken & Zachrisson Degree of abrasion was minimal Diacrylate with macrofiller & other resin with submicrometer sized particles Debonding – adhesive was left purposely & abrasion over 12 months was studied Very thin film of residual adhesive showed reduction.Fiber optic transillumination is used to view them . no composite on tooth surface . • Study by Gwinnet & Ceen Unfilled sealant begin to wear & did not showed plaque accumalation Filled. • Adhesive remnant wear Remain undetected due to colour Abrasion depends on – size. type & amount of reinforced filler Small size. <10% on tooth surface 5.
05%) F solution for several months Good oral hygiene If strong solution is used then it causes precipitation of ca phosphate which blocks pores & limits remineralization.05% NaF & regular use of F dentifrice Apply f varnish/ titanium tetrafluoride agent in caries susceptible areas Hollender & Koch – reversal of white spot on labial surface after daily tooth brushing with 0.• White spot/Reversal of decalcification Areas of demineralization of varying extent Gorelick et al – in multibanded technique 50% developed increase in white spots Highest incidence. fine powdered pumice & glycerin Isolate gingiva with rubber dam/block out resin Apply gel with electric toothbrush for 3-5mins ( smaller tip) Rinse for 1 min Can be repeated monthly 2-3 times Removes.0. • Microabrasion Removes superficial opacities Eliminate enamel stains with minimal enamel loss Procedure Abrasive gel – 18% Hcl.2% NaF for 2-4 mins • Recommendations – Daily/ twice daily application of weak (0.resistance of orthodontic bracket to a low voltage direct current .white spots.maxillary laterals • Prevention Daily rinsing with dil.22% NaF paste Fehr et al – reversal of white spot along gingival margins after rinsing with 0. brown-yellow discoloration ELECTROTHERMAL BONDING.Given by Voster in 1979 . streaks.Acceleration of the setting by selective application of heat to brackets • Heat .
with distinct impression of the bracket mesh .Unacceptable . Bracket may be accurately positioned. Based on Arrehenius equationFor every 18-28ºF rise in temp. • Removal of filled resin requires rotary inst.enamel loss was only 7. Several attachments can be done with one mix composite. 20µ.5µ.5 amps. • But with careful use of TC bur. speed of chemical reaction doubles & vice versa Temp at bracket –tooth interface is 45.of electricity passed through it by means of a specially designed tweezer. 2. duration of current flow & no of pulses 7. 3. Whereas. 4. Adhesive remnant index (ARI) -Artun • Used to evaluate the amount of adhesive left on the tooth after debonding. Setting occurs in 3-6secs Influence on enamel by different debonding techniques Enamel Surface Index .Zachrisson and Artun (1979-AJO 0 – Perfect surface . • High speed bur and green rubber wheel removes appro. Pulp.000rpm 2 – Acceptable – fine sandpaper 3 – Imperfect – medium sandpaper 4 .3-98. 5.2-3 & 5-6ºC • Advantages – 1. Bond achieved is strong due to less disturbance during polymerization.diamond Amount of enamel lost in debonding The amt is related to several factorsAn initial prophylaxis with bristle brush for 10-15 sec abrade as much as 10µ. Can be used with both light & chemically cured 8. Clinician can control current level.5ºC at 7. Cleanup of unfilled resin with hand only results in a loss of 5-8µ. No pulpal reaction 6.none 1 – Satisfactory – TC burs – 25. loss may then be 10-25µ.9-50. Score 0 : No adhesive left on the tooth Score 1 : Less than half of the adhesive left Score 2 : More than half of the adhesive left Score 3 : All adhesive left on the tooth. Setting can be accurately controlled.2ºC at 5 amps or 84. with rubber cups only 5µ.
4.calcium sulphate dihydrate Pot. Using this method1. Debonding & clean up are much easier with minimal iatrogenic damage. 4. 5. a new method of bonding that involves crystal growth on enamel surface described. 3. Sulphate crystals were longest Lithium sulphate – highest shear bond strength.sulphuric acid Polyacrylic acid • Sulphates of Lithium Sulphates potassium of Sulphates Magnesium of Solution applied. Enamel surface is not significantly damaged.L. Enamel surface is not significantly damaged.A. if any resin tags are left behind. Adequate bond strength for clinical practice is achieved. 3.CRYSTAL BONDING SYSTEM OR CRYSTAL GROWTH INTERLOKING SYSTEMAccording Kartz & Smith. There is minimal effect on outer fluoride rich enamel layer. 2. Debonding & clean up are much easier with minimal iatrogenic damage.80% • Advantages1. Few.Jones & K. In this extensive procedure the bond does not rely on extensive penetration into enamel & micromechanical interlocking is created at enamel surface. 5. Adequate bond strength for clinical practice is achieved. if any resin tags are left behind. 6. These crystals grow in spherulite manner.Pizarro BJO 1994 Conducted a study using 4 crystal growing solutions 50% polyacrylic acid + conc. There is minimal effect on outer fluoride rich enamel layer. M. . 6.Crystal interface offers possibility of incorporation of fluoride or other antiplaque agents in future to anticariogenic action. The crystals building on enamel surface serves as an additional retentive mechanism for resin that bonds the orthodontic attachment to teeth. Few. 2. Crystal interface offers possibility of incorporation of fluoride or other antiplaque agents in future to anticariogenic Action. This system consists of a polyacrylic acid treatment liquid containing a sulfate component that reacts with needle shaped crystals.
Higher tensile strength than composites .1µm coating of flexible ceramic. silane coupler 4.NTG-GMA .• ADHESION PROMOTERSGeorge Newmann et al AJO 1995 Various adhesion promoters are1. Megabond Bowens promoter. GTR. Rocatec.In medicine.Smartbond – ethyl cyanoacrylate + silica gel Polymerization starts in moisture & pressure If used on polycarbonate brackets.In 1991. opaque layer cured • 5.9-13. skin sutures . Silicoat.sandblast with 110µm of corundum.Used as superglue.3 parts M1.pretreated with water When it polymerize in presence of water white acrylic like Powder is formed & process is called as ‘Blooming’ Surface should be bonded closely.glycidyl methacrylate in acetone.automobiles. Sandblasting + silane (Bondpor) 3.Magnesium salt of N.2 drops of M1 & M2 are mixed for 5secs & 3 coats are applied on tooth surface – glossy .ethyl cyanoacrylate introduced . If not results in formation of voids . M2. glass layer deposited on bracket base. light aircrafts . Sandblasting -90µm aluminum oxide 2.Etch tooth surface & air dry .Treat with silane coupler. M3 – Mono & difunctional monomers & oligomers & activators in acetone • Procedure.fracture fixation.Tolyglycine. cardiac surgery.PMGDM – pyromellitic glycerol dimethacrylate in acetone.Bond bracket & allow to dry for 5secs Indications Hypocalcified teeth Fluorotic teeth Bond strength.sandblast with 250µm of corundum.3 MPa • SMARTBOND. 0.2/3 drops of M2 & M3 are mixed & 2 coats are applied on metal mesh .
no water absorption.no discoloration • Advantages Bonds to wet surface Moisture control Use with metal. • Classification . Styrene -50% -reduces viscosity Cross-linking the molecular chains of the polyester. • Advantages Non-corrosiveness Translucency Good bonding properties Ease of repair Potential for chair side and laboratory fabrication • Long FRC – bars which joins teeth to form anchorage/ active splints .according to the effect of heat on their properties. which is usually styrene. plastic & ceramic brackets Bonds to composite & porcelain materials • • FIBER-REINFORCED COMPOSITES (FRC) Fiber-reinforced composites are sometimes referred to as ‗polymers‘.decreased bond strength No residual monomer reacts later. 1.Thermoplastics .soften with heating and eventually melt. Composed of long chain-like molecules consisting of many simple repeating units. Thermosetting materials.polyester and epoxy Once cured. are formed from a chemical reaction Undergo a non-reversible chemical reaction to form a hard. These resins can therefore be moulded without the use of pressure and are called ‗contact‘ or ‗low pressure‘ resins. or ‗thermosets‘. hardening again with cooling. Eg-nylon. Manmade polymers are generally called ‗synthetic resins‘ or simply ‗resins‘. pale coloured liquids consisting of a solution of polyester in a monomer.phenolic resins. infusible product. Brackets with deep mesh/undercuts. chopped fibers such as glass • 2. thermosets will not become liquid again if heated • Most polyester resins are viscous. Polyester resins have a limited storage life as they will set or ‗gel‘ on their own over a long period of time. Eg .without the evolution of any byproducts. polypropylene Can be reinforced with short.
New partially polymerized continous long chain FRC - PRE-PEGS Superior properties with good coupling, easily formed, flexible Uses – Retention Anchorage Active tooth movement • RIBBOND Reinforced polyethylene fiber – Ribbond Ultrahigh molecular weight Treated with cold gas plasma to enhance adhesion to synthetic restorative materials Special fiber network- efficient transfer of stresses Translucent –excellent aesthetic Ease of adaptation to dental contours Ease of bonding Easy & fast technique – one appointment Acceptable strength Good clinical longetivity Thin – volume of appliance reduced Easy repair • Uses Periodontal splints Endodontic Posts & cores Treat cracked tooth syndrome FPD Trauma stablization • 1. Fixed retention Etching with 36% phosphoric acid for 30 secs Ribbond of required size is cut & saturated with bonding agent Flowable composite applied on tooth surface & Ribbond placed •
2. fixed space maintainer Dentin primer applied on tooth surface Ribbond segment saturated & bonded with flowable composite •
3. Temporary esthetic appliance•
4. Post traumatic stabilization splint •
FRC in Lingual OrthodonticsAnchorage reinforcement 2 FRC bars – labial surface from I PM to I M Procedure Buccal surface microetched then acid etched Bonding agent applied over tooth surface & cured • Thin layer of flowable composite applied on enamel surface & FRC positioned & pressed against composite. Light cure for 5 secs Each fiber layer covered with layer of flowable composite & Light cure for 40 secs
• SPLINT Kelvin fibers- weak in compression S-glass fibers – SPLINT Matrix- light curable thermoset BisGMA Modulus of elasticity – 70% greater Yield strength- 6 times greater Resilience- 24 times greater
• 1. Any attachments like brackets, hooks can be directly bonded to FRC
FRC bar can be easily removed by peeling action • • 2. Intermaxillary elastics are applied without bands/wires eliminating bracket-wire play • • • • • • 3. Vertical elastics to close open bite when incisor extrusion indicated •
4. Posterior & anterior anchor units with bonded attachments for space closure •
5. - T- loop used for space closure with bonded ceramic bracket on anterior FRC - Chain elastics for space closure •
6. Uprighting second molar with full arch FRC With straight archwire segment With T-loop •
decreased irregularty Ways to increases retention are1. Adhesion promoter. striations & cloudy areas .BisGMA & HEMA resin combined with amines Scotchbond multipurpose plus primer. Etching time – study by Peter Ng‘ang‘a et al 40% phosphoric acid for 60 secs.It is seen tnat 37% phosphoric acid. Filled composite Concise to visible-light-cured composites for bonding.7. Apply Scotchbond MP.can bond to amalgam or porcelain that has been microetched with 40-micron aluminum oxide before acid etching. then position the bracket on the tooth • Light cured composite veneers for fluorosed teeth. .Above+ remove 1-2mm of enamel with carbide drill . Repair of FRC bars – bond replacement connector • Bonding to Fluorosed Enamel.resin layer to flow on etched surface • Adhesive. and light-cure it for 10 seconds per tooth 4. JCO 2006 Gp A – surface cleaned with plain non-fluoridated pumice & water Gp B. because fluorosed enamel seems to diffract visible light and prevent complete curing • 1.James Noble et al Angle Orthod 2008 Primer.apply & gently air dry for 5 secs Light cure Only 1 bond failure in 9 months 3.better etching pattern Bond strength.aluminum oxide/silicon carbide 2.Fluorosed enamel manifests as defects in subsurface enamel ranges from white to brown. Etch for 20 seconds with 37% phosphoric acid gel 3.Frequent bracket failure at compromised enamel interface in fluorosed teeth due to outer hypermineralized & acid resistant layer which prevents proper etching of enamel. Microabrasion along with sandblasting – improves retention. Apply Concise to each bracket.aq soln of HEMA & polyalkenoic acid.8N/mm2 for fluorotic teeth 8. Microetch each fluorosed tooth 2.6N/mm2 for nonfluorotic teeth Scotchbond MP (Multi-Purpose) . pits & irregular opaque lines.
2 paste Chemically cured.greater but not clinically significant strength • Bond strength with self etching Primer AJO 2004 Study done by Helen Grubisa. Marco Almedia.other alternate • Bond strength between composites & RMGI as a adhesive AJO 2004 Study done by Andrew Summer et al.Transbond XT Hydrophillic primer .A.7% VARIOUS STUDIES Direct bonding to porcelain AJO 1995 Study done by Vanessa Barbosa.easy clean up SEM – less rough & porous surface after 10% polyacrylic acid etching Effect of blood contamination on shear bond strength of conventional & hydrophillic primer AJO 2004 Study done by Marier F. burning with loss of tissue. Light cured . intense pain for several days APF. Sfondrini et al Conventional primer.80% of strength in15 mins Light cured – Zionomer.Fuji ortho LL & composite.concise Results Decreased shear bond strength with RMGI Predominant failure at enamel adhesive interface Weak bond.erythema. Orlando Chevitarese Hydrofluoric acid – better retention to porcelain Mucosal contact.74% B.80% of strength in 20 secs Chemically cured.Above + porcelain veneers Bond failure. RMGI. SEP‘s – ph of 1 Shear bond strength is less than achieved with 37% phosphoric acid • Bond strength of light cured GI & chemically cured GI Study done by Anne M.Ketac bond ( rapid setting) AJO 1992 .25.Transbond MIP Results Non-contaminated surface.9% C. Compton et al.1. Gp C.highest bond strength Contaminated surface.
highest bond strength of 3.pretreat with polyacrylic acid to increase bond strength Cook & Youngston. Light curing – Ortholux for 20 secs Results Mean bond strength of light cured GI > chemically cured at 1 hr & 24 hrs Bond strength for both increased from 1 to 24 hrs.87 Ketac cem – 11.12 failure with GIC & 3 with composite Majority failure in 6 months Bond strength for GI – 32kg/mm2 Bond strength for composite– 103kg/mm2 F release in GIC – prevents demineralizaion Povie et al.better adhesion • Clinical evaluation of Glass polyalkenoate cement for direct bonding 1992 Study done by John Fricker Fuji I & system 1+ Bracket failure recorded at 3 month intervals Results After 12 months.91MPA It is a water hardened soln with polyacrylic acid Freeze dried Provides more consistent mix Minimal material between bracket & tooth. • Shear bond strength of 4 primer systems AJO 1992 Study done by Mark Neil Corril et al Segasealant Max cure Scotchbond 2 Concise enamel bond • Results Shear bond strength tested with Instron testing machine Max cure – highest mean bond strength of 25.43pounds Fuji I – 6. Precise Results Mean force for bond failure inPrecise.33N/mm2 Scotchbond 2 – lowest • Bond strength of 3 GI cements AJO 1990 Study by Valerier Bowser Fajen et al Ketac cem . Fuji I.2.no difference AJO .3 Keatc cem.
Legler. • Debonding techniques on enamel surface AJO 1995 .6.less shear bond strength & less adhesive for removal after debonding.15 secs • ResultsMax depth etch.steel & ceramic brackets with chemically & light cured composites AJO 1990 Study done by V. E.3. Joseph. Bradley.37% for 60 secs Min depth etch.5% for 15 secs Amount of enamel dissolved increases with increase in acid conc upto 27%.minimal enamel loss than 37% No difference in shear bond strength Even 5% can be used • Effect of phosphoric acid concentration on shear bond strength AJO 1995 Study done by Wolfgang Carstensen Phosphoric acid concentration in 37.L.high bond strength than s.2% Results Less conc.for 60. 9 subgroups 37%.66% • Effect of phosphoric acid concentration & etch duration on enemel depth of etch AJO 1990 Study done by L.15 secs 5% . Retiet.15 secs 15% . D.R.5µm with conventional etching SEP .1µm. Pushpa Hazarey 5 & 37% phosphoric acid 5% .5.30.Concise ( macrofilled) Light – Heliosit (microfilled) Results Most fractures with chemically cured & ceramic brackets Creamic.1µm Better etching with conventional acid etching.for 60. Chemical.for 60. • Shear bond strength of SEP to fluorosed teeth Journal of Dentistry 2005 Thick resin tags of 3.30.H. Above 27% it decreases – formation of MCPM • Effect of phosphoric acid concentration on shear bond strength AJO 1995 Study done by Wasundhara Bhad.steel Ceramic bracket fracture. Rossouw.5µm.• Shear bond strength of s.P.30.27.
000rpm with air cooling Final finish.12 fluted tungstun carbide bur at 20.000 rpm Finish.J. Site of failure between adhesive & enamel • .C.Study done by K. M. Zarrinnia.strong bond under dry condition. Advance Results Remnants from GI were heavier than composite Remnants of Advance. Results Better bracket removal with bracket removal plier Bulk resin removal with.graded. Francis K.M.rubber cup with zircate powder • Role of sandblasting on retention of metallic brackets with GIC Ketac cem & Right Results Sandblasting of bracket base for 3secs at 10mm distance Produced good micro-roughned surface Increased mean bond strength by 22% Mean survival time increased BJO 1993 • Remnant amount & clean for 3 adhesives after debracketing AJO 2002 Study done by Valerie David et al. Patrick T. Concise & Fuji Ortho LC (RMGI) Results Concise strongest shear bond strength Fuji Ortho LC. Transbond.Kehoe. Fuji Ortho LC. medium/fine superfine sof-lex disks at 10..larger Bonded to acid etched teeth took 1-11/2 longer to clean up • Enamel surface after orthodontic Debonding Angle Orthod 1995 Study done by Phillip Cambell Tungstun carbide bur & abrasive disks 30 fluted tungstun carbide bur most efficient with least amount of scarring Steps Bulk removal with 30 fluted tungstun carbide bur Enhance cups & points to remove gross scarring Water slurry of fine pumice to obtain smooth surface Final finish with brown & green cups • Shear bond strength of resin reinforced GICAJO 1999 Study done by Chun Chung.
adequate None produced enamel fracture during debonding • In vivo.Transbond XT Conc – 0%.Mutans. Light bond Results High bond strength – light bond+Enhance LC Tranbond XT – best bond strength with Orthosolo Lightbond left less adhesive None of adhesion promoters increased adhesive remaining on tooth surface • Shear bond strength of 3 Self etching adhesives AJO 2006 Study done by Neslihan et al.Reliance Results Degree of cure of both do not differ Amount of monomer leached is same No cytotoxic effects on PDL • Antimicrobial properties of an adhesive with Cetylpyridinium Chloride 2006 Study done by Tahani Musallam et al. 10% Results Bacterial inhibition with CPC 2.Rely-a bond VLC.Light & chemically cured. 5%. 2. Adaper prompt L-Pop Clearfil protect bond ( F & antimicrobial) Transbond Plus SEP ( F) Results Clearfil protect bond.5%.degree of cure/ monomer leaching & cytotoxicity AJO 2005 Study done by Christiana Gioka et al Chemical.Effect of fluoridated antiplaque dentifrice on enamel demineralization AJO . Orthosolo.glycidyl methacrylate & hydrophilic resins Adhesives – Transbond XT. All-Bond 2.max shear bond strength Adaper. reaches plateau upto 60 days • Effect of Adhesion promoters on shear bond strength AJO 2006 Study done by Ascension Vincente et al.Tolyglycine. Enhance LC Contains N. S.risk of caries CPC – antiplaque Added to filled photoactivated adhesive.5% best antimicrobial without affecting DTS Initial more release upto 15 days.
• Porcelain surface treatment by laser for bracket porcelain bonding AJO 2005 Study done by Tolga Akova et al.Tandy F antiplaque paste – Triclosan/zinc/Pyrophosphate Antiplaque –superior. One step Failure rates recorded after 14 months Results Transbond plus – 0.1ºc Polycrystalline brackets – significant decrease in bond strength than with monocrystalline • Effect of Argon laser curing on shear bond strength when bonded with light cured GIC AJO 2005 .11.4% with halogen & 10. 20 secs superpulse CO2 laser irradiation provides adequate bond strength between metal brackets & porcelain surface Silane application after laser improves bond strength • Nd. Transbond plus. Laser – wavelength of 1060nm Results High peak power at 2J more effective for debonding Max temp on pulpal walls.P. Transbond XT.Ireland. Chiba. less demineralization • Assessment of long term failure of 2 SEP’s Study done by Nikolaos Pandis et al.failure rate 3. Pettermerides.5.3 secs Halogen light.Fuji Ortho LC Plasma arc light.20 secs ResultsTransbond XT.41% with both lights Fuji Ortho LC . M.Sheriff.10% More in mandibular arch AJO 2005 • Plasma curing light & Conventional halogen curing light AJO 2005 Study done by A. AJO 2006 F paste .J.YAG laser for debonding ceramic brackets AJO 2005 Study done by Kotaro Hayakawa. A.94% One step – 8.2% with plasma No difference in bond failure but time can be saved with plasma light.
halogen light for 40 secs.Study done by Glaucco Serra et al.6 secs & with caution 3 secs. Light cured Bonding system JCO 2005 Study done by Alberto Armenio Brajen unibond .Zoom (25% hydrogen peroxide Bonded with composite adhesive Bleaching do not affect shear bond strength • Bonding impacted teeth without moisture contamination JCO 2005 Study done by Sandhya Jain Etch tooth surface Clean & dry surface by wiping enamel with alcohol swab Water irrigation not needed • New Self Etching. et al Conventional halogen. high power halogen light –NEW (Swiss master light) Cost effective solution to reduce curing time Recommended time. At home bleaching. • Effect of bleaching on shear bond strength AJO 2005 Study done by Samir Bishara et al.5% Argon leaves more adhesive on tooth surface • Light curing time reduction with new high power halogen lamp AJO 2005 Study done by Christine B.long curing time Low priced. Argon laser for 5 secs. Results Bond strength – equivalent in both groups but reduces cure time by 87.S.opalescence bleaching agent (10% carbamide peroxide) In office bleaching.average bond strength of 22MPa Fluoride release Viscosity prevents bracket flotation Good resistance to discoloration • Modified amalgam plugger for Etchant application JCO 2005 Study done by John Baccelli Std amalgam plugger modified with crosshatch file Etchant can adhere to surface Carefully scraping against enamel surface removes all debris & pellicle • .
.CONCLUSIONSimplicity of bonding can be misleading . Success in bonding requires understanding of and adherence to accepted orthodontic and preventive dentistry principles. then 1) to light-cured to dual-cured (chemical light) to moisture-active Even the device that threatens to replace conventional brackets altogether—the aligner—relies on bonded buttons. so it appears that some form of bonding will be with us for a while. It has taken half a century for orthodontic bonding procedures to evolve from acrylic to chemically cured (2-phase.
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