ORIGINAL ARTICLE

Shear bond strength of composite, glass ionomer, and acidic
primer adhesive systems
Samir E. Bishara, BDS, DDS, DOrtho, MS,a Valeria V. Gordan, DDS, MS,b Leigh VonWald, BA,c and
Jane R. Jakobsen, BA, MSd
Iowa City, Iowa, and Gainesville, Fla

The purpose of this study was to determine the shear bond strengths of orthodontic brackets bonded with
one of three methods: (1) a glass ionomer adhesive with a 20% polyacrylic acid enamel conditioner; (2) a
composite resin adhesive used with 37% phosphoric acid etchant and a conventional primer; or (3) the
same composite resin used with an acidic primer that combines the etchant with the primer in one
application. The brackets were bonded to the teeth according to one of three protocols. Group I teeth were
etched with 37% phosphoric acid and bonded with Transbond XT (3M Unitek, Monrovia, Calif) following the
manufacturer’s instructions. Group I acted as the control group. Group II teeth were etched with an acidic
primer (Clearfil Liner Bond 2. J.C. Moritta Kuraway, Japan) that contains both the acid (Phenyl-P) and the
primer (HEMA and dimethacrylate) and was placed on the enamel for 30 seconds; the adhesive used to
bond the brackets was Transbond XT as in Group I. Group III teeth were etched with 20% polyacrylic acid
and the brackets were bonded with Fuji Bond LC (G.C. America, Chicago, Ill). A steel rod with one flattened
end was attached to the crosshead of a Zwick test machine (Zwick GmbH & Co, Ulm, Germany). An
occlusogingival load was applied to the bracket, producing a shear force at the bracket-tooth interface. The
results indicated that the resin/phosphoric acid adhesive system (control group) provided the strongest
shear bond strength – x = 10.4 ± 2.8 MPa). The glass ionomer adhesive system provided a significantly lower
bond strength (x–x = 6.5 ± 1.9 MPa). The least shear bond strength was present when the acidic primer was
used with an orthodontic adhesive (– x = 2.8 ± 1.9 MPa). In the present study, the use of either a fluoride-
releasing glass ionomer or an acidic primer in combination with an available orthodontic composite
adhesive resulted in a significantly reduced shear bond strength when compared with that of the
conventional composite resin adhesive system. At the present time, the orthodontist and the patient are
better served by using phosphoric acid/composite resin adhesive system or other equivalent systems that
provide a clinically reliable bond strength between the bracket, the adhesive, and the enamel surface. (Am J
Orthod Dentofacial Orthop 1999;115:24-8)

I
n their attempt to minimize the incidence of cooperation and that the fluoride ion should diffuse or
decalcification around orthodontic appliances, ortho- dissolve over a prolonged period. In addition, it would
dontists have always emphasized the need for good oral be beneficial if the fluoride ion release were site spe-
hygiene.1 The role of fluoride in preventing caries has cific to those areas most susceptible to demineraliza-
also been well documented.2,3 As a result, the applica- tion, namely, adjacent to bonded orthodontic brackets.
tion of fluoride solutions topically to the etched tooth Underwood et al14 examined in vivo, the durability and
during bonding and the use of fluoride rinses during caries-inhibition properties of a fluoride-exchanging
treatment have been suggested.4 In addition, several resin for 60 days after bonding. They concluded that
fluoride-releasing cements have been developed and the fluoride-exchanging resin has a caries-preventive
used clinically to reduce decalcification.5-7 potential and reduces the incidence of very early dem-
Fluoride-releasing resins have been studied for ineralization of enamel around orthodontic appliances.
more than 30 years.8-12 In discussing fluoride-releasing Fluoride-releasing composite resins have been
materials, Gwinnett and Ceen13 recommended that flu- introduced for clinical use; some were discontinued
oride availability should be independent of patient because of an increased incidence of bond failure. Fur-
thermore, the composite resin initially released fluoride
aProfessor, Orthodontic Department, College of Dentistry, University of Iowa. in very small amounts, with no measurable fluoride
bInstructor, Department of Operative Dentistry, University of Florida. release detected after 3 days.15,16 In a study on a light-
cResearch Assistant, College of Dentistry, University of Iowa.
dAdjunct Assistant Professor, Department of Preventive and Community Den-
cured fluoride-releasing resin, Chan et al17 evaluated
tistry, College of Dentistry, University of Iowa. its various properties including fluoride release, tensile
Reprint requests to: Professor Samir E. Bishara, BDS, DDS, DOrtho, MS, bond strength, and polymerization through metal
Orthodontic Department, College of Dentistry, University of Iowa, Iowa City, brackets. They concluded that the tensile bond strength
IA 5242
Copyright © 1999 by the American Association of Orthodontists. of the fluoride-releasing resin was significantly less
0889-5406/99/$8.00 + 0 8/1/88896 than the conventional resin at 2 and 42 days after bond-
24

Furthermore. glass-ionomer liners includes high compressive resis- tance.32 Each bracket was subjected to a 300 g force. . into three groups. to the enamel surface _ can provide clinically acceptable est in areas outside the brackets. Ill).22-24 attempts were made to improve their the same composite resin used with the newly intro- physical properties to make them more useful in areas duced acidic primer that combines the etchant with the where strength is of primary importance. eg.) is a light-cured resin.27. with no agents. J. Liner glass-ionomer materials are shear bond strength of orthodontic brackets bonded differentiated from other glass-ionomer cements by with one of three methods: (1) a glass ionomer adhesive their extremely small particle size (about 5 µm or less).18.31 Combining condition. regardless of the expo.C.American Journal of Orthodontics and Dentofacial Orthopedics Bishara et al 25 Volume 115. They also found that the composite resin was hard.28 Fuji Bond L.30. Unitek. Japan) that contains both the acid ing and priming into a single treatment step saves time (Phenyl-P) and the primer (HEMA and dimethacrylate) and should increase the cost-effectiveness of the pro.4 MPa) when used with sure time. A unique characteristic of some new trol group. • Group II: Teeth were etched with 20% polyacrylic acid etching systems is that they combine the conditioning and the brackets were bonded with Fuji Bond L. hydrogen peroxide. shear bond forces (x = 10. Ill. This group acted as the con- an adhesive resin.C. used to bond the brackets was Transbond XT as in Group These new acidic primers were used originally on I.4 ± 4. or (3) of fluorides.2 mm. 3M to the glass-ionomer acid chains. agents into a single acidic primer solution that can be • Group III: An acidic primer (Clearfil Liner Bond 2. bonded with Transbond XT (3M Unitek) following the namely an enamel conditioner. ished with nonfluoridated pumice and rubber prophy- ing the chemical bond. (G. Mixing the components of the lactic cups for 10 seconds and randomly separated material initiates the conventional glass-ionomer acid. a highly (77%) filled adhesive (Panavia 21). and liners. The authors suggested that more research was needed to Glass Ionomers determine whether the currently available orthodontic In general. The criteria for tooth selection included: reinforced glass ionomer used as a dentin/enamel intact buccal enamel. Number 1 ing. restorative The purpose of this study was to determine the material. Monrovia. dentin. (2) a Because of the favorable characteristics of glass composite resin adhesive used with either a 37% phos- ionomer liners.30. was placed on the enamel for 30 seconds. Properties of primer in one application. thus facilitat. Like conventional bonding ment chemical agents. MATERIAL AND METHODS oride. Chicago. Chicago.18-28 particularly the long-term release phoric acid etchant and a conventional primer. America. with a 20% polyacrylic acid enamel conditioner. Calif) were used in this study. The adhesive cedure to the clinician and indirectly to the patient. lected and stored in a solution of 0. The teeth were cleansed and then pol- the surface for the resin tag to interlock. Bonding Procedure The brackets were bonded to the teeth according to Acidic Primers one of following three protocols: Conventional adhesive systems use three different • Group I: Teeth were etched with 37% phosphoric acid and agents when bonding orthodontic brackets to the tooth. glass ionomer products are divided into adhesive systems can be used with an acidic primer.25 average bracket base surface area was determined to be A glass ionomer hybrid was also introduced29 that 12. ume) thymol.C. exposure to visible light initiates polymerization of both the water-soluble Brackets Used resin monomers and the methacrylate groups attached Orthodontic metal brackets (Victory Series. (Phenyl P) and priming (HEMA and dimethacrylate) America.33 three different categories: luting cement. cracks due to the pressure of the extraction forceps.25 low thermal conductivity. The tion to the spontaneous polymerization of HEMA.C.22-24 radio-opacity. and manufacturer’s instructions. This occurs in addi.C. acrylic acid) that removes the smear layer and prepares and no caries. used on enamel and dentin. a primer solution.2 combines the properties of composite and glass ionomers.18 effective bonding to dentin.19-21 release of flu. base setting reaction. not subjected to any pretreat- bonding agent and liner. fol- The findings from a recent study 33 indicated that lowing which excess bonding resin was removed with the use of acidic primers to bond orthodontic brackets a small scaler. Moritta Kuraway.1% (weight/vol- (G.26 Teeth and higher dentinal bond strengths than conventional Seventy freshly extracted human molars were col- glass-ionomer restorative material. this product has its own conditioner (20% poly.

–x = Mean SD = Standard deviation. The ARI scores were also used as a more bond/phosphoric acid group (ie. 2. When allel to the force applied. a Duncan’s multiple range test was used to identi- ples were stored in deionized water at 37°C for 48 fy which of the groups were different.Ratio = 79. A mounting significant differences existed between the various jig was used to align the facial surface of each tooth to groups. hand.26 Bishara et al American Journal of Orthodontics and Dentofacial Orthopedics January 1999 Table I. Lake Bluff.001) composite remained.3. P = .8 under ×10 magnification. RESULTS A computer electronically connected with the Zwick Shear Bond Strength Comparisons test machine recorded the results of each test. the ARI scores under 1 and 2 were com- end was attached to the crosshead of a Zwick test bined as were groups 4 and 5.4-19. Statistical Analysis less residual adhesive left on the enamel after debond- Descriptive statistics including the mean. indicates that no composite remained on the enamel. *Groups with different lettering are significantly different from each other (P ≤ . the teeth and brackets were examined with Transbond/phosphoric acid etch (x = 10. With the glass ionomer.05).9 1.0001.9 MPa). Any adhesive remaining after MPa). less than 10% of composite remained on the tooth sur. The use sive Remnant Index (ARI) and scored with respect to of an acidic primer with the Transbond _adhesive pro- the amount of resin material adhering to the enamel duced the lowest shear bond strength (x = 2. with the Transbond/acidic primer group. more than 10% but less than 90% of the com. Adhesive Remnant Index (ARI) Comparisons face. and the bracket base. The chi-square hours. 4.4 2. and minimum and maximum values were testing. 3. When compared _ After failure. Ulm. During testing. P = Probability. sent.8 ± 1. There was a greater remained on the tooth along with the impression of the frequency of ARI scores of 1 and 2 with the Trans- bracket base. so its labial surface was par.34. The ARI scale has a range between 5 and 1: 5 MPa). standard ing).9 3. All sam.1-7. the adhesive.5 ± 1. If a statistically significant difference was pre- be perpendicular with the bottom of the mold.8 C F .05.9 surface. Descriptive statistics in MegaPascals (MPa) and results of analysis of variance comparing the shear bond strength of the three groups tested Groups tested –x SD Range P* Transbond + phosphoric acid 10. all of the composite between the three groups tested. Significance for all sta- machine (Zwick GmbH & Co.1 A Fuji bond LC 6. the glass ionomer adhesive had a significantly _ bracket removal was assessed according to the Adhe. there was a higher frequency of ARI scores of 4 and 5 (ie. two of the brackets failed before deviation. Debonding Procedure calculated for each of the three groups of teeth tested. A steel rod with one flattened calculating χ2. occlusogingival load was applied to the bracket base. more residual adhesive complex means of defining the sites of bond failure was left on the enamel after debonding).6 B Transbond + acidic primer 2. Shear The descriptive statistics for the shear bond bond strengths were measured at a crosshead speed of strengths of the three groups tested are presented in 5 mm/minute. Table I. The teeth were embedded in acrylic placed in phe.8 1. and 1. Ltd. P = .5 1. Analysis of variance indicated that the shear bond strengths of the three groups were significantly Residual Adhesive different from each other (P = . Furthermore. The results of the χ2 comparisons indicated that posite remained on the tooth. An tistical tests was predetermined at P ≤ . Ill).8 6.5-10. more than 90% of the there were significant differences (χ2 = 39. each tooth was oriented with the (χ2) test was used to determine significant differences testing device as a guide. The analysis of variance was used to determine whether nolic rings (Buehler. there was a greater fre- .4 ± 2. lower shear bond strength (x = 6.0001). in the ARI scores between the different groups. Germany). producing a shear force at the bracket-tooth interface. On the other between the enamel.

ie. J Am Dent Assoc 1957. The cation after etching. Addition of stannous fluoride to orthodontic cement. Carlos JP. quency of ARI scores of 3 (ie. The use of glass ionomer adhesive systems has the the orthodontist and the patient are better served by advantage of releasing fluoride ions from the bonding using a phosphoric acid/composite resin adhesive sys- material. Swartz ML. Schrotenboer GH. The latter combinations and resulted in higher materials has been an essential part of the bonding pro. the yet it was still above the minimal bond forces required adhesive. used in restorative dentistry and was _ found to provide 3. J Am Dent Assoc 1982.102:473-4. primer was combined with a highly filled adhesive 2.8 ± 1. acidic primers. Panneton MJ. 3 = > 10% but < 90% remains on tooth. However.8 MPa). oride releasing orthodontic adhesives on bracket bond strength. tion that can be successfully used to bond orthodontic 8. 5. Shannon IL. J Am Dent Assoc 1981.5 ± 1. There was a tendency to have less residual adhesive remaining on the tooth DISCUSSION when an acidic primer was used. 1 4 15 20 *1 = All composite on tooth. el. est to the clinician (Table II). The glass In the present study. two types of adhesives with tooth surface and the bracket (higher frequency of ARI different types of etchant and primers were compared. On the other hand. and the enamel surface until a compatible for orthodontic purposes suggested by Reynolds. tendency for the adhesive to be equally present on the In the present study. Bradley EL.34 acidic primer/orthodontic adhesive is introduced to The use of acidic or self-etching primers is thought the market. cally reliable bond strength between the bracket. Skibell RB.9 MPa). 2 = > 90% of composite on tooth. frequency of ARI scores of 1 and 2.30-32 In an earlier study. On the improve our ability to maintain a clinically useful bond other hand.4 ± 2.4 ± 4. Effect of certain restorative materials on solubility of enam- brackets. the shear bond strength tem or other equivalent systems that provide a clini- was not found to be as strong as with composite resins. Bishara SE. to simplify the clinical handling of adhesive systems by combining the etching step with primer application in REFERENCES one mix. frequency of ARI scores of 4 and 5 as compared with olutionized and improved the clinical practice of ortho. Frequency distribution of the Adhesive Remnant Index (ARI) of the three groups evaluated ARI Scores* Groups tested 1 2 3 4 5 N Transbond + phosphoric acid 2 8 8 6 1 25 Fuji bond LC . J Clin Orthod 1981. Rezich PM. Barkmeier WW. Therefore. The lowest nation with an available orthodontic composite adhe- shear bond strength was present when the _acidic primer sive resulted in a significantly reduced shear bond was used with an orthodontic adhesive (x = 2. .9 strength when compared with that of the conventional MPa). Phillips RW. comparable shear bond strength (x x = 10. 5 = no composite remains on tooth.11:131-5. In vitro evaluation of fluoride and non-flu- find an acidic primer-orthodontic adhesive combina. The results indicated that the resin/phosphoric acid adhesive system (control CONCLUSIONS _ group) provided the strongest shear bond strength x = 10. more research is needed to 7. there was a higher The direct bonding of orthodontic brackets has rev.79:523-34. The findings on the ARI scores should be of inter- sive on the tooth as it was on the bracket). with the glass ionomer there was a greater strength while minimizing the amount of enamel loss. score of 3). the scores when phosphoric acid was used as an dontics.15:694-706. Abadir EA. Sadowsky PL.American Journal of Orthodontics and Dentofacial Orthopedics Bishara et al 27 Volume 115. Am J Orthod Dentofacial Orthop 1989.104: 193-7. Int J results from the present study indicated that current Orthod 1973. Prevention of decalcification in orthodontic patients. Shannon IL. Fluoride benefits—after 30 years.1: 101-4. .95:259-60. This should be cedure in order to allow good wetting and penetration advantageous to the clinician because it will require of the adhesive tags. The use of acid etchants followed by primer etchant. Number 1 Table II. the use of either a fluoride- ionomer adhesive system provided a significantly releasing glass ionomer or an acidic primer in combi- _ lower bond strength (x = 6. composite resin adhesive system. there is a need to less time to clean the teeth after debonding.33 the same acidic 1. Enamel fluoride uptake from orthodontic cement and its effect on demineralization.54:623-6. At the present time. there was as much adhe. Retief DH. 4 = < 10% composite on tooth. Am J Orthod 1981. The prevention of dental caries: ten years later.4 MPa) 4. J Esthet Dent 1989. The effects on the bonding strength of fluoride appli- as conventional orthodontic adhesive systems. orthodontic adhesives might not be compatible with 6. 2 16 4 1 23 Transbond + acidic primer . Chan D.

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