BONDING

IN
ORTHODONTICS

Dr. Jitendra Bhagchandani

IInd year,
Dept. of Orthodontics,
Saraswati Dental College.
CHARACTERISTICS
OF NORMAL
ENAMEL

(Between a 10 year old boy and an adult)

10 year old boy
An adult
BONDING
HISTORICAL
PREVIEW
 Successful Bonding in orthodontics is now said to
be approx. 35 yrs old from the time it is used in the
dental offices around the world.

 Early bonding system consisted of brackets welded

onto the bands; bonded to the tooth with zinc
phosphate cement.
 The introduction of the acid etch bonding technique
has led to dramatic changes in the practice of
orthodontics.

 Acid pretreatment for increased adhesion, using

85% phosphoric acid- 1955 Buonocore.

 In 1965 – Newmen started with the epoxy resin

bonding.

 In 1968 – Smith introduced zinc polyacrylate

(carboxylate) cement.
 Around 1970 – Miura et al. described acrylic resin
(Orthomite), using modified trialkyl borane catalyst,
that proved to be successful for bonding in the
presence of moisture.

 The most widely used resin, commonly referred to

as Bowen’s resin or bisGMA (bisphenol A glycidyl
dimethacrylate) having improved bond strength and
increased dimensional stability by cross-linkage.
 INDICATIONS FOR BONDING

 Esthetically superior

 Faster and simpler

 Less discomfort for the patient

 Thickness of the bands inter proximally

 Precise

 Hygienic
 Partially erupted or fractured teeth

 Mesio-distal enamel reduction is possible during

treatment

 Inter proximal areas are accessible

 Caries risk under loose bands is eliminated

 No band spaces to be closed at the end of the

treatment

 Lingual brackets can be used

 DISADVANTAGES OF BONDING
 Weaker attachment than a cemented one

 Operator might not follow the directions for use of

the adhesive properly

 Adhesive may extend beyond the bracket base

 Protection against inter proximal caries of well-

contoured cemented bands

 Rebonding a loose bracket requires more

preparation
 Bonding
Procedure
( Steps involved in direct bracket bonding on
facial or lingual surfaces )
• Cleaning

• Enamel conditioning

• Sealing

• Bonding
 CLEANING
 Cleaning of the teeth with pumice removes
plaque the organic pellicle that normally
covers all teeth.

 The need for conventional pumice

polishing before acid etching has been
questioned.
 Reisner et al. found more consistent results
when buccal tooth surfaces were abraded
lightly with a tungsten carbide bur (#1172)
at slow speed (25,000 rpm) than when the
surfaces were pumiced for 10 seconds
before acid etching.
 ENAMEL CONDITIONING
 Moisture Control
(salivary control and maintenance of a dry
working field is essential)

• Lip expanders and cheek retractors

• Saliva ejectors
• Tongue guards with bite blocks
• Salivary duct obstructors

• Gadgets that combine several of these

• Cotton or gauze rolls

• Antisialagogues
 Enamel Pretreatment
(the conditioning solution or gel is applied
over the enamel surface for 15 to 30
seconds)

 Salivary contamination of the etched surface

must not be allowed.

 If contamination occurs, rinse with the water

spray or re-etch for a few seconds; the
patient must not rinse
 Next, the teeth are dried thoroughly with a
moisture and oil-free air source to obtain
the well-known dull, frosty appearance.
 Teeth that do not appear dull and frosty
white should be re-etched.

 Cervical enamel, because of its different

morphology.
 Scanning electron micrograph of an enamel
surface that has been etched with 37%
phosphoric acid.
 The prism centers have been removed
preferentially.
 The loss of prism peripheries demonstrates the
head and tail arrangement of the prisms
Transverse section of an etched porous enamel
surface showing two distinct zones, the
qualitative porous zone (QPZ) and the
quantitative porous zone.
 ACID ETCHING IN PRIMARY
TEETH
 The outer 30um of primary enamel is prismless
layer which does not produce a uniform etch.

 Primary enamel has a much higher organic

content.

 The prism rods in deciduous teeth approach the

surface at a greater angle and are thus more
difficult to etch
 Studies
 Silverstone reported that a 120sec etch
was necessary on primary enamel to
establish proper oral porosity.

 Mueller in 1977 found that by increasing

the etch time an increase in tag formation
was seen.
 Nordenvell et al compared primary young
and mature permanent teeth using various
etch times between 15-60sec. They found
that 15sec etch of primary teeth gave the
greatest surface irregularity

 Redford reported that an etch time of 15sec

with 38% phosphoric acid was adequate
for primary enamel.
 Agents used in acid etching :
 Phosphoric acid is the acid of choice

 Other agent like Pyruvic acid or lactic

acid have been tried – used further
investigators

 10% Maleic acid.

 Alternatives to acid etching

 Sand blasting/air abrasion

 Laser etching

 Crystal growth
 Sand blasting / Air abrasion

 High stream of aluminum oxide particles

{ 50-90 } microns propelled by air pressure

 MILLETT - Sandblasting the base of the

bracket increased the bond strength
Factors affecting the bond strength

1.Particle size of the aluminium oxide particles

2.Air pressure

3.Exposure time

4.Microstructure of the enamel

Wendela Van Waveran, Albert Feilzer
; AJO-DO 2000

Compared the bond strength and enamel loss

b/w sand blasting and conventional acid
etching at varying exposure times and air
pressure. They concluded that the bond
strength and enamel loss of sand blasting
was less as compared to conventional acid
etching
 Laser etching
Depending on the wavelength

 UV range [Krypton Fluoride, argon fluoride]

 Visible light [helium,neon]

 Infra red range [Carbon dioxide Laser, ND: YAG

Laser (Neodymium: YTTRIUM-Aluminium-
Garnet]
 Carbon dioxide laser can etch mineralized
structures because of its ability to vaporize water
in tissues.

 LIBERMAN et al 1984 showed in his study that

the bond strength of composite to enamel
following carbon dioxide laser treatment was
comparable to that of acid etching.
 Crystal growth
 Demonstrated by Smith and Cartz (1973)

 50% Polyacrylic acid + sulphate ion -

crystalline deposit

 Crystal formation due to the sulphate

component form calcium sulphate
hemihydrate crystals that are needle shaped
Other Ionic salts:
 Magnesium sulphate
 Potassium sulphate

 Study by MAIJER and SMITH found the

maximum density of long, needle shaped crystals
growing on the enamel surface after conditioning
for 4 minutes with 40% polyacrylic acid
containing 3.8% of sulphate ions
 VARIOUS
TECHNIQUES OF
BONDING TO
NON-ENAMEL
SURFACES
Bonding to crowns and restorations

 Microetcher (Danville Engineering, San

Ramon, California)

 Uses 50 µm white or 90 µm tan aluminum

oxide particles at about 7 kg/cm2 pressure

 This tool is also useful for tasks such as

rebonding loose brackets, increasing the
retentive area inside molar bands, creating
micromechanical retention for bonded
retainers, and bonding to deciduous teeth.
 Bonding to porcelain

 In 1986 Wood et al. showed that

roughening the porcelain surface, adding a
porcelain primer, and using a highly filled
adhesive resin when bonding to glazed
porcelain added progressively to bond
strength.
 Roughening of porcelain and silane treatment.

 Silane application for a chemical bond.

 Clinical effectiveness of single-component liquid

silanes, unhydrolyzed (Porcelain Primer, Ormco,
Orange, California) and prehydrolyzed
(Scotchprime, 3M), have been questioned.
 The most commonly used porcelain etchant is
9.6% hydrofluoric acid in gel form applied for 2
minutes.

 Hydrofluoric acid is strong and requires careful

isolation of the working area, cautious removal of
gel with cotton roll, rinsing with high volume
suction, and immediate drying and bonding
 In vitro study of two different techniques -
namely, (1) hydrofluoric acid gel treatment and
(2) sandblasting and silane (Scotchprime)

 Failure rates of 8.2% versus 8.6%.

 Produced equally strong bonds to a feldspathic

porcelain.
 Bonding to amalgam
1. Modification of the metal surface (sandblasting,
diamond bur roughening)

2. The use of intermediate resins that improve bond

strengths (e.g., All-Bond 2 Bisco, Schaumburg,
Illinois], Enhance, and Metal Primer [Reliance
Orthodontics])

3. New adhesive resins that bond chemically to

nonprecious and precious metals (e.g., 4
methacryloxyethyl trimellitate anhydrid [4-
META] resins and 10-MDP bis-GMA resins).
 LARGE

versus

SMALL

AMALGAM RESTORATIONS
 Bonding to composite restoratives

 The bond strength obtained with the addition of

new composite to mature composite is
substantially less than the cohesive strength of
the material.

 Bonding to a fresh, roughened surface of old

composite restorations appear to be clinically
successful in most instances.

 Use of an intermediate primer is probably

advantageous as well.
 Bonding to gold

 Different new technologies—including

sandblasting, electrolytic tin-plating or plating
with gallium-tin solution (Adlloy)

 Use of several different types of intermediate

primer, and new adhesives that bond chemically
to precious metals (Superbond C&B, Panavia Ex
and Panavia 21 (Kuraray America, New York)
have been reported to improve bonding to gold in
laboratory settings.
 QUESTIONS :
1. Should the etch cover the entire facial
enamel or only a small portion outside
the bracket pad?
2. Are gels preferable to solutions?
3. What is the optimal etching time? Is it
different for young and old teeth?

4. Is sandblasting as effective as acid

etching?

5. What is the preferred procedure for

deciduous teeth?
6. Is prolonged etching necessary when teeth
are pretreated with fluoride?

7. Will incorporation of fluorides in the

etching solution increase the resistance of
enamel to caries attack?
8. How much enamel is removed by etching,
and how deep are the histologic
alterations? Are they reversible? Is etching
harmful?
9. Should means other than acid etching with
phosphoric acid (e.g., polyacrylic acid,
maleic acid, or self-etching primers) be
preferred?
 Sealant, primers

 After the teeth are completely dry and

frosty white, a thin layer of bonding agent
(sealant, primer) may be painted over the
etched enamel surface

 The coating may be thinned by a gentle air

burst for 1 to 2 seconds followed by
bracket placement
Functions of sealants: -

Studies show divergent findings

 Increased bond strength.

 Protect enamel from consequent demineralization
by acid etching procedure.
 Improves resistance to micro leakage.
 Use of sealant in two-paste system may be un-
necessary for strength but it may offer extra
protection to enamel while debonding.
 A particular problem is that the sealant film on
facial surface is so thin (50 – 100 micron) that
oxygen inhibition of polymerization is likely to
occur right through film with auto polymerizing
sealants.

 With acetone containing and light polymerized

(Joseph, 1992, JCO) sealants, non-
polymerization seems less a problem.
 Light polymerized sealants Vs
Chemically polymerized sealants

 Light-polymerized sealants protect enamel

adjacent to brackets from dissolutions and
subsurface lesions (HIGH ABRASION
RESISTANCE)

 Chemical-curing sealants may polymerize

poorly (LOW ABRASION RESISTANCE)
 Enamel sealants: a clinical evaluation
of their value during fixed appliance
therapy
The European Journal of Orthodontics 2005 16(1):19-25

 A clinical trial was undertaken to evaluate

the effectiveness of two new enamel
sealing systems in the prevention of
enamel decalcification following bracket
bonding. Eighty patients undergoing fixed
appliance therapy were included.
 The results showed that 75 per cent of patients were
affected by some decalcification.

 The viscous sealant reduced the extent of decalcification

of tooth zones by 13 per cent.

 The non-viscous sealant produced no significant

difference.

 Over 60 per cent of decalcification occurred in the

gingival areas.

 Maxillary lateral incisors and canines, and mandibular

canines and second premolars were the teeth most
severely affected, and the most likely to benefit from
sealing.
 Light Curing the Primer -
Beneficial???
The Angle Orthodontist: 2006, No. 2, pp. 310–313

 Metal brackets were bonded to each tooth under

different enamel surface conditions:

 Dry
 Contaminated with blood or contaminated with
saliva after primer application without light
curing the primer
 Contaminated with blood or contaminated with
saliva after primer application with light curing
the primer
 There was no statistically significant difference between
the groups bonded under dry conditions.

 On the other hand, curing the primer before adhesive

application enhanced the bond strength in the
contamination groups.

 Saliva and blood behaved similarly, showing higher bond

strength values when the primer was light cured before
contamination.

 Under ideal conditions, light curing the primer did not

introduce any advantages.

 However, curing the primer before contamination

revealed higher bond strengths.

 To minimize the negative effect of contamination on bond

strength, it would be appropriate for clinicians to light
cure immediately after the application of the primer.
 Self etching primers (SEPs):-
(Methacrylated phosphoric acid ester)
 Conditioning and priming in single step.
 Less time consuming & cost effectiveness.
 No separate acid etching and subsequent
rinsing with water & air spray
 TECHNIQUE FOR SEP
PROMPT L POP & TRANSBOND
SELF ETCH PRIMER
 SEM –
Etched enamel vs
SEP treated enamel
Three mechanism acts to stop the etching
process:-

1st: The acid group attached to the monomer are

neutralized by forming a complex with a calcium
from hydroxyapatite.

2nd: As a solvent is driven from the primer during the

air burst step, the viscosity rises, slowing the
transport of acid groups to the enamel interface.

3rd: As the primer is light cured and the primer and

monomer are polymerized, transport of the acid
group to the interface is stopped.
 Comparison of Bonding Time and
Shear Bond Strength Between a
Conventional and a New Integrated
Bonding System
The Angle Orthodontist: 2006, No. 2, pp. 237–242

 This study compared the total bonding

time and shear bond strength (SBS) of 2
bracket-bonding systems:
(1)an integrated system that incorporates a
self-etching primer
(2)a conventional system in which the
etchant and primer are applied separately
The mean SBS :
 9.4 ± 3.7 MPa for the new bonding system
 6.2 ± 4.4 MPa for the conventional system

The mean total bonding time :

 36.5 s/tooth for the new system
 46.7 s/tooth for the conventional system

The clinician has to decide whether the increase

in bond strength, the decrease in the total bonding
time, and the steps saved during the bonding
procedure with the new bonding system balance
the increased cost incurred
 Shear Bond Strength of Orthodontic
Brackets Bonded using Conventional vs
One and Two Step Self-
etching/adhesive System
The Angle Orthodontist: 2007, No. 3, pp. 518–523

Materials and Methods:

one-step self-etching primer and adhesive
used was Clearfil tri-S bond

the two-step fluoride-releasing

antibacterial self-etching primer and
adhesive was Clearfil Protect Bond
 Results: Mean shear bond strength values, 9.55
MPa for Clearfil Protect Bond, and 9.48 MPa for
Clearfil tri-S Bond

 Conclusions: One-step self-etching adhesive and

two-step fluoride-releasing antibacterial self-
etching adhesive have sufficient mechanical
properties for the bonding of orthodontic brackets
 Bishara et al evaluated the effectiveness of using Prompt
L-pop (ESPE, Seefeld, Germany) to bond orthodontic
brackets with composite resin. According to the results,
this SEP provided significantly lower (but clinically
acceptable) shear bond strength when compared with a
conventional etch/priming technique before bonding
brackets with Transbond XT adhesive paste (3M Unitek,
Monróvia, Calif).

 More recently, additional modifications were done, and a

new release, Adper Prompt L-pop (3M ESPE, St Paul,
Minn), was introduced to improve enamel and dentin
bond strengths for more consistent performance.

 The null hypothesis was that there would be no difference

in the shear bond strength between groups whether a
conventional multistep or a SEP system was used
 The Angle Orthodontist: 2006, No. 3, pp. 466–469
Evaluation of a New Self-etching
Primer on Bracket Bond Strength In
Vitro
 The purpose of this in vitro study was to evaluate
the influence of a new self-etching primer (Adper
Prompt L-pop; 3M ESPE, St Paul, Minn) on
shear bond strength of orthodontic brackets:

 group 1 (control), phosphoric acid + Transbond

XT primer (3M Unitek, Monróvia, Calif)

 group 2, Adper Prompt L-pop. Transbond XT

adhesive paste (3M Unitek) was used in both
groups for bracket bonding
 group 1 = 16.23 MPa (4.77), group 2 = 13.56 MPa (4.31)

 No significant difference was observed in the bond

strengths of the two groups evaluated (P = .069)

 However, the adhesive remnant index was significantly

less when conditioning the enamel with Adper Prompt L-
pop compared with phosphoric acid (P = .0003)

 The amount of adhesive on the enamel after debonding

was significantly less when using Adper Prompt than
when using phosphoric acid.
 The Angle Orthodontist: 2007, No. 3, pp. 524–527
Shear Bond Strength of Precoated and
Uncoated Brackets Using a Self-etching
Primer

 Materials and Methods: APC Plus

precoated brackets and uncoated brackets
were bonded with Transbond XT adhesive
using the self-etching primer Transbond
Plus Self-Etching Primer (TPSEP).
Scanning electron microscope (SEM)
observations of enamel surfaces treated
with TPSEP were also carried out.
 Results: No significant differences were
observed in the shear bond strengths for the two
groups evaluated (P < .05). TPSEP/APC Plus left
significantly less adhesive on the tooth after
debonding than did TPSEP/Transbond XT (P <
.05). It was observed that SEM left a porous and
potentially retentive surface

 Conclusions: There was no significant difference

in the bond strength of the two systems tested,
but there was a significant difference in the
percentage of area of adhesive remaining on the
tooth
 Moisture-insensitive Primers
Hydrophilic primers that can bond in wet
fields
(Transbond MIP, 3M/Unitek)

 Bond strengths were significantly lower

under wet conditions than in dry conditions.

 Hydrophilic primers suitable in difficult

moisture-control situations
 Second molar bonding.
 Impacted canines
 Partially erupted teeth

Drawback:-
Low bond strength
4. Bonding:-
Done immediately after teeth have been
painted with primer.

Procedure:

a. Transfer
b. Positioning
c. Fitting
d. Removal of excess
a. Transfer:-

 Grip the bracket with reverse action tweezer.

 Apply adhesive to the back of the bonding
base.
 Immediately place the bracket on the tooth
close to its correct position.
b. Positioning:-

 Use a placement scaler to position the brackets

mesiodistally and incisogingivally and to
angulate them accurately relative to the long axis
of the teeth.

 Vertical positioning is enhanced by measuring

devices or height guides.

Totally undisturbed setting is essential for

achieving adequate bond strength
c. Fitting:-

 With the scaler make one point contact with the

tooth surface and push the bracket firmly towards
the tooth surface.

 Tight fit ensures good bond strength and less

sliding.
d. Removal of excess:-

Slight bit of excess adhesive is essential to:

 Minimize voids.
 Ensure proper flow into the bracket backing.
 On teeth with abnormal morphology.

Should be removed from the gingival margins to:

 Minimize gingival irritation & plaque build up
 Reduce periodontal damage.
 Reduce decalcification.
 Improve esthetics.
e. Light Curing :-
 After completing these procedures check the
position of each bracket.

 Rebond any ill positioned bracket immediately.

 Insert the leveling archwire and instruct the

patient about proper brushing and give a program
of daily fluoride mouth rinses (0.05% NaF) to
follow
 Bonding to Premolars :-

 Technical problem for obtaining accurate bracket

placement on maxillary first & second premolar

 Visibility for direct bonding should be facilitated by

bonding the teeth one at a time without the lip
expander

 Gingival offset brackets are recommended for newly

erupted mandibular premolar
ADHESIVES FOR

BRACKET BONDING
CLASSIFICATION OF DENTAL COMPOSITES
1.Based on resin types
Acrylic based
Diacylate based
2.Based on curing
Self-curing
Light curing (uv & light)
Dual curing
Staged curing
3.Based on filler content
Macrofill
Midifill
Minifill
Microfill
ACRYLIC BASED RESINS
Based on self-cured acrylic resins. These may be filled or
unfilled.

COMPOSITION
POLYMER: polymethylmethacrylate (PMMA)
MONOMER: methylmehhacrylate (MMA)
INITATIOR: benzoyl peroxide.
ACTIVATOR
- Tertiary amine system
- tri –N – borane derivative

PROPERTIES
These have large coefficient of thermal expansion. 92.8 x 10-6
/ºC (8 times to tooth)
These have 6- 10% volumetric contraction on curing.
COMMERCIAL VARIETIES
1.O.I.S adhesive system (Ortho-International-Service}
It was the first bonding system commercially available to
orthodontist.
It was powder liquid based system. 2 scoops of powder
were put on one end of glass plate & 7 drops of liquid
are added to it and mixed with triangular spatula for 15-
20 seconds.

2.Bracket Bond (G.A.C)

3.Orbond (Ormco)
4.Orthomite D.B.S (rocky mountain):-
It is based on tri-n-borane catalyst
5.Direction (T.P.orthodontics)
6.D.B.KIT (Unitek)
DIACRYLATE BASED
These resins have been loosely described under a variety
of different names –epoxy, epoxy type, acrylated epoxy,
dimethacrylate, epoxy-acrylic, which has led some
confusion. Epoxy resins per se (e.g. Araldite) have not
found commercial recognition in dentistry due to the
length of cure time (15-30 minutes). The most
commonly found diacylate resin is bisphenol A glycidyl
dimethacrylate (Bis GMA) that was patented by Bowen
1962 (Bowen’s resin)
Other diacrylates
Urethane dimethacrylate (UDM) (UDMA): - high viscosity
Triethylene glycol dimethacrylate (TEGDMA, TEGDM,
TGDMA): - low viscosity
COMPOSITION
RESIN MATRIX: - Bis GMA, UDM
FILLER: - Quartz, Colloidal silica, Heavy metal glasses, Non
silicate (nano –filler)
Coupling agent: - Organosilane (produce interfacial bonding)
Hydoquinone: -prevent premature polymerization
OPACIFIERES:TiO2, Al2O3
Color pigments
Modern resins: contain precoated silica particle with silane
RESIN MATRIX: Bis GMA, UDM
These are superior to acrylic resins but have certain limitations
Increased viscosity –TEGDMA can be added as diluents.
Difficult to synthesis pure composition
Strong inhibition to polymerization
BASED ON CURING
1.CHEMICAL CURED –
These can be powder & liquid systems; two paste systems,
or paste & liquid system (no-mix).
In two-paste system base contains initiator (benzyl
peroxide) & catalyst contains activator (tertiary amine).
When pastes are spatulated setting is due to interaction
of peroxide & peroxide.
In no mix adhesives catalyst is added in primer (sealer).
Disadv. – Working time is restricted.
Numbers of brackets that can be placed with one
mix are limited (not problem with no mix adhesive)
2. LIGHT ACTIVATED RESINS –

• a) U.V light cured: - 364 – 367 nm wavelength is used.

The advantage is that material sets on command but
90 sec. application of curing light is required on each
bracket. U.V light has poor transillumination so plastic
brackets or perforated brackets are essential. This light
has limited depth of curing. U.V light may cause skin
cancer, eye damage or erythema.
So this curing system was replaced by visible light
cure.
b) Visible light systems: - 440 – 480 nm wavelength is
used. Owing to limitations of U.V light systems, a visible
light cured system was suggested by Douglas et al in
1979.
Adv. – More safe
Can be cured by transillumination as tooth can conduct
VL.
VLC resins are useful in which a quick set is required,
such as on palatally impacted canine after surgically
uncovering.
These are also adv. In situations where longer working
time is desirable, such as difficult premolar bracket
position
c) Dual cured: -
It contains both light cured and self-curing resins.
Self-curing resins are slowing setting and useful
in those areas, which can not be adequately
cured by light curing.
d) Staged curing: -this is the curing method in
which filtering light is used from curing unit for
initial cure (20 seconds). Excessive material can
be finished, as it is soft. After that filter is
removed and curing is done with full intensity of
light (20 – 60 seconds).
3. Thermocured (Heat activated)

-Initiation occurs through exposure to heat.

-Not intended for direct bonding.
-Polymerization initiator system restricts their use
to indirect bonding.
-Not commonly used.
4. Moisture-active

-Cyanoacrylate (smart bond)

-No liquid component is involved.
-Paste formulation only.
-Initiation is achieved through exposure to water.
-One-step-procedure.
-Enamel surface must be initially wetted.
5.Moisture- resistent (Transbond MIP)

-Primer compatible with the use of adhesives.

-Application of primer on wet enamel surface.
-Recently introduced.
6.Adhesive-precoated brackets

-Bracket covered with predetermined amount of

adhesives.
-Direct application of primer onto the adhesive-
covered base and bonding.
-Bond strength comparable to conventional
chemically cured systems.
-Efficient mode of bonding.
FILLER PARTICLES:
Various types of composites according to size of fillers
Macrofill: - 10-100micron
Midifill: - 1-10micron
Minifill: - 0.1-1micron
Microfill: - 0.01-0.1micron
Nanofill: - 0.005 -0.01 micron
 The term fill or filler is preferred to filled as fill describes filler
particle size not the method of producing mixtures
 Composites with mixed range filler are called as hybrid
composites. Largest filler particle size range defines the hybrid
 If the composite is the mixture of filler and uncured matrix then
it is called homogeneous composite and if it also includes pre
cured composite particles then it is called as heterogeneous
composite
Filler particles lead to: -
 Decreased curing shrinkage
 Decreased water sorption,
 Improved mechanical properties e.g. Strength,
stiffness etc.

Factors that determine properties and clinical application

 Amount of filler added
 Size of particles and its distribution
 Index of refraction
 Radiopacity
 Hardness
Types of fillers
• Ground quartz: -
o It is obtained by grinding or milling the quartz. It is
physically hard and chemically inert.

• Colloidal silica: -
o It is obtained by pyrolytic or precipitation process. It is
added in small amount (5%wt)
Coupling agent: -
Coupling agent bonds filler particles to resin matrix.

• Most commonly used coupling agents are organosilanes

(3-methoxy –propyl –trimethoxy silane)

• In hydrolyzed state silanol group of organosilanes interact

with silanol group of filler to form siloxane bond (Si-O-Si)

• Methacrylate group of Organosilane form covalent bond

with resin.

Functions
• It improves physical and mechanical properties.
• It provides hydrolytic stability.
PRIMERS (SEALANTS, ENAMEL BONDING AGENTS):

• These are unfilled resins similar to resin matrix of

composite resins that are diluted by other monomer to
decrease viscosity.

• This is applied between enamel and adhesive and

between adhesive and attachment.

• This increases the wetting of enamel and also it may act

as a coupling agent i.e. it may form chemical union
between of these surfaces and adhesive.
Examples: -
• Silanes: - Primer supplied with Direction (T.P), Z6030 with
Orthomite (R.M.O)

• Unfilled diacrylate resins: - Nuvaseal used with Bracket

bond & Nuvatach
Primer supplied with Rely-A- Bond & Transbond

• Coupling agents used between attachments &

adhesive: -acrylic resins used to bond polycarbonate
brackets with Bowen’s resin.
• Acidic primer systems (self etching primer/ adhesive): -

These combines conditioning agent:

(phenyl P) & priming agent (Diacrylates).

Advantage is improved chair side time. This concept of

acidic primers was introduced by Nakabayashi in 1982.
• Self Etching Primers (systems) – (SEP’s)

– Clearfil Liner bond V (Kuraray)

– Megabond (Kuraray)
– Prompt –L-Pop (Unitek-3M)
– First Step (Reliance)
– Transbond Plus SEP (Unitek -3M)
– Ideal1 (GAC)
– One up Bond F (Tokuyama)
• Moisture insensitive primers: -

These are ethanol-based primers. These are moisture

insensitive. These can be used easily in areas of difficult
access.
eg. 1. Transbond MIP (3M- Unitek)
2. Assure (Reliance)
 Dental Resins (Polymers) –
Ist generation
CHEMICALLY AUTOPOLYMERISING
PASTE – PASTE SYSTEM – (mid 1970’s)

 Acrylic (Linear polymers ; Plastic brackets ; MMA

& Ultra fine powder)

 Diacrylate (Cross – linkages ; Metal brackets ;

Acrylic modified epoxy resins – Bis GMA/Bowens
resin)

 Both may either be filled or unfilled.

ADVENT – COMPOSITE RESINS
– II nd generation (mid 1970’s)

 Filled with large & coarse silica glass

particles / Quartz (3-20 micron) –
ABRASION RESISTANCE PROPERTY
with HIGHER STRENGTH FOR
METAL BRACKETS
 III rd generation - (late 1970s)
 These were filled or composite resins. These
have high percentage of inert filler material.

 A small quantity of a composite can be mixed so

that it sets rapidly & develops full strength in
only a few minutes.

 Both direct bonding technique & indirect

bonding but removing the flush around the
margins of brackets is a problem. E.g. Concise
 NO MIX ADHESIVES:
IV th generation (mid 1980s)
Rely- a- bond & System 1
 Autopolymerising (30-60 secs)

Etch enamel

Primer fluid application

One paste application with back of bracket &

etched tooth surface

 Liquid activator – Allergic reactions

 LIGHT POLYMERISED ADHESIVES
Vth generation (early 1990’s)
– Most popular e.g. TRANSBOND
– Comparable bond strength
 Advantage – Extended & not indefinite working
time

 Curing depth :
 Composition of composite
 Light source
 Exposure time

 Dual cure resin :

 Light initiators
 Chemical catalyst
 Fluoride releasing visible light
curing adhesives

 Caries prevention
 Durability
 Bond strength

A BIG QUESTION ??????????

 Fluoride release from orthodontic
band cements—a comparison of
two in vitro models
Journal of Dentistry January 2003, Pages 19-24

 To compare, in vitro, the fluoride release

from a conventional glass ionomer cement
(Ketac-Cem), a resin-modified glass
ionomer cement (3M-Multicure) and a
polyacid modified composite (Ultra Band-
Lok)
 INFERENCE

 At 30 days, the mean cumulative fluoride

release was greatest from 3M-Multicure
followed by Ketac-Cem, which in turn
released more fluoride than Ultra Band-
Lok.
 Bond Strength of Orthodontic
Brackets Using Different Light and
Self-Curing Cements
The Angle Orthodontist: Vol. 73, No. 1, pp. 56–63

(1) System One (chemically cured composite resin)

(2) Light Bond (light-cured composite resin)
(3) Vivaglass Cem (self-curing glass ionomer
cement)
(4) Fuji Ortho LC (light-cured glass ionomer
cement) used after 37% orthophosphoric acid
etching of enamel
(5) Fuji Ortho LC without orthophosphoric acid
etching
 RESULTS
 System One attained the highest bond strength

 Light Bond and Fuji Ortho LC, when using an

acid-etching technique, obtained bond strengths
that were within the range of estimated bond
strength values for successful clinical bonding

 Fuji Ortho LC and Vivaglass Cem left an almost

clean enamel surface after debracketing
Orthodontic adhesives: a systematic
review
Journal of Orthodontics, Vol. 29, No. 3, 205-210,
September 2002

Objectives :

To evaluate which orthodontic adhesives

(a) bond orthodontic brackets to teeth more
reliably and (b) are more effective at
preventing decalcification
 The trials compared:

(a) light- and chemically-cured composite;

(b) chemically-cured composite and
conventional glass ionomer cement;
(c) chemically-cured composite and light
cured compomer
 Conclusions

 It is difficult to draw any conclusions from

this review; however, suggestions are made
for methods of improving future research
involving orthodontic adhesives
PRE – COATED LIGHT CURED
COMPOSITE (APC Plus)
– Both Metallic & ceramic brackets

 Color changed adhesive for thorough &

easier flash clean up
 Consistent quality of adhesive
 Reduced flash
 Improved cross – infection control
 Adequate bond strength
 INDIRECT BONDING
ADHESIVES
Chemically cured composite bonding resin
Maximum Cure (MC) versus the Flowable
light-cured resin Filtek Flow (FF)

 MC adhesive came loose (2.9% failure rate)

compared with the FF group (2.4% failure rate)

 The failure rates were low for both adhesives

Sondhi™ Rapid-Set Indirect
Bonding Adhesive
 This lightly filled resin cures in half the time (2
minutes vs. 4 minutes) of other indirect
adhesives, while achieving two thirds of its bond
strength within the first five minutes.

 From the doctor's angle, it means less wasted

time per patient and less stress.

 From the patient's angle, it means a faster, more

comfortable, more confident bonding experience.

 From the business angle, it means more cost

effective use of doctor time.
 LIGHT SOURCES
 Conventional & fast halogen lights

 Argon lasers

 Plasma arc lights

 Light emitting diodes (LED’s)

 Conventional & fast halogen lights

 For Light initiated bonding resins

 Photo initiators / Absorbers –
Camphoroquinone
 Absorption maximum in blue region of
visible light spectrum – 470 nm
 Halogen base / Halogen bulb
 Commonly used till recent times
 Disadvantages :
Output – less than 1 percent of consumed
electric power

Limited life time – 100 hours

Curing time – 20 seconds per bracket ;

Prolonged curing time hence :
Fast halogens (Optilux 501 / Demetron)

 Higher intensity output

 Uses turbo tips to focus & concentrate light

on a small area

 Curing time reduced to half

 Argon lasers (Late 1980’s)
 Highly concentrated beam

 Promised to reduce curing time dramatically

 Wavelength – 480 nm

 Collimated light – Consistent power density over

distance

 Curing time just reduced by 5 seconds

 Advantage :
Reduces enamel demineralization

 Disadvantage :
Poor portability
Increased cost
 Plasma arc lights – Xenon plasma
(Mid 1990’s)
 Cathode – Quartz tube filled with xenon gas
 Anode – Tungsten
 Forms plasma
 Emits white intense light
 Filtered to blue wavelength (430-490 nm)
 Energy level – 900 mW; Delivers energy for
polymerization in short span.
 3-5 secs for metal brackets
 High intensity light

 Chances of pulp damage if exposure

beyond 5 secs

 Bond strength similar to conventional

halogen
 Light emitting diodes (LED’s)
Mills et al (1995)

 Uses junctions of doped semiconductors to

generate light
 Lifetime – 10,000 hrs
 Least degradation in output
 No filters to emit blue light
 Resists shock and vibration
 Least power consumption
 20 secs curing
 New generation LED’s
 High intensity diodes

 Reduces curing time (ORTHOLUX LED)

10 secs – Metal
5 secs – Ceramic
 GLASS IONOMER CEMENTS
(1972) – Fluoride releasing capacity
 Primarily : Luting & restorative
 Properties : Chemical bonding to enamel &
steel
 Preferred for banding to Zn-phosphate &
polycarboxylate
Stronger
Chemical adhesion
Less demineralization at the end of treatment
 Advantages :
Faster setting
Increased initial strength

 Disadvantages :
Moisture contamination
24 hrs to reach maximum strength
 Copolymers with maleic and acrylic acid
are modified to produce dual cure / Hybrid
cements (Fuji Ortho) – VI th generation
 RESIN IONOMER HYBRIDS
 Resin modified GIC – Failure rate : 24.8%

 Modified Composites (COMPOMERS /

POLYACID MODIFIED COMPOSITE
RESIN) - Matrix – Composite
- Filler – Aluminosilicate glass
- Failure rate : 7.4%
 Conditioning tooth surface prior to
bonding :
Removes surface contaminant
Alters surface energy

 Failure rate reduced by : 7%

 Shear bond strength
 In maxillary teeth – 6-13 MPa
 In mandibular teeth – 9-13 MPa
 Permanent teeth have slightly higher bond
strengths to deciduous.
 SELF CURE V/S LIGHT CURE:

SELF CURE:
 Polymerization starts immediately on
mixing.
 Operator cannot manipulate the setting
time.
 Air bubbles that arise during mixing can
result in decreased bond strength
 LIGHT CURE:

 Compared to UV light, visible light has

deeper curing capabilities and is more
effective through enamel.
 It is a single paste system.
 Brackets can be positioned accurately.
 Excess material can be removed prior to
polymerization.
 Disadvantages of light cure
composites:

 Incomplete polymerization beneath the

surface.
 Limited depth of cure ranging from 2-3
micrometers.
 Doubling the exposure time only hastens
the depth of curing by about 1/3rd
 Exposure through tooth substance reduces
the depth by 1/3rd
 INDIRECT BONDING

Advantages
 Permits more accurate placement of brackets
 Decreases chair time of appliance treatment
 Less patient discomfort
 Prevents brackets slide during placement.
 Reduced amt. of resin flash – minimize clear up
and gingival irritation
 Minimize adhesive thickness-less
polymerization shrinkage.
 Easier clean up after debonding.
 Disadvantages
 Chair side procedure is more critical at
least for inexperienced clinicians
 Removal of excess adhesive is more
difficult and more time consuming.
 Risk for adhesive deficiencies under the
brackets is greater.
 Failure rates seem to be slightly higher
 Several techniques for indirect bonding are
available most of them are based on the procedure
described by ELLIOTT SILVERMAN AND
MORTON COHEN
General consideration:

 Patient selection- cases which exhibit short clinical crown

height, severe rotation or poor oral hygiene habits are not
suitable.

 Stability of dentition
– No changes between the impression appointment and delivery
appointment.
– If extraction then brackets are placed before the extraction.
 Selection temporary adhesive
Hold bracket to the working cast.
Water-soluble adhesive - Sticky wax
 Bonding adhesion:
• Mix system
• No mix system by Fried and Newman short
working time and short setting time

 Tray material
 Clear tray
 Opaque tray

 But tray material must be easy to use; tray material must

flow around the bracket as completely as possible.

 Chair side armamentarium

 High-speed evacuation. Dry air supply and a good
retraction system are extremely important.
 CLINICAL PROCEDURE

 The Indirect bonding techniques differs in the way :

 The brackets are attached temporarily to the model
(caramel candy, laboratory adhesives bonding resin)
 Type of Transfer (Silicone, Vacuum formed acrylic with
transfer arms, etc.,)
 The adhesive or sealant employable
 Whether segmented or full bonding is used.
 The way the transfer is removed so as not to exert
excessive force on still maturing bond

 Two popular methods are:

 SILICONE material
 Double sealant
 For silicone tray fabrication, mix materials
according to the manufacturer’s instructions.
Press the putty onto the cemented brackets and
form the tray allowing sufficient thickness for
strength.

 After the tray material is set the model with the

tray is immersed in hot water to release the
bracket from the model. Remove any
remaining adhesive under running water.

 Trim the Silicone tray and mark the midline.

 Teeth preparation is done and mentioned

preciously
 Mix adhesive, load it in a syringe, and apply a
sufficient portion to the bonding base.

 Seat the tray on the prepared arch and hold with

firm and steady pressure for about 3 minutes.

 Remove the tray after 10min,tray must be cut

longitudinally or transversely to reduce the risk
of bracket debonding when it is peeled off.
 Complete the bonding by careful removal of
excess adhesive flash use oval (No.700.6 and
No.7) or tapered T.C. bur to clean the area
properly around each bracket.

 If this step is neglected gingival irritation with

redness, hyperplasia and bleeding will develop
within a short time

 Also inspect for adhesive voids and fill in with

a small mix of adhesive if needed.
 DOUBLE SEALANT
TECHNIQUE
 A placement tray is vacuum formed for each
arch

 The bracket bases are painted with catalyst

sealant resin (PART B) 6 drops per arch. The
etched teeth surfaces are painted with the
universal sealant resin (PART A) (Should not
be reversed)

 Tray is inserted in the patient’s mouth seated

and held in place for atleast 3 minutes
MOIN AND DOGON
TECHNIQUE - 1977
 EFFICIENT AND EFFECTIVE
INDIRECT BONDING TECHNIQUUE
 Anoop Sondhi AJO 1999
 A cohesive and complete system for fabricating trays for
indirect
bonding
 A new resin specifically designed for indirect bonding {3M
UNITEK}

 Fine particle, filled silica filler

 No bracket drift
 Resin has a quick set time of 30 seconds
 Completely cured in two minutes
 Custom base with light cured adhesive.
 Quick efficient and easy
 SLOT MACHINE AND INDIRECT
BONDING
AJO 1993
Thomas D.Creekmore and Randy L.Kunik

 Anticipated results were not achieved by using

Pre Adjusted appliances and straight wires due to
the following results :

1.Inaccurate bracket placement.

2.Variation in tooth structure.
3.Variation in the vertical and anterior posterior jaw
relationships.
4.Overcorrections for tissue rebound.
5.Mechanical deficiencies :
 Force application on a tooth by an archwire
through brackets located away from center of
resistance.
 Play between archwire and archwire slot
 Force dimunition
 DEBONDING
OBJECTIVES:

 Remove the attachment

 To remove all the adhesive resin from the
tooth.
 To restore the surface as closely as possible
to its pre treatment condition with out
inducing iatrogenic damage.
 SITES OF BOND FAILURE:

 Interface failure between resin and bracket

base
 Failure within the resin itself.
 Interface failure between resin and enamel.
 Surface enamel detachment
 Clinical debonding procedure may be
divided into :
1. Bracket removal.
2. Removal of residual adhesive.
 Bracket removal:

1.Mechanical method (Conventional).

2.Ultrasonic method.
3.Electrothermal method.
4.Laser aided method.
Mechanical method (Conventional)
 Ultrasonic method:

 Slow but effective method of bracket removal.

 Decreased chance of enamel damage.

 Water spray is used to minimize generation of

heat and possible pulp damage.
 Study to compare debonding using Conventional and
Ultrasonic technique
AJO 1993
Keith V.Krell, James M.courey and Samir E.Bishara.

 Enamel loss is minimized by first debonding the bracket

with the pliers and then ultrasonic removal of residual
adhesive

 The tooth surface was not adversely affected when total

ultrasonic debonding and clean up technique was used.

 Debonding orthodontic bracket first with plier followed

by ultrasonic removal of residual adhesive required less
time than the other two techniques
Electro thermal Debonding –
338 to 421 degree centigrade
 Electro thermal debracketing : patient
acceptance and effects on the dental
pulp.
Bishara, Dovgan, Walton (AJO-DO Sep 1995)
 The ETD instrument produces a very high
temperature at the tip that may damage the pulp
or cause patient discomfort
 Histological few pulp tissues demonstrated mild
degree of inflammation, but necrosis was not
observed, odontoblastic disruption and formation
of reparative dentin
 Patient experienced slight discomfort and an
apprehension
 This instrument removes ceramic brackets
quickly with minimum discomfort to the patient.
 Advantages

 With the Electro thermal approach, the composite

adhesive softens above a critical temperature
(approximately 150° to 200° C) and allows
bracket debonding at a significantly reduced
force magnitude.

 Since the detachment occurs within a short time

interval (1 to 5 seconds), significant heat
conduction that might result in patient discomfort
or irreversible pulpal changes is avoided.
 Drawbacks

 The whole assembly head must cool down after

the removal of a few brackets

 The instrument is designed to fit a specific

bracket design. Ideally, the orthodontist would
like to have a universal tool that allows
atraumatic debonding
Laser Debonding
 Laser-aided debonding of ceramic brackets
Strobl, Bahns, Willham, Bishara, and Stwalley
( AJO-DO Feb 1992 )

 The removal of ceramic brackets from the enamel surface

by means of laser heating was investigated with the use of
CO2 and YAG lasers.

 The two bracket types investigated were polycrystalline

alumina and monocrystalline alumina.

 The purpose of this study is to determine the efficiency of

using CO2 and Nd: YAG (neodymium: yttrium-
aluminum-garnet) lasers in debonding ceramic brackets
from the enamel surface.
 CO2 laser-aided bracket-debonding techniques
resulted in significantly lower residual debonding
torque force when compared with nonlaser
debonding

 No enamel damage was found when the surface

was inspected with a X10 magnifying glass

 Therefore this method has the potential to be

more atraumatic (less painful) and safer (less risk
of enamel damage) for the patient.
 Removal of Residual Adhesive
 Scaler

 Scraping with a sharp band or bond removing

plier

 Burs
-- Dome shaped TC bur
-- Ultrafine diamond bur
-- White stone finishing bur
 INFLUENCE OF ENAMEL BY
DIFFERENT DEBONDING
INSTRUMENTS
 Adhesive remnant index (ARI) – Artun (AJO 1979)

 SCORE 4
Unacceptable scratches were seen with diamond
instruments
Even fine diamond burs produce coarse scratches.

 SCORE 3
Medium sand paper disks and green rubber wheel
produced similar scratches that could not be polished.
 SCORE 2
Fine sand paper disks produced several marked
and some even deeper scratches

 SCORE 1
Plain cut and spiral flutted T.C. burs at 25,000
rpm- satisfactory surface appearance.

 SCORE 0
None of the instruments tested left the virgin
tooth surface
(Perikymata intact)
Average enamel loss of 7.4 µm with careful
use of TC bur
AMOUNT OF ENAMEL LOST IN
DEBONDING
Depends on :

 Instruments used for prophylaxis and debonding.

 Bristle Brush 10-micron mm
 Rubber cup 5-micron mm
 High-speed bur and Green rubber wheel 20-
micron mm
 Low speed TC burs 10-micron mm

 Type of resin employed

 Filled or Unfilled
 Enamel
Tearouts\Cracks\Decalcification

 Tearouts due to macrofillers used in resins

 Sharp sound associated with bracket removal

lead to the formation of enamel cracks

 Ceramic brackets show a higher risk of enamel

damage due to chemical adhesion and lack of
ductility.
 Decalcification or demineralisation sites seen
on the tooth surfaces are similar to carious
lesions of varying extent.

 Prevented by regular use of fluoride containing

dentrifice or regular application of fluoride
varnish

 Compensated partly by the natural process of

remineralisation.
 The Angle Orthodontist: 2006 , No. 2, pp. 289–294.
A Comparison of Bond Strength Between
Direct- and Indirect-bonding Methods
Brandon James Linn;a David W. Berzins;b Virendra B.
Dhuru;c Thomas Gerard Bradley

 The direct-bonded group (group 1) used a

light-cured adhesive and primer
(Transbond XT). One indirect-bonded
group (group 2) consisted of a chemical-
cured primer (Sondhi Rapid Set)

 Mean shear bond strengths were 16.27 &

13.83 respectively
 Rebonding
 Bracket removed from arch wire.
 Remnant adhesive on the bracket removed with
a TC bur.
 Remaining adhesive treated by sandblasting.
 Tooth cleaned and Re-etched.
 Bracket rebonded.
 Bond strength comparable to that of new
brackets.
 Recycling

 Main goal is to remove the adhesive from the bracket

base without damaging it nor cause any change in the slot
dimensions.

 Methods of recycling

 Application of heat to burn off the adhesive – 450 degrees

(Lew, Djeng 1990)

 Use of chemical solvents to strip off the adhesive.

(Zachrisson, 1985)

 Both these methods have been investigated.

( Buchman’80, Hixon’82, Mascia and Chen’82,
Smith’86, Regan’90)
Heat recycling (Lew, Djeng 1990)

Esmadent system
 The brackets are heated to 454°c for 45 minutes

 Following this, the hot brackets are immersed

into a cold cement solvent and ultrasonically
cleaned for 10-15 seconds

 The brackets are washed, dried and

electropolished for 30-45 seconds
 Chemical Recycling (Zachrisson,
1985)

 They use a solvent stripping process together

with high frequency vibrations at temperatures
below 100°c to remove the composite

 This is followed by heating to 250°c for

sterilization and a very short phase of
electropolishing.
 Effects of recycling (Matasa
1989)
 Due to heat recycling :
1. Steel corrosion
2. Structural metal weakening
3. Clogging of base mesh with debris.
4. Vertical slot of obstruction.

 Due to Electropolishing :
1. Slot enlargement
2. Wings sharpen
3. Base flattening
4. Undercuts shaved
 The Effects of Recycling on the Tensile
Bond Strength of New and Clinically Used
Stainless Steel Orthodontic Brackets.
Regan, Van Noort (BJO May 1990)

 The tensile bond strengths were evaluated for 3

different brackets pre and post recycling.

1.Dyna-Lock
2.Edgeway
3.Rocky Mountain
 Following recycling by either of the methods, all
the bases demonstrated a significant reduction in
the bond strength

 Also, chemical better than thermal

 Clinically used brackets demonstrated a slightly

lower bond strength when compared to unused
brackets.
 Recycling effects on ceramic brackets: a
dimensional, weight and shear bond
strength analysis
( Martina, Laino EJO Dec 1997)

 Shear bond strength values :

1.New : 15.52mpa
2.Recycled once : 11.23 mpa
3.Recycled twice : 10.10mpa
4.Recycled five times : 10.04mpa
INFERENCE
 The future of bonding is promising

 Also new avenues for bonding in orthodontics are

opening up – including lingual bonding, “invisible
braces”, various types of bonded retainers and
splints, semi permanent single-tooth replacements,
resin buildups, addressing tooth shape and size
problems and bonded space maintainers.
THANK YOU