Dental Materials Journal 2015; 34(1): 41–47

Comparison of enamel-bracket bond strength using direct- and indirect-bonding

techniques with a self-etching ion releasing S-PRG filler
Teresa FLORES1, Juan R. MAYORAL2, Lluís GINER3 and Andreu PUIGDOLLERS1

1
Department of Orthodontics, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
2
Department of Restorative Dentistry, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Barcelona, Spain
3
Department of Biomaterials, Universitat Internacional de Catalunya, School of Dentistry, Josep Trueta, s/n, 08195, Sant Cugat del Vallés, Barcelona,
Spain
Corresponding author, Andreu PUIGDOLLERS; E-mail: apuigdollersp@gmail.com

This in vitro study compared the shear bond strength (SBS) and adhesive remnant index (ARI) of two systems for bonding orthodontic
brackets to enamel. The first system involved a self-etching primer (Beauty Ortho Bond, BO) containing surface pre-reacted glass
filler. The second involved a primer applied with phosphoric acid etching (Transbond XT, TX). Ninety-six extracted human premolars
were divided into eight groups: Group I (TX/direct bonding), Group II (TX/indirect bonding), Group III (BO/direct bonding), and Group
IV (BO/indirect bonding). Groups V-VIII were identical to Groups I–IV, respectively, but were also subjected to 1,500 thermal cycles
between 5 and 55°C. ARI was scored by binocular microscopy. SBS was analyzed by three-way ANOVA and the Bonferroni test. ARI
was analyzed by the chi-squared test. The BO groups showed lower SBS and ARI results than the TX groups. SBS was significantly
influenced by the primer material, bonding technique, and thermal cycling.

Keywords: Shear bond strength, Self-etching, Direct bonding, Indirect bonding, Enamel loss

solution, and an adhesive resin. Although most clinicians

INTRODUCTION
The acid-etching bonding technique, introduced by
Buonocore1) in 1955, has revolutionized the bonding of
orthodontic brackets2,3). Newman described the first use
of acid-etching in bonding orthodontic brackets with an
epoxy-derived resin3,4). In 1972, Silverman and Cohen5)
introduced the first indirect bonding process, in which
the brackets before bonding were positioned on a cast
model of the patient, and then successively transferred to
the patient’s mouth via customized trays. Development
of this technique reduced the chair time and operator
stress, increased the precision and accuracy of bracket
placement, reduced the need for re-bonding, and,
consequently, reduced enamel loss6,7). Enamel loss due
to demineralization around the brackets can also result
from plaque accumulation, independent of the bonding
technique8).
When a direct technique of bracket bonding is
compared with the indirect bonding technique, it is
shown that the bonding protocol of indirect bonding is
less technical sensible, and the bonding is performed in
a one step procedure, in other hand, the direct technique
requires more skills and experience, also the position of
the bracket it is not always accurate6,7,9), when a self-
etch adhesive is used with the indirect bracket bonding
technique, this method could be more simplified and
bonding performance would be comparable with the
acid-etching technique10).
Over the years, several studies have compared
direct and indirect bonding in vitro7,9) and in vivo11,12).
Most of these have compared light-cured and chemical-
cured sealants7,9-12). These sealant materials require
three different agents: an enamel conditioner, a primer
accept 37% phosphoric acid as the standard enamel
conditioner, some authors argue that acid etching
produces an iatrogenic effect that results in enamel
surface loss, estimated at between 10 and 30 μm13-15).
Furthermore, the resin tag can penetrate up to 50 μm
into the enamel. Cleanup of the adhesive after bracket
removal produces a total enamel loss of between 50 and
55.6 μm13-17).
To reduce enamel loss and simplify bonding, self-
etching primers have been introduced in orthodontics18).
A new self-etching primer, which contains surface pre-
reacted glass-ionomer (S-PRG) filler, has been shown
to inhibit demineralization. The S-PRG filler has been
shown to inhibit demineralization by releasing of Al,
Si, and Sr19,20). Although sereval studies have compared
direct and indirect bonding in vitro and in vivo, there has
not been comparison between the two bonding methods
when the brackets were cemented by means of a self-
etching primer.
The aim of this in vitro study was to evaluate the
shear bond strength (SBS) of two bonding methods
with a direct and indirect bonding a self-etching primer
containing S-PRG filler, and compared SBS the same
methods with phosphoric acid etching. This study
evaluated how thermal cycling influences the SBS of the
two systems and assessed the adhesive remnant index
(ARI)21).
MATERIALS AND METHODS
Specimen preparation
Ninety-six human premolars extracted for orthodontic
reasons were collected and stored in distilled water at

Received May 12, 2014: Accepted Aug 18, 2014

doi:10.4012/dmj.2014-138 JOI JST.JSTAGE/dmj/2014-138
42 Dent Mater J 2015; 34(1): 41–47

37°C. This in vitro study received approval from an
ethics committee at the Universitat Internacional de
Catalunya (Sant Cugat, Catalunya, Spain). All teeth
were cleaned and polished with pumice using rubber
cups and fluoride-free paste (Detartrine, Septodont,
Saint-Maur-Des-Fossés, France) applied with a low-
speed handpiece (10 s). Teeth were washed with water
(30 s) and dried with an oil-free air source before
bonding. All samples were mounted with a custom-made
jig (Fig. 1) to standardize the position of the teeth, with
the buccal surface of the teeth parallel to the direction
of the force during the SBS test. Teeth were attached
with wax to the jig and placed in a container filled with
cold-cured acrylic.
For indirect bonding, samples were mounted in
blocks, each holding four teeth. Samples for direct
bonding were mounted individually (Fig. 1). A working
model was manufactured for the samples used for
indirect bonding. A silicone impression (Hydrorise Putty
Fast; Zhermack, Marl, Germany) of the mounted teeth
was made, and hard stone (Elite Model, Zhermack) was
poured into the impression. The working model was set
overnight, covered with a layer of separating medium
(Prothyl Isolator, Zhermack), and left to dry for 20 min.
Experimental groups
Materials used in this study are listed in Table 1.
Teeth were randomly divided into eight groups (n=12),
according to the adhesive system and bonding method
used. Premolar stainless steel brackets with a 0.022-inch
slot (Victory series; 3M/Unitek Corp., Monrovia, CA,
USA) were used. The average bracket base area was 9.75
mm2. The bonding procedure was performed according
to the manufacturer’s instructions, as described below.

Fig. 1 Representative images of the custom-made jig for standardize the position of the
teeth.
(a) Direct bonding; (b) Indirect bonding views. Representatives images of a bonded
tooth set in an acrylic block and positioned in the testing machine. (c) Direct bonding;
(d) Indirect bonding views.

Table 1 Composition and handling procedure of the adhesive systems tested

Material Manufacturer Components (Lot No.) pH Composition

35% phosphoric acid, tetraethyleneglycol

3MUnitek, Etching gel:(DF5JW9)
Transbond dimethacrylate (TEGDMA), bisphenol-A-diglycidel
Monrovia, primer:(DF5JW); 1.39
XT methacrylate (Bis-GMA); Bis-GMA, TEGDMA, silane-
California, USA paste: (DF4JW)
treatedquartz, amorphoussilica, camphorquinone

Primer A: (1010); Water, acetone, others, phosphoric acid monomer,

Beauty Shofu,
primer B: (1010); 2.20 ethanol, TEGDMA, surface pre-reacted glass-ionomer,
Ortho Bond Kyoto, Japan
paste: (1010) filler, Bis-GMA, camphorquinone
 Dent Mater J 2015; 34(1): 41–47 43

1. Group I: TX (Transbond XT, 3M/Unitek Co., California,
USA)/direct bonding
Teeth were etched with acid (35% H3PO4) for 30 s, washed
for 20 s with an air-water spray, and dried to a chalky
white appearance. The TX primer was applied to the
etched surface. Brackets were bonded with TX and light-
cured by LED curing light (Bluephase, Ivoclar Vivadent,
Schaan, Liechtenstein) for a total of 30 s, divided into
three, 10-s intervals on the mesial, distal, and occlusal
sides, respectively.
2. Group II: TX/indirect bonding
Brackets were bonded on the working model with TX
and light-cured by the same protocol as for Group I.
Transfer trays were made from clear addition silicone
which can be light-cured through (Elite Glass; Zhermack,
Marl, Germany), and had a working time of about 40
s. After the transfer trays had set, they were soaked in
warm water for 30 min and removed from the models.
Composite adhesive on the custom bracket base was
cleaned by sandblasting (Dento-prep; Ronvig, Daugaard,
Denmark) for 3 s and 2–10 mm distance, aluminium
oxide 50 µm and 2 bar were used to remove stone and
separating medium. Enamel was prepared by the same
direct-bonding procedure as for Group I. The transfer
tray was placed over the mounted teeth. The adhesive
was light-cured by the same protocol as for Group I.
by using the flattened end of a steel rod, which was
attached to the crosshead of the testing machine. The
SBS was calculated by dividing the load by the base area
of the bracket (9.75 mm2).
Adhesive remnant index evaluation
The ARI on the enamel surface was examined under a
SZ40-PT binocular microscope (Olympus; Tokyo, Japan)
using 4× magnification. The ARI of each sample was
scored according to the method of Årtun21). The ARI
score measures bond failure by assessing the amount
of adhesive left on the tooth as follows: 0, no adhesive
remaining; 1, less than half of the adhesive remaining;
2, more than half of the adhesive remaining; 3, all
adhesive remaining.
Statistical analysis
Three-way analysis of variance (ANOVA) was used to
determine the significant differences among the samples
consisting of different materials and subjected to various
bonding methods, thermal cycling, and combinations
thereof. The Bonferroni test was used to analyze multiple
comparisons. Chi-squared analysis was used to test the
significance of differences in the distributions of the ARI
scores. Results were analyzed with a statistical software
program (Statgraphics; Warrenton, VA, USA). The level
of statistical significance was set at p≤0.05.

3. Group III: BO (Beauty Ortho Bond, Shofu, Kyoto, RESULTS

Japan)/direct bonding
Teeth were conditioned with self-etching primer after
mixing the two components (Primer A and Primer B).
The brackets were bonded with BO and light-cured by
the same protocol as for Group I.
4. Group IV: BO/indirect bonding
Brackets were bonded on the working model with BO
and light-cured by the same protocol as for Group I.
Transfer trays were made by the same process as for
Group II. Enamel was prepared with the same direct-
bonding procedure as for Group III. The transfer tray
was placed over the mounted teeth, and the adhesive
was light-cured by the protocol as for Group I.
5. Groups V, VI, VII and VIII
These groups were identical to Groups I, II, III, and IV,
respectively, but were also subjected to thermal cycling
according to the ISO11405 recommendation22). Each
specimen underwent 1,500 complete cycles between 5
and 55°C in distilled water, with a dwell time of 1 min.
Shear bond strength
Table 2 presents the descriptive statistics of SBS. The
highest mean SBS value (14.99±2.64 MPa) was observed
for Group I, and the lowest mean value (6.46±2.14 MPa)
was observed for Group VIII. Three-way ANOVA (Table
3) showed that the SBS was significantly influenced
by the materials, bonding techniques, and exposure to
thermal cycling (p<0.05). The three-way interaction
between materials and thermal cycling showed that the
Table 2 Descriptive and comparative statistics of shear
bond strength for two adhesive systems
Shear Bond Strength (MPa)
Group Mean SD
I 14.99 2.64
II 13.40 2.69

Debonding procedure III 11.38 3.66

All teeth were stored in distilled water at 37°C for 24 IV 9.06 3.30
h. The SBS was tested on a universal testing machine
(Quasar 5; Galdabini, Cardano al Campo, Italy) at a V 14.54 2.67
crosshead speed of 0.1 mm/min. The buccal surface of VI 13.20 2.01
each tooth was placed parallel to the direction of the
force of the machine (Fig. 1). An occlusogingival load VII 7.23 2.85
was applied to each bracket, producing a shear force at
VIII 6.46 2.40
the bracket-tooth interface. This step was accomplished
44 Dent Mater J 2015; 34(1): 41–47

Table 3 Three-way ANOVA test of factors influencing SBS (*p<0.05): materials (MAT), bonding techniques (BT) and
thermal cycling (T)
Source Sum of Squares Freedom of Motion Mean Square F P

MAT 725.72 1 725.72 93.45 0.00*

BT 54.13 1 54.13 6.97 0.00*

T 82.83 1 82.83 10.6 0.00*

MAT × BT 0.03 1 0.03 0.00 0.94

MAT × T 55.95 1 55.95 7.2 0.00*

BT × T 4.88 1 4.88 0.63 0.42

MAT × BT × T 2.57 1 2.57 0.33 0.56

Error 691.16 89 — — —

Total 1614.2 95 — — —

Table 4 Results of Bonferroni test for comparing the influence of materials (MAT), bonding techniques (BT) and thermal
cycling (T)

Groups Contrast Sign. Difference Limits

MAT BO-TX p<0.05 −5.49 1.30

BT DB-IB p<0.05 1.50 1.30

T NT-T p<0.05 1.85 1.30

* TX (TransBond XT), BO (Beauty Ortho Bond), DB (direct bonding)

IB (indirect bonding), NT (Not Thermally cycled), T (Thermally cycled)

Table 5 Distribution frequency and percentages of adhesive remnant index (ARI). The level of statistical significance
was set at p≤0.05
ARI Score (%)
Groups
0 1 2 3 n
I 2 (16.67) 5 (41.67) 3 (25.00) 2 (16.67) 12
II 4 (33.33) 3 (25.00) 2 (16.67) 3 (25.00) 12
III 6 (50.00) 4 (33.33) 1 (8.33) 1 (8.33) 12
IV 6 (50.00) 4 (33.33) 2 (16.67) 0 (0.00) 12
V 2 (16.67) 7 (58.33) 2 (16.67) 1 (8.33) 12
VI 3 (25.00) 5 (41.67) 4 (33.33) 0 (0.00) 12
VII 9 (75.00) 1 (8.33) 2 (16.67) 0 (0.00) 12
VIII 8 (66.67) 4 (33.33) 0 (0.00) 0 (0.00) 12

χ2=31.93, p value=0.05

TX samples were influenced by thermal cycling to a lesser
extent than the BO samples (p<0.05; Table 3). Thermal
cycling decreased the SBS values for both bonding
techniques (indirect and direct bonding, p<0.05; Table
3). Indirect bonding caused a statistically significant
decrease in the SBS values of the two materials (TX and
BO; Table 3). The Bonferroni test showed statistically
significant differences for multiple comparisons between
different groups (Table 4).
Adhesive remnant index
Table 5 shows the ARI scores after debonding. Chi-
 Dent Mater J 2015; 34(1): 41–47
Fig. 2 Representatives images for ARI.
(a) the ARI score 0, no adhesive remaining; (b) the ARI score 1, less than half of the
adhesive remaining;(c) the ARI score 2, more than half of the adhesive remaining; (d)
the ARI score 3, all adhesive remaining.
squared analysis (level of statistical significance was set
at p≤0.05) comparing the ARI scores among all groups
(χ2=31.93) indicated that the groups were significantly
different (p=0.05). TX had a greater frequency of ARI
values of 2 and 3 (Fig. 2), whereas BO showed a greater
frequency of ARI values of 0 and 1 for all groups (Fig. 2).
Group I exhibited the highest ARI score, corresponding
to the most composite remaining on the enamel surface.
The lowest score (least composite remaining) was
observed in Group VIII.
DISCUSSION
Numerous studies have investigated the strength of
self-etching primer systems15,18,19,23-33). Most of these
studies demonstrated that self-etching systems have
significantly lower SBS values than conventional acid-
etching systems18,24,26,34,35). However, the greater SBS of
conventional phosphoric acid-etching adhesive systems
is offset by the greater extent to which these systems
erode the enamel14). Plaque accumulation around fixed
orthodontic appliance is another major cause of enamel
demineralization8).
The present study aimed to analyze whether the
SBS of an indirectly bonded system, using a self-etching
primer containing S-PRG filler as a fluoride-releasing
source, could be considered clinically acceptable. This
self-etching primers is less abrasive13) and inhibit the
demineralization of adjacent enamel; indirect bonding
reduces enamel loss by helping to avoid unnecessary
rebonding7,8,20). For both direct and indirect bonding, the
BO self-etching primer provided a lower SBS value than
TX with conventional etching. However, the SBS values
for all groups were greater than the 6 to 8 MPa estimated
by Reynolds to be necessary in orthodontic treatment26).
Although self-etching is clinically acceptable, it
produces weaker bonds compared to phosphoric acid
etching27-29). The findings of the present study are
further corroborated by the results of Elekdag-Turk et
al.36). Those authors compared the clinical performances
of self-etching and acid-etching systems over a 6-month
period, and reported that the two adhesive systems did
not show significant variations in failure and survival
rates. Thus, the self-etching system can be effectively
45
used for the bonding of orthodontic brackets.
The higher SBS value of conventional acid-etching
can be attributed to the etching action of phosphoric
acid, which offers the advantage of increased bond
strength. However, phosphoric acid etching causes a
greater degree of enamel loss14). Hashimoto et al.37),
evaluating the erosion of BO and TX on enamel by
atomic force microscopy, observed that TX increased
the porosity of the enamel surface and significantly
increased the enamel loss. Scougall-Vilchis et al.18,23,26)
reported that in scanning electron microscopy (SEM)
images of the enamel surface morphology, BO induced
more conservative effects than did the acid-etching
system.
The BO used in this experiment contained S-PRG
filler as a fluoride-releasing source, which contributed to
inhibiting enamel demineralization19). Fluoride release
also promotes tooth mineralization and modulates
the acidic conditions produced by oral cariogenic
microorganisms38,39). Phosphoric acid-etching adhesive
systems for the enamel result in higher SBS values than
self-etching systems, but can increase the occurrence of
caries, visible as white and brown spots around or under
the brackets after debonding19).
One other self-etching primer, Transbond Plus [TP]
(3M/Unitek Corp.), has a significantly higher mean SBS
than that of BO and produces results similar to those of
conventional etching with 35% phosphoric acid30,31). BO
displays a lower pH value and milder self-etching ability
compared to TP. The lower SBS of BO, compared to TP
and TX33), may arise from the reduced penetration of the
adhesive resin into the enamel surface. Indeed, lower
porosity in BO systems has been observed via SEM
micrographs of untreated enamel surfaces, phosphoric
acid-etched surfaces, and self-etched surfaces (TP and
BO)31,32). Enamel surfaces treated with the two self-
etched primers were demineralized to a lesser extent
than enamel surfaces conventionally etched with 37%
phosphoric acid31,32).
Numerous authors have discussed the advantages
and disadvantages of indirect bonding compared to
direct bonding, and all agree that the indirect system is
more accurate9-11). The indirect procedure was found to
provide optimal visibility of the bracket placement as the
46 Dent Mater J 2015; 34(1): 41–47
bond develops, and is less sensitive to timing. Bracket
positioning on the patient model is straightforward
and precise, and brackets can be changed easily if
necessary7). Most studies report significant differences in
the SBS of directly and indirectly bonded systems. Some
exceptions include Thiyagarajah et al.40), who compared
the clinical performance of the direct and indirect
techniques, as well as Linn et al.9) and Daub et al.41), who
observed no significant differences in the SBS of the two
techniques. Comparisons should be interpreted carefully
and with discernment by the reader, as most of the
previous studies related to indirect bonding9,40,41) have
investigated different techniques of bonding procedures
with two different types of materials, such as light-cured
and chemically cured, but these materials require the
application of a conditioner agent such 37% phosphoric
acid21),, which have showed higher mean values of SBS
than the self-etching system34,35) that has been analyzed
in the present study.
During thermal cycling tests, samples are subjected
to thermal changes and exposed to water, to simulate
the conditions of the oral cavity. In the current study,
thermal cycling reduced the mean SBS in all groups.
Significant differences were observed in the SBS values
before and after thermal cycling. Thermal cycling had a
significantly different effect on each material, producing
a larger difference in the SBS of BO compared to TX.
This difference may explain why the penetration of the
self-etching primer into the enamel was lower than
with 37% phosphoric acid15). Elekdag-Turk et al.33)
not observed significant decrease in the mean SBS of
systems that had been prepared with phosphoric acid
etching after 2,000 and 5,000 thermal cycles, whereas
systems that had been prepared with self-etching
primer showed a significant decrease of the mean SBS
value after 2,000 thermal cycles. However, Daub et al.41)
reported a significant decrease in the mean SBS of metal
brackets, directly and indirectly bonded with phosphoric
acid and TX adhesive, after only 500 thermal cycles. The
comparison of bond strength measurements of different
studies is complicated because of variety of materials
and methods, including variations in tooth type, storage
conditions, method of debonding, analysis of the results,
and the selection of products for comparison41).
The differences in the ARI scores between the two
materials investigated were statistically significant.
In the BO groups, less adhesive remained on the
enamel, which corresponded to lower SBS scores31,34). In
orthodontics, a lower ARI score is favourable because
the clinician must remove any remaining adhesive from
the tooth after debonding31,34). Significant differences
in the distribution of the ARI scores between BO,
TX, and TP indicated that the use of BO resulted in
more frequent bond failure at the enamel-adhesive
interface27,30,32). Hence, the advantage of the self-etching
BO in facilitating clean-up of the enamel surface would
be mitigated by the corresponding decrease in SBS
between the enamel and bonding resin19,27,30). Lower ARI
was observed in the indirect techniques to compare with
direct techniques. The findings of the present study are
further corroborated by the results of Klocke et al.42)
whose reported similar ARI result of indirect techniques
for TX groups after sandblasting with aluminium oxide
50 µm to remove stone and separating medium. Shinha
et al.43) observed higher ARI in the indirect techniques
when the bracket were bonded on the working model with
water soluble glue instead of resin where sandblasting
were unnecessary.
CONCLUSIONS
Within the limitations of this in vitro study, the following
conclusions could be drawn:
1. The mean values of SBS yielded by a fluoride-
releasing orthodontic adhesive (BO) were
significantly lower than those of TX with 35%
phosphoric acid etching.
2. Indirect bonding resulted in significantly lower
SBS values than direct bonding.
3. Thermal cycling decreased the SBS values of all
tested groups. BO exhibited significantly lower
SBS values than TX before and after thermal
cycling.
4. Samples prepared with TX primer and phosphoric
acid etching showed higher ARI values than
samples prepared with BO, indicating that more
adhesive remained on the teeth. Use of the BO
self-etching primer with the indirect-bonding
technique provides sufficient SBS for clinical
applications, and a reduced amount of remnant
adhesive.
ACKNOWLEDGMENTS
The authors would like to thank Shofu, 3M/Unitek, and
Zhermack, for generously providing the materials used
in this study.
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