Orthodontic Adhesives

Presented By: Guided By:

Dr. Sahana M Jain Dr. Basanagouda C Patil Sir
(1st PG) Prof and HOD
CONTENTS
 Introduction
 History
 Development of Epoxy Resins
 Current Resin Developments
 The Evolution
 Bonding Materials
 Mechanisms of Adhesion
 Requirements of Adhesive System
 Contents..
 Range of Orthodontic Adhesives
 Components of a Composite Resin

 Organic Resin Component

 Inorganic fillers
 Coupling agent
 Initiator System
 Classification of Bonding Agent

 Classification of Adhesives

 Advances in Adhesives

 Conclusion

 References
INTRODUCTION
Adhesion:
The state in which two surfaces are held together
by interfacial forces which may consist of valence
forces/ interlocking forces or both.
Molecular Theory : A range of attractive forces
operate in and between the molecules. These may
produce bonds of varying strengths ranging from
covalent and ionic bonds to hydrogen bonds and
other relatively weak intermolecular forces.
Introduction..
Adhesive:
Material frequently a viscous fluid that joins two surfaces
together, solidifies and therefore is able to transfer the load
from one surface to the other.
Few solids self cohere when brought into sufficient
proximity Ex: mechanical force in case of gold foils and gentle
heat in case of Wax.
Tooth tissues and orthodontic brackets do not cohere upon
contact because the forces operating between the tooth and the
bracket are of very small distance and decrease in magnitude
with the inverse sixth or seventh power of separation.
Introduction..
 Thus an adhesive promotes intermolecular bonding at
the interface. This bonding is resistant to disruption by
small tensile forces and readily debonds by shear
forces.

 Bonding = Adhesion + Attachment

 Adhesion: specific molecular interlinking via forces
 Attachment: a tag formation with acid etched enamel. A
rigid but porous substrate allows the penetration of an
adhesive/resin followed by solidification in situ.
Introduction..
 Bonding of brackets to enamel has been a critical
issue in orthodontics because of the significance in
achieving a stable bond between a tooth and its
bracket.
 Biomechanical principles require the transfer of a
load applied to the bracket to the tooth without
exceeding its bond strength
 Early bonding systems consisted of brackets welded
onto bands bonded to enamel with zinc phosphate
cement
Introduction..
 Apart from esthehtic concerns, this approach presented
other serious disadvantages like, requirement of
additional arch space and complicating the debonding
owing to presence of interdental spacing.
 Extensive chair time, frequent screening for
decalcification or caries of underlying tooth structure and
pronounced effect on periodontal health due to chemical
and mechanical irritation of the gingiva are other
considerable disadvantages.
 Hence there came a need for an alternative procedure that
would provide retention of the brackets to the enamel.
Introduction..
 Orthodontic Adhesive : A good one should keep the
bracket bonded to the tooth throughout the treatment,
avoiding delays, untoward expenses or patient
inconvenience.

 The current trends in the development of adhesives

attempt to simplify bonding steps and make them
user friendly.
HISTORY
 Research into bonding agents for attachment of resin to tooth
structure was started in the early 1950s
 1st attempt: By Hoggers, a Swiss Chemist working for the
amlgamated dental company in London and Zurich in 1947
 1955: Buonocore experimented on enamel surface from 85%
H3PO4 for 30 seconds. A simple acid decalcification was
achieved with increase in surface area due to acid etching
reaction.
 1956: Dr. Bowen formulated resin molecule Bis-GMA
 Weisser and Silverman et al first used Bis-GMA for direct
bonding of brackets.
History..
 1960: Fibre filler particle was added in experimental
combinations to formulae the first composite resin.
 1961: Work shop on adhesive retortive dental materials
organized by Philips.
 1962: Dr. Bowen of the ADA Research unit developed a
new type of composite resin material using BisGMA
and a coupling agent.
 1968: Newman was the first person to use epoxy resin
and acid etch technique for bonding stainless steel
brackets to enamel.
History..
 1970: Introduction of photocured composite resin using U-
V Light.
 1972: Introduction of first visible light curing sysytem
 1992: Introduction of fibre reinforced composites which
were composed of oven glass or polythene fibres.
 1996: Development of flowable composites
 1998: Introduction of COMPOMER having combined
property of GIC and Composite
Introduction of Ion releasing composite material
 1999: Single crystal modified composite
COMPOSITE REFINEMENTS REVIEWING
THE LAST 57 YEARS
EPOXY RESINS
 Epoxide: An organic compound (cyclic ether) whose
molecule contains a three membered ring involving
an oxygen atom and two carbon atoms
 An epoxy resin is defined as a molecule containing
more than one epoxy group capable of being
converted to a thermoset form
 Comprise of 4 ingredients: The monomeric resin, a
hardner, an accelerator and a plasticizer.
Epoxy Resins..
 1937: Castain and Dr. Trey Freres, Zurich made a
major break through in polymer chemistry with the
invention of Epoxy Resins, by condensation of
alkaline oxides with anhydrides of polybasic acids.

 Epoxy resins has formed the basis for most of the

current composite resins in which vinyl groups were
attached to the end groups of epoxy resin converting
it to dimethacrylate.
CURRENT RESIN
DEVELOPMENT
 1958: the first low shrinking resin produced by
Schmidtt and Purrman in Germany. It was a low
viscosity epimine resin.

 1962- Bowen’s Resin: Bowen filed his first patent in

the united states on his famous bis - GMA resin,
based on the epoxy molecule and produced a dental
restorative material containing vinyl silane treated
fused silica.
Current resin developments..
 Loster and walker made urethane dimethacrylate
resin for use in resin composite dental material.

 Advantages of these new resins are higher molecular

weight, low viscosity, certain degree of toughness in
the urethane moiety together with less staining bis-
GMA.
Current resin developments..
 Martim et al. synthesized new multifunctional-
urethane-methacrylate monomers for dental
composites. The conventional bis-GMA (bisphenol-
A-diglycidylmethacrylate)and glycerol
dimethacrylate (GDMA) were modified using
nucleophilic addition reactions.
 Production of U-(bis-GMA)-Mod and U-(GDMA)-
Mod adhesive resins, both free of BPA
Current resin developments..
 Composites derived from these two new urethane
monomers have more advantages than those prepared
with commercially available bis-GMA monomers, with
a comparable polymerization shrinkage and stress,
degree of conversion, improved mechanical properties,
a faster rate of polymerization, and significantly lower
water sorption and water solubility [54–56].

Hassan R, Aslam Khan MU, Abdullah AM, Abd Razak SI. A review on current trends of
polymers in orthodontics: BPA-free and smart materials. Polymers. 2021 Jan;13(9):1409 .
Current resin developments..
 Hong et al. designed and synthesized a novel resin monomer
(tetramethyl bisphenol F acrylate, human tetramethyl
bisphenol F acrylate (TMBPF-Ac) using a multistep
condensation reaction
 flexural strength (F.S.), flexural modulus (F.M.), indentation
hardness (HIT), and indentation modulus (MIT) values of
TMBPF-Ac/TEGDMA and TMBPF-Ac were also higher than
those of the bis-GMA/TEGDMA resin. From all of the
highlighted physical and biological properties, TMBPF-Ac-
based resin is better than bis-GMA-TEGDMA resin.
Hassan R, Aslam Khan MU, Abdullah AM, Abd Razak SI. A review on current trends of
polymers in orthodontics: BPA-free and smart materials. Polymers. 2021 Jan;13(9):1409 .
Current resin developments..
 Iliadi et al. synthesized two experimental BPA-free
resin composite adhesives for lingual fixed retainer
bonding. EXA and EXB
 1. EXA containing a single-aromatic ring highly
reactive multifunctional monomer (PCDMA,
TEGDMA ,UEDMA and silanated glass (70 wt%)
and catalysts
 2. EXB, which is based on aromatic-free urethane
dimethacrylate monomers (TEGDMA, UEDMA,
silanated glass (60 wt%), and catalysts)
Current resin developments..
 EXB presented the highest value of degree of
conversion (DC) % followed by EXA

 DC% was significantly improved in EXB as bis-GMA

was substituted with the aliphatic UEDMA monomer.

Hassan R, Aslam Khan MU, Abdullah AM, Abd Razak SI. A review on
current trends of polymers in orthodontics: BPA-free and smart materials.
Polymers. 2021 Jan;13(9):1409
The Evolution
 1950s: Use of Epoxy resins
 Early 1960s: epoxy acrylates
 Mid 1960s: Bis- GMA Resin composites
 late 1970s: filled acrylics
 Early 1980s: composites two paste system
 Mid 1980s: no mix adhesives, visible light cure adhesives
 Late 1980s: dual cured composites
 Late 1990s: glass ionomers, compomers, giomers
 2000: Cyanoacrylates
BONDING MATERIALS
1. Etchant
 Decreases the surface energy.
 Decalcification of the inorganic portion.
 Exposes the inter and peritubular collagen
 15 seconds of 37% H3PO4 solution and gels has been widely
accepted.
 A scanning electron microscopy study, however, showed that
etching with 37% phosphoric acid for at least 30 seconds
produced more optimal etching patterns than etching for 15
seconds.
– (Johnston CD, Hussey DL, Burden DJ. The effect of etch duration on the
microstructure of molar enamel: An in vitro study. AmJ Orthod Dentofac Orthop
1996;109:531- 534.)
Bonding materials..
2. Primers
 Restores the surface energy

 Stabilizes the collagen fibers

 Surface wettabilty and spreadability

 Enhances the adaptation of resin to the conditioned

enamel thus promotes bonding.

 Acid primers containing COOH group are used in

self etching bonding agents

Bonding materials..
 Primers are hydrophilic monomers carried via
solvent. The hydrophobic group(OH) binds to dentin
(hydrophilic part)and methacrylate group binds to the
adhesive (hydrophobic)
 Examples of non acidic primers: HEMA, 4META,
NPG-GMA, BPDM, PENTA(5th Gen)
Bonding materials..
3. Adhesive
 Unfilled resins were traditionally used as bonding

agents in resin composite bonding system.

 Adhesives with large particle fillers are

recommended for extra bond strength.

 Two basic types of dental resins are currently in use

for bracket bonding, both are polymers and are

classified as
Acrylate resins
 Based on self curing acrylics

 Consist of methyl methacrylate monomomer

 Form linear polymers only

Diacrylate resins
 Based on the acrylic modifies epoxy resin bis-GMA

or Bowens resin
 Polymerized by cross linking into a three

dimensional network. The cross linking contributes

to greater strength.
FACTORS AFFECTING
ADHESION
 Contact Angle : The contact angle is the angle
formed by a liquid at the three phase boundary
where the liquid, gas, and solid intersect. Contact
angle is inversly proportional to adhesion
Factors affecting adhesion..
 Surface energy: High surface energy means a
strong molecular attraction, while low surface energy
means weaker attractive forces. Surface energy is
directly proportion to adhesion.
Factors affecting adhesion..
 Surface Tension: Cohesive forces between
molecules cause the surface of a liquid to contract to
the smallest possible surface area. This general effect
is called surface tension. Surface tension is inversly
proportion to adhesion.
Mechanisms of Adhesion
 Mechanical Adhesion
 Adsorption Adhesion
 Electrostatic Adhesion
 Diffusion Adhesion
Mechanical Adhesion
Interlocking of adhesive with irregularities in the
surface of the adherend. (Attachment = Mechanical
iterlocking).
Adsorption Adhesion
The molecular forces on the surface layers of the
adhesive and substrate greatly influence the
attainment of intimate molecular contact across the
interface. This is called the adsorption theory of
adhesion.
Electrostatic Adhesion
Forces in the form of an electrical double layer are
produced at the adhesive-adherend interface. Found
in the total etch adhesive system.
 Diffusion Adhesion
Relates to polymer-polymer interactions. The adhesion
is developed through the interdiffusion of molecules in
between the polymer substrate-adhesive interfaces.
Ex: adhesion of GIC to teeth conditioners/primers.

 Clinical note: when applying the bonding agent to the

tooth surface and bracket base, the diffusion process
required for polymerization is intensified by pressing the
bracket to the enamel.
REQUIREMENTS OF ADHESIVE SYSTEM

 Wetting: an adhesive must give good wetting of the

adherends (or both surfaces in question)
 Viscosity: adhesive should have a suitable viscosity to
flow readily into the surface irregularities (pores and
valleys) of the adherend
 Strength: Adhesive should possess high bond
strength to dentin and similar to that of enamel
 Dimensional Stability: the setting of the adhesive
should occur without much dimensional changes i.e.,
little or no expansion or contraction
Requirements of adhesive system..
 It should form a favorable contact angle between the
surfaces
 Minimal microleakage at the margins
 Prevent recurrent caries and marginal staining
 Should produce a lasting bond strong enough to resist
masticatory forces
 Versatile for direct and indirect bonding
 Replacement of loose bond should be accomplished
with minimal efforts
Requirements of adhesive system..
 Permit easy removal of brackets durinf debonding
without damage to the enamel surface and with least
discomfort to the patient.
 Allow adequately long working time for positioing
the brackets
 The adhesive should be non irritating to the mucosa.
 Provide simple way of application , convenient way
of curing and has fluoride – release potential.
Range of Orthodontic Adhesives
 Resins
 Cements
 Resin cement Hybrids
Components of a Composite Resin
 Organic resin component that forms matrix
 Inorganic filler
 Coupling (interfacial) agent to unite the resin with
the filler
 Initiator system, to activate the setting mechanism
 Stabilisers
 Pigments
Organic resin component
 Composite resins vary in their resin component but
all the variations are diacrylates
 High viscosity aromatic monomer- Bis GMA
 The legthy diacrylate chain of this monomer
minimize the polymerization contraction
 Some systems contain oligomeric compounds based
on urethane dimethacrylate(UDMA) to replace bis-
GMA either partially or completely
 Low viscosity Monomers:

TEGDMA, EGDMA and HEMA to facilitate clinical

handling. (Diluents to reduce viscosity)

There must be carbon-carbon double bonds of each

end of the monomer chain to allow polymerization
and cross-linking.
Inorganic Fillers
 Silica in crystalline form or non crystalline form is
used generally as an inorganic filler.
 Crystalline forms are harder and stronger hence

difficult to polish.
eg: Crustobalite Tridymite, Quartz
Non crystalline forms are most popular fillers.
Eg: silicate glass made of Al, Zn, Yt, Ba
 Macro Fillers:
Made of glass, quartz or ceramic by crushing,
grinding and sieving to achieve splinter-shaped
particles
The average size formulations is 1-50 µm

Clinical Implication: Larger filler particles- extra bond

strength
 Micro Fillers :
Microfiller particles are amorphous silica (SiO 2)
Average diameter 0.04µm. Prepared by
Hydrolysis and Precipitaion. They are Radiolucent
Coupling Agent
 Vinylsilane- helps reinforcement between the filler
and poymer .

 Silane coupling affects the durability of the

composite resin

 Loss of coupling releases particles and leads to

surface breakdown.
Pigments
 Colored pigments are incorporated into dental
resin composites to produce clinically acceptable
shades
 Usually Metal oxides such as Titanium or aluminium
oxides and ferric oxide or ferric hydroxides in low
concentrations are added as pigments to match the
different shades of tooth color.
Initiator System
 Light cure
 Chemical Cure
 Dual Cure
 Light Cure System
LED
Plasma arc
Argon Laser
Visible light
UV Light
TQH Unit
Camphoroquinone
 Camphoroquinone as a photoinitiator, which is
sensitive to light in the blue region of the visible light
spectrum, with pick absorption at approximately 470
nm. Once the light reaches the resin surface, free
radicals generated, initiating the polymerization
process.
LED System

Emits light in the 430-480nm range at an

intensity of 1000mW/cm2

Ortholux LED Curing System

LED Units
 Light curing units with gallium nitride blue light
emitting diodes (LED) have been developed. Their
spectral output falls within the absorptive region of
camphoroquinone, which means that no filters are
required for the production of blue light.
 Their spectrum flux is concentrated over a much
narrower bandwidth than that of TQH or PAC.
Energy is released almost exclusively as light energy,
generating minimal heat
 Advantages of LED compared to TQH and PAC:
Lifetime over 10000 hours, invariable output energy
over this term without any degradation.
Suitability for portable use because of their small size.
Low energy consumption and high resistance against
shock or vibration
They produce between 410 nm to 500 nm. Advances
in the power output of LEDs have allowed LEDs to
achieve emission intensity up to 1,600 mW/cm2,
decreasing the curing time. The curing time per bracket for
a LED unit is estimated to be 9 sec to 10 sec.
 Plasma Arc Curing System

 As an alternative for rapid light curing, the plasma arc

curing unit (PAC) was introduced in the late 1990s.
PAC uses a high-frequency electrical field to generate
plasma energy.
 Two electrodes are used in order to transform xenon
gas into a mixture of ions, electrons and molecules,
releasing a significant amount of energy as plasma.
 PAC produces high intensity lights delivering up to
2,000 mW/cm2 and the light can be filtered to a
narrow bandwidth concentration of 450 nm to 500
nm for peak absorption by camphoroquionone
 An irradiation time of 6 sec to 9 sec is sufficient in
order to achieve an adequate resin polymerization,
equal to that achieved by a 40 sec exposure of a
conventional TQH
 Their lifespan is up to 5,000 hours. However, PAC
units have several disadvantages, such as their high
purchase cost, their relatively large size and their
 Plasma arc light can be considered an advantageous
alternative to conventional light curing because they
enable the clinician to reduce the curing time of
adhesive precoated orthodontic brackets with
significantly affecting the bond failure rate.

Plasma arc versus halogen light curing of adhesive precoated ortodontic brackets; A 12
month clinical study of bond failures. AJOSO 2004 Vittorio Cacca festa et al
 The results suggest that a similar or higher DC
than the control values could be achieved in 6-9
seconds by plasma arc curing, in 10-15 second by
fast halogen curing, or in 20sec by LED curing.

Degree of conversion of 2 lingual retainer adhesives cured with different light

sources_ EJO 2005 By Serdar Usumez
Argon Laser
 A statistically lower overall bond failure rate was
found(2.5%) compared with conventional light
curing(5.7%)
 An argon laser can cure a light-cured orthodontic
resin composite more quickly (10 seconds) than
traditional visible light (20 to 40 seconds) with no
detrimental effect on the bond strength.
Visible light activated systems
 Two component initiator system – Diketone and
tertiary amines (Camphoroquinone)
 Activation of diketone combines with the amine to
form a complex that breaks down to release free
radicals which then initiate polymerization of the
resin.
UV Light Cure Systems
 NUVA-fil introduced by LD CAULK CO in 1970 was the
first in Light cure composite resins

 These systems used Benzoin methyl ether as initiator

 UV radiation generated by a light source capable of

emitting an intense luminous radiation was used to
polymerize the resins

 Wavelength between 320 and 365nm

 Disadvantages of UV system:
 Limited curing depth
 Harmful effects of UV radiations ex:
Ophthalmological effects
 Carcinogenic
 Loss of intensity over time
TQH Units (Infrared)

 Tungsten-quartz halogen curing units (TQH) have

been conventionally used as the source of visible light.
TQH is an incandescent lamp which produces a broad
spectral emission.
 Most of the emission is actually infrared irradiation
that generates heat, which is harmful to the dental
tissues and leads to overheat of the device itself.
Because of all the heat generation, the power loss
reaches 70% and less than 1% of the electrical energy
is used for light emission.
 Other Disadvantages:
The light intensity decreases approximately 10%
when a filter is used to reduce infrared irradiation and
obtain the optical wavelength range required for
curing the composite resins.
Main disadvantage of TQH is that halogen bulbs
have a limited effective lifetime of around 100 hours,
above which their energy output gets more and more
decreased.
Transbond XT Light Cure
Adhesive
 Bonds metal and ceramic brackests to tooth surfaces
 Available in both syringes and capsules
 Uses light cure adhesive technology
 The viscosity of adhesive prevent adhesive run-on
and bracket skating.
 Easy application, increased control and convenience
 Reduces adhesive waste.
 Immediate archwire tie-in.
Transbond LR Adhesive
 Developed specifically for bonding lingual retainers.
 Optimal handling characterstics and easy to apply
 Extended working time
 Optimized viscosity, softer consistency than
Transbond XT adhesive
 Placement is enhanced, product waste is minimized
Classification of Bonding agents
A. Classification based on Generations:
1st Generation:
 Enamel Etch technique
 2 steps
 2 components
 Consists of co monomer NPG-GMA
 2nd Generation:
 Enamel etch technique
 2 steps
 2 components
 Based on phosphorous esters meth acrylate
 Eg: Scotchbond (3M ESPE)
Bondilite ( Kerr Corporation)
 3rd Generation:
 Dentin conditioning
 3 steps
 2-3 components
 Consists of HEMA and 10 MDP
 Eg: Amalgambond Plus , Superbond D Liner
 4th Generation:
 Total Etch technique or etch and rinse technique
 3 step procedure (E+P+A)
 2 bottle system (syringe + Bottle + Bottle)
 Eg: All-Bond 2 , Opti-Bond FL
 5th Generation:
 Total Etch Technique
 Single component system
 2 stepprocedure ( E+ PA)
 1 bottle system (syringe + Bottle)
 Consists of HEMA, bis GMA, dimeth acrylate ,
polyacrylic acid
 Eg: Gluma Comfort bond
6th Generation:
 Self Etch techique

 1 step procedure (EP+ A)

 2 bottle system ( Bottle + Bottle)

 Eg: Clearfil SE Bond, Xenox

 7th Generation/ 6th Gen Type 2:
 Self etch technique
 All in one system
 1 step procedure
 1 compnent (E+P+A)
 True: Both supply and application in one bottle
 False: Etching Brush + primer and adhesive in one box
withtwo compartments
 Just before applying, these are mixed with the brush
contatining etchant, so every(12nm)
 8th Generation:
 1 step, 1 bottle, self etch
 Introduced in 2010 by Voco America (voco
futurabonf DC)
B. Classification based on Mechanism of Adhesion
 3 step

Etchant + Primer + Bond

(Acid Etching System)
 2 Step

a. Self Etching Primer + Bond ( Self Etching Sytem)

b. Etchant + Self Priming Bond( Acid Etching Sytem)
 1 Step

All in One Adhesive ( Self Etching Sytem)

Classification of Adhesive Systems
 Based on the polymeization initiation mechanism,
orthodontic adhesives may be classified into
1. Chemically Activated (Chemically cured =
autocured= self cured)
a. Two Paste System
b. One Paste System
2. Light Cured= Photocured
3. Dual Cured
4. Thermocured
Chemically Activated
 Employ benzoyl peroxide as an initiator which is
activated by a tertiary aromatic amine such as
dimethyl p toluidine or dihydroxy ethyl-p-toluidine.

 Initiation occurs from mixing the paste and liquid

components of these systems and free radicals are
formed by a multistep process.
Two Paste System
The two phase products were the first to be tried by the
orthodontists in the early days of bonding.
Their application involves mixing the paste and liquid
components
Disadvantages:
Manipulation process is time consuming
Hand Mixing of the two components introduces
potentially critical defects such as surface porosity and air
voids in the bulk material owing to the prolonged exposure
to air and the inevitable entrapment of air bubbles.
Pore Volume in the bulk composite: order of 3%
Surface porosity: nearly 50%
Degree of cure(DC) : upto 55%

Eliades et al observed High amount of monomer

leaching compared to the relatively high DC for a
chemically cured adhesive.
This is attributed to the mixing process and to the
detrimental effect of air entrapment on the carbon double
bond conversion in the vicinity of voids.
One Phase System (One Paste System)
The principle of inhomogenous polymerization
was introduced in orthodontics with the development
of no mix bonding resins which were intended to
minimize the mixing induced defects and to reduce
the steps required for the placement of material.
In these systems, a catalyst gradient is
established from the primed enamel surface towards
the brackets by means of a diffusion process.
 Paste –Primer (no mix) formulations do not require
mixing and set on intimate contact of the paste and
primer, allowing the diffusion of the components.
 Under these conditions, the resin strength is
presumed to be decreased by the establishment of a
disturbed cross linked network, which nonetheless
may facilitate bonding.
 DC for these adhesives is comparable to that of the
two paste systems for surfaces in contact with the
enamel. This might be attributed to the surface to
volume ratio of the adhesive layer.
 The mean layer thickness is increased when
complex bases possessing grooves and crystal like
projections are pressed into the adhesive presumably
owing to the retention of material in the base.
But the smooth bases would be expected to
transfer applied force more uniformly to the adhesive
layer.
When applying the bonding agent to the tooth
surface and bracket base, the diffusion process
required for polymerization is intensified by pressing
the bracket to the enamel
Photo Cured Adhesive System
 For a monomer system in which light curing is used
to initiate polymerization, the extent of
polymerization depends upon several factors like
 Exposure time
 Photoinitiator concentration
 The light intensity emitted by the curing unit at the
peak absorbance wavelength of the photoinitiator.
 The filler volume fraction.
 Light scattering at the surface of the filled composite
can reduce the intensity of the induced light reaching
the bulk material resulting in decreased conversion in
thick specimens
 The filler size is a critical factor for the degree of
scattering and the optimal particle size is √λ/2
 λ : The light intensity at the peak absorbance
wavelength of the photoinitiator
 Frequency of the light emission from the curing unit
is also important.
 Light curable composite resins are supplied as single
paste which contains
a. Photoinitiator: Comphoroquinone 0.25wf%
b. Amine accelerator: Diethyl-amine ethyl
methacrylate
Exposure from a light of correct wavelength
activates the photoinitiator which then interacts with
the amine to form the free radical.
Comphoroquinone has an absorption range
between 400mm and 800mm being the blue region of
visible light spectrum.
 Under clinical Conditions;
 Increased irradiation time and light intensity lead to
higher strength since a structure with a higher density of
cross links is formed.
 The rapid setting reaction for the relatively thin layers of
photocured composites greatly reduces the time
availability for the atmospheric oxygen to diffuse into
the bulk and deactivate the free radicals produced by the
photoinitiator.
 As a result, significantly less oxygen inhibition and
better peripheral bracket sealing are obtained with light
cured composites compared to chemically cured.
Dual Cured Systems
 The dual curing approach combines the advantages
of rapid initiation for photopolymerizing resins and
high conversion rates for chemically cured resins in
the bulk material.
 In these system activation of polymerization is
induced through surface exposure of the material to a
visible light and polymerization in the bulk material
occurs by chemical curing process
 Therefore both improved surface and bulk material
properties would be expected.
 In a study, the dual cured adhesive was found to
provide significantly higher bond strength compared
to chemically cured and light cured materials in 24
hours following activation.
 Under Clinical Conditions:
 The application process for this type of adhesive is
prolonged because both mixing and photocuring are
required.
 Additionally, mixing may induce bulk defects by
increasing the porosity of the material.
Heat Activated System
 Thermocured systems have been introduced for
indirect bonding and restoration.
 It is claimed that these adhesives present a
substantially increased polymerization rates and
accordingly superior properties.
 Their use is currently limited because of the
increased temperature required to initiate
polymerization and the necessity for adapting an
indirect bonding setup.
Advances in Adhesives
Despite the moisture control steps and measures
available, it is still a challenge to obtain an
environment devoid of saliva and GCF. Especially,
during bonding of partially erupted premolars and
molars where bracket failure occur because of the
proximity of adhesive to cervical portion of the
crown.
It is important to note in this context that the term wet
refers to the presence of water, while saliva or crevicular
fluid are considered as contaminants.
Moisture Resistant Adhesives
 Available in a Primer formulation that replaces the
conventional bonding agents.
 It is based on the hydrophilic attraction of the
constituents of wet enamel surface.
Ex: Transbond MIP
 The main reactive component of this product is a
methacrylate functionalized polyalkenoic acid
copolymer originally used in the dentin bonding
system.
 Excess interfacial water ionizes carboxylic groups,
forming hydrogen bonded dimers.
 A reversible breaking and reforming of calcium-poly-
alkenoic acid complexes with enamel is established,
providing stress relaxation capacity.
 Thus a dynamic equilibrium occurs at the interface
incorporating water in the bonding mechanism,
minimizing the detrimental plasticizing effect of
water that occurs with Moisture contamination of
conventional bonding agent.
Moisture Active Adhesives
 These Require rather than tolerate the presence of
moisture for proper polymerization.
 These materials available as pastes and pocess a
completely different composition and polymerization
mode requiring no bonding agent.
Ex: Smart Bond.
 The surface must be intentionally wetted prior to its
application.
 This offers easy clinical application without the need
for etching and liquid resin coating.
 They are based on cyano-acrylate formulations. The
setting reaction involves two steps.
1. Organo-silane (gamma-methacryloxy propyl
trimethoxy silane) Isocyanate groups react with water,
forming an unstable carbamic acid component, which
rapidly composes to carbon dioxide and the
corresponding amine.
2. The amine reacts with residual isocyanate
groups, cross linking the adhesive through substituted
urea groups.
Disadvantages: First step occurs only in the presence of
excess water resulting in the formation of deleteriously
brittle polymer films.
The release of CO2 during the prolonged setting
reaction which is capable of only limited diffusion through
the adhesive film as, polymerization proceeds and may
become trapped, forming gaps or voids with detrimental
effects on the interfacial strength.
in vitro : presence of water (gives good results)
in the oral cavity: Saliva contamination instead of
water, thus the actual performance is hindered.
Self Etching Primers
 A move towards simplifying the acid etch technique
by using self etching primers Ex: prompt L-pop.
 These combine, the conditioning(etch) and priming
into one step, thus reducing clinical chair-time and
the possibility of moisture contamination.
 The procedure that rinsing off the enamel surface
after its application is not required.
 The active ingredient in these products is
methacrylated phosphoric acid ester, which dissolves
calcium from the hydroxyapatite crystals in enamel.
 The calcium then attaches to the phosphate group of
the ester and forms a complex, which is polymerized
when the resin is set.
 Etching and monomer penetration to exposed enamel
rods are simultaneous and depth of etch and primer
penetration are identical.
 There is no significant evidence showing low bond
failure and reduced clinical chair time with this
system compared to the conventional bonding
system.
A meta-analysis was conducted by Fleming et al in 2012, to review the evidence comparing
bonding with traditional acid-etch technique, compared to using selfetching primers
 The shear bond strength they provide is slightly lower than that
of phosphoric acid etching technique, but similar to that
provided by RMGICs because self-etch primers work by
dissolving the calcium from hydroxyapatite crystals, therefore
bleached enamel with decreased calcium content will cause the
self-etch primer to be less effective.

 Additionally, it has been shown that self-etch primers provide a

clinically acceptable bond strength of 12 MPa to 20 MPa (25%
reduction in their mean bond strength), even when the enamel
surface is contaminated with saliva and they appear to have a
lower decalcifying ability.
 Since the purpose is not to obtain the highest possible
bond strength, but adequate bond strength for
orthodontic treatment purposes and conditions for the
safe debonding, the self-etch primers seem to
perform well. It has to be noted, though, that not all
self-etching primers perform equally, since their
concentrations in phosphoric acid differ.
Antibacterial Self-etching Adhesives

 In order to reduce even more the decalcifying

ability of self-etch primers, experimental one-step
or two-step bonding systems which incorporate
antibacterial substances have been introduced into
the market.
 The bond strength of these self-etching adhesives
has been reported comparable with conventional
adhesive systems (appox 9.50MPa).
 These products contain MDPB (12-
methacryloyloxydodecyl-pyridinium bromide), an
antibacterial monomer, which copolymerizes with other
monomers after curing and the antibacterial agent is bonded
to the polymer network, acting as contact inhibitor against
the bacteria that attach to the surface.
 Studies have confirmed the antibacterial ability of MDBP-
containing primers and validated their usefulness. Their
antibacterial effect in combination with their simplified
application procedures makes them a good choice for
orthodontic bonding.
Biomimetic Adhesives
 Combining the gecko and mussel adhesion
mechanisms leads to a new adhesive material called
“geckel”, which functions like a sticky note and
exhibits a strong yet reversible adhesion in both air
and moisture.
 Mussel-mimetic polymers have an amino acid called
L-3,4-dihydroxyphenylalanine (DOPA), found in
high concentrations in the “glue” proteins of mussels.
 A deep understanding of this type of biomimetic
adhesive could be useful in manufacturing brackets.
Brackets having bases with pads mimicking the
gecko foot and covered with a layer of DOPA would
provide a sufficient bond strength to sound enamel
without prior enamel conditioning and would avoid
color and structural alterations of enamel.

Hassan R, Aslam Khan MU, Abdullah AM, Abd Razak SI. A review on current trends of
polymers in orthodontics: BPA-free and smart materials. Polymers. 2021 Jan;13(9):1409.
Cements as Orthodontic Adhesives
 1. Zinc Polycarboxylate Cement
Polycarboxylate cement is the reaction product of
zinc oxide(alkaline) and a polycarboxylic acid
solution(acidic).
The carboxyl groups spaced along the
polycarboxylic acid chain chelate to calcium in
enamel and dentin, resulting in a chemical bond
between the cement and the tooth.
 The chelation of carboxyl groups to divalent and
trivalent cations results in a chemical bond to tooth
surfaces and metal surface oxides.
 Polycarboxylate cement was the first chemically
adhesive dental cement.
 Though considered as a biocompatible cement, its
relatively high solubility and relatively low fracture
resistance limits its clinical use.
 2. Glass Ionomer Cement (GIC): These cements
capitalize on carboxyl chelation to enamel, dentin,
and most metals by employing various mixtures of
carboxyl-containing acids (polyalkenoic acids)
reacted with aluminosilicate glass.
 Compared with polycarboxylate cements GICs show
higher bond strengths to enamel, dentin and metals.
Their low fracture resistance limit their orthodontic
use primarily to band cementation.
 Glass ionomer cements have significantly higher
compressive and tensile strength when compared to
zinc phosphate or zinc polycarboxylates.
 Hence preferred for the cementation of appliances
that are under exceptional mechanical strain or for
cementation of bands to teeth with unusual crown
morphology.
 GIC’s inhibition of demineralization in adjacent enamel
and its improved band retention are the chief reasons to
remain useful for orthodontic cementation. Hence are
preferable for cementation of appliances or bands that
remain in the mouth for extended period of time.

 GICs have been used for orthodontic bracket bonding,

but bracket retention was poor compared with resin
controls. Despite the low bracket-retention rates of
GICs, their chemical adhesion and moisture tolerance
eliminate the need for acid etching and drying.
 3. Resin Modified Cements: The addition of 10% to
20% resin monomers to the GICs resulted in a cement
that is initially hardened with the use of either light or
chemical activators to polymerize the monomers. The
slow acid-base reaction ultimately brings about the
final strength.
 RMGICs are hybrid materials of traditional GICs with
improved physical properties and more stable
hydrogels compared with GICs. They carry the
advantages of both adhesion to tooth structure, and
rapid hardening usually by visible light.
 In addition to the chemical bonding of RMGICs, resin
monomers penetrate surface irregularities to produce a
micromechanical interlock after polymerization
 Light-activated polymerization proceeds significantly faster
than acid-base (cement forming) reactions, resulting in
improved early physical properties, especially fracture
resistance.
 Maturation hardening, sustained fluoride release/recharge,
and caries inhibition are similar compared with conventional
GICs. Also similar are the abilities of both GICs and
RMGICs to chemically bond in the presence of moisture.
 Compomers or Polyacid-modified Composite
Resins : Polyacid modified composite resins, known
as compomers were developed to bring the features
of both caries inhibition and carboxyl chelation to
teeth surface.

 Compomers are single-component systems

consisting of aluminosilicate glass in the presence of
carboxylmodified resin monomers and light-activated
conventional resin monomers.
Ex: Fuji Ortho LC
 Although the alkaline glass and acidic carboxyl
components are packaged in the same container,
allegedly no acid-base setting reaction occurs
because water is absent from the composition.
 After light-activation of the compomer, it is
postulated that water sorbs into the compomer,
allowing a delayed acid-base reaction that may
release fluoride and other remineralizing ions from
the aluminosilicate glass

Ewoldsen N, Demke RS. A review of orthodontic cements and adhesives. American Journal
of Orthodontics and Dentofacial Orthopedics. 2001 Jul 1;120(1):45-8.
 The relatively weak acid-base reaction does not
result in increased physical properties of the
compomer. The absence of hydrogels restricts ion
uptake and release, although fluoride recharging of
compomers has been reported and can be explained
by water sorption and diffusion dynamics.
 Acid etching or other surface treatment is required
before compomers are used, and bonding surfaces
must be dry. Carboxyl chelation with cations on
enamel, dentin, and metallic surfaces has not been
shown to occur with compomer adhesives
 Physical properties are acquired quickly, as compomers
polymerize, and their early setting strengths are superior to
those of the RMGICs but inferior to those of the resin
adhesives.
 Because of absence of water in the formula, the material is not
self adhesive like the conventional glass ionomer or hybrid
glass ionomers. Banding to tooth surface is by mechanical
interlocking.

Ewoldsen N, Demke RS. A review of orthodontic cements and adhesives. American Journal of Orthodontics
and Dentofacial Orthopedics. 2001 Jul 1;120(1):45-8.
BONDING TO NON-ENAMEL SURFACES

1. Porcelain/Ceramic:
 When bonding to porcelain adequate bond strength is
desired, with easy removal to avoid damage of the
restored teeth.
 Surface preparation includes the application of acids,
laser techniques, roughening by diamond
burs(removal of glazed surface), sandblasting(with
Aluminium oxide) and silanization.
 The use of hydrofluoric acid greatly increases the
bond strength. This is due to the acid's ability to react
with the silica phase, creating micromechanical
retention through microchannels.
 Over time, the glassy matrix partially dissolves and
increases the formation of such retentive channels.
Therefore, it is suggested that the etching phase of
bonding is extended to 60 seconds.
 Bonding to feldspathic porcelain: 2 different techniques
Hydrofluoric acid (9.6% for 2 mins) gel treatment, and
Sand blasting and silane (Eg: Scotch prime).
 Bonding to high allumina porcelains: Hydrofluoric acid
is not found very effective for bonding to high allumina and
glass ceramics. A newly introduced technique for these
teeth is silica coating but clinical trials are needed.

Pawar RL, Ronad YA, Ganiger CR, Suresh KV, Phaphe S, Mane P. Cements and Adhesives in
orthodontics-An update. Biological and Biomedical Reports. 2012;2(5):342-7.
Amalgam
 In adult orthodontic patients, and occasionally in
adolescents as well, amalgam restorations exist on
the buccal surfaces of posterior teeth.
 Surface treatment procedures include roughening
the amalgam surface with a diamond bur,
sandblasting, Ga-Sn liquid application, use of
adhesion boosters and chemical corrosion.
Amalgam
 Sandblasting is the most common method used for
surface preparation, since it creates scratch-like
irregularities that increase bond strength. Air
abrasion also increases the surface area of Co-Cr
and Ni-Cr alloys leading to improved adhesion to
resins containing 4-META. (new adhesive resins
that bonds chemically to non-precious and precious
metals)
Gold
 The combination of 4-META with surface
conditioning has been found to be suitable for
bonding to other metal surfaces, including gold and
stainless steel.
 Use of different intermediate primers and new
adhesives that bond chemically to precious metals
(PANAVIA).
 Intraoral sandblasting produced better bonding
(20 MPa) to a gold-palladium, porcelain-fused-to
metal alloy than roughening with a diamond bur
(10 MPa), An adhesive resin composite (Superbond
C&B; Sun Medical Kyoto, Japan) produced better
bonding than a conventional resin composite

Buyukyilmaz T, Zachrisson YO, Zachrisson BU. Improving orthodontic

bonding to gold alloy. Am J Orthod Dentofac Orthop 1995;108:510-518.
Bleached Tooth
 On Bleached tooth : Recently bleached teeth have
significantly lower bond strengths; however, use of
carbamide peroxide bleaching had no effect on bond
strength of a resin composite after 48 hours of bracket
placement.
 The reduced SBS values may be attributed to alterations in
the microstructure of bleached enamel surfaces after acid
etching, including reduced micro hardness, calcium loss,
over etching and loss of enamel prisms or other underlying
mechanisms, such as the release of oxygen radicals on the
enamel surface by residual components of bleaching agents.
 Antioxidant agents seem to increase the SBS of orthodontic
brackets bonded to bleached teeth, even when applied 3 hours
after the bleaching procedure.
 Following this process, the elimination of oxygen–free
radicals from the enamel is not immediate and may remain for
several days.

 Oxygen is an inhibitor of the composite polymerization

process. Studies have also shown that the resin tags produced
when etching bleached teeth, are smaller, more fragmented
and penetrate to a shallower depth than in untreated enamel,
again leading to a weakened bond strength.
 In order to avoid bonding failure on bleached teeth,
several methods have been proposed viz.,
The delay of bracket bonding up to 4 weeks after
bleaching, pumicing the bleached teeth.
The application of antioxidant agents, such as
10% sodium ascorbate or 10% α-tocopherol, prior to
bracket bonding, in order to neutralize the effect of
released oxygen radicals from residual components
Hypermineralized Enamel
 Fluorosed enamel has an outer hypermineralized and
acid-resistant layer, followed by hypomineralized
defects in the subsurface layer.
 The enamel crystals in fluorosed teeth may be
separated by larger inter-rod spaces, no other
significant difference in the enamel crystals is
observed compared to those of non-fluorosed teeth
 There are several studies reporting that fluorosis has
a negative influence on the SBS of orthodontic
brackets
 Satisfactory SBS is obtained when self-etching
primer is used. Further improvement of the SBS
values shall occur when the fluorosed enamel surface
gets air abraised prior to etching procedure, or by the
application of the resin infiltration technique.
 It is generally accepted that increased etching time
allows more penetration into the hypermineralized
enamel layer and potentially elicit higher bond
strengths.
Hypomineralized Enamel
 Amelogenesis imperfecta (AI) is a developmental
abnormality with poor development or complete
absence of enamel.

 It is essential that the delicate enamel is deemed

suitable to withstand not only orthodontic forces, but
also the debonding procedure.
 Conventional fixed appliance therapy can be used,
but bond strengths have been shown to be less
reliable. So, the use of resin-modified glass-ionomer
cement has been suggested.

 This adhesive system is less reliant on resin tag

formation and will potentially also reduce further
demineralization of the enamel surface, due to its
fluoride properties.
 The use of ceramic brackets has been recommended
for AI cases, as they are able to be removed with a
high-speed handpiece.

 This avoids the use of traditional debonding pliers,

which exert a high force on the tooth, and thus helps
to preserve the delicate enamel surface.
 Bonding of Orthodontic Adhesives to
Various Brackets
 1. Ceramic Brackets:
Retention of adhesives to ceramic brackets can be
mechanical or chemical or both.
 Mechanical bonding requires indentations or
undercuts in the bracket base, a roughened surface
caused by micro-abrasion (sandblasting or micro-
etching), or roughness caused by chemical etching
with a 9.6% hydrofluoric acid (HF) gel.
 One bracket (Transcend 2000, Unitek) uses
aluminum oxide particles to provide increased
surface area and greater retention of the adhesive.
 Chemical bonding requires treatment of the ceramic
bracket base with a silanating agent. One end of the
silane molecule bonds to the ceramic, whereas the
other end bonds to the carbon-carbon double bonds
available from the adhesive.
 2. Metal Brackets:
Bonding of an adhesive to a metal bracket is
typically accomplished by mechanical retention, by
incorporating a metal mesh at the base of the bracket;
thus, highly filled resin composites yield the highest
bond strengths.
Bond strength of adhesive to metal brackets is
lowered by spot welds and broken mesh, causing
stress concentration.
Orthodontic Adhesives to Bands
Zinc phosphate, zinc polycarboxylate, and glass
ionomer cements are commonly considered of which
GIC is most commonly used for orthodontic banding.
Chemically cured, hybrid ionomer cements have a
potential advantage because of their high bond
strength to unetched enamel.
Surface treatment, such as photo-etching, of
orthodontic bands can result in improved bond
strength of glass ionomer and hybrid ionomer
adhesives to stainless steel band material.
Resins used for Indirect Bonding
 In the initial trials of indirect bonding softened candy was
used to position brackets on the teeth, and chemically cured
filled resins( Concise 3M Unitek) were used to bond the
brackets to the teeth.
 Although the method was effective, it resulted in a
significant amount of excessive flash around the bracket,
and the cleanup of the resin presented a significant problem.
 This technique was also cumbersome and involved
significant amount of doctor and laboratory time.
Alternative adhesives have been used over the years, but
most have proved to be only moderately successful.
 The next major improvement in the indirect methodology
occurred during the 1980s. This occurred when heat-cured
resins entered the market.
 However, there were reports of clinicians experiencing
problems with the brackets drifting on the working models
during the time required to heat cure the resin. The transfer
model with the brackets attached had to be heated to 250°F to
300°F for approximately 15 to 20 minutes as a means of
curing the resin (Thermacure;, Itasca, IL).
 Furthermore, some nonceramic esthetic brackets could not be
exposed to this heat. This necessitated placing the brackets
separately on the models, resulting in a more cumbersome
procedure.
Indirect bonding
 From attempts over the years it became
increasingly evident that one of the deficiencies in
the available systems came from the fact that all the
resins and procedures had been originally designed
for direct bonding and had subsequently been
adapted for indirect bonding.
Anup Sondhi Adhesive
 Developed exclusively for indirect bonding
 This resin was developed with the aid of 3M
Unitek (Sondhi Rapid Set, 3M Unitek).
 The viscosity of the new resin was increased with
the use of a fine-particle-fumed silica filler
(approximately 5%), so that it would have the
ability of filling any such voids without
compromising bond strength.
 The new resin was developed with a quick-set time
of 30 seconds. The latter significantly decreases the
time needed to hold the bonding tray in place
during curing. The resin is completely cured in 2
minutes, which allows for rapid removal of the
bonding tray.10 This new resin has been
specifically designed for indirect bonding and
would not be useful for direct bonding.
CONCLUSION
 Orthodontic brackets cemented on the tooth surface
acts as a medium for the delivery of forces applied by
the arch wires and auxiliaries. The main contributing
factors for the success of force transfer include the
surface preparation of the enamel and the type of the
material used for bondiing. The layyer play a key role
in the orthodontic treatment procedure.
 Success of orthodontic treatment is greatly dependent
upon the adhesion or bonding characteristics of the
cements and adhesives.
Conclusion..
 Though the newer cements, adhesive resins and
hybrid cement resin combinations offer improved
physical properties and clinical benefits, they also
have some short comings. Therefore a clear
understanding of the features, benefits and
limitations is required to choose materials wisely
and obtain optimal results
REFERENCES
 Alster D Feilzer AJ, De Gee Aj, Davidson CL, Tensile
strength of thin resin composite layers as a function of
layer thickness. J Dent Res 1995; 74: 1745-8.
 Eliades G, Vougiouklakis G, Cupro A. Degree of
doouble bond conversion in light-cure composites. Dent
Mater 1987; 3: 19-25.
 Sondhi A. Effective and efficient indirect bonding: The
Sondhi method. InSeminars in Orthodontics 2007 Mar 1
(Vol. 13, No. 1, pp. 43-57). WB Saunders.
References..
 Grewal Bach GK, Torrealba Y, Lagravère MO. Orthodontic
bonding to porcelain: a systematic review. The Angle
Orthodontist. 2014 May;84(3):555-60.
 Hassan R, Aslam Khan MU, Abdullah AM, Abd Razak SI.
A review on current trends of polymers in orthodontics:
BPA-free and smart materials. Polymers. 2021
Jan;13(9):1409.
 Pawar RL, Ronad YA, Ganiger CR, Suresh KV, Phaphe S,
Mane P. Cements and Adhesives in orthodontics-An update.
Biological and Biomedical Reports. 2012;2(5):342-7.
References..
 Patil P, Kaur S, Kaur M, Kaur M, Vinuta S, Kaur RK.
Orthodontic cements and adhesives: a review. J Adv
Med Dent Sci Res. 2014 Jul;2(3):35-8.
 Powers JM, Kim HB, Turner DS. Orthodontic
adhesives and bond strengthtesting. InSeminars in
orthodontics 1997 Sep 1 (Vol. 3, No. 3, pp. 147-156).
WB Saunders.
 Kotrogianni M, Rahiotis C. Resin composites in
orthodontic bonding. A clinical guide. J Dent Oral
Biol. 2017;2(7):1054.
THANK YOU