Office Copy Thesis

“AN IN VITRO COMPARISON OF SHEAR BOND STRENGTH OF RE-BONDED
BRACKETS WITH VARIOUS IN OFFICE RECYCLING METHODS”
DISSERTATION
Submitted to Dr NTR University of Health Sciences, Vijayawada Andhra Pradesh
In partial fulfilment of the requirements for the degree of
MASTER OF DENTAL SURGERY
In Specialty of
ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS
Submitted by
Dr. JOEL ARUMBAKAN
Reg.no: D190130848
Under the guidance of
Dr. UDAY KUMAR DIGUMARTHI

PROFESSOR AND HOD
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS
ANIL NEERUKONDA INSTITUTE OF DENTAL SCIENCES
VISAKHAPATNAM
(2019-2022)
ACKNOWLEDGEMENT
ACKNOWLEDGEMENT
In the first instance, I thank the Almighty God for all his kind blessings. The
following piece of work has been possible because of contributions from the
individuals who have always been so kind, so as to devote considerable amount of
time and resource towards the accomplishment of this dissertation.
I am grateful to esteemed teacher and guide, Dr. Uday Kumar Digumarthi,
Professor and HOD, Department of Orthodontics and Dentofacial Orthopaedics, Anil
Neerukonda Institute of Dental Sciences, Visakhapatnam. A simple word of thanks is
not enough to express his support, surveillance and inspiration during this
dissertation. He has constantly given me outstanding guidance and encouragement
during my entire post-graduation.
I thank my co-guide Dr. Anil Chirla, Professor, Orthodontics and Dentofacial
Orthopaedics, who has enlightened me about the world of orthodontics with his
immense knowledge and has been an ideal teacher. His constant inspiration and
encouragement made me to be the present form.
I am deeply grateful and obliged to our Principal, Prof. Dr. L. Vamsi Krishna
Reddy for providing all the amenities needed for this study and helping me to
overcome hurdles in my professional and personal life with his words of wisdom and
heartfelt encouragement which paved way for my spiritual and mental enlightenment.
It is with great pleasure and heartfelt gratitude that I put on record, the
guidance, support and patience I received from Dr. Tarakesh Karri, Associate
Professor, Orthodontics and Dentofacial Orthopaedics.

ACKNOWLEDGEMENT
I am deeply thankful to. Dr. Meher Vineesha Cheepurupalli, Assistant
Professor for imparting Knowledge, necessary tips and guidance at each stage of my
post-graduation.
I express my honest thanks to Dr. Geethika Simhadri, Dr. Neeraja Pitta,
Assistant Professors, Orthodontics and Dentofacial Orthopaedics, for their
continuous encouragement and support.
I sincerely thank Prof. A. Siva Kumar, Department of Chemistry, ANITS for
guiding me throughout the study. I also extend my thanks to Dr. Sandeep Alanka,
Professor, GITAM Engineering College for his timely guidance in the evaluation of
Shear Bond Strength of specimens under Universal Testing Machine.
I specifically thank Dr. P. AdityaTeja Prasad for providing tremendous
statistical guidance and Mr. Aakash for helping me with the lab work.
I must place on record the cooperation of postgraduate colleagues Dr. M. Sai
Nagasri, Dr. M. Jaganath Venkat my juniors Dr. R. Madhu Vanya, Dr. B. Radhika,
Dr. S. Manojna and sub-juniors Dr. E. S. S. Hemanth, Dr. Sravya Ganta, Dr. Vinny
Pushpanjali for extending their support for the study.
I am deeply obliged to my fellow post graduates Dr. Harshitha Garapati, Dr.
Srujana Aravinda and Dr. Manjusha Chava for their onerous support all through.
Finally, though words do not suffice, I take this opportunity to express my
sincere gratitude to my parents A.D.K.Raju, P. Padmaja and my brother Joshua
Arumbakan whose years of efforts, sacrifice and blessings have made me whatever
I am today.
Dr. JOEL ARUMBAKAN

LIST OF ABBREVATIONS
LIST OF ABBREVIATIONS
MPa Mega Pascal

3M Minnesota Mining Manufacturing
H3PO4 Phosphoric acid
HCl Hydrochloric Acid
TC Tungsten Carbide
SBS Shear Bond Strength
Al2O3 Aluminium Oxide
mm Millimetres
PSI Pounds per square inch
µm Micrometres
FIG Figure
% Percentage
SPSS Statistical Package for Social Sciences
SD Standard Deviation
ANOVA Analysis of Variance
n Number of samples
Er:YAG Erbium: Yittrium Aluminium Garnett
i
CONTENTS
CONTENTS
S.no TITLE PAGE NO

1. INTRODUCTION 1-5
2. AIM AND OBJECTIVES 6
3. REVIEW OF LITERATURE 7-21
4. MATERIALS & METHODOLOGY 22-44
5. RESULTS 45-56
6. DISCUSSION 57-66
7. LIMITATIONS 67
8. SUMMARY 68-69
9. CONCLUSION 70
10. REFERENCES 71-81
11. ANNEXURES viii-xi
ii
LIST OF FIGURES
LIST OF FIGURES
S.N LEGEND PAGE

O NO
1 FIGURE: 1 120 Extracted human first premolar teeth 24
2 FIGURE: 2 Pumice 24
3 FIGURE: 3 Rubber cup 24
4 FIGURE: 4 Straight hand piece – Saeyand KOREA, Marathon 24
SDE – H37L1
5 FIGURE: 5 Vinyl polysiloxane impression material – FLEXCEED 25
6 FIGURE: 6 Camlin White Board marker ink bottles – RED, BLUE, 25
GREEN, BLACK
7 FIGURE: 7 Clear Acrylic Resin (DPI- RR Cold Cure) 25
8 FIGURE: 8 Pink Acrylic Resin (DPI- RR Cold Cure) 25
9 FIGURE: 9 37% Phosphoric acid (ultra-Etch; Ultradent products 26
INC)
10 FIGURE: 10 160 - 0.022 slot MBT Metal First Premolar brackets - 26
3M Unitek Gemini
11 FIGURE: 11 Transbond XT Primer and Transbond XT adhesive 26
12 FIGURE: 12 Light emitting diode curing unit – Woodpecker LED.D 26
13 FIGURE: 13 Distilled water 27
14 FIGURE: 14 12 fluted Tungsten Carbide bur 27
15 FIGURE: 15 Ultrasonic Scaler – Woodpecker UDS – J 27
16 FIGURE: 16 90um Aluminium Oxide particles (Bego) 27
17 FIGURE: 17 Sandblaster – Bio Art 28
18 FIGURE: 18 Acid bath (32% Hydrochloric acid + 55% Nitric acid in 28
1:4 ratio)
19 FIGURE: 19 Organic solvent (N – Methyl – 2 – pyrrolidone with 28
0.1% Zinc acetate catalyst)
20 FIGURE: 20 Microwave – Bajaj 2000 ETB, output – 8000W, 28
Frequency 2450 MHz
iii
LIST OF FIGURES
21 FIGURE: 21 INSTRON 8801 Universal Testing Machine – Blue Hill 29

Software 2.0
23 FIGURE: 22 Teeth mounted on colour coded acrylic blocks 37-38
24 FIGURE: 23 Cleaning the teeth with pumice and rubber cup 38
25 FIGURE: 24 Etching Protocol 39
26 FIGURE: 25 Application of primer on tooth and bracket base 40
27 FIGURE: 26 Placement of bracket with adhesive on tooth 40
28 FIGURE: 27 Light curing with LED curing unit 40
29 FIGURE: 28 Storage of teeth in distilled water for 24 hours 40
30 FIGURE: 29 Control group testing in UTM 40
31 FIGURE: 30 Debonding the bracket with pliers and debonded 41

bracket
32 FIGURE: 31 Recycling with 12 fluted Tungsten Carbide bur 41
33 FIGURE: 32 Recycling with Ultrasonic Scaler 41
34 FIGURE: 33 Recycling with sand blaster 41
35 FIGURE: 34 Recycling with Flaming and Acid bath (32% 42

Hydrochloric acid + 55% Nitric acid in 1:4 ratio)
36 FIGURE: 35 Recycling with Organic solvent 43
37 FIGURE: 36 Cleaning the composite on tooth surface with low 44

speed tungsten carbide bur
38 FIGURE: 37 storage of teeth in distilled water for 24 hours 44
iv
LIST OF FIGURES
39 FIGURE: 38 Shear bond strength testing in INSTRON 8801 44

Universal Testing Machine – Blue Hill Software 2.0
v
LIST OF TABLES
LIST OF TABLES
S.NO LEGEND PAGE NO
1 Table 1 Grouping of samples 30
2 Table 2 Control group 34
3 Table 3 1st Recycling Groups 34
4 Table 4 2nd Recycling Groups 35
5 Table 5 Mean shear bond strength (MPa) of brackets bonded 46
to natural teeth after first recycling by various
procedures.
to natural teeth after second recycling by various
procedures.
to natural teeth of Control groups.
to natural teeth pre and post recycling by various
procedures.
9 Table 9 Pair wise comparisons to determine the statistical 55
significance between various groups after first
recycling
10 Table Pair wise comparisons to determine the statistical 56
10 significance between various groups after second
recycling
vi
LIST OF GRAPHS
LIST OF GRAPHS
S.NO LEGEND PAGE NO

1 Graph 1 Comparison of Mean scores among various groups 47
after first recycling
2 Graph 2 Comparison of Mean scores among various groups 49
after second recycling
3 Graph 3 Comparison of Mean scores among Control groups 51
4 Graph 4 Comparison of Mean scores among various groups in 53

pre and post recycling by various procedures.
vii
Introduction
INTRODUCTION
INTRODUCTION
In orthodontics as well as in other dental field there is a trend to
simplify the technical procedure to reduce operative time and treatment
cost1. Bracket bonding is an early and important stage of orthodontic
treatment. During fixed orthodontic treatment, one of the most commonly
encountered chairside problems is bracket debonding which has been
reported to occur up to 17.6%2. According to Eminkahyagil et al. one out of
every five brackets came loose during orthodontic treatment3. The brackets
can either get accidentally dislodged or are intentionally removed in order to
reposition them to achieve occlusal goals4.
The bond failure may occur because of other factors like the type
and design of bracket used, the tooth being bonded, the treating orthodontist,
and the eating habits of individual patients2,5. The Shear Bond Strength is a
physical property of the bracket that plays an important role in orthodontic
treatment, which must be clinically found in an orthodontic bracket at a
magnitude of 5.9 to 7.8 MPa6. There has been made various attempts to
achieve higher Shear Bond Strength and lower Bond Failure which led to
development of new techniques and materials2. But still bracket debonding is
inevitable. When rebonding a bracket during treatment the operator is faced
with the choice of rebonding the same bracket or using a new one. Using a
new bracket increases the cost of providing treatment, particularly if brackets
are purchased in “one- patient” kits since using a new bracket means
breaking into a new kit7.
Page 1
INTRODUCTION
Before rebonding an orthodontic bracket, the elements to be
considered are reconditioning of the enamel surfaces, the use of new or
original debonded brackets, and the bonding system to be used8.
The Bond Strength of a rebonded bracket has been reported to
exceed the minimum force requirement9,10. According to Wright et.al 10, the
rebond strength when compared with original bond strength, is lower and is
reduced by 6-60% according to Eminkahyagil 3, is comparable to original
bond strength according to Jassen et.al9, and is greater than the original
bond strength according to Leas et.al 11. From the practitioners stand point,
the optimum bonding system is one that results in sufficient Bond Strength to
retain the brackets during active orthodontic treatment while allowing speedy
removal of brackets and complete removal of residual resin from tooth
surface at the end of treatment8.
The rebonding of a dislodged bracket is considered as an economic
saving option which can be done with use of in-office methods or by
commercial recycling2. The aim of all these methods is to remove the
adhesive from the bracket base completely without causing structural
damage, in order to eliminate or minimize contaminants to produce a
clinically acceptable adhesive bond of adequate strength during
rebonding12. The best reconditioning method of enamel following debonding
is to remove the residual composite from the enamel surface using 12-fluted
Tungsten Carbide bur, acid-etching the enamel surface for 60 seconds
using 30% H3PO4 (Phosphoric acid) and rebonding using self etch or light
cured system8.
Page 2
INTRODUCTION
In bracket recycling methods the commercial recycling can be done
by either application of heat to burn off the adhesive or using chemical
solvent to strip off the adhesive.
Esmadent system16 uses heat application in which the brackets are
heated to 454°C for 45 minutes following which the hot brackets are
immersed into a cold cement solvent and ultrasonically cleaned for 10-15
minutes. The brackets are then washed, dried and Electropolished for 30-
45 seconds. Brackets are then placed in sodium bicarbonate solution to
neutralize the electrolyte, followed by rinsing with hot water.
Orthocycle company utilize a solvent stripping process together with
high frequency vibrations at temperatures below 100°C to remove the
adhesive. This is followed by heating to 250°C for sterilization and a very
short ‘flash’ electropolishing stage.
As the commercial recycling methods cannot be used chair-side
because of large and expensive setup involved and also requires an
additional appointment, a variety of in-office methods like Mechanical (Hand
piece with rotary burs7 or chair side Sand Blaster13), Thermal (Flaming14 or
heating in furnace) or Combination methods (Buchman method 15- flaming
followed by sandblasting an electro polishing) are preferred.
Various studies1,10,14 have showed a decrease in bond strength values
when recycling of brackets is done with the use of Tungsten Carbide(TC)
bur. In this method the debonded bracket base is cleaned with slow speed
round Carbide bur.
Page 3
INTRODUCTION
In Sandblasting method, within a ventilated hood, the bracket bases
are held approximately 5mm from the tip of the micro-etcher and etched
with 90um Aluminium oxide at 90 PSI until all visible bonding material was
removed from the bracket base. This requires approximately 15-
30seconds13. Sandblasting method increases the bond strength of recycled
brackets compared to that of Tungsten carbide (TC) bur14. The
disadvantage of Sandblasting method is that the air pressure can dislodge
the bracket from the forceps, causing unwanted delays16. And also pitting
and corrosion may be produced on the brackets16,17.
Another commonly used method for recycling brackets is the use of
an Ultrasonic scaler1 to clean the bracket base. This method gives Bond
strength greater than the TC bur, but less than the Sandblasting method.
A simple and quite inexpensive way to clean a bracket after de-
bonding is by flaming followed by submerging it in Acid bath 16 (32%
Hydrochloric acid + 55% Nitric acid in 1:4 ratio) for 5-15 seconds. This
process removes any tarnish and dissolves the adhesive residue remaining
after flaming and quenching in water. The disadvantage is the slight
discoloration of the bracket because of flaming that makes the bracket
unsightly.
A quick and efficient method is the use of Er:YAG Laser18 for bracket
recycling but it is not preferred in this study as it is cost effective and also
causes distortion and flattening of brackets in cases of recycling brackets
which are rebonded for second time19.
The most recently introduced technique is the use of an Organic
Page 4
INTRODUCTION
solvent20 (N-Methyl-2- Pyrrolidone with a 0.1% Zinc acetate catalyst) which
causes swelling of the adhesive (polymer) on the bracket base and enables
it to become loose. N-Methyl-2-Pyrrolidone also has advantages in stability
at ambient temperature, low volatility, low in- flammability, no clear toxicity
profile, and its industrial scale usage in polymerization and plastics industry
makes it easily available and is recommended22. The choice of the solvent
was also based on the composition of the adhesive material used, so an
adhesive solvent with some catalyst to accelerate the adhesion material
release process22,23 was needed and the Organic solvent with 2% Zinc
acetate was created which could detach the adhesive material from the
bracket base24,25.
All these facts prompted a renewed interest to conduct a study to
determine if the Organic solvent method would produce a better Bond
strength value than that of the other commonly used in-office methods (TC
bur13, Sandblasting10, Ultrasonic scaler13, acid bath16). As the brackets keep
getting dislodged due to various factors during the course of treatment there
is also a need to evaluate and compare the changes in bond strength
values when recycling of the brackets is done for the second time by
various methods described above.
Page 5
Aim & Objectives
AIM AND OBJECTIVES
AIM AND OBJECTIVES
AIM OF THE STUDY:
The aim of the present study is to evaluate and compare the shear bond
strength of stainless steel brackets reconditioning by five in-office methods.
OBJECTIVES OF THE STUDY:
1. To evaluate the shear bond strength of stainless steel brackets
recycled using TC bur.
recycled using Sandblaster.
recycled using Ultrasonic scaler.
recycled by flaming followed by Acid bath.
recycled using Organic solvent.
6. To evaluate and compare the shear bond strength of stainless steel
brackets recycled for the second time by various in-office methods.
Page 6
Review of Literature
REVIEW OF LITRATURE
REVIEW OF LITRATURE
H.A.Jassem et al (1981)9 conducted a study to investigate the effects of low
viscosity sealing resins and temperature cycling on the tensile and shear strengths of
bonded and rebonded attachments. The study was conducted on 80 extracted non
carious human maxillary central incisors and the tensile bond strength of chemically
activated bonding paste to an etched enamel with and without a low viscosity sealing
resin, and with and without 500 temperature cycles between 5 degree centigrade
and 55 degree centigrade were determined. The tensile bond strength was
determined after rebonding on the same teeth in such a way that the rebonded
specimens were subjected to the same two variables as the originally bonded teeth.
The shear bond strength and rebond strengths were determined on the remaining 40
teeth. An Instron machine was used to test for failure, and the bond strengths were
expressed in MN.m-2. It was noted that the temperature cycling adversely affected
tensile and rebond strengths, whereas the sealing resin had no additional effect on
the tensile and shear bond and rebond strengths. The tensile versus bond and the
bond versus rebond strengths for the similarly prepared specimens were not found to
be significantly different.
Eliakim Mizrahi (1982)6 to evaluate the frequency of cementation failure with
orthodontic attachments secured to teeth by banding or bonding. He conducted his
study on 882 bands and 1194 directly bonded brackets placed on 100 consecutively
completed cases that are treated with full fixed appliance using the Begg light wire
technique and observed an adhesion failure rate of 4.7% and he stated that the
lowest attachment failure rate during the orthodontic treatment can be achieved by
banding the molars and bicuspids and bonding the maxillary cuspids and incisors
Page 7
REVIEW OF LITRATURE
and on lower anterior teeth. With this study he concluded that lowest failure rates
were found with banding on buccal teeth and bonding on anterior teeth.
D. Regan et al. (1993)7 conducted a study to investigate the effect on tensile
strength of the variables associated with the bracket base, the enamel surface, and
the type of adhesive when both new and used brackets were rebonded to a
previously bonded enamel surface. They evaluated tensile bond strength for three
different types of stainless-steel bracket/ base combinations. The bracket bases
selected were conventional foil-mesh base, a cast integral base and a photo-etched
base and the brackets selected were pre-adjusted edgewise premolar brackets with
a slot size of 0.022 x 0.028. They used two-paste highly-filled orthodontic bonding
system and a light cured, highly-filled orthodontic adhesives to bond the brackets.
Following debonding, they removed the old adhesive from the enamel using either a
hand scaler or a tungsten-carbide bur and a group of new brackets were bonded to
the teeth using a chemically-activated or a light-cured adhesive. They observed that
even with no differences between the enamel preparations or the adhesives the
rebonded new brackets demonstrated a small, but statistically significant fall in bond
strength. Another group of previously debonded brackets were rebonded to the
same teeth and prepared the bracket bases by either smoothing with a green stone
or heating in a bunsen flame followed by sandblasting and electropolishing and they
observed highly significant falls in bond strength with all the bases with no significant
differences between the two methods of bracket preparation.
William L.Wright et al (1985)10 conducted a study to evaluate the effects of 4
rebonding procedures, or the in vitro tensile bond strengths of four filled diacrylate
adhesives on orthodontic brackets. The four procedures that were used were-
thermal reconditioning, chemical reconditioning, the removal of residual adhesive
Page 8
REVIEW OF LITRATURE
with a green stone and grinding the mesh base with a green stone. In the study, the
mesh base, stainless steel brackets were bonded to plastic cylinders and the tensile
bond force that was necessary to cause bond failure was recorded. It was also noted
that the initial bond strengths for the no-mix adhesive and both the two paste
systems were significantly higher than the tensile bond strengths for any rebonding
condition and the different rebonding conditions reduced tensile bone strength to
different degrees, when each of the three adhesives were used. It was also noted
that the initial bond strength for the visible light cured adhesive was not significantly
from 3 out of the 4 rebonding conditions and was found to be lower than the initial
bond strength of the other three adhesives used in the study.
Frank R. Egan et al. (1996)4 conducted a study to determine the bond
strength of brackets that were rebonded using a no-mix or a paste-paste resin
system and to study the efficacy of plastic conditioners and Enhance adhesion
booster (Reliance Orthodontic Products, Inc., Itasca III) as an aid in rebonding. The
study was conducted on 60 extracted human premolar teeth, divided into 2 groups
based on the adhesive system used. The two groups were further subdivided into an
initial bond, a rebond and a rebond using plastic conditioner and adhesion booster
subgroups. The samples were stressed to bond failure by using an Instron machine.
Majority of the samples showed bond separation at the enamel/resin interface. The
mean bond strengths ranged from 78.8 kgcm-2 in the case of rebonding with no mix
adhesive and no other conditioners, to 182.7 kgcm-2 in the case of initial bonding
using a paste-paste adhesive. The results showed that rebonding with a paste-paste
adhesive with no other conditioners produced a bond strength that was statistically
indistinguishable from the initial bonding with either system and the plastic
conditioner and adhesion booster failed to improve the rebond strength. Thus, the
Page 9
REVIEW OF LITRATURE
data of the study suggested that given certain circumstances, rebonding is a viable
option when a bracket has debonded.
B.Mui et al (1999)8 conducted a study to compare the shear bond
strength(SBS) of bonded and rebonded orthodontic brackets following commonly
used conditioning treatments involving both light cured and self-cured composite
resin systems. The brackets that were debonded during the initial determination of
SBS were rebonded after the removable of the residual resin from the enamel
surface using five different treatment methods, the first one in which the residual
resin was removed using a tungsten carbide bur followed by retching the enamel
surface and bonding a new bracket, the second one, where the resin was removed
from the base mesh by micro etching followed by rebonding the same bracket; third,
where the residual resin was removed from the enamel surface using resin removing
pliers followed by reconditioning of the enamel with an air powder polishing and
bonding a new bracket, the fourth method, where residual resin was removed using
a rubber cup and pumice followed by bonding a new bracket and a fifth method,
where the residual resin was removed using only pliers and then followed by bonding
a new bracket. The results revealed that using a light cured system resulted in a
higher SBS in the initial bond compared to the self-cured system. The highest SBS
and clinically favorable fracture characteristics was achieved when a tungsten
carbide bur was used to recondition the enamel surface followed by acid etching,
with a difference of 5.8 MPa. Thus, the data suggested that the optimal procedure
for the purpose of rebonding a dislodged orthodontic bracket is to resurface the
enamel using a tungsten carbide bur followed by acid etching the enamel and using
a new or a reused old bracket after micro etching.
Page 10
REVIEW OF LITRATURE
Aisha M. Basudan et al (2001)14 conducted a study to compare the effect of
5 in office bracket reconditioning methods on the bracket slot width and inter wing
gap measurements, the appearance of bracket bases under a scanning electron
microscope and the shear/peel bond strength. The study was conducted by dividing
125 initially bonded brackets into five experimental groups, reconditioning was done
by adhesive grinding using green stone (for group 2), sandblasting (for group 3),
direct flaming (for group 4), using the Big Jane machine (for group 5) and using the
Buchman method (for group 6). Outcome showed the distortion of brackets, and
three representative specimens from from each group was studied under SEM. The
remaining brackets were then rebonded and the shear/peel forces to failure was
measured. The ANOVA and multiple comparison test showed only a statistical, not
clinically significant increase in the bracket measurements of Group 4, whereas there
was a significant reduction of about 28% in the SPBS of Group 2. When observed
under the SEM, the wire mesh structure was maintained, but the remnants of the
adhesive significantly varied among the groups. Thus, it was concluded that none of
the in-office reconditioning methods that are applied adversely affect the bracket
base and the bracket measurements and reconditioning with a green stone was not
found to be effective. The preferred methods of reconditioning would be sandblasting
and direct flaming owing to their simplicity and time saving advantages.
Neslihan Eminkahyagil et al. (2006)3 conducted a study to determine the
effect of different resin removal methods on the shear bond strength of rebonded
brackets, the condition of the enamel surface, the time spent on the removal of resin
remnants and to determine the location of the bond failure. The study was conducted
on 80 premolars, where 50 of them were divided into 5 groups and bonded using
Light Bond sealant and Quick Cure adhesive. 10 of the samples were debonded and
Page 11
REVIEW OF LITRATURE
then the shear bond strength of the first debonding was calculated. 40 brackets were
debonded using pliers and observed under an optical microscope with 16x
magnification, in order to determine the location of the bond failure interface using a
modified Adhesive Remnant Index (ARI). The remnant adhesive was cleaned using
4 methods, i.e, with a low-speed tungsten carbide bur (TCB), a high-speed tungsten
carbide bur, Sof-Lex finishing disks, and a micro etcher. After the brackets were re
bonded a second set of SBS and ARI values were calculated and subjected to
statistical evaluation. 30 premolars were divided into 5 groups, subjected to the
same resin removal methods and examined under a scanning electron microscope.
The results showed that the rebonded teeth had a greater shear bond strength than
the initial bonding in all the groups except group 4. Groups 1-3 showed similar
rebonded SBS values, while only group 4 showed a statistical difference. Using Sof-
Lex disks were found to be the most time-consuming procedure and also left behind
much adhesive remnant, whereas high speed TCB was noted to be the most
hazardous to enamel. The scarring of enamel after debonding although inevitable,
can be reduced.
AF. Heravi et al (2008)27 conducted a study to compare the shear bond shear
bond strength of rebonding using recycled brackets on the enamel surface. For this
study, the bonding of brackets on extracted bicuspids was divided into 5 different
groups and tested to compare their shear bond strength. The groups were as follows
- Group N - control group which included new brackets on enamel surface of newly
extracted teeth, Group R- which included recycled brackets on newly extracted teeth,
Group NR- which included new bracket on the cleaned enamel surface of previously
bonded teeth using a tungsten carbide bur, Group RE- including reused brackets on
cleaned surface of previous teeth and Group RR- which included the brackets that
Page 12
REVIEW OF LITRATURE
was subjected to recycling twice on the newly extracted bicuspids. Adhesive
Remnant Index was also specified for each of the mentioned groups. The results
showed that the highest shear bond strength was of the control group, Group N
which rated as 12.00 MPa, followed by Group NR with 11.85 MPa, then Group RE
with 10.80 MPa, then Group RR with 10.00 MPa and group R with 9.94 MPa
respectively. The difference observed between groups N and NR with groups R and
RR were significant. Thus, it was concluded that rebonding had no significant effect
on the reduction of shear bond strength, tungsten carbide burs were suitable for
removal of composite remnant from brackets and enamel surface, and that
chemically recycled brackets had a clinically acceptable shear bond strength.
S.Yassaei et al. (2013)2 conducted a study to evaluate the effects of different
resin removal methods on shear bond strength of rebonded brackets. They divided
eighty extracted premolars teeth into four groups and bonded them with metal
brackets and then debonded the brackets and removed the adhesive remnants on
the brackets using Er:YAG laser, sandblasting, direct flame and CO 2 laser and
enamel surfaces with carbide burs. The brackets were recycled and rebonded and
then debonded with Dartec testing machine and determined the shear bond
strengths for all four groups. They observed that the brackets recycled using direct
flame and CO2 laser showed lower shear bond strengths compared to other two
groups and there is complete adhesive removal with Er:YAG laser irradiation while
with other groups they observed microroughening of bracket base with sandblasting
and incomplete adhesive removal with other two groups. They concluded that
Er:YAG laser irradiation is the most effective method for recycling of brackets.
Aksu M et al. (2013)28 conducted a study to know whether there will be any
change in the shear bond strength of brackets after two different base-cleaning
Page 13
REVIEW OF LITRATURE
procedures such as sandblasting or carbide bur cleaning, and also to determine if a
previously bonded tooth surface had any effect on bond strength. They collected 120
extracted premolars and bonded them and then debonded and recorded the bond
strength and divided these debonded brackets into two groups and recycled them
either by sandblasting or tungsten-carbide bur cleaning and these sixty recycled
brackets were divided into two subgroups: In each group; 30 recycled brackets were
bonded to unused 30 extracted premolars. The remaining brackets were bonded to
30 previously used premolars. The brackets were debonded again and their bond
strengths were remeasured. With this study they found out that the bond strength of
rebonded brackets after sandblasting was not significantly different from that of new
brackets while the bond strength of rebonded brackets after carbide bur cleaning
group significantly decreased and also the previously bonded tooth surface did not
affect the bond strength significantly.
Prince K Chacko et. al. (2013)29 evaluated the ERBIUM: Yttrium aluminum
garnet (Er:YAG) laser efficiency with Environmental Scanning Electron Microscope
(ESEM) and shear bond strength analysis as a method of recycling stainless steel
orthodontic brackets and to compare.Stainless steel brackets were bonded to eighty
extracted premolar teeth and tested for rebonded shear bond strength after recycling
by four methods and compared with a control group. These 80 samples were divided
into four groups and recycled by four methods, which include sandblasting, thermal
method, adhesive grinding by tungsten carbide bur, and Er: YAG laser method. ER:
YAG laser group had the maximum bond strength among the recycled brackets
followed by the sandblasting, thermal and electropolishing, and finally the adhesive
grinding method. Environmental Scanning Electron Microscope analysis showed with
Er: YAG laser there was complete removal of adhesive from the brackets which
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REVIEW OF LITRATURE
mimicked the control group.The study concluded that ER: YAG laser (2940 nm) was
the most competent method for recycling, which was followed by the sandblasting,
thermal, and the tungsten carbide methods.
Manuela M.Haro Montero et. al. (2015)30 conducted a study to evaluate the
in vitro shear bond strengths of brackets that were recycled by sandblasting with
aluminium oxide particles of different sizes or reconditioned industrially after
successive rebonding procedures. For this study, 80 brackets were bonded and
debonded sequentially thrice. The first debonding was done and then the brackets
were divided into 4 groups, as follows - sandblasting with aluminium oxide particles
of size 25 microns (group1), sandblasting with aluminium oxide particles of size 50
microns (group 2), sandblasting with aluminium oxide particles of 110 microns (group
3), and industrial recycling (group 4). The bond strength and the adhesive material
that remained on the debonded bracket base was evaluated for each successive
debond. It was found that no significant difference was present between the four
groups following the first recycle, and after the second cycle, the bond strength was
significantly greater in the industrially recycled group compared to the other groups.
On comparing the shear bond strength within each recycling method, the bond
strength of the sanblasted brackets decreased with the increase of particle size. The
industrially recycled group showed no significant differences between the three
sequences. When the bond material remnant was evaluated, it was found that the
industrially recycled group left significantly less bond material after each successive
recycling when compared to the other; and within each of the recycling methods the
adhesive remnant significantly reduced after successive debond. It was thus
concluded that industrial recycling obtained better results when compared to
sandblasting after three successive debondings. It was also noted that the bracket’s
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REVIEW OF LITRATURE
shear bond strength reduced as the size of the aluminium oxide particle being used
for sandblasting increased as the recycling was repeated.
Tudehzaeim MH et. Al. (2015)31 the purpose of the study was to evaluate
microleakage under rebonded stainless steel brackets by using sandblast and laser
methods. Sixty premolars were divided into three groups, group 1 was control group
and group 2 and 3 include debonded brackets where adhesive was removed by
using sandblasting and Er-YAG laser. After rebonding, with 2% methylene blue
teeth were stained for 24 hours, sectioning was done and examined under a
stereomicroscope. At the adhesive-enamel and bracket-adhesive interfaces marginal
microleakage was seen in the occlusal and gingival margins. The results showed no
significant difference between three groups. All groups showed elevated
microleakage in gingival margins at enamel-adhesive interface, whereas in
adhesive-bracket interface, higher microleakage in occlusal margin. The study
concluded that sandblasting and Er-YAG laser irradiation showed acceptable
microleakage.
Alawy et. Al. (2017)32 the purpose of the study was to evaluate recycling and
repeated recycling with erbium: Yttrium aluminum garnet (Er:YAG) laser effect on
shear bond strength of stainless steel brackets and surface characteristics. Ninety
brackets were bonded to upper first premolars and divided into three groups which
contain 30 teeth per each group. Group 1 as control, group 2 contain debonded
brackets and recycled one time using Er:YAG laser and group 3 contain debonded
brackets and recycled two times using Er:YAG laser. Twenty samples from group 2
and 3 were again rebonded to the same reprepared enamel. Shear bond strength
was analyzed for remaining sixty samples, 20 from each group using universal
testing machine. Under a scanning electron microscope en debonded brackets from
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REVIEW OF LITRATURE
each group were examined to identify the surface characteristics of the brackets’
mesh. The results showed that repeated recycled brackets had lower bond strength
when compared to other groups. The study concluded that in case of bond failure
brackets recycled with Er:YAG laser can be used as an alternative to new brackets.
It is preferred to use new brackets in case of second bond failure of same bracket.
Venugopal et al. (2017)33 had done a study to compare the shear bond
strengths of .022 slot pre-adjusted edgewise brackets with conventional mesh base
design recycled by two different chair-side techniques, one being flaming/heating
and other being sandblasting. They took a sample of 80 extracted human premolars
and divided them into three groups Group A (Heated/Flamed Brackets), Group B
(Sandblasted Brackets) containing thirty teeth each, and Group C (Control group)
and bonded them with .022 slot preadjusted edgewise brackets onto the lingual
surface and then debonded them. After initial debonding the bracket base was
studied under a scanning electron microscope at different magnifications for aperture
size, mesh continuity and surface roughness. Then they rebonded the brackets onto
the labial surface of the premolars and debonded them using a Universal testing
machine to produce a shear strength at the tooth bracket interface. They observed
that the highest bond strengths were observed within the control group and least
bond strengths with the flaming/heating group, higher bond strengths with
considerably rougher mesh surface texture in sandblasting group andalso observed
the reduced aperture dimensions and loss of mesh continuity in heating/flaming
group.
Tanusha Mahobia et. al. (2017)1 conducted a study regarding the recycling of
brackets in clinical practice. The recycling process involves removal of the bonding
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REVIEW OF LITRATURE
agent remnants from the bracket base, allowing the bracket to be reused in the
procedure. The study was conducted on eighty non carious human premolars that
were extracted for orthodontic reasons. The extracted teeth were randomly allocated
to 4 groups, three experimental (B, C, D) and one control group(A). The bonding
procedure was performed step by step. The brackets of the experimental groups
were debonded within 30 minutes to simulate the condition where a newly bonded
bracket was tied to the arch wire. The results showed that the control group in which
no debonding and rebonding was performed had the highest shear bond strength
followed by the experimental group D where the bracket base was cleaned with
aluminium oxide sandblasting and the group C where the bracket base was cleaned
with an ultrasonic scaler, and the least SBS was seen in group B where the bracket
base was cleaned with slow speed round carbide bur. It was thus concluded that, the
recycling of debonded brackets with aluminium oxide sandblasting gave better
results and a better bond strength and proved to be more efficient and satisfactory to
the clinician compared to the other techniques with respect to the bond strength.
Neeraj Gupta et. al. (2017)34 compared the effect of three recycling methods
on the shear bond strength of stainless-steel brackets. They conducted the study on
eighty extracted premolar teeth and bonded them with pre-adjusted edgewise
premolar brackets of 0.022 slot and divided them into 4 groups. In group I, recycling
and initial bonding was not done where as the brackets in the other three groups
were debonded and recycled with sand blasting, sandblasting/direct flaming, sand
blasting/direct flaming/acid bath solution (32% hydrochloric acid and 55% nitric acid
in 1:4 ratio) and then bonded the recycled brackets and tested with Universal testing
machine. They observed that the shear bond strength of new brackets is higher than
the recycled brackets and brackets sandblasted with 90µm aluminium oxide particle
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REVIEW OF LITRATURE
air-abrasion showed higher shear bond strength when compared to with other two
recycling methods. They concluded that sandblasting with 90µm aluminium oxide
particle air-abrasion is the most effective, simplest and preferred method.
Gina Maringka et. Al. (2018)20 conducted a study to prove that organic
solvents are effective and efficient as sandblasting and burning for cleaning of
rebonded brackets. For this study, thirty stainless steel metal brackets were mounted
on thirty maxillary first premolar teeth and this was categorized into 3 cleaning
method groups where each consisted of 10 brackets. After 24 hours a universal
testing machine was used to perform shear bond strength tests. The results of the
one-way ANOVA test showed that there was a significant difference with the p value
of 0.000 among the mean SBS values in the three cleaning method groups. The
modified adhesive remnant index by a Kruskal- Walli’s analysis showed that there
was no significant difference with p value of 0.868. The SEM results revealed that
the organic solvent cleaning method showed a better bracket performance when
compared to the other 2 methods. The energy dispersive X-ray spectroscopy results
showed that the adhesive material which remained on the bracket base was
relatively similar when the 3 cleaning methods were compared. In conclusion, based
on the practicality and the results of the study the organic solvent cleaning method
was proved to be effective and efficient. Thus, organic solvents can be used as an
alternative cleaning method for detached brackets.
Fouad Salama et.al. (2018)11 conducted a study to compare the shear bond
strength of new and rebonded brackets bonded to the facial surfaces using two
adhesive cements: resin composite and resin modified glass ionomer cement. They
included 40 premolars which were grouped randomly into four with 10 teeth per each
group. The universal testing machine had a crosshead speed of 1millimetre/minute
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REVIEW OF LITRATURE
for knowing the bond strength. With the use of adhesive remnant index (ARI) two
investigators had scored the remaining adhesiveness on enamel after debonding of
the bracket and they were unaware of the grouping. A significant statistical difference
in shear bond strength of the groups had determined a P value of 0.005. The values
of shear bond strength obtained are significantly higher of the cleaned enamel
surface rather than compared to sound enamel. The values of shear bond strength
were significantly higher for rebonded brackets rather than compared to newer
brackets. Between the two adhesive cements there was no significant difference
found. The Stainless-steel brackets which were debonded and sandblasted obtained
higher bond strength values compared to the newer ones. There was sufficient
Shear Bond Strength exhibited by Resin Modified Glass Ionomer orthodontic
adhesive and Resin-composite for bonding brackets.
Raja et. al. (2019)35 the study aimed to estimate the in-office bracket
reconditioning effect on shear bond strength of stainless steel brackets. The study
used 30 stainless steel brackets which were divided into group 1- control group
(FRESH BRACKETS) and group 2 – experimental group (recycled brackets). The
results showed slightly superior bond strength values by recycled brackets compared
to new brackets. No considerable difference was seen between them. The study
concluded that, recycled stainless steel brackets can be used as a substitute to new
brackets.
Khanal PP et. al. (2021)36 compared the shear bond strength of stainless steel
brackets by using different recycling methods.They used Standard MBT (0.022″)
brackets were bonded to 120 extracted premolars with light cured primers which
were divided into four groups. Group I was assigned as control and the brackets of
Group II recycled by flaming, Group III flaming with sandblasting, and Group IV
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REVIEW OF LITRATURE
flaming with ultrasonic cleaning. Rebonding was done and by using universal testing
machine at a speed of 0.5 mm/min shear bond strength was determined by final
debonding. The results showed that group I with highest shear bond strength,
followed by Group III and Group IV, and the low value was obtained with Group II.
Analysis of variance was used to detect significant differences among the groups.
They concluded that flaming with sandblasted brackets showed sufficient bond
strength, borderline value by flaming with ultrasonic cleaned brackets considerably
least value by flaming alone.
Page 21
Materials and Methodology
MATERIALS AND METHODOLOGY
MATERIALS
1) 120 Extracted human first premolar teeth
2) Pumice
3) Rubber cup
4) Straight hand piece – Saeyand KOREA, Marathon SDE – H37L1
5) Vinyl polysiloxane impression material – FLEXCEED
6) Camlin White Board marker ink bottles – RED, BLUE, GREEN, BLACK
7) Clear Acrylic Resin (DPI- RR Cold Cure)
8) Pink Acrylic Resin (DPI- RR Cold Cure)
9) 37% Phosphoric acid (ultra-Etch; Ultradent products INC)
10) 160 - 0.022 slot MBT Metal First Premolar brackets - 3M Unitek Gemini
11) Transbond XT Primer
12) Transbond XT adhesive
13) Light emitting diode curing unit – Woodpecker LED.D
14) Distilled water
15) 12 fluted Tungsten Carbide bur
16) Ultrasonic Scaler – Woodpecker UDS – J
17) 90um Aluminium Oxide particles (Bego)
Page 22
MATERIALS AND METHODOLOGY
18) Sandblaster – Bio Art
19) Acid bath (32% Hydrochloric acid + 55% Nitric acid in 1:4 ratio)
20) Organic solvent (N – Methyl – 2 – pyrrolidone with 0.1% Zinc acetate
catalyst)
21) Microwave – Bajaj 2000 ETB, output – 8000W, Frequency 2450 MHz
22) INSTRON 8801 Universal Testing Machine – Blue Hill Software
Page 23
MATERIALS
FIG 1: 120 Extracted human first

Fig 2: Pumice
premolar teeth
FIG 3: Rubber cup FIG 4: Straight hand piece
Page 24
MATERIALS
FIG 5: Vinyl polysiloxane impression FIG 6: Camlin White Board marker ink
material – FLEXCEED bottles – GREEN, BLUE, RED, BLACK
FIG 7: Clear Acrylic Resin (DPI- RR FIG 8: Pink Acrylic Resin (DPI- RR
Cold Cure) Cold Cure)
Page 25
MATERIALS
FIG 9: 37% Phosphoric acid (ultra- FIG 10: 160 - 0.022 slot MBT Metal
Etch; Ultradent products INC) First Premolar brackets - 3M Unitek
FIG 11: Transbond XT Primer, FIG 12: Light emitting diode curing unit
Transbond XT adhesive – Woodpecker LED.D
Page 26
MATERIALS
FIG 13: Distilled water FIG 14: 12 fluted Tungsten Carbide bur
FIG 15: Ultrasonic Scaler – FIG 16: 90um Aluminium Oxide

Woodpecker UDS – J particles (Bego)
Page 27
MATERIALS
FIG 18: Acid bath (32% Hydrochloric

FIG 17: Sand blaster - Bio Art
acid + 55% Nitric acid in 1:4 ratio)
FIG 19: Organic solvent (N – Methyl – FIG 20: Microwave – LG 2000 ETB,
2 – pyrrolidone with 0.1% Zinc acetate) output – 8000W, Frequency 2450 MHz
Page 28
MATERIALS
FIG 21: INSTRON 8801 Universal

Testing Machine – Blue Hill Software
2.0
Page 29
METHODOLOGY
METHODOLOGY
PREPARATION OF SPECIMENS
120 human first premolars, extracted for orthodontic reasons are
collected. Premolars with intact buccal enamel free of cracks or dental caries
or developmental defects are included in the study. The teeth are cleaned of
all debris and stored in distilled water until use. The teeth are further divided
into 6 groups of 20 each. Putty molds were fabricated with inner dimensions
of 20 mm diameter and 30 mm length. The teeth are embedded till the depth
of 1 mm below the cemento-dentinal junction, leaving only the crowns
exposed in chemically activated resin with color-coding as indicated in Table -
1. Grouping is done based on the type of recycling the brackets undergo
before re-bonding onto the tooth surface.
GROUPING OF SAMPLES (N = 20 each)
RECYCLING
GROUP PROCEDURE COLOUR CODE
GROUP – A Control Black
GROUP – B Tungsten carbide bur Pink
GROUP – C Ultrasonic scaler Blue
Aluminium oxide
GROUP – D sandblaster Violet
GROUP – E Flaming + Acid Bath Red
Organic solvent
GROUP – F Green
Table 1: Grouping of samples
Page 30
METHODOLOGY
BONDING OF BRACKETS
The buccal surfaces of all 120 teeth will be cleaned with fluoride-free
pumice and rinsed. The placement of brackets is done by etching the surface
of the tooth with 37% phosphoric acid (Ultra-Etch; Ultradent Products Inc.) for
15 seconds, followed by rinsing with running water for 10 seconds and then
drying with air spray to reveal a frosty or chalky white surface.
Further, bonding is performed by applying Transbond XT primer on the
tooth and the bracket base initially followed by application of Transbond XT
adhesive. The bracket is placed on the tooth parallel to the tooth axis and
pressed into place gently and excessive adhesive is removed with a probe.
Curing is done with a Light Emitting Diode Curing Unit for 5 seconds each on
Mesial, Distal, Gingival and Occlusal sides.
RECYCLING METHODS:
In Group A, (Control) all the samples are subjected to shear bond
strength test done after storing in distilled water for 24 hours. Following this
the surface of enamel is cleaned with 12 fluted TC bur to make the it free of
remnant adhesive. Further acid etching of the enamel was done for 60
seconds with 30% phosphoric acid. The surface was rinsed and dried
following which new brackets were bonded as mentioned in the initial bonding
procedure. This group is now labeled as AN1 (Non-recycled new brackets will
be bonded to teeth debonded after SBS testing of group A).
Group B to Group F will be subjected twice to shear bond strength
test; once after chairside debonding and recycling the brackets. So, the
Page 31
METHODOLOGY
specimens which will be subjected to SBS for the first time are labeled as
Group B1 to Group F1. Further, the brackets debonded due to SBS testing
will be collected, recycled for the second time, bonded again to the same
tooth surface and finally subjected to SBS testing for the second time, thus
the groups are labeled as Group B2 to Group F2.
In Group B1 to Group F1 brackets are de-bonded from the tooth
surface with a de-bonding plier, followed by recycling with different methods to
remove the resin layer from the bracket base prior to re-bonding.
Group B1 - The resin layer on the bracket base is removed by TC bur using
straight slow speed handpiece at a speed of 25,000 RPM till the resin is
removed from the bracket base.
Group C1 - Resin layer from the base of brackets is cleaned using an
Ultrasonic scaler.
Group D1 - Bracket recycling is done using portable sandblasting unit with
90um alumina particles for 15 seconds at a pressure of 5 bar.
Group E1 -
The brackets are flamed in the reduction zone of a mini Torch flame for 5
seconds until the surface of the bracket base turns red and then quenched in
water to dislodge resin from the bracket base. It is then submerged in a
solution of 32% HCl and 55% Nitric acid mixed in 1: 4 Ratio (Acid Bath) for 5
to 10 seconds to remove the residual resin from the bracket base.
Page 32
METHODOLOGY
Group F1 - An organic solvent is used for recycling of the brackets. It is done
by soaking the bracket in a closed heat resistant container with N-Methyl - 2-
pyrrolidone and 0.1 % Zinc acetate (Catalyst). The container is placed in 800-
watt microwave for 3 minutes.
The enamel surface of the teeth from all the recycling groups are
cleaned with 12 fluted Tungsten carbide bur, till they look glazed, to remove
the residual adhesive on the tooth surface. This is followed by acid etching
and Re-bonding of the recycled brackets as described in the initial bonding
procedure. All the samples (both control and Recycling group) are stored in
distilled water for 24 hours until the shear bond test.
SHEAR BOND STRENGTH TESTING
After 24 hours, all the specimens i.e., from Group AN1 and Group B1
to Group F1 are subjected to Shear Bond strength test using a Universal
testing machine with a load of 50 kg and crosshead speed of 0.5mm/min by
applying an occluso-gingival load at the bracket adhesive interface. The
values will be recorded in Mpa.
After SBS testing, the debonded brackets are collected and the
process of recycling and re-bonding is repeated second time on all the
specimens in group B1 to Group F1 and labeled as Group B2, Group C2,
Group D2, Group E2, and Group F2.
The specimens in Group AN1, new brackets are bonded to the same
tooth surface after conditioning and labeled as Group AN2. The shear bond
strength test is performed again for all the above groups.
Page 33
METHODOLOGY
Table 2: CONTROL GROUP
Group A Non-recycled new brackets are bonded
Non-recycled new brackets are bonded to teeth debonded
Group AN1 after SBS testing of group A
Non-recycled new brackets are bonded to teeth debonded
Group AN2 after SBS testing of Group AN1
Table 3: 1ST RECYCLING GROUPS
Debonded bracket base recycled with slow speed

Group – B1
Tungsten carbide bur.
Group – C1
Debonded bracket base recycled with Ultrasonic scaler
Debonded bracket base recycled with aluminium oxide

Group – D1
sand blaster
Debonded bracket base recycled by flaming followed

Group – E1
by submerging it in an Acid Bath
Debonded bracket base recycled by soaking it in an

Group – F1
Organic solvent
Page 34
METHODOLOGY
Table 4: 2ND RECYCLING GROUPS
Group – B2 Brackets debonded by SBS testing in Group B1

cleaned with slow speed Tungsten carbide bur.
Group – C2 Brackets debonded by SBS testing in Group C1

cleaned with Ultrasonic scaler.
Group – D2 Brackets debonded by SBS testing of teeth in Group

D1 cleaned with aluminium oxide sand blaster.
Group – E2 Brackets debonded by SBS testing of teeth in Group

E1 cleaned by flaming followed by submerging it in
Acid Bath.
Group – F2 Brackets debonded by SBS testing of teeth in Group

F1 cleaned by soaking it in an Organic solvent.
Page 35
METHODOLOGY
EXPERIMENTAL DESIGN
120 premolars
Cleaned and stored in distilled water
Mounted in acrylic blocks
Grouping according to recycling methods
A B C D E F
New brackets bonded
Debonded with plier
SBS test Recycling done and rebonded
AN1 B1 C1 D1 E1 F1
New brackets SBS test

Debonded brackets are collected, recycled, rebonded
SBS test
New brackets
B2 C2 D2 E2 F2
AN2
SBS TEST
Page 36
METHODOLOGY
FIG 22: TEETH MOUNTED ON COLOUR CODED ACRYLIC BLOCKS
FIG. 22 (A) - TOTAL SAMPLE
FIG. 22 (B) - GROUP A FIG. 22 (C) - GROUP B
Page 37
METHODOLOGY
FIG. 22 (D) - GROUP C FIG. 22 (E) - GROUP D
FIG. 22 (F) - GROUP E FIG. 22 (G) - GROUP F
FIG 23: Cleaning the teeth with pumice and rubber cup
Page 38
METHODOLOGY
FIG 24: ETCHING PROTOCOL
FIG 24.1: Etchant

application
FIG 24.2: Cleansing with Water FIG 24.3: Air drying
FIG 24.4: Chalky white

appearance
Page 39
METHODOLOGY
FIG 25: Application of primer on tooth and bracket base
FIG 26: Placement of bracket with FIG 27: Light curing with LED curing
adhesive on tooth unit
FIG 28: Storage of teeth in distilled

FIG 29: Control group testing in UTM
water for 24 hours
Page 40
METHODOLOGY
FIG 30: Debonding the bracket with pliers and debonded bracket
FIG 31: Recycling with 12 fluted FIG 32: Recycling with Ultrasonic
Tungsten Carbide bur Scaler
FIG 33: Recycling with sand blaster
Page 41
METHODOLOGY
FIG 34: Recycling with Flaming and Acid bath (32% Hydrochloric acid + 55% Nitric
acid in 1:4 ratio)
FIG 34.1: Flaming with mini torch FIG 34.2: Rinsing with water
FIG 34.3: Air drying FIG 34.4: Recycling in Acid bath
Page 42
METHODOLOGY
FIG 35: Recycling with Organic solvent
FIG 35.2: Organic solvent with

FIG 35.1: Organic solvent with brackets
brackets in Microwave
FIG 35.3: Organic solvent with brackets after Microwaving
Page 43
METHODOLOGY
FIG 36: Cleaning the composite on tooth

FIG 37: storage of teeth in distilled
surface with low speed tungsten carbide
water for 24 hours
bur
FIG 38: Shear bond strength testing in INSTRON 8801 Universal Testing Machine –
Blue Hill Software 2.0
Page 44
Results
RESULTS
RESULTS
All statistical calculations were performed using statistical package for
social sciences (SPSS) version 21.0 software. Descriptive statistics is done to
know the Mean and Standard Deviation (SD) between the groups and
Analysis of Variance (ANOVA) is done to know the overall significance in
between the groups. Unpaired t-test is done to know the intergroup
comparisons.
Page 45
RESULTS
Table 5: Mean shear bond strength (MPa) of brackets bonded to natural teeth
after first recycling by various procedures.
GROUPS Sub N MEAN STANDARD p value

Groups DEVIATION
GROUP – A AN1 20 15.91 0.03 0.000***
(Control)
GROUP – B B1 20 7.15 0.11

(Tungsten
Carbide Bur)
GROUP – C C1 20 9.67 0.06
(Ultrasonic
scaler)
GROUP – D D1 20 14.97 0.07
(Aluminium
oxide
sandblaster)
GROUP – E E1 20 11.96 0.03
(Flaming +
Acid Bath)
GROUP – F F1 20 14.01 0.02
(Organic
solvent)
***p < 0.001 – Statistically Significant
Page 46
RESULTS
Graph 1: Comparison of Mean scores among various groups after first
recycling
Table 5 shows the mean shear bond strength for orthodontic steel brackets
bonded to caries free extracted maxillary first premolars after first recycling.
The control group AN1 (new bracket bonded to one time bracket debonded
tooth surface) (15.91 MPa) showed highest shear bond strength. Group D1
(Aluminium oxide sandblaster) (14.97MPa) showed higher mean shear bond
strength followed by Group F1 (Organic solvent) (14.01MPa). The least mean
shear bond strength was observed in Group B (Tungsten carbide bur) (7.15
MPa) after first recycling. In Group E1 (Flaming + Acid bath) (11.96 MPa) and
Group C1 (Ultrasonic Scaler) (9.67 MPa), intermediate shear bond strength
was observed. The mean shear bond strength between all the groups after
first recycling is statistically significant.
Page 47
RESULTS
after second recycling by various procedures.

Groups DEVIATION
GROUP – A AN2 20 15.48 0.00 0.000***
(Control)
GROUP – B B2 20 5.25 0.13

(Tungsten
Carbide Bur)
GROUP – C C2 20 7.23 0.11
(Ultrasonic
scaler)
GROUP – D D2 20 11.90 0.20
(Aluminium
oxide
sandblaster)
GROUP – E E2 20 10.43 0.10
(Flaming +
Acid Bath)
GROUP – F F2 20 13.67 0.08
(Organic
solvent)
Page 48
RESULTS
Graph 2: Comparison of Mean scores among various groups after second
recycling
bonded to caries free extracted maxillary first premolars after second
recycling. The control Group AN2 (new bracket bonded to two times bracket
debonded tooth surface) (15.48 MPa) showed highest shear bond strength.
Group F2 (Organic Solvent) (13.67MPa) showed higher mean shear bond
strength followed by Group D2 (Aluminium oxide sand blaster)
(11.90MPa).The least mean shear bond strength was observed in Group B2
(Tungsten Carbide bur) (5.25 MPa) after second recycling. In Group E2
(Flaming + Acid bath) (10.43 MPa) and Group C2 (Ultrasonic Scaler) (7.23
MPa) intermediate shear bond strength was observed.
The mean shear bond strength between all the groups after second recycling
is statistically significant.
Page 49
RESULTS
of Control groups
CONTROL N MEAN STANDARD

GROUP DEVIATION p value
AN 20 15.91 0.035 0.000***
AN1 20 15.48 0.006
AN2 20 15.15 0.084
Page 50
RESULTS
Graph 3: Comparison of Mean scores among Control groups
Table 6 shows the mean shear bond strength for orthodontic steel
brackets bonded to caries free extracted maxillary first premolars in control
group. Group AN (15.91MPa) (new bracket bonded to fresh tooth surface)
showed highest mean shear bond strength followed by Group AN1
(15.48MPa) (new bracket bonded to one time bracket debonded tooth
surface) and Group AN2 (15.15) (new bracket bonded to two times bracket
debonded tooth surface).
The mean shear bond strength between all the groups after second recycling
is statistically significant.
Page 51
RESULTS
pre and post recycling by various procedures.

Groups DEVIATION
AN 20 15.91 0.03
GROUP – A
AN1 20 15.48 0.01 0.000***
(Control)
AN2 20 15.15 0.08
GROUP – B B1 20 7.15 0.11
(Tungsten Carbide B2 20 5.25 0.13

Bur)
GROUP – C C1 20 9.67 0.06
(Ultrasonic scaler) C2 20 7.23 0.11
GROUP – D D1 20 14.97 0.07

(Aluminium oxide D2 20 11.90 0.20
sandblaster)
GROUP – E E1 20 11.96 0.03

(Flaming + Acid E2 20 10.43 0.10
Bath)
GROUP – F F1 20 14.01 0.02
(Organic solvent) F2 20 13.67 0.08
Page 52
RESULTS
Graph 4: Comparison of Mean scores among various groups in pre and post
recycling by various procedures.
bonded to caries free extracted maxillary first premolars. The highest mean
shear bond strengths were observed in Control groups among which Group
AN (new bracket bonded to fresh tooth surface) (15.91MPa) showed the
highest shear bond strength followed by AN1 (new bracket bonded to one
time bracket debonded tooth surface) (15.48MPa) and AN2 (new bracket
bonded to two times bracket debonded tooth surface) (15.15).
Among the first recycled groups Group D1 (Aluminium oxide sandblaster)
(14.97MPa) showed highest mean shear bond strength followed by Group F1
(Organic solvent) (14.01MPa).
Page 53
RESULTS
Among the second recycled groups Group F2 (Organic solvent) (13.67MPa)
showed highest mean shear bond strength followed by Group D2 (Aluminium
oxide sandblaster) (11.90MPa).
The least mean shear bond strength was observed in Group B (Tungsten
carbide bur) (B1 - 7.15 MPa and B2 – 5.25 MPa) after first and second
recycling. Intermediate shear bond strength was observed in Group E
(Flaming + Acid bath) (E1 – 11.96 MPa and E2 – 10.43Mpa) and Group C
(Ultrasonic Scaler) (C1 – 9.67 MPa and C2 – 7.23 MPa) after first and second
recycling.
ANOVA test is done to know the overall significance between groups and the
results showed a p value of 0.000 which represents that a statistically
significant difference in the bond strength is obtained among all the groups.
Page 54
RESULTS
Table 9: Pair wise comparisons to determine the statistical significance
between various groups after first recycling
GROUPING AN1 B1 C1 D1 E1 F1
AN1 -- 0.000*** 0.000*** 0.000*** 0.000*** 0.000***
B1
(TC BUR) 0.000*** -- 0.000*** 0.000*** 0.000*** 0.000***
C1
(SCALER) 0.000*** 0.000*** -- 0.000*** 0.000*** 0.000***
D1
(SAND
BLASTER) 0.000*** 0.000*** 0.000*** -- 0.000*** 0.000***
E1
(FLAMING +
ACID BATH) 0.000*** 0.000*** 0.000*** 0.000*** -- 0.000***
F1
(ORGANIC
SOLVENT) 0.000*** 0.000*** 0.000*** 0.000*** 0.000*** --
Table 9 presents unpaired t-test done for intergroup comparisons. The results
showed that on comparison of differences in the mean shear bond strength all
the pairs presented statistical significance after first recycling.
Page 55
RESULTS
Table 10: Pair wise comparisons to determine the statistical significance
between various groups after second recycling
GROUPING AN2 B2 C2 D2 E2 F2
AN2 -- 0.000*** 0.000*** 0.000*** 0.000*** 0.000***
B2
0.000*** -- 0.000*** 0.000*** 0.000*** 0.000***
(TC BUR)
C2
0.000*** 0.000*** -- 0.000*** 0.000*** 0.000***
(SCALER)
D2
(SAND 0.000*** 0.000*** 0.000*** -- 0.000*** 0.000***
BLASTER)
E2
(FLAMING + 0.000*** 0.000*** 0.000*** 0.000*** -- 0.000***
ACID BATH)
F2
(ORGANIC 0.000*** 0.000*** 0.000*** 0.000*** 0.000*** --
SOLVENT)
Table 10 presents unpaired t-test done for intergroup comparisons. The
results showed that on comparison of differences in the mean shear bond
strength all the pairs presented statistical significance after second recycling.
Page 56
Discussion
DISCUSSION
DISCUSSION
During fixed orthodontic treatment, one of the most commonly
encountered problems is bracket debonding which has been reported to
occur up to 17.6%2. According to Eminkahyagil et al., one out of every five
brackets came loose during orthodontic treatment3. Using a new bracket may
be more time-efficient than reattaching the debonded bracket but requires a
larger, more expensive inventory, especially if attachments are purchased in
single-patient sets. As the manufacturing of brackets becomes increasingly
precise and the design of brackets more complex, the cost of the brackets
spirals upward. This leaves the orthodontists in a dilemma whether to use
new brackets or to recycle the debonded brackets. Even if a new bracket is
used, the bond strength may be affected by residual adhesive on the enamel
surface37. Recycling is considered as one of the swift and cost-effective
alternatives for using the same bracket. With the known fact that a single
bracket can be reused up to five times, evaluating the efficacy of various
recycling methods is of prime importance38.
The goal of bracket reconditioning is to clean and remove adhesive
composite remnants from the base of the bracket with less damage to bracket
base (retentive mesh), providing efficient clinical SBS needed for optimal
attachments to withstand the masticatory forces39.
According to Reynolds6, clinically acceptable bond strengths ranged
from 5.9 to 7.8 MPa. Literature has mentioned that the bond strength can be
affected by several factors, including the bracket base type and size, tooth
surface contour, types of samples (human or animal teeth), types of teeth
Page 57
DISCUSSION
(incisor, canine, premolar, or molar; young or old permanent teeth, deciduous
teeth), etching time, concentrations of etchant, pretreated condition (humidity,
temperature, and duration of water bathing), rebonding tooth surface, method
of recycling of bracket, types of resin used for bracket bonding and testing
speed of the debonding machine40-48.
Traditional in-office bracket recycling methods include the use of
greenstone bur10, 12-fluted tungsten carbide bur3, flaming49, ultrasonic
scaling36, electropolishing27, adjunctive use of acid bath16 to flaming,
sandblasting13,51,52, air abrasion with prophy jet52, Er: YAG laser32,53. Each
method of recycling has its own pros and cons, and no standardized protocol
has been proposed to date in the literature.
In the current study all the above stated parameters due to which the
bond strength might alter have been standardized and the efficiency of
various recycling methods namely 12-fluted tungsten carbide bur, ultrasonic
scaler, 90µm size aluminium oxide particles with sand blaster, flaming
followed by quenching in acid bath has been evaluated. In addition to the
above stated recycling protocols a newer inorganic solvent also has been
tested which is composed of N-methyl-2-pyrrolidone with a 0.1% zinc acetate
catalyst20.
Orthodontic brackets in the mouth are subjected to a combination of
three forces: shear, tensile and torsion. The shear bond strength of a
recycled, rebonded bracket has been reported to exceed the minimum force
requirement, and hence in the current study, the main objective is to evaluate
the shear bond strength of recycled rebonded brackets54.
Page 58
DISCUSSION
In the current study, maxillary premolars are the choice of specimen
because the studies of Zachrisson55,56 and Newman57 showed the highest
failure rates for direct bonding on maxillary and mandibular bicuspids ranging
between 10-30%.
Post extraction, the storage media used in this study is distilled water
which is considered as one of the best storage mediums used for bond
strength studies in order to prevent the dehydration of tooth, which might lead
to a decrease in flexibility and increase in stiffness. Distilled water also does
not alter the chemical, physical and mechanical properties of extracted
teeth58.
After initial bonding, recycling and rebonding, all the specimens are
stored in distilled water because the age of repaired composite also affects
the bond strength, with the greatest reduction in reactivity occurring during the
first 24 hours59. Silva et al. has shown that using distilled water as a storage
media provides less variation in bond strength values by comparing the effect
of the storage time and type of storage on bond strength of extracted teeth60.
It has been suggested that at least 20 per experimental group should
be utilized40 since bond strength data may not follow a normal distribution61
and abnormal distribution of data is likely to be found in the sample sizes of
less than ten specimens in each group. In order to eliminate the bias that may
occur in minds due to the sample size, the number of specimens is kept
maximum so that reliable results can be obtained62.
It has been stated by Kimura et al. that the preparation of enamel
surface provides great surface energy for bonding63. In our study, polishing,
Page 59
DISCUSSION
rinsing with water/ air, and drying with the steam of compressed air has been
done for teeth preparation. The fluoride-free pumice was used for teeth
polishing since the bond strength might be affected by fluorapatite formation
resulting from deposition of fluoride in hydroxyapatite on the enamel surfaces
as stated by Aasenden et al64.
In this study, a conventional etching protocol with 37% orthophosphoric
acid gel for 15 seconds was employed. It has been reported that bond
strength of 15s etching, when compared to that of 60s etching, were 9.38±
4.35 Mpa and 12.15± 4.25 MPa, respectively, which is higher than the
required clinical successful orthodontic bonding values 6-8 MPa65. Transbond
XT light cure adhesive and primer have been used in this study, which is
considered as one of the most popular bonding materials in orthodontic
clinics. It has been reported in many studies that Transbond XT light-cured
resin has a strong bond strength than that of the self-cured resin of concise66.
The tooth surface after debonding was cleaned using a slow speed
tungsten carbide bur under water spray as Zachrisson and Artun, Van Waes
et al. have stated that a tungsten carbide bur at low speed produced the finest
scratch pattern with the least enamel loss of 7.4 µm67,68.
In light of the result of this study, the control group [group AN] with new
brackets had the greatest values of shear bond strength with a mean value of
15.91 MPa [ Table – 7] significantly. This result was in agreement with the
result of Samir. E. Bishara41, who concluded that the highest shear bond
values are generally achieved after initial bracket bonding. However, after first
recycling, a decline in the bond strength was observed in Group AN1, which is
Page 60
DISCUSSION
15.48 MPa. The bond strength was further decreased after second recycling
in Group AN2, which is 15.15 MPa. Zachrisson and Artun have stated that no
method can completely free the tooth surface of the adhesive, and
microscopic tooth substrate alterations are inevitable, and therefore the slight
decrease in the bond strength after each recycling is observed in the control
group67.
The organic solvent group [Group F1] showed the second-highest SBS
value of about 14.01 MPa after first recycling and showed a shear bond
strength of 13.67 MPa after 2nd recycling [Group F2], which is the highest
among second recycling groups [Table 8]. This organic solvent is composed
of N-methyl-2-pyrrolidone and 0.1% zinc acetate. The mechanism of action
involved with the use of N-methyl-2-pyrrolidone is that it causes swelling of
the adhesive material on the bracket base so that the adhesive material
becomes damaged or loose while 0.1% zinc acetate catalyst detaches the
adhesive material from the bracket base. The sustainable higher shear bond
strength values after second recycling with organic solvent is because the
treatment of brackets with solvent does not alter the bracket characteristics
(physical, chemical, or mechanical properties), which could affect the ongoing
orthodontic treatment. This result is in accordance with the Maringka et al20.
Subjecting the brackets to recycling with organic solvent presents an added
advantage that it did not cause any discoloration, unlike sandblasting and
flaming methods. Also, solvent-based recycling can clean many brackets at
once, unlike any other recycling method, which improves the practicality and
efficiency whilst saving time and expenses26,69-72. The reason for choosing N-
methyl-2-pyrrolidone as the solvent is mainly due to its advantages of stability

Page 61
DISCUSSION
at ambient temperature, low volatility, low flammability, no clear toxicity
profile20.
Sandblasting technique with aluminum oxide air abrasion although
showed better result after first recycling, sustainable results are not seen after
second recycling. After first recycling, the highest bond strength was observed
with the aluminum oxide sandblaster group [Group D1], which is 14.97 MPa.
[Table 5] However, upon second recycling, a deterioration in bond strength is
observed in Group D2, which is 11.90 MPa. [Table 6]
The findings of this group showed a significant decrease in values of
SBS in comparison with the control group. This result was in accordance with
the findings of Regan et al. who reported a significant difference in his results
with a 41.4 percent reduction in SBS following the sandblasting technique4.
However, Sonis et al. have indicated that the findings of his work show no
significant difference in SBS between new and sandblasted brackets 13.
On the contrary, the results of our study have shown that the SBS of
new brackets was significantly higher than that of reconditioned brackets74.
The difference in results between the two studies could be explained by
variation in the type of bracket used, sandblasting duration in different studies,
aluminum oxide (Al2O3) particle size, and distance between the etcher tip and
base of the bracket. Willems has revealed that bracket type has a great effect
on the efficiency of sandblasting74. In our study, we used premolar metal
brackets (3M Unitek Gemini), whereas the Sonis has used other type of
premolar brackets (GAC International, Inc., Central Islip, N.Y.)13.
Page 62
DISCUSSION
According to Quick et al., recycling brackets at a pressure of 4.5 bar
and using aluminum oxide granules 50μm for 15s duration time was enough
to remove the remaining compound of adhesives without compromising the
strength of the bond75. However, Millett52 and Aricit76 have stated that
sandblasting the recycled brackets for an extended duration of time with
larger granules leads to a decrease in SBS as a result of bracket base
damage and distortion. Also, Neumann et al. and Rajagopal et al. had a great
concern about recycling brackets for a longer time by sandblasting, as this
could lead to harm and damage the area of undercut in the bracket base,
which may compromise the SBS77. So, a shorter duration of sandblasting is
recommended.
Therefore, in this study, 90 μm aluminum oxide (AL2O3) abrasive
powder has been used at a pressure of five-bar (72.5-psi) for a shorter time
duration of 10s to prevent the obliteration of the bracket base mesh by
residual adhesive material and alteration of the definition of retentive area,
which ascertains the higher bond strength after first recycling. Higher SBS
values of the sandblasted brackets can be attributed to micro roughening of
the bracket base produced by AL2O3 particles, which is supported by findings
of Willems et al74. Also, Alluazy stated that increased micro-roughness results
in increased surface energy and the surface area, thus increasing the bond
strength. There was no visible loss of mesh continuity on the brackets treated
with sandblasting when observed under scanning electron microscopy, which
could be the possible reason for its better bond strength 77.
Page 63
DISCUSSION
However, upon second recycling, a deterioration in bond strength is
observed in Group D2, which is 11.90 MPa. [Table 6] This could be attributed
to the fact that multiple exposures of the bracket surfaces to the larger
aluminum oxide particles result in obliteration of the brackets mesh by
adhesive remnants and a loss of definition in the retentive areas leading to the
loss of retentive capacity14.
Intermediate shear bond strength values are observed in the flaming
and acid bath group [Group E]. After first recycling, the mean SBS value of
group E1 is 11.96 MPa and after second recycling the mean SBS value of
group E2 is 10.43 MPa and the difference is statistically significant [ p-value –
0.000].
The direct flaming technique in this study has recorded the lowest SBS
among all the groups, which is significantly different from the control group.
These findings seem to confirm the result of Dawjee S16. Chetan in his study
has shown that heating the bracket base for bonding material removal
reduced bracket hardness78. Removing the adhesive material requires
exposure to heat for a longer time which is a crucial factor that has a negative
effect on bracket material and its microstructure29. Heat affects mesh strand
diameter, loss of aperture dimension further leading to decline in bond
strength as a result of reduction in effectiveness of the retentive parts of the
base and their size79. Moreover, the physical properties of the metal of the
brackets might be affected by gas torch used for heating brackets80. In this
study, we used gas torch for only 10s for bracket recycling, which was found
to be not enough to remove all the remnant of composite, and could lead to
Page 64
DISCUSSION
obstruct the mechanical retentive area of bracket base75. Orthodontic brackets
are fabricated from austenitic stainless steel15 with homogeneous and
nongranular microstructure. Exposing the brackets to heat above 400°C leads
to chromium carbide precipitate79 and this in turn makes the brackets more
vulnerable to fracture under masticatory forces due to the weakened structure
and disintegration of the metal alloy. Furthermore, it causes discoloration
which is inacceptable for most of patients80 and a decrease in corrosion
resistance which are the main disadvantages along with the reduction in bond
strength after heating process. Huang Tsui-Hsien et al have reported that
thermal recycling method makes brackets more susceptible to tarnish and
corrosion, which are responsible for bracket failure in the oral cavity6.
In our study in order to remove the oxide layer the brackets are treated
in acid bath to make them more esthetic as suggested by Dawjee S,
Gheevarghese O16. This method is simple, quick, and inexpensive way to
clean a bracket after the adhesive has been burned off when compared to
electropolishing. The brackets were submerged for 5 seconds in a solution of
32% hydrochloric acid and 55% nitric acid, mixed in a 1:4 ratio. This process
rapidly removes any tarnish, dissolves any adhesive residue, and has a
disinfectant effect. A bracket that was recycled with a flame and acid bath
solution looks more like a new bracket than one that has been recycled using
a flame and micro etcher and therefore would be more esthetically pleasing
for the patient. An assumption was made that brackets would become
aesthetic along with dissolving residual adhesive, removing tarnish and
having a disinfectant effect without affecting the bond strength. However, the
acid treated brackets in our study became esthetic but the bond strength was
Page 65
DISCUSSION
significantly reduced. Heating the brackets to burn off residual composite
resin from bracket base also imposes the risk of toxic fumes inhalation which
are product of composite incineration process34. The chief reason for the low
SBS values for this group might be because the heating phase of the
recycling process produces small changes in slot width and depth, and also in
the total bracket base area, allowing a three-dimensional thermal expansion
of the bracket itself12.
Among the testing groups, after first recycling the least values were
observed with ultrasonic scaler - Group C1 (9.67 MPa) followed by Tungsten
Carbide bur- Group – B1 (7.15 MPa) which are at the lower range of the
optimal clinically acceptable shear bond strength. Whereas after second
recycling the same groups showed much lesser SBS values [Group C2 – 7.23
& Group – B2 – 5.25 MPa] which are even below the clinically acceptable
shear bond strength. [Table 8]
The cleaning procedure is carried out with these groups till there are
no visible remnants of adhesive resin on the bracket base. So, this grinding
method can wear the mesh surface and cause physical distortion of the
bracket thus eliminating all mechanical retention 28. This is in accordance with
a similar study conducted by Regan et al who claimed that a 40 % reduction
in the bond strengths of the recycled brackets was observed7. Bracket
recycling with these methods had the least shear bond strength of all the
groups in this study and it may be assumed that these methods are preferably
less indicated for bracket recycling.
Page 66
Limitations
LIMITATIONS
LIMITATIONS
1. This study is done in-vitro and therefore it did not simulate the oral
environment and other factors that could have an influence on
shear bond strength such as tooth brushing technique, para
functional habits, age and sex of the patient, dietary habits and type
of saliva. The masticatory forces present in -vivo are inconsistent
unlike in-vitro where a controlled amount of force led to bond failure.
2. Thermocycling of the specimen is not done in this study which
might have an effect on SBS values.
3. The Universal Testing Machine is capable of producing only pure
debonding forces, not the combination of them unlike the forces
seen in the oral cavity.
Page 67
Summary
SUMMARY
SUMMARY
The present study evaluated and compared the shear bond strength of
stainless-steel brackets reconditioning by five in-office methods.
120 human first premolars, extracted for orthodontic reasons were
collected. Grouping was done based on the type of recycling the brackets
undergo before re-bonding onto the tooth surface. Group AN: control group,
Group B: Tungsten carbide bur, Group C: Ultrasonic scaler, Group D:
Aluminium oxide sandblaster, Group E: Flaming + Acid Bath, Group E:
Organic solvent. Each group included a sample of 20 teeth. The Shear Bond
Strength values after first and second recycling of all these recycling methods
were evaluated using universal testing machine.
The control Group AN1 with new brackets had the greatest values of
shear bond strength with a mean value of 15.91 MPa significantly. Whereas,
the bond strength was decreased after second recycling in group AN2, which
was 15.15 MPa.
The organic solvent group [Group F1] showed the second-highest SBS
value of about 14.01 MPa after first recycling and showed a shear bond
strength of 13.67 MPa, which is the highest among second recycling groups
[Group F2].
After first recycling, the highest bond strength was observed with the
aluminum oxide sandblaster group [Group D1], which was 14.97 MPa.
Page 68
SUMMARY
However, upon second recycling, a significant deterioration in bond strength is
observed in Group D2, which was 11.90 MPa.
Intermediate shear bond strength values were observed in the flaming
and acid bath group [Group E]. After first recycling, the mean SBS value of
group E1 was 11.96 MPa and after second recycling the mean SBS value of
group E2 was 10.43 MPa.
Among the testing groups, after first recycling the least values were
observed with ultrasonic scaler - Group C1 (9.67 MPa) followed by Tungsten
Carbide bur- Group – B1 (7.15 MPa) which are at the lower range of the
optimal clinically acceptable shear bond strength. Whereas after second
recycling the same groups showed much lesser SBS values [Group C2 – 7.23
& Group – B2 – 5.25 MPa] which are even below the clinically acceptable
shear bond strength.
So overall performance of the organic solvent group is proven to be the
most efficient method of recycling without altering the bracket base and the
least SBS is observed with tungsten carbide bur.
Page 69
Conclusion
CONCLUSION
CONCLUSION
The highest mean Shear Bond Strength was observed in control group in
which a new bracket was rebonded to the specimens.
Among the first recycling groups sand blasting method showed highest mean
SBS followed by organic solvent group
Among the second recycling groups, organic solvent group showed highest
followed by the sand blasting group
After recycling all the groups twice, organic solvent group was found to be the
most efficient method of recycling without altering the bracket base.
The least SBS is observed with tungsten carbide bur.
Nevertheless, any additional recycling causes deterioration of the bond
strength. Among the chairside recycling techniques, organic solvent can be
used as a better alternative compared to other methods.
Page 70
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Page 80
Annexures
ANNEXURES
ANNEXURES
INSTITUITIONAL ETHICAL CLEARANCE
Page viii
ANNEXURES
MASTER CHART
AN AN1 AN2 B1 B2 C1 C2 D1 D2 E1 E2 F1 F2
15.98 15.47 15.03 6.99 5.23 9.57 7.05 14.89 12.01 11.97 10.36 13.99 13.78
15.86 15.5 15.28 7.32 5.37 9.77 7.4 15.1 11.91 11.91 10.59 14.05 13.52
15.92 15.49 15.18 7.23 5.35 9.66 7.08 14.91 11.89 12.02 10.26 14.02 13.7
15.96 15.48 15.06 7 5.31 9.68 7.24 14.9 12.02 11.92 10.46 14 13.66
15.91 15.49 15.2 7.03 5.01 9.7 7.29 14.99 11.99 12.01 10.4 14.03 13.63
15.93 15.48 15.16 7.26 5.23 9.57 7.34 15.02 12 11.95 10.42 14.04 13.72
15.91 15.49 15.09 7.17 5.37 9.77 7.39 14.99 11.96 11.97 10.51 14.04 13.77
15.97 15.48 15.24 7.25 5.35 9.66 7.38 15 11.43 11.98 10.5 14 13.58
15.97 15.48 15.09 7.32 5.31 9.68 7.29 14.93 11.27 11.99 10.54 13.99 13.66
15.88 15.49 15.17 7.2 5.01 9.7 7.21 15.03 11.9 12.01 10.48 14.02 13.76
15.88 15.48 15.25 6.97 5.23 9.57 7.14 14.88 11.95 12 10.59 14.02 13.59
15.9 15.48 15.06 7.24 5.37 9.77 7.1 14.96 11.98 12.01 10.29 14.03 13.74
15.91 15.48 15.21 7.05 5.35 9.66 7.3 14.94 11.93 11.94 10.38 14 13.64
15.95 15.49 15.2 7.22 5.31 9.68 7.17 14.97 12.03 11.93 10.56 13.99 13.72
15.89 15.49 15.29 7.18 5.01 9.7 7.33 15.1 11.95 11.98 10.41 14.01 13.7
15.92 15.49 15.08 7.03 5.23 9.57 7.25 14.88 11.94 11.99 10.26 14.04 13.55
15.88 15.48 15.13 7.22 5.37 9.77 7.07 14.98 11.93 11.96 10.5 14.05 13.75
15.95 15.48 15.21 7.1 5.35 9.66 7.31 15 11.98 11.96 10.53 14.05 13.69
15.9 15.48 14.99 7.31 5.31 9.68 7.12 14.89 11.78 11.93 10.4 14.03 13.73
15.86 15.48 15.17 7.03 5.01 9.7 7.29 15.1 12.21 11.94 10.28 14.02 13.52
Page ix

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“AN IN VITRO COMPARISON OF SHEAR BOND STRENGTH OF RE-BONDED

BRACKETS WITH VARIOUS IN OFFICE RECYCLING METHODS”

Submitted to Dr NTR University of Health Sciences, Vijayawada Andhra Pradesh

In partial fulfilment of the requirements for the degree of

MASTER OF DENTAL SURGERY

Dr. JOEL ARUMBAKAN

Dr. UDAY KUMAR DIGUMARTHI

DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS

ANIL NEERUKONDA INSTITUTE OF DENTAL SCIENCES

individuals who have always been so kind, so as to devote considerable amount of

time and resource towards the accomplishment of this dissertation.

I am grateful to esteemed teacher and guide, Dr. Uday Kumar Digumarthi,

Professor and HOD, Department of Orthodontics and Dentofacial Orthopaedics, Anil

Neerukonda Institute of Dental Sciences, Visakhapatnam. A simple word of thanks is

dissertation. He has constantly given me outstanding guidance and encouragement

during my entire post-graduation.

I thank my co-guide Dr. Anil Chirla, Professor, Orthodontics and Dentofacial

encouragement made me to be the present form.

Professor, Orthodontics and Dentofacial Orthopaedics.

I am deeply thankful to. Dr. Meher Vineesha Cheepurupalli, Assistant

I express my honest thanks to Dr. Geethika Simhadri, Dr. Neeraja Pitta,

Assistant Professors, Orthodontics and Dentofacial Orthopaedics, for their

continuous encouragement and support.

I sincerely thank Prof. A. Siva Kumar, Department of Chemistry, ANITS for

Shear Bond Strength of specimens under Universal Testing Machine.

I specifically thank Dr. P. AdityaTeja Prasad for providing tremendous

I must place on record the cooperation of postgraduate colleagues Dr. M. Sai

Pushpanjali for extending their support for the study.

I am deeply obliged to my fellow post graduates Dr. Harshitha Garapati, Dr.

Finally, though words do not suffice, I take this opportunity to express my

sincere gratitude to my parents A.D.K.Raju, P. Padmaja and my brother Joshua

Dr. JOEL ARUMBAKAN

MPa Mega Pascal

S.no TITLE PAGE NO

2. AIM AND OBJECTIVES 6

3. REVIEW OF LITERATURE 7-21

4. MATERIALS & METHODOLOGY 22-44

10. REFERENCES 71-81

11. ANNEXURES viii-xi

S.N LEGEND PAGE

21 FIGURE: 21 INSTRON 8801 Universal Testing Machine – Blue Hill 29

24 FIGURE: 23 Cleaning the teeth with pumice and rubber cup 38

25 FIGURE: 24 Etching Protocol 39

26 FIGURE: 25 Application of primer on tooth and bracket base 40

27 FIGURE: 26 Placement of bracket with adhesive on tooth 40

28 FIGURE: 27 Light curing with LED curing unit 40

29 FIGURE: 28 Storage of teeth in distilled water for 24 hours 40

30 FIGURE: 29 Control group testing in UTM 40

31 FIGURE: 30 Debonding the bracket with pliers and debonded 41

33 FIGURE: 32 Recycling with Ultrasonic Scaler 41

34 FIGURE: 33 Recycling with sand blaster 41

35 FIGURE: 34 Recycling with Flaming and Acid bath (32% 42

37 FIGURE: 36 Cleaning the composite on tooth surface with low 44

39 FIGURE: 38 Shear bond strength testing in INSTRON 8801 44

S.NO LEGEND PAGE NO

1 Table 1 Grouping of samples 30

2 Table 2 Control group 34

3 Table 3 1st Recycling Groups 34

4 Table 4 2nd Recycling Groups 35

5 Table 5 Mean shear bond strength (MPa) of brackets bonded 46

to natural teeth after first recycling by various

6 Table 6 Mean shear bond strength (MPa) of brackets bonded 48

to natural teeth after second recycling by various

7 Table 7 Mean shear bond strength (MPa) of brackets bonded 50