Bonding

BONDING IN
ORTHODONTICS
Prepared by: Dr. Snehal Patel
Post graduate student part I
Guided by: Dr. Roopal Patel(Reader & P.G Guide)
Dr. Dolly Patel (Dean & H.O.D, Department
of Orthodontics and Dentofacial
Orthopaedics, AMC Dental College and Hospital)
1
Index
 Introduction
 History
 Advantages and disadvantages
 Basic steps
 Adhesives and brackets
 Bonding over different surfaces i.e crowns and restorations, porcelain,
amalgam, gold, composite restoratives.
 Re-bonding and Recycling
 Indirect Boding
 Lingual Bonding
 De-bonding
 Bonding failure
 Conclusion
 References
2
Introduction
3
Griffins resilient arch Angle’s pin and tube appliance 1958
assemblage 1930
Rigid attachment as advocated Angle’s ribbon arch appliance

by Dr. Ray D robinson
Angle’s edgewise arch mechanism
4
If you look at most surfaces
Through a microscope, you
Will find that they are not smooth
What an adhesive does is fill in the

Gaps and build a bridge between two surfaces
The adhesive must then harden, so that the bond stays together
5
Introduction
 From the inception of fixed-appliance orthodontic
treatment, brackets traditionally have been welded
to gold or stainless steel bands.
 The band encompassed the tooth circumferentially,
requiring the creation if interproximal space to
accommodate the width of the band material.
 This separation process, which was accomplished
initially by placing wires and later elastomerics,
was time-consuming for the orthodontist and
uncomfortable for the patient.
Paul Gange: The evolution of bonding

in orthodontics. AJO-DO 2015 vol 47
12/09/2023 issue 4 page no 556-563 6
Introduction
 At the conclusion of treatment, these
interproximal gaps had to be addressed again.
 In addition, banded appliances frequently
caused gingival trauma when fitted, and
decalcification under bands sometimes
occurred during treatment.
 Therefore, the obvious solution to these
problems was for the clinician to attach the
brackets directly to tooth enamel, thus
eliminating the need for bands.
issue 4 page no 556-563
7
Introduction
 Banding has failure rate of 7 to 21 %[1] whereas
that of bonding is 5%[2].
 Since the first reported attempt by sadler in
1958 to cement orthodontic brackets directly to
the enamel surface, the direct bonding
technique has developed to the extent that it is
now a generally accepted means for attaching
brackets to teeth for orthodontic treatment[1]
1-Eliakim Mizrahi, Success and failure
of banding and bonding:A clinical
study.AO 1982 4(71-77)
2- Graber, Vanarsdall: Orthodontic
current principles techniques, 4th
edition,2005. St. Loius , Mosby. page
579-629. 8
History
 In 1955 BUNOCORE1 introduced acid etching technique.He

demonstrated increased adhesion produced by acid
pretreatment of enamel. This led to dramatic changes in
practice of orthodontics
 1965-with the advent of epoxy resin bonding NEWMAN
1
began to apply these findings to direct bonding of
orthodontic attachments. In early 1970s considerable no. of
preliminary reports were published on different
commercially available direct &indirect bonding system.
1- Sudhir Sharma, Pradeep Tandon,
 A survey conductedAmit byNagar,
LEONARD GOERLICK 2 revealed
Gyan P Singh1, Alka
Singh, Vinay K Chugh. A comparison of
almost 93% of orthodontists started
shear bond strength bonding brackets (at
of orthodontic
brackets bonded with four different
least in anteriors )instead ofadhesives
orthodontic banding.Journal of
Orthodontic Science 2014;201 (3):29-33
2-leonard goerlick Survey Of Bonding
JCO January 1979 12
History

issue 4 page no 556-563 13
Advantages
1. Esthetically superior.
2. Faster & Simpler.
3. Less discomfort for the patient
4. Arch length is not increased by band material.
5. Allows more precise bracket placement even in tooth with aberrant
shape.
6. Improved gingival health.
7. Better access for cleaning .
8. Mesiodistal enamel reduction possible during treatment.
9. Interproximal areas are accessible for composite buildup.
10.Caries risk under loose bands is eliminated.Interproximal caries can be
deducted & treated.
11. No band spaces to close at end of treatment.
12.No large supply of bands are needed.
13. Brackets can be recycled further reducing the cost.
Premalatha Kannaiyappan, S. kishore
14. Invisible lingual brackets can be used
Kumar,when estheticEnamel
W,S. Manjula. is important.
15. Attachments can be bonded to pretreatment before bonding brackets-
fixed bridgeworks.
A Literature Review. Biomedical &
Pharmacology Journal, Oct 2015 vol.8
(631-640) 14
Disadvantages
1.Bonded brackets have weaker attachments than cemented band.
2. If excess adhesive extends beyond bracket base increases risk of
plaque accumulation .
3. Protection against interproximal caries of well contoured
cemented brackets is absent.
4. Bonding generally not indicated when lingual auxillaries or
headgear required.
5. Rebonding loose brackets require more preparation than
rebanding loose bands.
6. Debonding- more time consuming due to more difficult removal of
adhesives.
7. Evidence based decalcification & whiteS.spot
Premalatha Kannaiyappan, kishore lesion occurs more
Kumar, W,S. Manjula. Enamel
following bonding than banding.
pretreatment before bonding brackets-
(631-640) 15
Basic Steps In Bonding
 Cleaning
 Enamel conditioning
 Sealing
 Bonding
Graber, Vanarsdall: Orthodontic

579-629. 16
17
Cleaning
 Careful use of pumice to avoid trauma to
gingiva.
 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.

579-629. 18
Enamel conditioning
Moisture control
 Dry working field is mandatory
•Lip expanders &cheek retractors
•Saliva ejectors
•Tongue guards with bite blocks
•Salivary duct obstructers
•Cotton or gauze rolls
•Antisialogogues (tablet 50mg per 45kg, injectable solution of
methantheline bromide, propantheline bromide,atropine sulfate)

579-629. 19
Enamel conditiong
Enamel Pretreatment
 Conditioning gel or solution is applied over
enamel for 15 to 30 secs
 Rinse off etchant using abundant water spray
and high speed evacuator. Salivary
contamination should be avoided at this stage
at all cost.
 Dry the teeth thoroughly with moisture and oil
free source
 Check for dull frosty apperance
579-629.
20
Enamel Conditioning
 Most common etchants :
 37%(removes 3 to 10 um of enamel) to 50%(removes
5-25) um of enamel) phosphoric acid
 10% polyacrylic acid
 10% maleic acid
 9.6% hydrofluoric acid(for porcelain surface)
 Sandblasting with 50 to 90 micrometer alumina
particles for 3 sec at 10mm distance. (for stainless
steel crown)
21
Enamel conditioning
 NEW CONCEPTS OF ETCHING:
 Laser etching: This new concept was proposed in 1993.
-Angle by J.A.Von Fraunhofer. He showed at 3 watts for 12 sec
laser etching produced acceptable bond strength though
significantly less than conventional acid etching.
 He used Nd/ YAG as laser source.
 Serder Usumuz et al in AJO-DO 2002 used ErCr ; YSGG as the
hydrokinetic laser system for acid etching & came to the same
conclusion.
 But major disadvantage as reported by Fraunhofer is that high
laser produces heat in sufficient magnitude to cause at least

localized pulpal inflammation & possible irreversible damage to
pulpal tissue immediatelyKumar, opposite the site of laser irradiation.
W,S. Manjula. Enamel
(631-640) 22
Etch Pattern
Type 1 Honey comb Type -2 Cobblestone Type -3 Pitted

appearance with loss appearance with prism enamel with map
of enamel prism edges lost. like appearance.
centers.
Premalatha Kannaiyappan, S.
kishore Kumar, W,S. Manjula.
Enamel pretreatment before
bonding brackets- A Literature
Review. Biomedical &
Pharmacology Journal, Oct 2015
vol.8 (631-640)
Type -4 Granulation of
enamel with numerous
holes 23
15sec 30 sec 60 sec
Enamel after 37% phosphoric acid etching
Enamel after 15% phosphoric acid
37% H3PO4 acid

Premalatha Kannaiyappan, S. kishore 90 um AlO2 air abrasion
10 % polyacrylic acid etching Kumar, W,S. Manjula. Enamel
24
(631-640)
Some Debate Over Enamel Conditioning
Enamel Pretreatment
1.To etch the entire buccal surface or only a small portion outside bracket pad?
Etching the entire facial enamel is harmless- at least when a fluoride
mouth rinse is used regularly
2.Gels or solutions?
Gels provide better control for restricting the etched area but may
require more thorough rinsing afterward.
3.Optimal etching time??? & diff. for young and old teeth?
15 to 30 seconds. K.J Nordenvall did a comparison between the effects
of 15 and 60 seconds of etching with a 37% phosphoric acid solution on
enamel surfaces of deciduous and young and old permanent teeth. For
deciduous teeth, no difference was found in effect between the etching
periods. For young permanent teeth, 15 seconds of etching created more
retentive conditions than 60 seconds.
In case of impacted/surgically exposed canine care has to taken to
remove cuticle layer

579-629. 25
Some Debate Over Enamel Conditioning
Enamel Pretreatment
4.Sand blasting as effective as acid etching?
Sandblasting without acid etch has low bond strength.
Sandblasting followed by acid etching procedures produces bond strength
comparable to or higher than acid-etched enamel.
5.Preferred procedure for deciduous teeth?
Sandblast with 50 micrometer aluminum oxide for 3 seconds to
remove outermost aprismatic enamel then etch for 30 seconds with 35%
phosphoric acid gel
6.Is prolonged etching required when teeth are pre treated with flouride?
Extra etching time is not necessary
7.Incorporating flouride increases resistance to caries?
They have similar morphologic etching effect to non- fluoridated ones.
No proper study has been done regarding effect on caries
protection.
579-629. 26
8.Etching permissible on internal white spot lesions?? Or etching will
open up underlying demineralized areas??
One should exercise caution, etching time should be reduced.
Use of TOOTH MOOSE is preferrable
9.How much enamel is removed by etching?how deep are histologic
alterations?are they reversible?
3 to 10 micrometer of anamel is removed. Another 25
micrometer reveals subtle histologic alterations, creating
necessary mechanical interlocks. Enamel alterations are largely
reversible.
10.Other means like polyacrylic acid/maleic acid/self etching
primers .. Are they preferred???
Use of polyacrylic acid with residual sulfate and maleic acid has
same retention area compared to phosphoric acid but much weaker
bond and less risk of enamel damage at debonding.

579-629. 27
The use of sodium hypochlorite combined with
polyacrylic acid increased the bond strength of
brackets bonded with RMGIC.
By eliminating the organic substances from the

enamel surface before etching(deproteinization)
orthodontic bond strength can theoretically be
increased because the resulting etch-pattern is
predominantly type 1 and 2, instead of type 3
Alessandra Marques et al.
Consequences of enamel preparation
with sodium hypochlrite, polyacrylic
and phosphoric acids for the bonding of
brackets with resin modified glass
ionomer cement. 2013, material
research, vol 16 28
 Several in-vitro studies have proved tha
Fluoride-releasing resin-modified glass
ionomer cements (RMGIs) can routinely be
used to bond brackets, instead of composite
resins.
 It reduces the incidence of white spot lesions, a
major current iatrogenic effect of orthodontic
treatment. Robrto Justus, Tatiana Cubero, Ricardo
Ondarza, Fernando Morales. A new
technique with dosium hypochlorite to
increase Bracket Shear Bond strength of
fluoride releasing resin-modified glass
ionomer cements: Comparing shear
bond strength of two adhesive systems
with enamel surface deproteinization
before etching, Seminar in
Orthodontics, volume 16, issue 1 (66-75) 29
Sealing
 Why a sealent(intermediate resin) is necessary?
 To achieve proper bond strength
 To improve resistance to microleakage
 Permits relaxation of moisture control
 Provide enamel cover in areas of adhesive voids.

579-629. 30
Sealing
 After the teeth are completely dry and frosty white, a
thin layer of bonding agent(sealent,primer) may be
painted over the etched enamel surface. The coating
may be thinned by a gentle air burst for 1 to 2 seconds.

579-629. 31
Sealing
 Moisture insensitive primers:
1)Transbond MIP, 3M/Unitek,
2)Assure, Reliance Orthodontics
should be used in cases of second molar, half

erupted teeth, impacted canine bonding where
there is risk of blood contamination
When bonding to enamel, one must place the resin

sealent/primer onto prepared enamel before
pellicle(biofilm) from the saliva
579-629. 32
Sealing
Self- Etching Primers

Condition+priming, so the need of acid etching and subsequent rinsing is
eliminated.
Active ingredient-methacrylated phosphoric acid that dissolves calcium

from hydroxyapatite which form complex and is incorporated into a
network when the primer polymerizes.
Etching and monomer penetration to the exposed enamel rods are

simultaneous, and the depth of etch and primer penetration are identical.
Bond failure with self etching primer were higher than those with
conventional etching and priming.
579-629. 33
Sealing(SEP)
 Mechanism of action:
Methacrylated phosphoric acid dissolves calcium from hydroxyapaptite.
Removed calcium forms complex and is incorporated

into the network when the primer polymerizes
Etching and monomer penetration to the exposed enamel rods are simultaneous,
and the depth of etch and primer penetration are identical
Three mechanism act to stop etching process

i) Acid groups attached to the monomer are neutralized by forming a complex with
calcium
ii) Solvent is driven from primer during airburst step, the viscosity rises, slowing the
transport of acid groups to enamel interface
iii) Primer is light cured, primer monomer are polymerized, transport of acid group to
34
the interface is stopped.
Sealing
 Self- Etching Primers (clinical steps)
 Dry the tooth surface
 Apply transbond plus. Has three components.
Methacrylated posphoric acid+ acid esters
+photosensitizers+stabilizers; water and soluble fluoride;
applicator microbrush are the respective components.
Mix first compartment comonents and apply it with
microbrush present in third compartment. Stay on tooth
surface to avoid gingival irritation. Rub thoroughly for
atleast 3 seconds and always wet the surface with new
solution to ensure monomer penetration.
 Bond the bracket with Transbond XT and cure with light.
579-629. 35
KEYS TO SUCCESS WITH SELF-
ETCHING PRIMERS
 1. Thorough prophylaxis mandatory.

 2. Apply a small amount of primer to the tooth
surface (thin coat).
 3. Longer agitation (5s.) vs. (3s.). 4. After drying,
tooth must look “resin” shiny–not “water” shiny.
 If there is saliva contamination after application,
the process must be repeated.
 Once the surface is etched air drying has to be
gentle to prevent dessication
Orthodontic bonding manual by paul
gange 36
Sealing
 Self- Etching Primers (clinical steps)

37
gange
Bonding
 Procedure consist of following steps:
 Transfer: The bracket is gripped with reverse action tweezers, mixed
adhesive is applied to the back of the bonding base. Bracket is
immediately placed on tooth close to its correct position.
 Positioning: Placement scaler is used for correct mesio-distal, inciso-
gingival, and angular relation according to long axis of tooth. Mouth
mirror aids in horizontal positioning, particularly on rotated
premolars.
 Fitting: Scaler is turned, firmly pushed toward the tooth surface
with one point contact with bracket.
 Removal of excess: Slight bit of excess minimizes possibility of voids
and ascertains that adhesive is buttered into the bracket backing.
Removed with scaler before adhesive setting and with burs after
adhesive setting. Prevents ginival irritation, plaque build up,
exposed adhesive might become
Graber, Vanarsdall:discoloured
Orthodontic in oral environment.
579-629. 38
Adhesives and brackets
 ADHESIVES
Basically 2 types.
1. Acrylic resins: • These are self curing resins • Composed of
methylmethacrylate monomer & ultra fine powder • They
produce linear polymer so has less bond strength
2. Diacrylic resins: • These are acrylic modified epoxy resin
(bis –GMA or Bowen's resin) •They polymerize by forming
cross linking-3D network. •So increase strength •Decrease
water absorption •Decrease polymerization shrinkage
 Filled resins of bis GMA type; e.g. concise& phase II have
best physical properties & strongest adhesives for metal

brackets. Graber, Vanarsdall: Orthodontic
579-629. 39
Adhesives
 Can also be classified as
1. Unfilled resins:
• Has minute filler particles of uniform size ( 0.2 & 0.3

millimicron)
• Yield smoother surface
• Retains less plaque
• More prone to abrasion
2.Filled resins:
• Has coarse filler particles of quartz or silica of variable size;3-
20 um.
• Increase abrasion resistance.
• Increase plaque accumulation.
579-629. 40
Adhesives
 No mix adhesives
• Here one paste is applied to bracket base & a primer is
applied to etched enamel. When both come in contact
under slight pressure its cured chemically generally within
30-60 sec.
• Simplicity.
• Unpolymerized monomer might retain causing toxicity
& allergy.

579-629. 41
Adhesives
 Visible light cured adhesive
-provide increased working time.
•Light cured composite resins used with metal brackets are usually dual cured
having both light initiators & chemical catalyst.
 Light sources used are :
• Halogen is the conventional light source used.

• Argon laser curing
• Xenon or plasma arc lamp from 1998
• Light emitting diode (LED) introduced by mills et al
Depth of curing usually depends on

• Composition of resin
• Light source
• Exposure time

579-629. 42
Adhesives
 Curing process begins when a photo initiator is activated.
 These adhesives are cured when exposed to light.They contain
CAMPHOROQUINONE as absorber.light is absorbed at the wave length of
470 nm(blue region of visible light spectrum) & thus gets activated.
 Halogen
• Light is generated using hot filaments(tungsten).
• It uses about 300 mW / cm 2 power.
• It has a broad wave length of 400 – 520 nm .This results in decreased intensity
of light .
• Curing time:Ortho composites 20 sec. & resin modified glass ionomers-40 sec.
Halogen light achieved highest bond strength with 40 sec curing time .
Disadvantages: power output=less than 1% of power consumption.
-limited lifetime of 100 hours.
579-629. 43
Adhesives
 Argon laser
• Its introduced in late 1980s to increase output light energy to 800 mW / cm2
• It has narrow wave length of 480 nm which corresponds to the peak area of
absorption of camphoroquinone.
• It produces 60% conversion in 5 sec (for unfilled)-10 sec (for filled resins).
Advantages:
• Superior to conventional light cure regarding bond strength.
• It saves chair time.
 Disadvantages:
• Requires shielding appliance over teeth which are not bonded.
• Cost.
• Poor portability Graber, Vanarsdall: Orthodontic
579-629. 44
Adhesives
 Plasma arc or xenon arc lamp
• Introduced in 1990s for high intensity curing of composites.
-tungstun anode & a cathode in quarts tube filled with xenon gas.
• Light source is xenon gas that is ionized by 2 electrodes.
• The intense white light is filtered to width of 430-490 nm.
• Power density can reach more than 900 mW/cm2 which is about 5 times
more intense than halogen. It uses 1370 mw/ cm2.
IT saves chair side time
3-5 sec. for metal brackets. Bond failure rate is as low as that of halogen.
 Disadvantages:
-heat generated can harm pulp tissue.

temp. rise: 2.8*C with halogen & 1.1* with plasma arc.
So, 5-10 sec. curing with plasma arc= safe.
579-629. 45
Adhesives

Light emitting diode ( LED )
• Introduced since 2000.
• It uses doped semi conducters to generate light instead of hot
filaments.
 It has the wavelength of 468 nm.
 4 generations have evolved, in clinical practice 3rd genration which is
battery operated is commonly used.
Advantages • • • •
• Has high lifetime of 10000 with little degradation.
- Requires little power to operate.
- Requires no filter to produce blue light.
- It is resistant to shock & vibration.
579-629. 46
Adhesives
 Following results were obtained from various
studies:
light source & adhesive must be compatible.
New light sources are faster than conventional
halogens
fast halogens=brand specific;low heat;less
expensive.
plasma arc lights=shortest curing time, but
expensive and generate heat.
 LEDS= small size,
Graber,cordless,quiet,minimal
Vanarsdall: Orthodontic
heat.
579-629. 47
Generation of composites
 First Generation
 BUONOCORE (1956) – Demontsrated the use of a
Glycerophosphoric acid dimethacrylate – containing
resin, would bond to acid etching dentine.
 BOWEN (1965), tried N – phenylglycine and glycidyl
methacrylate .
 Bonding occured due to the interaction of this
bifunctional resin with the calcium ions of
hydroxyapatite.
 Drawback – Poor bond strength (1 to 3 MPa ).
 The first commercial system of this type – Cervident, SS
White
(631-640)
48
 Second Generation
 In the late 1970’s the second generation system were
introduced.
 Incorporated halophosphorous esters of unfilled
resins such as bisphenol – A glycidal methacrelate or
bis – GMA, or hydroxyethyl methacrylate, or HEMA.
 Bonded to dentine through an ionic bond to calcium
by chlorophosphate groups.
 Weak bond strength, but significant improvement
over first generation.
 Scotch Bond (3M Dental ), Clearfil (Kuraray Co. Japan)

(631-640)
49
 Third Generation
 The primer contains hydrophilic resin monomers which
include hydroxyethyl trimellitate anhydride, or 4–META, and
biphenyl dimethacrylate or BPDM.
 The primers contain a hydrophilic group that infiltrates smear
layer, modifying it and promoting adhesion to dentin.
 The phosphate primer modifies the smear layer by softening
and cures, forming a hard surface. Following, the unfilled
resin adhesive is applied, attaching cured primer to the
composite resin.
 Drawback – Bonding to smear layer – covered dentine was not
very successful.
 Mirage bond, Scotch bond 2, Prisma Universal bond 2 and 3.

(631-640)
50
 Fourth Generation
 The use of the total etch technique is one of the main
characteristics of fourth generation bonding system, here complete
removal of the smear layer is achieved.
 The Total etch technique permits the etching of enamel and
dentine simultaneously using 40% phosphoric acid for 15 to 20
seconds. The surface must be left moist to avoid collagen collapse.
 The application of hydrophilic primer solution can infiltrate
collagen network forming the hybrid layer. According to
Nakabayashi (1982) the hybrid layer is defined as “the structure
formed in dental hard tissues by demineralization of the surface
and subsurface, followed by infiltration of monomer and
subsequent polymerization.
 All bound -2 (BISCO), Scotch bond Multipurpose (3M).

(631-640)
51
 Fifth Generation
 Consist of two different types of adhesive materials the so called “one bottle”
systems and the self etching primer bonding system.

 ONE BOTTLE SYSTEMS combined the primer and adhesives into one
solution to be applied after etching. Total etching was done with 35 – 37%
phosphoric acid for 15 to 20 secs.
 SELF ETCHING PRIMER was developed by Watanabe and Nakabayashi. It is
a aqueous solution of 20% phenyl – P in 30% HEMA.

 An acidic primer combines the etchant with the primer in one application,
Contains both acid (Phenyl – p) and the primer ( HEMA and dimethacrylate).
 Clearfil liner bond V (Kuraray)
 Mega bond (Kuraray)
 Prompt – L – Pop ( 3M UniteK )
 First step (Reliance)
 Transbond Plus ( Unitek 3m )
 Ideal 1 (GAC )
 One up Bond F ( Tokuyama)
 Adv – The combination of etching and priming steps reduce the working time.
 Single bond (3M), One step (BISCO)

(631-640)
52
 Sixth Generation
 Recently several bonding system were developed and
these systems are characterised by the possibility to
achieve the proper bond to enamel and dentine using only
one solution. These should really be one – step bonding.
 Unfortunately, the first evaluations of these new system
showed a sufficient bond to a conditioned dentin while
the bond with enamel was less effective. This may be due
to systems are composed of an acidic solution cannot be
kept in place, must be refreshed continuously and have a
pK that is not enough to properly etch enamel.
 Prompt – L – Pop (ESPE, Germany).

(631-640)
53
 Seventh generation: The trend in the latest
generation of dental bonding systems is to
reduce the number of components and clinical
placement steps. The introduction of 1 Bond, a
single – bottle adhesive system, is the latest to
new generation materials that combines
etchant, adhesive and desensitizer one
component.

(631-640)
54
Adhesives
 “The 5 Keys to Success with a Light Cure Bonding
Adhesive”
 1. Light must be of proper intensity.
 2. Divide your total curing time into 2 increments,
one angle always being the incisal (occlusal)…..
 3. Place light director as close to bracket base as
possible for 1-2 seconds
 4. Be sure light maintains intensity throughout
entire curing process.
 5. Adequate cure time – Never cure for less than 6
seconds per bracket
gange 55
Bonding on different surfaces
METAL SURFACE( SS
AMALGAM
CROWN)
1. Intra oral sandblasting amalgam alloy 1. Thorough prophylaxis-rinse
with 50 micron aluminium oxide for 3 sec
and dry
2. If small restorations, then condition 2. Micro etch(50-um white or
the surrounding enamel with 37% 90-um tan aluminium oxide
phosphoric acid for 15 sec. particles at about 7kg/cm2
pressure) metal surface with
3. If large restoration Apply reliance or alumina particles- rinse and
any metal primer that has 4-META &
wait for 30 sec dry
3. Apply primer and air dry
4. Bond with composite resin and check 4. Proceed with adhesive and
occlusal interferences if there are any.
bracket application
579-629. 61
BONDING TO PORCELAIN BONDING TO A TOOTH WITH
CROWN A COMPOSITE RESTORATION
 1) Thorough prophylaxis-Rinse and  Thorough prophylaxis-Rinse
dry
and dry
 2)Place barrier gel(KOOL-DAM) on
gingival margin to protect soft tissue
 Roughen the composite
 3)Deglaze an area slightly larger than surface with a fine diamond-
the bracket base by sandblasting with Rinse and Dry
50um aluminium oxide for 3 seconds.  If there is enamel present-
 Place porcelain etchant 9.6%HF on
crown-leave for 2 minutes. Etch Rinse and dry
 Apply 1 thin layer of porcelain  Apply bonding resin and
conditioner-leave for a minute lightly dry with air
 Proceed with appliaction of paste and
bracket
 Proceed with the application
of bracket
579-629. 62
 BONDING TO GOLD
In vitro studies showed sandblasting & special primers with
4-META containing resin bonding provides good adhesion.
Tin plating improved bond strength only marginally But
clinically is still difficult to achieve good bond strength when
bonding to gold & it’s also disapproved by food and drug
admin. For intraoral use.
Gloria Nollie et al in ANGLE 1997 reported that Type –1V
gold treated with adlloy(plating with gallium-tin solution)
has increased bond strength & gives twice as strong as those
found in microetched gold.
579-629. 63
Factors affecting bond strength
 Material related
 Tooth related
 Miscellaneous
Waleed Bakhadher, Hassan Halawany,

Nabeel Talic, Nimmi Abraham, Vimal
Jacob. FACTORS AFFECTING THE
SHEAR BOND STRENGTH OF
ORTHODONTIC BRACKETS- A
REVIEW OF IN VITRO STUDIES 2015
ACTA MEDICA;58(2):43-48 64
Material Related
 Type of etching material: SBS of self-etching
primer and adhesive systems were much lower
than that of the conventional acid etch and
bond system
 The air abrasion followed by acid etching has
significantly higher SBS values compared to air
abrasion alone
 No significant difference in SBS is observed
between laser-ablated etching compared to acid
etching Waleed Bakhadher, Hassan Halawany,
ACTA MEDICA;58(2):43-48
65
Material Related
 Types of brackets:
 SBS of ceramic brackets is significantly higher than that
of stainless steel bracket used. Thus risk of enamel
fracture is more with ceramic brackets during debonding
 Bracket base design and size:
 SBS is significantly higher for the brackets with laser
structured base compared to that of the brackets with foil
mesh base
 The brackets with circular concave base has higher SBS
 The bracket with larger mesh size has higher SBS than
that compared to smaller mesh size
66
Material Related
 Adhesives:
 SBS of the composite resin- phosphoric acid
adhesive system is significantly higher than glass
ionomer adhesive system.
 Bonding to restorative materials:
 For amalgam restoration highest SBS is achieved by
sandblasting the surface( amongst available options
like polishing, sandblasting, chemically corroding
the surface)
 Feldspathic porcelian type has a higher SBS than
aluminous percelian type
Nabeel Talic, and Vimal
Nimmi Abraham, glass porcelian type.

ACTA MEDICA;58(2):43-48 67
Teeth-Related Factors
 For fluorosed teeth irrespective of the bonding
material used, air abrasion followed by acid
etching has significantly higher SBS than that
compared to acid etching alone
 Highest SBS is found in lower first molar and
lowest SBS is found on upper first molar
 Furthermore SBS is higher in anterior teeth
compared to posterior teeth in upper arch and
SBS is lower in anterior teeth compared to
posterior teethWaleed
inBakhadher,
lower arch
Hassan Halawany,
ACTA MEDICA;58(2):43-48 68
Miscellaneous
 Fluoride containing CPP-ACP applied after
acid- etching, has higher bond strength than
that compared to 5% sodium fluoride solution.

ACTA MEDICA;58(2):43-48 69
Rebonding
-More time consuming & uncomfortable for orthodontists is loose
brackets during treatment.
Clinical procedure:
 The loose bracket is removed from arch wire.
 Ligatures of 2 neighboring brackets are cut & arch wire is placed
on top of these brackets.

 The adhesive remaining on tooth surface is removed with bur &
bracket is sandblasted.
 Do not burnish mesh backing .
 Tooth is etched for 15-30 secs
 sealed & bracket rebonded.
 Always better to replace loose ceramic bracket with a new,intact
bracket for optimum bond strength.

579-629. 73
Recycling
Main goal of recycling process is to remove the adhesive
from bracket base without damaging or weakening the
delicate foil mesh or distorting the dimensions of bracket
slot.
Some methods used are:
•Applying heat about 450 c to burn off the resin followed
by electro polishing ( to remove tarnish & oxide)
•Solvent stripping followed by high frequency vibrations
with only flash electro polishing
•Recycling with sandblasting
•Recycling with microetching
579-629. 74
Indirect Bonding
-It was first introduced by Silverman& Cohen in 1974.
-They used methylmethacrylate adhesive to attach to
plastic brackets to model cast in laboratory.An unfilled
bis-GMA resin was used as an adhesive between
etched enamel & previously placed adhesive.
Advantages
1. More accurate bracket positioning
2. Clinical chair side time is reduced.
3. Indirect technique has better bracket placement in

vertical position,but no significant difference
occurred in angulation or mesiodistal position.
75
Indirect Bonding
 Disadvantages
1.Technique sensitive
2. Increased lab time
3. Risk of adhesive leakage to gingival embrasure could lead to difficult
oral hygiene management
4. Removing adhesive is difficult to achieve & time consuming
5. Achieving consistent & predictable adhesion is difficult.
6. Accidental removal of brackets with tray is not unusual.
7. Failure rates are slightly higher
8. Less disturbance during adhesive polymerization is difficult to achieve
9. Closer fitting of bracket base is better achieved by one point contact of
scaler in direct bonding than when transfer tray should be held in place
by finger pressure in indirect bonding.

579-629. 76
Indirect Bonding
Procedure:
• Patients stone model is marked for long axis & vertical height
Separating medium.light cure/thermally cured composite is placed on bracket
base & bracket is positioned accurately
•Mixed silicone putty material is pressed onto the cemented brackets & tray is
formed with sufficient thickness for strength ,thermoplastic trays can also be used.
•After silicone sets model & tray are removed and adhesive bases are gently
sunblasted ,care taken not to abrade the resin base.
• Apply aceton to the bases to dissolve remaining separating medium.
•Patient’s teeth are prepared as per direct technique.

•Adhesive applied to bracket bases.
•Tray seated on patient’s arch & held firmly with steady pressure for 30 sec to
1min
•Allow 2 mins or more curing time
•Any excess adhesive is removed
579-629. 77
 Clinical Stage I
 1. Perform dental prophylaxis and upper and lower full-arch
impressions with high quality alginate, following the
manufacturer's instructions. Examine in full detail the
impression obtained, in order to avoid potential flaws that may
lead to distortions in the dental cast, paying special attention to
the areas corresponding to teeth.
 2. Obtain dental casts with type IV dental stone. This procedure
should be carried out judiciously so that dental casts are free
from imperfections (positive and negative bubbles). Surface
flaws will hinder brackets and tray fitting to the teeth, when the
former are transferred to the oral cavity. It is also necessary to
wait for the stone to fully crystallize and dry.
Lincoln issamau nojima,adriele

silvero,Matheues Alves. Indirect
orthodontic bonding - a modified
technique for improved efficiency and
precision
Dental Press J Ortho 2015 MAY-
JUNE;20(3):109-117 78
 Laboratory Stage
 3. Draw bracket positioning guidelines on the
previously obtained cast. First, with the aid of a
black pencil, determine the long axis of each
tooth on the center of its crown, using a
panoramic radiograph as an auxiliary method
to observe tooth angulation and increase
accuracy.
Lincoln issamau nojima,adriele

silvero,Matheues Alves. Indirect
orthodontic bonding - a modified
technique for improved efficiency and
precision
Dental Press J Ortho 2015 MAY-
JUNE;20(3):109-117
79
 With the aid of a red pencil, mark the
projection of mesial and distal marginal ridges
on the buccal surface of premolars and molars,
then join the two points. Horizontal red lines
represent the height of posterior teeth marginal
ridges and establish the depth of occlusal
contact. This procedure should be repeated for
all posterior teeth.
80
 Draw bracket slot height using a black pencil,
starting from the first molar. This position depends
on the type of malocclusion and on the anatomical
shape of teeth. In open bite and hyperdivergent
faces, brackets should be placed closer to the
occlusal surface of teeth; that is, close to the red line,
thus avoiding teeth extrusion, which could
compromise treatment results. On the other hand,
in deep overbite malocclusions, when extrusion of
posterior teeth is necessary, brackets should be
placed slightly further from the red horizontal line.
81
82
 6. Treatment plan should be reviewed with casts
in occlusion, and brackets previously selected
prior to drawing the guide lines on the lower
cast, so as to avoid setbacks during definitive
bonding, such as lower brackets interfering in
postbonding occlusion.
 7. Apply a thin layer of separator (Cel-Lac; SS
White, Rio de Janeiro, RJ, Brazil), mixed with
water in a 1:1 ratio, over cast teeth surfaces. Brush
the material in the same direction and wait for at
least 20 minutes for it to dry completely.
83
 8. Apply orthodontic light-curable adhesive to the bracket
base and position it over the cast surface. Follow the
previously established bonding guide, so that slot and
long axis of brackets lie over the drawn guide lines. Press
the bracket over the pre-established location and remove
excess adhesive . Once all brackets were placed and
positions were checked, use a light-curing unit, for
example Triad 2000 system (Dentsply, York, PA), to cure
the adhesive according to the manufacturer's instructions.
Should this type of unit be unavailable, use conventional
light-curing devices, directing the beam towards the
mesial and distal sides of each bracket, for 15 seconds each
and at 2 to 3 mm distance.
84
 9. Manufacture the transfer tray. Using a vacuum former,
thermoform a 1-mm thick sheet of Ethylene Vinyl Acetate
(EVA-foam) (Soft; Bio-Art, São Carlos, SP, Brazil) over the
cast. After heated, once the sheet reaches 10 to 12 mm of
distortion, according to manufacturer's instructions, it is
ready to be formed. Trim excess material with scissors and
spray a thin layer of silicone over the tray to help separate
it later from the second tray, to be made with more rigid
material. Thermoform a 1.5-mm thick sheet of
Polyethylene Trephthalate Glycol (PETG-plastic) (Cristal;
Bio-Art) and trim both plates using a carborundum disk, 2
to 3 mm above the cervical margin of teeth, on both
buccal/labial and lingual/palatal surfaces.
85
 10. Separate the Cristal tray from the set, trim its
labial/buccal surface up to the gingival margin of bracket
wings, eliminating retention. Use a Scotch Brite brush to
finish it and rinse with water and soap. In the meantime,
immerse the cast and the Soft tray in water for 15 minutes
to dissolve the separator. Press delicately each bracket to
dislodge it from the cast. Fit the Cristal tray over the Soft
tray and remove them from the dental cast. Clean the Soft
tray and the adhesive bases with water and soap, abrading
them gently with an interdental brush, rinse and dry them
completely with oil-free compressed air. Trim any excess
of Soft tray material with scissors, without detaching it
from the outer tray.
86
 11. After stone blasting on bracket bases for 2
seconds to remove residual separator, an
opaque surface will form. It is recommended
that stone blasting be carried out using 50-µm
particle size aluminium oxide under light
pressure. Additionally, special care should be
taken not to excessively abrade the adhesive.
Clean trays with oil-free compressed air.
87
 Clinical Stage II
 12. Without detaching the trays, cut vertical
slits on the Soft tray, above the mesial and
distal bracket wings, using a sharp tip pair of
scissors . This procedure will facilitate tray
removal after bonding. Slits should be cut
immediately prior to the clinical stage, to avoid
undesired bracket displacement in between
procedures, since they decrease tray retention.
88
 13. Perform prophylaxis using extra-fine
pumice or oil-free paste, and etch teeth areas to
be bonded with 37% phosphoric acid during 20
seconds. Wash, for additional 20 seconds, each
etched surface
89
 14. Isolate area with cotton rolls and dry thoroughly.
 15. The decision whether to bond the full arch at once or in
separate parts, by cutting trays into two or three segments, is
influenced by the quality of isolation achieved and ease of
insertion of the transfer tray.
 16. Select and apply adhesive to tooth surface and bracket
base, following the manufacturer's instructions. Clinical
experience and in vitrostudies have demonstrated
satisfactory results when Transbond XT Primer adhesive (3M
Unitek) is used for direct orthodontic bonding. A thin layer
of material should be applied to the etched tooth surface,
followed by gentle air spray and reapplication . A single
application over bracket base should also be carried out
90
 17. Carefully position the tray over teeth. Once
completely fitted, it is not recommended to
exaggerate on the pressure to stabilize it.
Visually confirm tray correct position through
the clear tray and light-cure each mesial and
distal bracket edges during 10 seconds or use
multiple tip light-curing devices for indirect
bonding.
91
 18. Remove the firm Cristal tray with the aid of
a smooth tip instrument, first pressing to
dislodge it towards the occlusal edge . Use
Mathieu pliers to pull the Soft tray off the
previously slit areas above each bracket,
releasing residual retentions, then fully remove
the tray.
92
 19. Remove cotton roll isolation and any excess
adhesive with proper instruments. Should
excess adhesive be noticed around brackets,
use specific low-speed burs to remove it. Floss
interproximal areas to secure they are clean.
Orthodontic wires can be inserted immediately
93
 https://youtu.be/mxMhX8FGmqM
95
Lingual Bonding
This is a recently invented technique introduced for patients
particularly adults who are highly esthetic consious
-Fujita of Japan was a pioneer in lingual bonding
Advantages:
• Esthetic
• Enamel demineralization is better controlled & of less consequence
• Precise detailing of tooth position can be made without the
distractions of wires & brackets.
• Lip posture seen correctly instead of being artificially determined
in front of incisors.
Kesling’s diagnostic setup in which teeth are set in theraputic
occlusion and brackets are secured onto a full dimension lingual
archwire using HIRO system is used.
579-629. 96
Debonding
 The aim of debonding is to remove the
attachments & all adhesive resin from the tooth
& to restore the surface as closely as possible to
its pretreatment condition without inducing
iatrogenic damage
 Procedure: 1. Bracket removal 2. Removal of
residual adhesive

579-629. 97
Debonding
 Various methods used for debonding are:
 Mechanical
 Thermal debonding
 Lasers
 Ultra sonic
98
Debonding methods Advantages Disadvantages
Mechanical Low cost Risk of enamel fracture
Electrothermal 1. Reduced incidence of Potential for pulpal
bracket failure damage and mucosal
2. Short debonding time burn
Laser Experimental, but High cost of equipment
increased precision
regarding time and
amount of heat
application
Ultrasonic 1. Potentially reduced 1. Increased debonding
enamel damage time
2. Reduced likelihood 2. Extensive wear of
of bracket failure expensive ultrasonic
tip
3. Some force required
4. Soft tissue injury
potential
99
Debonding
 Bracket removal- Original method was to place the tips
of a twin-beaked pliers against the mesial and distal
edges of the bonding base and cut the brackets off
between the tooth and the base. A gentler technique is
to squeeze the bracket wings mesiodistally and lift the
bracket off with a peel force
 The break is likely to occur at adhesive bracket interface
leaving remnant adhesive
 For ceramic brackets low speed grinding with water
cooling can be done
 Thermal debonding and use of lasers have potential to
be less traumatic and
Graber,less risky
Vanarsdall: for enamel damage.
Orthodontic
579-629. 100
101
DEBONDING
 Adhesive remanant index
 SCORE 0- No adhesive remained on enamel
 SCORE 1-Less than 50% adhesive remained on
enamel
 SCORE 2-More than 50% adhesive remained
on enamel
 All adhesive remained on enamel
Geeta Verma, Mridula Trehan, Sunil

Sharma, COMPARISON OF SHEAR
BOND STRENGTH AND
ESTIMATION OF ADHESIVE
REMNANT INDEX BETWEEN LIGHT-
CURE COMPOSITE AND DUAL CURE
COMPOSITE.IJCPD 2013; 6(3):166-170 102
Debonding
 Removal of residual adhesive:
Accomplished by (1) scraping with a sharp band or bond
removing pliers or scaler
(2) Using a suitable bur(tungsten carbide bur #1171 or #1172)
and a contrangle with light painting movement
Water cooling should not be used because it lessens the
contrast with enamel.
Traumatic debonding may result in
i) enamel tearouts
ii)Enamel cracks
iii)Adhesive remnant wear
iv)Microabrasion
579-629. 103
Bonding Failure
 TYPE I – BOND FAILURE:
 Majority of adhesive on bracket
 POSSIBLE CAUSES:
 1. Improper prophy. 2. Rubbing acid etch on tooth. 3.
Too short (<15s.) or too long of etch (>90s.). 4.
Incomplete rinsing of etch. 5. Insufficient drying of
tooth; or drying with contaminated air. 6. Saliva
contamination after etch. 7. Excessive sealant (primer)
on tooth. 8. Insufficient drying after scrubbing enamel
with Self Etching Primer 9. Moving bracket during
adhesive gel period. 10. Hard, acid resistant, fluorosed,
hypocalcified or aprismatic enamel.
gange 104
Bonding Failure
 BONDING TROUBLE SHOOTING TYPE II –
BOND FAILURE:
 Majority of adhesive on enamel surface
 CAUSES
 METAL BRACKETS:
 1. Paste not “buttered” into mesh.
 CERAMIC BRACKETS:
 1. Improper silination of bracket base. 2. Base
contaminated by handling.
105
Bonding Failure
 BONDING TROUBLE SHOOTING TYPE III –
BOND FAILURE:
 COHESIVE
 CAUSES
 1. Patient abuse 2. Improper light cure
106
Take Home Message
 Good bond strength apparently depends on
(1)avoiding moisture contamination (2)
achieving undisturbed setting of the bonding
adhesive than on variations in the etching
procedures.
 When deciding which etching and priming
system to use, each clinician must weigh bond
failure rates against the time saved in bonding
and debonding.
107
Bibilography
 1. Graber, Vanarsdall: Orthodontic current principles techniques, 4th
edition,2005. St. Loius , Mosby. page 579-629.
 2. Sudhir Sharma, Pradeep Tandon, Amit Nagar, Gyan P Singh1, Alka
Singh, Vinay K Chugh. A comparison of shear bond strength of
orthodontic brackets bonded with four different orthodontic adhesives
Journal of Orthodontic Science 2014;201 (3):29-33
 3. Marcia Cristina Rastelli, Ulisses Coelho, Emígdio Enrique Orellana
Jimenez. Evaluation of shear bond strength of brackets bonded with
orthodontic fluoride-releasing composite resins. Dental Press J Orthod
2010 May-June;15(3):106-13
 4. Daniel Stewart Bonding Orthodontic Brackets to Stainless Steel
Crowns 2009 Virginia Commonwealth University 1-27
 5. Bonding manual by paul gange
 6.Paul Gange: The evolution of bonding in orthodontics. AJO-DO 2015
vol 47 issue 4 page no 556-563
108
7.Waleed Bakhadher, Hassan Halawany, Nabeel Talic, Nimmi
Abraham, Vimal Jacob. FACTORS AFFECTING THE SHEAR
BOND STRENGTH OF ORTHODONTIC BRACKETS- A REVIEW
OF IN VITRO STUDIES 2015 ACTA MEDICA;58(2):43-48
8. Geeta Verma, Mridula Trehan, Sunil Sharma, COMPARISON
OF SHEAR BOND STRENGTH AND ESTIMATION OF
ADHESIVE REMNANT INDEX BETWEEN LIGHT-CURE
COMPOSITE AND DUAL CURE COMPOSITE.IJCPD 2013;
6(3):166-170
9. Premalatha Kannaiyappan, S. kishore Kumar, W,S. Manjula.
Enamel pretreatment before bonding brackets- A Literature
Review. Biomedical & Pharmacology Journal, Oct 2015 vol.8 (631-
640)
109
 10. Robrto Justus, Tatiana Cubero, Ricardo Ondarza, Fernando
Morales. A new technique with dosium hypochlorite to increase
Bracket Shear Bond strength of fluoride releasing resin-modified
glass ionomer cements: Comparing shear bond strength of two
adhesive systems with enamel surface deproteinization before
etching, Seminar in Orthodontics, volume 16, issue 1 (66-75)
 11. Alessandra Marques et al. Consequences of enamel
preparation with sodium hypochlrite, polyacrylic and phosphoric

acids for the bonding of brackets with resin modified glass
ionomer cement. 2013, material research, vol 16
 12. Lincoln issamau nojima,adriele silvero,Matheues Alves.
Indirect orthodontic bonding - a modified technique for

improved efficiency and precision
Dental Press J Ortho 2015 MAY-JUNE;20(3):109-117
110

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BONDING IN

Rigid attachment as advocated Angle’s ribbon arch appliance

Angle’s edgewise arch mechanism

What an adhesive does is fill in the

Paul Gange: The evolution of bonding

 In 1955 BUNOCORE1 introduced acid etching technique.He

Paul Gange: The evolution of bonding

Graber, Vanarsdall: Orthodontic

Graber, Vanarsdall: Orthodontic

•Tongue guards with bite blocks

•Salivary duct obstructers

•Cotton or gauze rolls

•Antisialogogues (tablet 50mg per 45kg, injectable solution of

methantheline bromide, propantheline bromide,atropine sulfate)

Graber, Vanarsdall: Orthodontic

 Serder Usumuz et al in AJO-DO 2002 used ErCr ; YSGG as the

laser produces heat in sufficient magnitude to cause at least

Type 1 Honey comb Type -2 Cobblestone Type -3 Pitted

Enamel after 15% phosphoric acid

37% H3PO4 acid

Graber, Vanarsdall: Orthodontic

Graber, Vanarsdall: Orthodontic

By eliminating the organic substances from the

Graber, Vanarsdall: Orthodontic

Graber, Vanarsdall: Orthodontic

should be used in cases of second molar, half

When bonding to enamel, one must place the resin

Active ingredient-methacrylated phosphoric acid that dissolves calcium

Etching and monomer penetration to the exposed enamel rods are

Removed calcium forms complex and is incorporated

Three mechanism act to stop etching process

 1. Thorough prophylaxis mandatory.

Orthodontic bonding manual by paul

best physical properties & strongest adhesives for metal

• Has minute filler particles of uniform size ( 0.2 & 0.3

Graber, Vanarsdall: Orthodontic

• Halogen is the conventional light source used.

Depth of curing usually depends on

Graber, Vanarsdall: Orthodontic

• It saves chair time.

-heat generated can harm pulp tissue.

 4 generations have evolved, in clinical practice 3rd genration which is

battery operated is commonly used.

Premalatha Kannaiyappan, S. kishore

Premalatha Kannaiyappan, S. kishore

Premalatha Kannaiyappan, S. kishore

systems and the self etching primer bonding system.

a aqueous solution of 20% phenyl – P in 30% HEMA.

Premalatha Kannaiyappan, S. kishore

Premalatha Kannaiyappan, S. kishore

Premalatha Kannaiyappan, S. kishore

Waleed Bakhadher, Hassan Halawany,

Jacob. FACTORS AFFECTING THE

Waleed Bakhadher, Hassan Halawany,

 Ligatures of 2 neighboring brackets are cut & arch wire is placed

on top of these brackets.

 Tooth is etched for 15-30 secs

 sealed & bracket rebonded.

 Always better to replace loose ceramic bracket with a new,intact

bracket for optimum bond strength.

2. Clinical chair side time is reduced.

3. Indirect technique has better bracket placement in

Graber, Vanarsdall: Orthodontic

•Patient’s teeth are prepared as per direct technique.