EVOLUTION OF ORTHODONTIC

BONDING MATERIALS

By
Mitasha Sachdeva
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Contents
Introduction - Definition
History
Disadvantages of banding
Advantages of bonding over banding
Steps in bonding
Materials used for Enamel preparation
Etchants
Orthodontic adhesive systems
Indirect bonding
Lingual bonding
Bonding to crowns and restorations
Alternate bonding agents
Newer bonding agents
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Introduction
Adhesive bonding is important for orthodontics
especially in term of fixation of brackets to teeth.
Definition :- process of joining two materials by
means of an adhesive agent that solidifies during
the bonding process.(phillips’ science of dental
materials- sixth edition)
It is due to the physical or chemical forces of
adhesion and mechanical retention in undercuts,
pores capillaries and crevices

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History
Self curing resins were developed in 1941 by a German
scientist.
Used tertiary amine – benzoyl peroxide to initiate
methacrylate polymerisation reaction.
Problem – polymerisation shrinkage
- poor color stability
- high thermal expansion
- poor adhesion to tooth surface

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In 1955 BUONOCORE introduced acid etching
technique
Improved retention of methyl methacrylate to
enamel using acid pretreatment by 85% phosphoric
acid for 30 seconds.
 Not successful for orthodontic purposes –

 Occlusal force
 Wide range of oral thermal change
 Wet environment

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 BOWEN in 1956 introduced BisGMA resin
(Bisphenol A Glycidyl Dimethacrylate)
 Greater strength
 Lower water absorption
 Less polymerization shrinkage
 Strongest adhesives for metal brackets
 bonding material with more stable properties
and better cosmetic qualities.
In 1965 NEWMAN introduced epoxy resin bonding as
a direct bonding method and subsequently bonding
became excellent alternative to banding

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SMITH in 1968 introduced zinc polyacrylate cement
and bracket bonding with this cement
WILSON AND KENT in 1972 described glass ionomer
cement bonding
In 1974 NEWMAN discussed use of acrylic based
adhesives to directly and indirectly bond plastic and
mesh base brackets.
By 1979 93% of orthodontists had started bonding
brackets instead of banding

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Light cure bonding and use of various light cure
adhesives was described by TAVAS AND WATTS in
1979
GWINNETT in 1979 introduced fluoride releasing
composite Fluor Ever.
Ethyl cyanoacrlylates as a new adhesive material in
orthodontics was introduced by THOMAS W.
ORTENDAHL in 2000
In 2001 MILLER described a new group of adhesive in
orthodontics and termed them as self etch adhesives

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Disadvantages of
banding
Early bonding systems considered brackets welded
onto bands bonded to enamel with zinc phosphate
cement.
Apart from esthetics other disadvantages were:-

1. Requirement of excessive chair time

2. Necessity of frequent screening for caries and
decalcification
3. Pronounced effect on periodontal health
4. Requirement of additional arch space
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Advantages of BONDING OVER
BANDING:
• It is esthetically superior
• Faster and simple.
• Less discomfort for patient
• Arch length not increased by band material
• Allows more precise bracket placement
• Improved gingival condition and there is better
access for cleaning.
• Partially erupted tooth or and fractured tooth can
be controlled.
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Mesiodistal enamel reduction is possible during
treatment
Interproximal areas are accessible for composite
buildups.
Caries risk under loose bands is eliminated.
Interproximal caries can be detected and
treated. Dental invaginations on incisors can be
controlled.
No band spaces at the end of treatment to close
No large supply of bands is needed.

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Brackets may be recycled, further reducing the
cost.
Lingual brackets (invisible bracket) may be used
when esthetics is important.

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Ideal requirements for bonding
system
•Must be dimensional stable
•Must be quite fluid
•Must gain it full strength early
•Easy to use clinically.
•Should be non toxic

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•Should produce long lasting bond
•Should be stain resistant
•Should induce enamel remineralisation
•Should withstand stresses of masticatory
forces
•Should have minimal expansion and water
absorption

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Bonding is of two types
Direct bonding
Indirect bonding

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Direct Bonding procedure
Cleaning
Enamel conditioning and bonding
Sealing
Bonding

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Cleaning Enamel conditioning Sealing

Bonding
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Use of bracket positioning gauge:

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Materials used for CLEANING
Pre-treatment is necessary as mouth is complicated by
saliva ,acquired pellicle , different organic and inorganic
components of enamel and dentin.
Essential to remove plaque
Pumice can be used-Requires rotary instruments –
rubber cup or polishing brush

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Materials used for ENAMEL
PRETREATMENT

Etching
Air abrasion/ sandblasting

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Etchants
Remove the smear layer and open dentinal tubules
and increase retention of resin sealant and promote
mechanical retention
Etching by phosphoric acid First proposed by
Buonocore in 1955.
Etching with 10-37% of phosphoric acid produces
highest bond strength to enamel
Use of 10% maleic acid for etching results in low bond
strength
Should be done for 15-20 seconds
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 Laser etching
- application of laser energy to enamel surface causes
localised melting and ablation
This new concept was proposed by J.A.Von Fraunhofer
(angle orthod 1993). 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.

Basaran et al (angle orthod 2007) used ErCr(eribium

chromium) ; YSGG (yttrium-scandium-gallium-garnet) as the
hydrokinetic laser system for acid etching & came to the
conclusion that enamel ethcing with this laser is comparable to
that obtained by acid etching. 22
 But major disadvantage as reported by Fraunhofer
is that high laser produces heat in sufficient
magnitude to cause at least localized pulpal infection
& possible irreversible damage to pulpal tissue
immediately opposite the site of laser irradiation.

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Air abrasion/sandblasting :-

Its a older technique of enamel

pretreatment introduced as early as
1940 by Dr. Robert Black. It uses
abrading with 50 um or 90 um particles
of aluminium oxide for 3 sec at 10 mm
distance.

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AJO-DO 1997 Marc .E. Olsen et al compared acid
etch technique and air abrasion and reported that air
abrasion significantly decreases bond strength.
So it is not recommended.

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Classification of orthodontic adhesive
systems
Chemically activated – self cure, autocure :
Two paste
One paste
Light cured
Dual cured
Thermocured

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 CHEMICALLY ACTIVATED
Utilized since 1970s

Liquid :
 Dimethyl p toluidine : activator

Powder :
 Benzoyl peroxide : initiator

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Two phase adhesive system
Used in early days of bonding
Application involves mixing the paste and liquid
components
Good bond strength
Disadvantages
1. Manipulation is difficult
2. Time consuming
3. Mixing two components : Produces surface
porosities

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One phase adhesive system
Application of one component on enamel and other
on the bracket base.
No mixing involved
Curing occurs – 30-60 secs
Advantages :-
 Procedure simplified

 Fast

 Efficient

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Disadvantage
1. Inhomogenous polymerisation pattern due to
diffusion of liquid component into paste during
application
2. Enamel and bracket sides of adhesives are more
polymerised relative to middle zones
3. Liquid activators – toxic, allergic reactions

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LIGHT CURED BONDING SYSTEM
Camphorquinone is the photosensitizer which is
absorbed at the wave length of 470 nm & thus gets
activated.

 Have superior mechanical properties and better

peripheral bracket sealing as compared to chemically
cured

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 Light sources used are :
• Halogen is the conventional light source used.

• Argon laser curing

• Xenon or plasma arc lamp

• Light emitting diode (LED)

Depth of curing usually depends on

• Composition of resin

• Light source

• Exposure time
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 Halogen

• Light is generated when electric energy heats a small

tungstun filament at high temperatures.
• It uses about 400 mW / cm2 power.
• It has a broad wave length of 400 – 520 nm .

In EJO 2004 wendl & droshl et al studied bond strenght

of light cure resin and light cure GIC with different polymerisation lamps and
reported halogen light achieved highest bond strength with 40 sec curing
time for the light cure resins whereas light cure GIC was independent of
duration of curing and type of lamp used.

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Disadvantages
1. Limited lifetime of 40-100 hours
2. High temperature cause degradation of halogen
bulb, reflector and filter reducing the intensity of
light output and effectiveness in curing composite

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 Argon laser

• It was introduced in late 1980s to increase

2
output light energy to 800 mW / cm
• It has narrow wave length of 470 nm which
corresponds to the peak area of absorption of
camphoroquinone.

• It produces 60% conversion in 5-10 sec.

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 Advantages
• Superior to conventional light cure regarding bond
strength also it causes less than half the frequency of
enamel fracture during debonding.
• It saves chair time as curing time is less

Disadvantages
• Cost.
•Poor portability

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 Plasma arc or xenon arc lamp
• Introduced in 1990s .
• Light source is xenon gas that is ionized by 2
electrodes.
• The large white light is filtered to width of 450-
500 nm.
• Power density can reach more than 2000
mW/cm2 which is about 5 times more intense
than halogen.
•Exposure time 3-5 seconds for metal brackets

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 Vittoriocacciofesta et al AJO-DO 2004 Aug
.
The purpose of this randomized clinical trial was to evaluate the performance of
adhesive-precoated brackets cured with 2 different light-curing units (conventional
halogen light and plasma arc light).

Plasma arc lights 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 without significantly
affecting their bond failure rate.

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Advantages
1. Time reduction
2. Immediate bond strength is high
3. No enamel damage on debonding
4. Rebonding is easy

 Disadvantages
1. Light emitted is very powerful so protective glasses
are needed
2. Higher cost

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 Light emitting diode ( LED )
• Introduced since 2000.
• It uses doped semi conducters to generate light instead of hot
filaments.
• It has the wavelength of 400-500 nm.

Advantages

• Has high lifetime more than 10000 hours

• Requires little power to operate.
• Requires no filter to produce blue light.

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DUAL-CURED:
Initiation – exposure to light
Propagation – chemically cured
Advantages :-
 Advantages of light and chemically cured
 Improved surface and bulk material properties
 Highest bond strength
 Ideal for bonding molar tubes
Disadvantages :-
 Most time-consuming
 Bulk defect due to mixing

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THERMOCURED OR HEAT
ACTIVATED SYSTEMS
Introduced for indirect bonding and restorations
Present with increased polymerisation rates and hence
superior properties
Use is limited as they require increased temperature to
initiate polymerisation.

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Adhesive precoated bracket
Bracket covered with predetermined amount of
adhesive
Direct application of primer onto the adhesive coated
base and bonding
Bond strength comparable to conventional chemically
cured systems

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 BONDING TO CROWNS & RESTORATIONS

AMALGAM RESTORATIONS & CROWNS

Methods used are

1. Modifying metal surface (sandblasting/ diamond bur roughening)
2. Use of intermediate resin
3. New adhesive resins that bond chemically to non-precious as well as
precious metals

Recommended procedure
By Zachrisson in AJO-DO 2000
1. Intra oral sandblasting amalgam alloy with 50 micron aluminium
oxide for 3 sec

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2. If small restorations, then condition the surrounding
enamel with 37% phosphoric acid for 30 sec

3. If large restoration or in crowns create a window & restore

it with composite resin & continue the same process

4. Apply any metal primer that has 4-META (4-Meth acryl oxy
ethyl trimellitate anhydride )& wait for 30 sec

5. Bond with resin.

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BONDING TO PORCELAIN

Procedure
1. Isolate the working field
2. Surface is to be roughened with sandpaper discs
3. 8-9.6%HF( hydrofluoric) acid gel applied for 2
min( HF is not effective when bonding to high
alumina porcelains & glass ceramics)
4. Remove the gel with cotton rolls and rinse
5. Use resin for bonding

AJO-DO 2000 Zachrisson

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 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

AJO-DO 2000 Zachrisson

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Indirect bonding
Originally described by Dr. Silverman and Cohen in
1972
the brackets are attached to the teeth on patients
model, transferred to the mouth with a tray to which
the brackets get embedded and then bonded
simultaneously

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Advantages
Brackets more accurately positioned
Less chair side time

Disadvantages
Chairside procedure is critical so Difficult for
inexperienced clinicians
Removal of excess adhesive is more difficult and time
consuming
Risk of adhesive deficiencies under the bracket are more
Failure rates are higher
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History of indirect bonding
Initially during 1980s heat cure resins were used for
indirect bonding
Clinicians faced problems with bracket drifting in the
models
So a new method was developed in which transfer of
brackets was done using a double silicone tray.
Brackets could be fixed on the models using light cure
resins or adhesive precoated brackets.

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There are two popular techniques
1. Indirect bonding with silicone
transfer trays
 Take an impression and pour with stone.
Model-dry. Mark the Long axis and
occlusal height for each tooth
 Select brackets
 Apply water soluble adhesive
 Position the brackets
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Mix putty silicone and press it onto the cemented
brackets
Immerse model and tray in hot water. Remove any
remaining adhesive
Trim the silicone tray and mark the midline
Prepare the patients teeth
Mix adhesive and Load adhesive in a syringe and apply
to the bracket base

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Seat the tray on the prepared arch
Remove tray after 10 min. tray must be cut
longitudinally or transversely to reduce risk of bracket
debonding
Complete bonding by careful removal of excessive
flash

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56
2. Indirect bonding with double
sealant technique
Bonding adhesive pastes rather than water soluble
temporary adhesives are used to attach brackets to
patient’s model.
After the material sets onto the brackets placed on the
models, a placement tray is vacuum formed for each
arch.
Models with tray attached are placed in water until
thoroughly saturated.
Then trays are separated and midline is marked
Embedded bonding bases are lightly abraded

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Lingual sides of bonding bases are painted with
catalyst sealant resin.
The dry etched teeth are then painted with universal
sealant resin
Trays are then inserted and held in place for 3 min
It is removed by peeling from lingual to buccal
Advantage :- cleanup is simple ( little flash)

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 LINGUAL BONDING
• This is a recently invented technique introduced for
patients particularly adults who are highly esthetic
conscious
•Fujita of Japan was a pioneer in lingual bonding

•Done by direct or indirect methods.

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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

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 Disadvantages
• Technique sensitive
• Time consuming
• Awkward working position
• More precision necessary for adjustment of arch wires
• Decreased interbracket distances
• Good active ligation us difficult

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Alternate bonding materials
GLASS IONOMER RESIN COMBINATION
MATERIALS :-

 Resin modified glass ionomer cement (RMGI)

(5% resin) eg. Fuji II LC
is used for bonding the orthodontic brackets

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LIGHT CURED/
DUAL CURED GIC

Tougher material with Decreased water senstivity

Longer working time than conventional GIC
Monomers such as hydroxyethyl methacrylate (HEMA)
were incorporated with chemical initiator systems or with
light curing system.
Have dual setting mechanism involving acid base reaction
of polyacid and glass and polymerisation reaction.

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Advantages over composite resins for bonding

1. Saves chairside time

2. Eliminates need for working in a dry field
3. Eliminates need for etching and priming the enamel
4. Fluoride release protects teeth
5. Repairs are quick and easy

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MOISTURE ACTIVE ADHESIVES

i.e. CYANOACRYLATES.
In 1991 a commercially available ethyl cyanoacrylate material
was tested a an orthodontic adhesive and found to have
significantly higher tensile strength than a conventional
composite.
Commercial name :- SMART BOND

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Mechanism:

First step- the iso cynate groups react with water forming
an unstable carbamic acid component which rapidly
decomposes to CO2 & corresponding amine.

Second step- Amine reacts with residual iso cynate groups

cross linking the adhesive through substituted urea groups.

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 Advantages
•Particularly useful in conditions where moisture control is
difficult like in Lingual bonding or while bonding surgically
exposed impacted tooth.
•No residual monomer
•No water sorption so no discolouration
•Bonds on composites and ceramic surfaces
•biocompatible

Disadvantages
•Do not work well on polycarbonate brackets
•Excess material will be instantly polymerised and turned into
white acrylic powder around bracket

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Newer bonding materials
ORMOCER ( organically modified ceramics)
Was formulated in an attempt to overcome the
problems created by the polymerisation shrinkage of
conventional composites.
It has low shrinkage and greater biocompatibility
Disadvantage :- low viscosity

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NANO COMPOSITE
Contains nano fillers of the size .005-.001 micrometer
Have marginal seal in enamel and dentin

METAL BRACKET ADHESIVE

Long working time
Increased initial bond strength
Is green in color but turns clear as it reaches the body
temperature and reverts green at debonding
Easy to clean up

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References
Thomas M Graber, Brainerd F. Swain – Orthodontics-
Current Principles And Techniques
Thomas M Graber, Robert L Vanarsdall-Orthodontics-
Current Principles And Techniques
Kenneth J, Anusavice, Phillips’ Science Of Dental
Materials
William A Brantley, Theodore Eliades- Orthodontic
Materials
A comparative in vitro study of directly bonded brackets
using different curing lights. EJO 2004;26:535-544

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Plasma arc verus halogen light curing of adhesive
precoated brackets AJO 2004;126:194-199
Orthodontic bonding to artificial tooth surfaces
AJO 2000;117:529-34
Comparison of shear bond strength and surface
structure between conventional acid etching and air
abrasion of human enamel AJO 1997;112:502-506
Laser etching in direct bonding Angle orthod
1993;63:73-77
Etching enamel for orthodontics with erbium,
chromium:yttrium,scandium, gallium-garnet laser
system Angle orthod 2007;77:117-124

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