SHORT COMMUNICATION

Bond strength of visible light-cured glass ionomer

orthodontic cement
Sejal B. Jobalia, a Rudolfo M. Valente, a Waldemar G. de Rijk, PhD, DDS, b
Ellen A. BeGole, PhD, c and Carla A. Evans, DDS, DMSc d
Chicago, Ill.

In this in vitro study, tensile strength tests were conducted with a visible light-cured glass ionomer
cement (Fuji Ortho LC, GC Amer ca Inc.) bonded to extracted teeth under six different enamet
surface conditions: (1) dry nonetched, (2) moist etched, (3) moist nonetched, (4) moist nonetched
rebonded, (5) moistened with saliva substitute, and (6) moistened with human saliva. Two resin
adhesives (Rely-A-Bond and Phase II, Reliance Orthodontic Products) were applied to dry and
etched enamel and served as control agents. The glass ionomer cement approached the strength
observed for resin adhesives and required the presence of moisture on the enamel surface for
optimal performance. (Am J Orthod Dentofac Orthop 1997;112:205-8.)

R e c e n t l y , interest has developed in the METHODS

use of glass ionomer cements as orthodontic bond-
ing agents because of their potential advantages
over conventional composite resinsJ The advan-
tages claimed include excellent wetting capacity that
allows the cement to adhere to the tooth surface
without the need for acid etching; adhesion in a wet
field; fluoride-releasing action that could reduce the
risk of decalcification at the periphery of the brack-
ets; less damage to the enamel surface in debonding;
more efficient operation with less armamentarium
for the practitioner; and shorter and more comfort-
able chair time for the patient. Laboratory
studies,2, 3 however, demonstrate lower mean shear
bond strength values for glass ionomer cement than
for bonding resins and question the suitability of
glass ionomer cements for orthodontic purposes.
The objectives of this study were (1) to deter-
mine the tensile bond strengths of the glass ionomer
cement, Fuji Ortho LC, and the two conventional
adhesives, Rely-A-Bond and Phase II, under six
different pretreatments of the enamel surface before
bracket bonding; (2) to assess the probability of
bracket failure; and (3) to determine whether the
tensile bond strength of the glass ionomer cement is
sufficient for orthodontic bracket bonding.
From the University of Illinois at Chicago, College of Dentistry, Depart-
ments of Orthodontics and Restorative Dentistry.
~Dental students.
hAssociate Professor of Restorative Dentistry.
CAssociate Professor of Biostatistics in Orthodontics.
dAssociate Professor of Orthodontics and Department Head.
Reprint requests to: Dr. C. A. Evans, Department of Orthodontics,
College of Dentistry, University of Illinois at Chicago, 801 S. Paulina St.
(M/C 841), Chicago, IL 60612-7211.
Copyright © 1997 by the American Association of Orthodontists.
0889-5406/97/$5.00 + 0 8/1/81568
Crowns of 70 sound extracted molars were embedded
in acrylic blocks with the buccal surface exposed and
subsequently returned to a preserving 10% formalin solu-
tion until bonding. A total of eight tests was conducted,
each involving 10 specimens. One set of 10 teeth was used
twice for the rebonding condition. Just before placement
of the attachments, the teeth of each test group were
rinsed with tap water, pumiced, rinsed again, and dried
with a compressed air nozzle. Subsequently, the proce-
dure specified for each experimental group was followed.
The eight conditions evaluated in this study inciude:
Group 1--dry tooth surface, nonetched enamel; Group 2
--enamel was etched with 10% polyacrylic acid for 20
seconds, then rinsed with tap water, allowing the moist
surface to remain for bonding; Group 3--moist tooth
surface with tap water, nonetched enamel; Group 4--after
testing, a rebond test was conducted on group 3--the
remaining cement was removed with a scaler and the
bonding condition of group 3 repeated; Group 5--moist
tooth surface with Saliva Substitute (Roxane Laborato-
ries), nonetched enamel (Saliva Substitute contains sorbi-
tol, sodium carboxymethyl cellulose, and methyl paraben);
Group 6--moist tooth surface with human saliva, non-
etched enamel; Group 7--a conventional one-step self-
cure orthodontic adhesive (Rely-A-Bond, Reliance Ortho-
dontic Products) following manufacturer's directions (dry
tooth surface and etched with 37% phosphoric acid for 30
seconds); and Group 8--a conventional two-step self-cure
orthodontic adhesive (Phase II, Reliance Orthodontic
Products) also following manufacturer's directions.
The teeth within the six groups (1 through 6) involving
the glass ionomer cement (Fuji Ortho LC Batch #130251,
GC America Inc.) were light cured for 10 seconds each on
the gingival, interproximal, and occlusal aspect for a total
of 40 seconds with an Ortholux-XT unit (3M/Unitek).
Teeth in the other two groups (7 and 8) served as controls.
205
206 Jobalia et aL American Journal of Orthodontics and Dentofacial Orthopedics
August 1997

Table I. B o n d s t r e n g t h u n d e r v a r i o u s e n a m e l surface conditions*

[
Mean .. SD Range I
Condition (Newtons) (Newtons) ml ; CI2 (cm) I S°S; CI(S°)

Dry nonetch 98.6 -+ 20.7 68.1-129.0 5.6; 3.1-7.6 106.7; 94.7-119.6

Moist etch 4 133.7 ,, 18.4 111.1-165.4 7.0; 3.9-9.5 138.0; 125.5-151.2
Moist nonetch 101.6 -- 27.9 58.5-154.8 4.2; 2.3-5.7 112.0; 95.5-130.7
Rebond test 117.0 _+ 14,9 86.8-135.2 11.3; 6.3-15.3 122.8; 116.0-130.0
Saliva subst 96.3 ,, 30.2 46.6-129.4 4.1; 2.2-5.6 106.7; 90.7-125.0
Human saliva 108.7 +- 22.8 89.6-145.8 4.2; 2.3-5.7 112.6; 96.3-131.2
Rely-a-bond 5 112.1 + 24.9 87.2-170.1 4.1; 2.3-5.5 117.6; 99.9-137.7
Phase II s 129.7 _+ 35.3 87.2-172.5 4.5; 2.5-6.1 142.6; 123.0-164.7

*The data may be converted to megapascal (mPa) units by dividing the force in newtons by the bracket base area (2.4 m m × 4.0 m m = 9.6 mm 2) and a factor
estimating the additional surface area resulting from the meshpad (~/2). For example, a bond strength of 100 newtons is approximately equivalent to 8.6 mPa.
l m = Weibull modulus.
2CI = Confidence interval (90%).
3S0 = Characteristic strength.
410% Polyacrylic acid (20 seconds).
537% Phosphoric acid (30 seconds).

All the specimens were allowed to bench cure for 10
minutes before placement into a 37° C water bath for 24
hours before testing. The attachments used were mesh-
backed bondable buccal extra-short tubes with hooks and
2.4 × 4.0 mm bracket pads (Lancer Orthodontics).
To test tensile strength, each sample was placed in the
vise of a universal testing machine (Instron Model 1125).
A 14-inch long 0.018 stainless steel wire was threaded
through the bracket and the ends were secured in the
upper vise creating a loop. The crosshead speed was set at
1 mm/minute. The load at fracture (kg) was determined
from the strip chart recording. Shear bond strength was
not tested because a finite element analysis of bond
strength protocols demonstrated a flaw in shear tests. 4'5
Particularly when shear stress is applied at a distance from
the adhesive interface,6 substantial tensile and compres-
sive forces result.
RESULTS
The nonetched groups had lower threshholds for
failure as demonstrated by the tensile bond strength
(Table I). The data used to derive the Weibull
modulus, m, and characteristic strength, S o, are also
shown in Table I.
Under a given load, pf = 1 - exp(S/So) m, where
p f is the probability of failure, S is the load applied,
S O is a constant known as the characteristic value or
scale parameter, and m is a constant called the
Weibull modulus or shape parameter. A plot of the
Weibull functions for two extremely different curves,
rebond and saliva substitute, demonstrates a cumu-
lative probability of failure at different applied loads
(Fig. 1). The Weibull modulus represents the under-
lying flaw distribution that is a measure of the
closeness of the grouped data points. A high value
for m indicates that there is a smaller range within a
specific group and therefore less variation. Thus the
Weibull modulus gives an indication of the reliabil-
ity of a cement, with a low value that indicates a
wide distribution of results and a higher probability
that a given specimen will have a low strength. In
addition, the Weibull distribution allows for cen-
sored data, in this case enamel pullouts. The
Weibull distribution is an extreme value (weakest
link) distribution ideally suited for fracture data. 7
Using Newton-Raphson iteration, the Weibull
modulus and the characteristic strength (So), the value
at which 63% of the bonds failed, were determined.
The differences in characteristic strength between the
six samples with glass ionomer cement and the two
control groups were not statistically significant.
The examination of the site of fracture and the
location of the remaining adhesive (Table II) re-
vealed that most adhesive remained on the brackets
in the dry, nonetched samples, whereas moisture
favors the bonding of adhesive to enamel. Three
instances of enamel tearout occurred during the
testing procedure in three different groups--moist
etched, human saliva, and a control group. The
corresponding values were excluded in the calcula-
tion of means and standard deviations of tensile
strength but included as censored data, i.e., a lower
limit estimate or right hand censored display, in the
Weibull calculations.
DISCUSSION
Current interest in glass ionomer orthodontic
cement stems from its tolerance of moisture during
the bonding procedure, as well as release of fluoride
ions. When conventional resins are used, most early
bond failures result from contamination with mois-
American Journal of Orthodontics and Dentofacial Orthopedics Jobalia et al. 207
Volume 112, No. 2

I11
• REBOND A SALIVA
SUBSTITUTE
_.1
i

1.00
I,A.
U . 0.80
0 0.60 i~ ~ ,~
>..
!-" 0.40
w

.,.I 0.20 A"

i &
IZl
0.00 0 35 70 105 140 175
IZl
0 APPLIED LOAD (in Newtons)
13,

Fig. 1. Comparison of bond strength of orthodontic brackets bonded to enamel in vitro in

rebond and saliva substitute tests.

ture. In fact, as shown in this study, moisture is Table II. Locationof the adhesivelayer after bracket failure
required for optimal adherence of glass ionomer Condition 0 ] 2 3~ 4
cement to the tooth surface.
Dry nonetch 0 7 1 2 0
Enamel apparently is less affected by glass
Moist etch 0 0 9 0 1
ionomer bonding procedures because phosphoric Moist nonetch 0 2 8 0 0
acid is not used to prepare the teeth and grinding Rebond 0 0 10 0 0
Saliva subst 0 1 9 0 0
tools are not required for removing the cement. It
H u m a n saliva 0 2 7 0 1
is likely that polyacrylic acid in the cement liquid Relay-a-bond _0 O 0 0 _1
etches the tooth surface, but less than phosphoric Total 0 12 53 2 3
acid. This hypothesis is supported by the rebond
0 = N o adhesive on tooth.
test in which the remaining glass ionomer cement 1 = Most of adhesive on bracket.
could be cleaned off the tooth with a scaler. The 2 = M o s t of adhesive on tooth.
3 = N o adhesive on bracket.
tearouts may be attributed to inherent weaknesses
4 = E n a m e l or dentin tear-out.
in the tooth structure that stem from a variety of
possible causes including age of the person at time
of extraction, length of time in storage, or damage gators, but the characteristic strength calculation pro-
as a result of the exodontic procedure, all of which vides a better description and understanding of the
may have led to exceeding the tensile limit of experimental data.
enamel. A number of issues require further investigation
In most studies of orthodontic bonding methods,8 of glass ionomer cements, including the relationship
the data are analyzed by descriptive nonparametric between laboratory testing of bond strength and
statistics, or the normal distribution is applied with the clinical usefulness. 1° Also, continued development
assumption that errors are randomly distributed. Be- of glass ionomer cements is needed to reduce clin-
cause this assumption is not inherent in Weibull sta- ical errors that may be related to the operator or
tistics, this method is particularly useful for the study of individual anatomic variation.
fracture data. 9 The applicability of the Weibull distri-
bution was evaluated by the linearity of the log-log CONCLUSIONS
transforms. In comparison, nonparametric statistics Glass ionomer cement approaches the strength ob-
are much less powerful. The means and standard served for conventional resin adhesives, is suitable for
deviations of fracture load values are provided in this rebonding brackets, and favors the presence of moisture
report for comparison with the work of other investi- on the enamel surface in the form of water, saliva, or
208 Jobalia et aL American Journal of Orthodontics and Dentofacial Orthopedics
August 1997

saliva substitute. However, its use on nonetched teeth
results in a lower threshhold for failure.
We acknowledge GC America Inc., Reliance Orthodon-
tic Products and 3M/Unitek for making this study possible.
REFERENCES
1. Silverman E, Cohen M, Demke RS, Silverman M. A new light-cured glass ionomer
cement that bonds brackets to teeth without etching in the presence of saliva. Am J
Orthod Dentofac Orthop 1995;108:231-6.
2. Wiltshire WA. Shear bond strengths of glass ionomer for direct bonding. Am J
Orthod Dentofac Orthop 1994;106:127-30.
3. Ewoldsen N, Beatty MW, Erickson L, Feely D. Effects of enamel conditioning on bond
strength with a restorative light-cured glass ionomer. J Clin Orthod 1995;29:621-4.
4. Versluis A, Douglas WH. Why do shear bond tests pull out dentin? J Dent Res
1996;75:177 (IADR Abst 1276).
5. Thomas R, de Rijk WG, Evans C. Finite element analysis (FEA) of orthodontic
attachment bond strength testing protocols. J Dent Res 1997;76:401 (IADR Abst
3104).
6. 13hatt A, Gheewalla E, Perry R, Kugel G. Comparison of a compomer and resin
cement for bonding of orthodontic brackets. J Dent Res 1996;75:175(IADR Abst
1259).
7. Lawless JF. Statistical models and methods for lifetime data. New York: John
Wiley; 1982.
8. Bishara SE, Damon PL, Olsen ME, Jakobsen JR. Effect of applying chlorbexidine
antibacterial agent on the shear bond strength of orthodontic brackets. Angle
Orthod 1996;66:313-6.
9. Allison PD. Survival analysis using the SAS system: a practical guide. Cary (NC):
SAS Institute; 1995. p. 69.
10. Kusy PP. Commentary on Dr. Wiltshire's article: When is stronger better? Am J
Orthod Dentofac Orthop 1994;106:17A.

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