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Bonding and Debonding From Metal to

Ceramic: Research and its Clinical Application
Samir E. Bishara, BDS, DDS, DOrtho, MS, and Adam W. Ostby, BS, DDS
Over the last 50 years, the bonding of various resins to enamel has also
developed a niche in orthodontics. The direct bonding technique revolves
around the concept of attaching orthodontic appliances to tooth structure
using adhesives, and this technique has become a foundation of contemporary orthodontics.
Although the specific techniques and materials used in bracket bonding
have changed, the basic procedure has remained relatively constant. In
general, the technique for orthodontic bonding includes 3 steps using an
etchant, a primer, and an adhesive. More recently, these 3 steps have been
combined into 2 or even 1 step. At the present time, numerous bonding
materials, techniques, and protocols have been established that have the
ability to provide the clinician with adequate bracket/adhesive/enamel
(shear bond strength [SBS]), over the course of treatment. However, bracket
SBS is influenced by many variables which may or may not be under the
control of the clinician.
It is important for the clinician to be aware of how these variables affect
SBS and apply this knowledge in their selection of the optimal bonding
adhesive/technique. In addition, because of the lack of standardization of
bond strength testing, the clinician should be cognizant that accurately
comparing bond strengths between different studies may be difficult. (Semin Orthod 2010;16:24-36.) © 2010 Elsevier Inc. All rights reserved.

The Basic Bonding Technique
he applicability of using adhesive bonding
resins in dentistry has significantly increased
with the introduction of the enamel acid-etch
technique by Buonocore in 1955. By demonstrating a 100-fold increase in retention of small
polymethylmethacrylate buttons to teeth that
had been etched with 85% phosphoric acid for
30 seconds, Buonocore introduced modern adhesive dentistry techniques.1 Over the last 50

T

From the Department of Orthodontics, College of Dentistry, University of Iowa, Iowa City, IA; College of Dentistry, University of
Minnesota, Minneapolis, MN.
Address correspondence to Samir E. Bishara, BDS, DDS,
DOrtho, MS, Department of Orthodontics, College of Dentistry,
University of Iowa, Iowa City, IA 52242-1001; E-mail: samirbishara@uiowa.edu
© 2010 Elsevier Inc. All rights reserved.
1073-8746/10/1601-0$30.00/0
doi:10.1053/j.sodo.2009.12.009

24

years, the bonding of various resins to enamel
has also developed a place in orthodontics. The
direct bonding technique revolves around the
concept of attaching orthodontic appliances to
tooth structure using adhesives, and this technique has become a foundation of contemporary orthodontics.
Although the specific techniques and materials used in bracket bonding have changed, the
basic procedure has stayed relatively constant. In
general, the technique for orthodontic bonding
includes 3 steps using an etchant, a primer, and
an adhesive. More recently these 3 steps have
been combined into 2 or even 1 step.
Further studies determined that microporosities created during the acid-etching process allowed for the incorporation of small resin “tags”
into the enamel surface, thereby creating microscopic mechanical “interlocks” between the
enamel and resin.2-4 The concept of adhesion
has been extensively studied, and currently a

Seminars in Orthodontics, Vol 16, No 1 (March), 2010: pp 24-36

the prevention. adsorption.Bonding and Debonding From Metal to Ceramic combination of mechanical. the levels of acidogenic bacteria. As the pH drops below the threshold for remineralization. including proper tooth brushing with a fluoridated dentifrice. This is true regardless of the bonding technique and/or materials that are used by the clinician. which is typically either self-setting and/or polymerized by light curing. If these bacteria have an adequate supply of fer- 25 mentable carbohydrates. with sufficient strength to withstand most of the forces routinely experienced in the oral cavity during orthodontic treatment. . and electrostatic theories are typically used to describe the phenomena. such as S. carious decalcification occurs. Enamel conditioning (etching) has traditionally been accomplished using 37% orthophosphoric acid.5 Mechanical theories propose that adhesion occurs primarily through microscopic interlocks between the adherent and adhesive. a fluoroapatite crystal structure is formed that has a lower solubility in the oral environment compared with hydroxyapatite.8 This is a significant finding and is important for both the patient and the clinician to realize. Dentifrices typically contain either sodium fluoride. monofluorophosphate. particularly when these patients do not follow the suggested proper oral hygiene regimen. Thus. there is a rapid shift in the composition of the bacterial flora of the plaque following the introduction of these appliances. diffusion. (3) primer application.7 Thus. mutans. which has the capability of dissolving enamel rods to create the microporosities necessary for resin tag development. (2) enamel conditioning (etching). When fluoride ions are incorporated into the surface of enamel. lowering the pH of the plaque. Such lesions have been clinically induced under loose bands within a span of 4 weeks. diagnosis. enamel cleansing is accomplished using rubber prophylactic cups and pumice for approximately 10 seconds per tooth. The first clinical evidence of this demineralization is visualized as a white spot lesion (WSL). stannous fluoride.1% in dentifrices is not recommended. which is often the period between 1 orthodontic appointment and the next. Oral Hygiene and the Role of Fluoride Studies have shown that fixed orthodontic appliances induce a rapid increase in the volume of dental plaque and that such plaque has a lower pH than that in nonorthodontic patients. acid byproducts will be produced. The priming agent is used to help the adhesive monomers diffuse the complete depth of the enamel etch pattern. By following this standardized procedure.” and thus. and if left untreated. amine fluoride. For less compliant orthodontic patients. The conventional acid-etch bonding process involves 4 steps: (1) enamel surface cleansing.6. these lesions can rapidly progress.9 This is because an appropriate level of fluoride ions is needed to provide an anticaries benefit by promoting enamel remineralization. This is followed by the application of an adhesive resin. Typically. The purpose of enamel cleansing is to eliminate debris or contaminants that may interfere with the conditioner or primer reaching the enamel surface during their application. or a combination of these compounds. More specifically. Perhaps the most important prophylactic measure to prevent the occurrence of WSLs in orthodontic patients is implementing a good oral hygiene regimen. Furthermore. the use of a fluoridated dentifrice alone may be ineffective in preventing the development of carious lesions. may produce carious cavitation that will need an appropriate restoration. a fluoride concentration below 0. clinicians have been successfully bonding orthodontic brackets and other appliances directly or indirectly to teeth. in greater adhesive forces. and treatment of WSLs is crucial to prevent tooth decay as well as minimize tooth discoloration that could compromise the esthetics of the smile. and supplemental sources of fluoride are often suggested. As orthodontic patients are at an increased caries risk. In the highly cariogenic environment adjacent to orthodontic appliances or under loose bands. become significantly elevated in orthodontic patients. This short introduction emphasized the critical importance of maintaining proper oral hygiene in patients who will be undergoing orthodontic treatment to minimize tooth decay and decalcification. and (4) adhesive application. The increase in the contacting surface area between the 2 results in a greater number of “interlocks. the plaque-retentive properties around fixed appliances predispose the patient to an increased cariogenic risk.

11-15 Several studies have demonstrated that reducing etching time from 30 to 15 seconds does not result in lower bond strengths.18 Furthermore. irreversible enamel loss during the procedure has been a concern to the clinician. Ostby As will be detailed in this article. Prim- . The acid produced mild etching of the enamel surface and also resulted in a crystalline deposit which bonded firmly to the enamel surface and resisted mechanical removal.11-13 It has also been reported that a significant reduction in bond strengths will occur when decreasing etching time beyond a certain point.12. it can be concluded that a shorter etching time of only 15 seconds can provide clinically acceptable SBSs when used to bond orthodontic brackets and also minimize the extent of enamel loss. using this technique increased both the quality of the etching pattern as well as the surface area of the enamel available for proper bonding.W.13 Olsen et al16 specifically investigated the effect of enamel etching time on the SBS of orthodontic brackets. Their findings indicated that a 5 second etch time with 37% phosphoric acid was insufficient to successfully bond brackets. Modifying the Bonding Procedure and its Effects on Bond Strength Etching Etching Time Manufacturers of bonding systems typically recommend specific conditioning protocols. Thus. and their formation depended mainly on the sulfate ion concentration in the polyacrylic acid solution.26 S. bonding procedures. It has been suggested that a shear bond strength (SBS) of 6.21 The crystals were shown to be calcium sulfate dihydrate (gypsum). the use of acid etchants followed by the application of priming materials was an essential part of the bonding procedure. The Primer Type of Etchant A 37% orthophosphoric acid concentration has typically been used for traditional bracket Traditionally.22 More recently.20 He found that polyacrylic acid cements adhered to dental enamel because of the interaction of the aqueous polyacrylic acid component with the enamel surface. Maleic acid was introduced as an alternative etching material in the early 1990s in an attempt to control the depth of the enamel etches.0 MPa is adequate for bonding orthodontic brackets to teeth. and mitigate the unwanted effects of plaque accumulation. Espinosa et al23 deprotenized the enamel surface using 5.17. When studied for use in bonding brackets. in general. scanning electron microscopy showed that the etch patterns produced by 10% maleic acid were morphologically similar but shallower than those produced by 37% phosphoric acid. as forces of the archwires used for initial leveling are. Bishara et al determined that the SBS of brackets bonded to enamel with either 10% or 20% polyacrylic acid were significantly lower than brackets bonded to enamel conditioned with 37% phosphoric acid. yielding differing results. other less aggressive etchants have been investigated. to improve the retentive properties of the adhesive to the enamel during bonding. in an effort to reduce the amount of enamel loss during the etching process. Studies have demonstrated that the use of 10% maleic acid as the etchant had no significant effect on the SBS of orthodontic brackets.10 While this range is generally regarded as a minimum bond strength for successful bonding. no significant difference in SBS was observed. Bishara and A. less than those applied at a later stage in treatment. Therefore.25% sodium hypochlorite (NaOCl) before applying phosphoric acid. When the etch time was reduced from the recommended 30 seconds to either 15 or 10 seconds. The effect of changing the conditioning time on the etching pattern has been investigated in depth. the bonding procedure has been significantly modified over the last 20 years to decrease technique sensitivity for the clinician as well as help minimize enamel loss for the patient. The use of 10% and 20% polyacrylic acid for bonding was introduced by Smith. According to the authors.19 Another enamel conditioner that has been investigated is polyacrylic acid. While this etchant provides a deep etching pattern and suitable bond strengths.0-8. Clinicians and researchers often investigate various modifications to these protocols to improve the bonding process.E. lower bond strengths may be adequate for initial bonding.9.

it may be advisable to reinitiate the procedure rather than apply a new coat of the primer. In an effort to reduce the number of steps involved in the bonding procedure. 27 Various studies have evaluated the SBSs of different bonding systems on both normal and contaminated enamel surfaces. a report indicated that the differences in the pH of the SEPs used to bond brackets does not significantly affect the SBS of the brackets. blood contamination was shown to have a more detrimental effect on SBS than saliva contamination. or BisCover.27 While all SEPs are acidic. it was reported that adequate SBS could be maintained if contamination occurred either before or after the application of the SEP.33 There was a reduction of about 50% in the mean SBSs when resin composite was bonded directly to saliva-contaminated etched enamel surfaces when compared with the bond strength to uncontaminated surfaces.27 More specifically. Recently. independent of when the contamination occurred during the bonding process. when there is too much saliva contamination before and after the application of SEP it is also advisable to reinitiate the bonding sequence. At the same time.35 A new material namely.26 It is interesting to note that scanning electron microscopies have shown that SEPs produce a less defined etch pattern than that produced by phosphoric acid. following blood contamination during the bracket bonding procedure. The application of BisCover as a separate layer underneath the adhesive had no significant effect on bracket SBS36 Furthermore.29.Bonding and Debonding From Metal to Ceramic ing agents are usually nonfilled or very lightly filled acrylic resins that often contain 2-hydroxyethyl methacrylate (HEMA) or dimethacrylate. BisCover (Bisco. Additionally. SEP. Ill. it has also been demonstrated that SEPs that produce a minimal etch pattern can still provide adequate bracket SBS. researchers evaluated whether the acid conditioner could be combined with the priming agent. The latter allows for the formation of “resin tags” deeper into the enamel surface. a significant reduction in SBS was observed. contamination with blood or saliva after the application of BisCover had no significant effect on bracket SBS. aggressive selfetchants with lower pH levels did not provide greater bonding strengths. Similarly.29-33 Success of resin bonding systems to enamel was negatively affected by contamination with oral fluids. adequate isolation during the bonding procedure is a critical variable that can jeopardize bond strengths if not maintained. before adhesive application when bonding brackets. such as saliva and plasma. The primary purpose of the primer is to allow good surface wetting and penetration of the adhesive into the etched enamel.24-26 It has been demonstrated that SBSs of brackets bonded using different “self-etch” primers were not significantly different from brackets bonded with the conventional acid-etch technique.28 Effect of Contamination on SBS As stated earlier.18 While these conditioners were initially developed for use on dentin. whereas contamination before BisCover application significantly decreased SBS values. those available on the market vary in their pH levels and aggressiveness. thus reducing the bonding procedure by 1 step. these “acidic primers” provided comparable SBS as the traditional acid-etch/ primer/adhesive systems.) was recently evaluated as a protective polish. researchers have determined that adhesive systems combining conditioning and priming can also be successfully used to bond orthodontic brackets to enamel. Self-Etching Primers One of the first reports on the use of self-etching primers (SEPs) during the bonding procedure demonstrated that when used with a highly filled composite resin.29. Bonding Material Composite Resins Traditional bracket bonding procedures have typically used composite resins as the adhesive of . contamination both before and after the application of the SEP resulted in a significantly weaker SBS34 It is of interest to note that when teeth were contaminated with blood. However. Schaumburg.33 When specifically testing the effects of saliva contamination on the SBS of orthodontic brackets when using a SEP.36 The results of these studies indicate that in general. thus creating a mechanical bond.24.

and cyanoacrylates. In an attempt to increase the bond strengths of GICs. be more widely used) in bonding orthodontic brackets in the future. resin particles were added to their formulation to create RMGI bonding systems. recently. Ostby choice to bond to enamel.17. a new no-rinse self-conditioner was used with a RMGI and provided adequate SBS for bonding brackets. compomers contain a GIC but at levels that are insufficient to produce an acid/base reaction in the dark whereas the RMGI cements discussed earlier retain a significant acid/base reaction as part of their overall curing process and only their initial hardening depends on photoactivation. Cehreli and Altay75 found that using a nonrinse conditioning (NRC) solution produced a smooth yet “adequately rough” enamel surface without a need for a prolonged etching time. namely. researchers have investigated the use of fluoride releasing materials for bracket bonding and met various degrees of success. the curing of compomers depends solely on photopolymerization. This is because these materials have provided a consistently adequate bond strength when using various etchants as well as SEPs. therefore.70 In contrast. As a result. in an effort to find a more ideal bonding adhesive.39-46 Of particular interest. The materials used for bonding included: glass ionomers.55-60 Studies indicated that earlier RMGI adhesives had lower SBS compared with composite resins. they recommended treating the enamel with NRC and bonding the brackets with a compomer adhesive. adhesives.38 in addition to their sustained fluoride release following bonding.26 Still.67 Additionally. These adhesives release fluoride ions like conventional GICs but can also be successfully used to bond orthodontic brackets because of their relatively higher bond strengths. in vivo studies have shown no significant differences in bracket failure rates between the RMGIs and composite Another class of materials known as polyacid modified resin composites. Essentially. Thus. Glass ionomer cements (GICs) have some desirable characteristics.71 This major compositional difference between these 2 classes of hybrid materials.16. the rate of fluoride release was shown to increase in the plaque adjacent to brackets bonded with GICs. that is.66 whereas a composite resin requires enamel etching with phosphoric acid. While the potential for using compomers for bracket bonding is apparent. the use of fluoride containing sealants and adhesives to bond brackets has been investigated.W.61 Although RMGIs are typically used with a polyacrylic acid conditioner.73 An in vivo study conducted by Millet et al74 found similar failure rates between brackets bonded with either a compomer or a resin composite when the enamel surfaces were etched with phosphoric acid. the duration of orthodontic treatment places the patient at an increased caries risk for a prolonged period. resin-modified glass ionomers (RMGIs). compomers. Bishara and A.68 Because of the recent improvements in the fluoride releasing capabilities and the adequate SBS of RMGI.25. explain the adequate bond strength of the resin modified glass ionomer that can be obtained with no enamel pretreatment. their ability to chemically bond to tooth structure37. because of their lower bond strengths48-54 their use for bonding orthodontic brackets became fairly limited.61-63 particularly within the first half hour after bonding.62-67 It was also reported that no significant differences were found between the SBS of brackets bonded with a RMGI or a composite adhesive following thermocycling. or compomers. has also been studied for their potential use in bracket bonding.64 Recently these products were found to have an increased SBS and are able to bond orthodontic brackets successfully. it has been suggested that these adhesives should/will play a greater role (ie. the presence of an initial acidic reaction could. They observed that the alterations were limited to the superficial enamel layer with no damage to the enamel prisms. As a result.E.47 However.72.69 Compomers Glass Ionomers and Resin-Modified Glass Ionomers In general. with the acid/ base reaction being initiated by water from the oral environment and being responsible for the fluoride release. continuous fluoride release from any or all the ingredients of the bonding system particularly around the periphery of the bracket base would be extremely beneficial. Bishara et al76 demonstrated that using the NRC with a compomer .28 S.

nano-composites. and easier to handle. The abundance of polymerization opportunities in these materials allows Ormocers to cure without leaving a residual monomer. a new packable restorative material was introduced called Ormocer. In contrast. In a recent study. Ormocer materials contain inorganicorganic copolymers in addition to the inorganic silanated filler particles.25-27 other adhesive systems have been designed to meet the same purpose of reducing the number of steps involved in the bonding procedure. which is an acronym for “organically modified ceramic” technology. further studies demonstrated that this adhesive lost 50% of its bond strength after water storage for 30 days80 and up to 80% of its initial strength following thermocycling.83 Some of the new products that have been introduced in the last several years include Ormocer.Bonding and Debonding From Metal to Ceramic provided significantly lower SBS when compared with an acid-etch/composite control. It has been suggested . Smartbond can be considered a 2-step (because it requires an etching step). however.79 While the cyanoacrylate adhesive provided adequate SBS at 30 minutes and 24 hours after bonding. A cyanoacrylate adhesive. 1 component orthodontic adhesive that sets on its own. it is very important to follow the manufacturer’s instruction literally and to apply a thin layer of the adhesive to ensure a quick and uniform setting. Ormocer was formulated in an attempt to overcome the problems created by the polymerization shrinkage of conventional composites because their coefficient of thermal expansion is very similar to natural tooth structure. Gothenburg. This is because the material has proved to be relatively reliable for both restorative and orthodontic purposes. and one-step adhesives. Therefore.81 Cyanoacrylate materials have the advantage of reducing the number of steps during bonding. Cyanoacrylates As described earlier. and more efficient light sources. An initial report that tested a cyanoacrylate adhesive to bond orthodontic brackets to enamel indicated that it provided clinically acceptable bond force levels within the first half hour after bonding. thus having greater biocompatibility with the tissues. whereas the Bis GMA itself has also been found to be cytotoxic in a number of cell culture systems. The presence of water in proximity to a thin layer of adhesive will ensure that most of the activated monomer will be converted into the more stable and cured polymer within a short period. Ormocers are described as 3-dimensionally cross-linked copolymers. it does not need to be light cured to obtain an effective bond. including the use of SEPs. New Bonding Adhesives Manufacturers are continuously introducing new restorative and adhesive systems in dentistry that are not cytotoxic and are more reliable. the clinician needs to be aware that this adhesive has a relatively short working time 29 and may not provide adequate bond strengths in the oral environment over time. stronger. there have been few fundamental changes in that aspect of the restorative-adhesive system since the introduction of dimethacrylates in the form of bisphenol A glycidyl dimethacrylate (Bis GMA). From a clinical perspective. SBS increased 24 hours after bonding. stronger adhesives. Although the resin matrix significantly influences the properties of composite resins. In addition to SEPs. namely cytotoxic and estrogenic potentials. Studies indicated that the bisphenol A component in the structure of the monomer Bis GMA may have an estrogenic effect. Orthodontists have benefited from these new innovations. less liable to leak at the margins. that is. that is. Sweden) that does not need any primer was introduced. when using this adhesive.78 Additionally. Smartbond (Gestenco International. Vicente et al77 found similar results. combining conditioning and priming into a single step or eliminating the need for one of these 2 components can potentially result in a reduction in application time and improvement in cost-effectiveness for the clinician.82-87 Ormocer In an attempt to overcome some of the limitations and concerns associated with the traditional composites. adhere better. it is necessary that it comes in contact with water on the enamel surface in order for the uncured monomer to be activated and to polymerize. which have been shown to be successful in bonding brackets.82.

91 One-Step Adhesives Another area of orthodontic adhesive research has focused on self-adhesive cements.01 ␮m in size. their potential in being used for orthodontic purposes is obvious and with further material advances. Ajlouni et al88 found that within the initial half hour following bonding. 2 separate self-etch adhesives. One report indicated that the bleaching process using 10% carbamide peroxide. RelyX Unicem (3M ESPE. In another study Dabanoglu et al90 found that a high filler degree combined with small particle dimensions reduced abrasion by up to 50% compared with composites of lower filler degree or those with organic (prepolymerized) fillers. Nano-Composites While composite based adhesives and resins are constantly being reformulated to produce more ideal restorative materials. the clinician can effectively reduce chair time and increase cost-effectiveness. and adhesive resin into a single paste that is mixed immediately before use. California). an over-the-counter product. This new class of materials has a unique internal structure and properties which contain nano-fillers that are 0. the authors . may be possible in the future. A report that tested a nano-filled composite. resulting in increased convenience and reduced costs for the patient. low shrinkage. Grandio. Orange. Bishara and A. orthodontists have been able to adopt some of these innovations and use them in clinical practice. which have the potential to further simplify the bonding process. by reducing the process of bonding orthodontic brackets to a true one-step procedure. primer. the adhesive Admira (Voco. With these advances.93 In summary. were evaluated for bonding brackets.W. Seefeld. the results indicated that there were no significant effects on the SBSs of orthodontic brackets to enamel when the bonding procedure occurred 7 and 14 days after bleaching. does not result in a significant change in the SBS to enamel. these one-step adhesives produced a SBS that was significantly weaker than controls. and greater biocompatibility than regular adhesives. These products are typically manufactured for use in operative dentistry and are marketed to be used on enamel and dentin without the need for any surface preparation. Germany) and Maxcem (Kerr. the effects of enamel bleaching on orthodontic bracket bond strength was investigated. that is. Recently. Cuxhaven. It was demonstrated that within the first half hour after bonding. Since some adults who are interested in orthodontic treatment might have also had their teeth bleached or might be interested in the procedure.005-0. Some of the external bleaching systems are applied by the clinician as an office procedure. Ostby that the newly introduced Ormocer restorative materials have a lower wear rate. In contrast. using a strong solution of hydrogen peroxide subjected to either heat or light to speed up the reaction. Grandio was found to be difficult to manipulate when placing brackets and 15% of brackets bonded using this material essentially failed before registering any force during testing.82-87 In evaluating an Ormocer based material for a potential use in orthodontics. while these new products are not yet recommended for bracket bonding at this time. Germany) as an alternative bracket bonding adhesive demonstrated that brackets bonded using Grandio were not significantly different from those bonded with a conventional orthodontic composite resin. This is possible because the product combines the etchant. However.94 In another study evaluating the effect of in-office and at-home bleaching on SBS. newer bleaching systems containing carbamide peroxide became commercially available and can be used at home. (Voco.92. Germany) can achieve SBS values that are similar to those obtained with Transbond XT (3M Unitek. various whitening systems are being used to “bleach” enamel. Recent research activity has been in the area of polymer nano-composites. Monrovia. Recently. Cuxhaven. CA).30 S. Geraldeli and Perdigao89 found that nanofilled composites had a marginal seal in enamel and dentin comparable to total-etch adhesives.E. A disadvantage with Ormocer from an orthodontic perspective is that in its present formulation it is not viscous enough to hold the bracket in position during bonding. Sybron Dental Specialties. Effect of Tooth Whitening on Bond Strength As patients are becoming more esthetically conscious.

These methods include (1) conventional methods that use pliers. they concluded that it is prudent to postpone bonding orthodontic brackets for at least 2 weeks following bleaching.11.112 Although all 3 methods can be used successfully to debond brackets. the clinician needs to be careful in debonding ceramic brackets and follow the manufacturer’s instructions regarding their recommended method for debonding their brackets.95 Metal Versus Ceramic Brackets The introduction of the direct bonding technique facilitated the construction of orthodontic appliances that are more esthetic and thus.100.101 that is.Bonding and Debonding From Metal to Ceramic observed a large variation in the SBS at 1 week after the in-office bleaching.101 Ceramics are extremely brittle. so less energy is necessary to cause a fracture of the bracket.100.102 Ceramic brackets.109-112 To reduce the rate of irreversible enamel surface damage.107.101. the early ceramic brackets used a silane coupler to act as a chemical mediator between the ceramic bracket base and the diacrylic or acrylic adhesive resin.114 other researchers have reported an increase in enamel cracks or crack length following debonding. The range of enamel damage was related to the type of bracket. and (3) a combination of both. several methods of debonding ceramic brackets have been suggested. (2) an ultrasonic method that uses special tips. Conclusions At the present time numerous bonding materials. even the smallest surface imperfections or cracks can significantly reduce the load that is necessary to fracture a ceramic bracket. The direct bonding of metal brackets was first introduced during the early 1970s.105 The fracture toughness refers to the ability of the material to resist breakage.100. and shortly after. bracket base design.113.100.108 In fact. and (3) the electrothermal method that involves an apparatus that transmits heat to the adhesive through the bracket. resist staining and slot distortion and are chemically inert to fluids that are likely to be ingested.101 Because of the earlier reports of bracket fracture and enamel surface damage that occurred during the debonding of ceramic brackets. (2) mechanical.102.115-117 Bishara et al115 reported that 18% of teeth had an increase in the number or severity of enamel cracks following the debonding of ceramic brackets.103. However. and adhesive system used.100. Three other studies have reported enamel damage ranging from 0% to 20% after debonding ceramic brackets with pliers.101 Despite these improvements. the first brackets made of monocrystalline sapphire and polycrystalline ceramic materials became widely available. minimally obtrusive.105. clinicians continue to be concerned. brittleness that can cause the bracket to fracture. and protocols have been established that have the ability to provide the clinician with adequate bracket/adhesive/enamel .116-118 As a result. As a result. the following disadvantages are associated with ceramic brackets: (1) the inability to form chemical bonds with adhesives without a coupling agent. While some studies have reported no enamel damage when debonding ceramic brackets with the appropriate pliers.100. techniques. and (3) an increased frictional resistance between metal arch wires and ceramic brackets. In the mid-1980s. plastic brackets were marketed as the esthetic alternative to metal brackets. chemical cohesion between the ceramic base and the adhesive resin is not possible.96-100 This led manufacturers to modify the plastic brackets by reinforcing the slots with metal and ceramic fillers. there are 3 different retention mechanisms available by which the base of the ceramic bracket can be made to adhere to 31 the adhesive: (1) chemical.106 Chemical retention resulted in an extremely strong bond that caused the enamel-adhesive interface to be stressed during debonding. the clinical problems of distortion and staining persisted. These polycarbonate brackets quickly lost favor because of discoloration and slot distortion caused by water absorption.101 At the present time. unlike plastic brackets. Consequently. (2) a low fracture toughness.104 Because of the inert composition of the aluminum oxide from which the ceramic brackets are made. the use of pliers to apply a shear or tensile force on the bracket is perhaps the most convenient and continues to be the most popular method used for debonding brackets.

Carol Stream. most orthodontic bonding systems are evaluated by performing SBS tests on universal testing machines. Gwinnett AJ. Inc. 1955 2. Britton JC. it is important for the clinician to realize that most bond strength tests are performed in vitro. as has been described. efforts have been made to compare in vivo and in vitro SBS to elucidate the differences. NY. and the values were compared with SBS obtained on previously extracted teeth which had been subjected to in vitro testing. Rolla G. Br Dent J 119:7780. 2004. Carol Stream. Ostby SBS. Weinberg R.123 References 1. Buonocore MG: Adhesion and caries prevention: a preliminary report. Part 1: lesion development. Shannon IL: Decreasing the depth of etch for direct bonding orthodontics. Thus. J Clin Orthod 16:130132. These teeth were subjected to the oral environment for 1 week. Quintessence Publishing Co. Summitt JB.. and that intraoral bond strengths may not be as high as those reported using in vitro models. Bishara SE.120 As a result. Eliades T. In Vitro Versus in Vivo Shear Bond Strength Additionally. it is important for the clinician to be aware of how these variables affects SBS and apply this knowledge to help select the optimal bonding adhesive/technique. et al: Fundamentals of Operative Dentistry: A Contemporary Approach. Arch Oral Biol 13:61-70. Am J Orthod 75:667-677. Powers JM. 1979 7. Kleinberg I: Effect of orthodontic band placement on the chemical composition of human incisor plaque. J Dent Res 34:849-853. Inc. the brackets were bonded to premolars which were planned for extraction. there are many variables in the oral environment that may affect bond strengths and cannot be simulated on an in vitro model. it has been suggested that the SBS values obtained in in vitro bond strength tests may not be clinically applicable. Using a special appliance designed to debond brackets in vivo while recording SBS. bracket SBS is influenced by many variables which may or may not be under the clinician’s control. 1980 14. Messersmith LM: Enamel etching and bond strength. Am J Orthod Dentofacial Orthop 98:348-353. pp 30. in Brantley WA. Athanasiou AE (eds): Risk Management in Orthodontics: Experts Guide to Malpractice. Hajrassie and Khier122 demonstrated similar reductions in intraoral bracket SBS when comparing them to an in vitro control. Teeth were mounted and subjected to bond strength testing. In one study. The physical relationship between enamel and adhesive. 1988 9. However. Gwinnett AJ. IL.32 S. the clinician should be cognizant to the fact that accurately comparing bond strengths between different studies may be difficult. McInnes P. it is important to realize that due to the difficulties involved with accurately and consistently testing bond strengths intraorally. Gwinnet JA. Shaffer SE: Effects of enamel etching time on bond strength and morphology. However.W. 1990 12. Mardaga WJ. 1967 5. These findings were consistent when bond strength tests were performed 10 minutes 24 hours 1 week. 1982 . 1979 8. Arch Oral Biol 12:1615-1620.. New York. due to the lack of standardization of bond strength testing. Ceen F: Plaque distribution on bonded brackets. Gwinnett AJ: Penetration of resin dental materials into enamel surfaces with reference to bonding. pp 105-122 11. 2000. Buonocore MG. Am J Orthod Dentofacial Orthop 94:68-73. The authors observed a 72% decrease in tensile bond strength and a 48% decrease in SBS when the in vivo premolars were compared with the in vitro samples. 2006:chap 8 6. 1968 3. Øgaard B.119 Thus. 3rd ed. Buonocore MG: A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. the authors found that the mean in vivo bond strengths were approximately 40% less than those in the in vitro groups. Arch Oral Biol 75:667-677. et al: Shear bond strength of ceramic orthodontic brackets to enamel. Additionally. Arends J: Orthodontic appliances and enamel demineralization. J Dent Res 59: 1156-1162. Matsui A: A study of enamel adhesives. Robbins JW. at which time the patients returned and had the teeth with the bonded brackets extracted. Eliades T (eds): Orthodontic Materials: Scientific and Clinical Aspects. Therefore.121 Recently. Bishara and A. and 4 weeks after bonding. etching time and period of water immersion. Beech DR. -32:chap 3 10. over the course of treatment. Quintessence Publishing Co. Matsui A. Gwinnett AJ. Hilton TJ. Duschner H: Enamel effects during bonding-debonding and treatment with fixed appliances. in Graber TM. Theime. J Clin Orthod 19:165-178. Jalaly T: Bonding of polymers to enamel: influence of deposits formed during etching. 1985 13. Barkmeier WW.E. Øgaard B. IL. Chatterjee R. 1965 4.

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