ORIGINAL ARTICLE

Effect of a self-etch primer/adhesive on the

shear bond strength of orthodontic brackets
Samir E. Bishara, BDS, DDS, DOrtho, MS,a Leigh VonWald, BS,b John F. Laffoon, BS,c and
John J. Warren, DDS, MSd
Iowa City, Iowa

Conventional adhesive systems use 3 different agents (an enamel conditioner, a primer solution, and an
adhesive resin) during the bonding of orthodontic brackets to enamel. A unique characteristic of some new
bonding systems in operative dentistry is that they combine the conditioning and priming agents into a single
product. Combining conditioning and priming saves time and should be more cost-effective to the clinician
and, indirectly, to the patient. The purpose of this study was to determine the effects of the use of a self-etch
primer on the shear bond strength of orthodontic brackets and on the bracket/adhesive failure mode. Brackets
were bonded to extracted human teeth according to 1 of 2 protocols. In the control group, teeth were etched
with 37% phosphoric acid. After the sealant was applied, the brackets were bonded with Transbond XT (3M
Unitek, Monrovia, Calif) and light cured for 20 seconds. In the experimental group, a self-etch acidic primer
(ESPE Dental AG, Seefeld, Germany) was placed on the enamel for 15 seconds and gently evaporated with
air, as suggested by the manufacturer. The brackets were then bonded with Transbond XT as in the first group.
The present in vitro findings indicate that the use of a self-etch primer to bond orthodontic brackets to the
enamel surface resulted in a significantly (P = .004) lower, but clinically acceptable, shear bond force (mean,
7.1 ± 4.4 MPa) as compared with the control group (mean, 10.4 ± 2.8 MPa). The comparison of the adhesive
remnant index scores indicated that there was significantly (P = .006) more residual adhesive remaining on
the teeth that were treated with the new self-etch primer than on those teeth that were bonded with the use
of the conventional adhesive system. (Am J Orthod Dentofacial Orthop 2001;119:621-4)

C
onventional adhesive systems use 3 different
agents (an enamel conditioner, a primer solu-
tion, and an adhesive resin) in the process of
bonding orthodontic brackets to enamel. A unique char-
acteristic of some new bonding systems in operative
dentistry is that they combine the conditioning and
priming agents into a single acidic primer solution for
simultaneous use on both enamel and dentin.1,2 Com-
bining conditioning and priming into a single treatment
step results in improvement in both time and cost-effec-
tiveness to the clinician and, indirectly, to the patient.
These relatively new systems were used originally
on dentin.1,3 Essentially, the acidic part of the primer
dissolves the smear layer and incorporates it into the
mixture. Acidic primer solutions also demineralize the
From the College of Dentistry, University of Iowa.
aProfessor, Orthodontic Department.
bResearch Assistant.
cResearch Assistant.
dAssistant Professor, Department of Preventive and Community Dentistry.
Reprint requests to: Samir E. Bishara, BDS, DDS, DOrtho, MS, Department of
Orthodontics, University of Iowa, College of Dentistry, Iowa City, IA 52242-1001.
Submitted, July 2000; revised and accepted, August 2000.
Copyright © 2001 by the American Association of Orthodontists.
0889-5406/2001/$35.00 + 0 8/1/113269
doi:10.1067/mod.2001.113269
dentin and encapsulate the collagen fibers and
hydroxyapatite crystals.2 This simultaneous condition-
ing and priming allows penetration of the monomer
into the dentin. The adhesive resin component will then
diffuse into the primed dentin, which produces a
“hybrid layer.”3 These new systems also were found to
be effective when bonding to enamel.4
In the early 90s, maleic acid was introduced as an
alternative etching material in an attempt to control the
depth of the enamel etch. Barkmeier and Erickson5
compared the use of 10% maleic acid with that of 37%
phosphoric acid and reported that the resulting bond
strengths were essentially similar (38.0 ± 6.5 MPa and
38.3 ± 8.0 MPa, respectively). Scanning electron
microscopy of the enamel surface treated with 10%
maleic acid and 37% phosphoric acid revealed a simi-
lar morphologic pattern, but the depth of the etched
surface was significantly less with maleic acid.6
Orthodontists use the acid-etch bonding technique
when attaching brackets to the enamel surface. Main-
taining a sound unblemished enamel surface after
debonding orthodontic brackets is a primary concern of
the clinician. As a result, bond failure at the bracket-
adhesive interface or within the adhesive is more desir-
able (safer) than failure at the adhesive-enamel inter-
621
622 Bishara et al
Fig 1. Self-etch primer is packaged for single-patient
use to avoid evaporation or contamination. Before use,
foil pack is pressed and folded to combine ingredients.
Mixture is then ready to be applied to tooth surface.
Table I. Descriptive
statistics and results of Student t test
that compared shear bond strengths of 2 groups
Mean SD Range
Groups tested (MPa)* (MPa) (MPa)
Acid + primer + Transbond 10.4 2.8 6.4-19.1
Self-etch primer + Transbond 7.1 4.4 1.0-18.6
*t = 3.06; P = .0038.
face because enamel fracture and crazing have been
reported at the time of bracket debonding, especially
with ceramic brackets.7 As a result, alternative enamel
conditioners (such as maleic acid and acidic primers
that contain phenyl P) have been tested to find whether
a clinically useful orthodontic bracket bond strength
can be attained while the depth of enamel dissolution
and the number of steps during the bonding procedure
are decreased.8
A newly introduced material, Prompt L-Pop (ESPE
Dental AG, Seefeld, Germany) is an all-in-1 adhesive
for composites and compomers. The material can be
light cured separately or after the application of the
cavity restoration or the orthodontic adhesive. Prompt
L-Pop contains methacrylated phosphoric acid esters
that combine an acidic component for etching the
enamel and the primer.
The purpose of this study was to determine the effects
of a newly introduced self-etch primer on the shear bond
strength of orthodontic brackets and the bracket/adhesive
failure mode.
MATERIAL AND METHODS
Forty-five freshly extracted human molars were
collected and stored in a solution of 0.1% (weight/vol-
American Journal of Orthodontics and Dentofacial Orthopedics
June 2001
Table II.Frequency distribution and results of chi-
squared analysis of ARI of 2 groups
ARI scores*†
Groups tested 1 2 3 4 5
Acid + primer + Transbond 2 8 8 6 1
Self-etch primer + Transbond — 5 15 — —
*1, All composite on tooth; 2, more than 90% of composite on tooth;
3, more than 10% but less than 90% of composite remains on tooth;
4, less than 10% composite on tooth; 5, no composite remains on tooth.
†χ2 = 10.37; P = .006.
ume) thymol. The criteria for tooth selection included
intact buccal enamel, not subjected to any pretreatment
chemical agents (eg, hydrogen peroxide), no cracks
caused by the presence of the extraction forceps, and
no caries. The teeth were cleansed and polished with
pumice and rubber prophylactic cups for 10 seconds.
Orthodontic metal brackets (Victory Series; 3M
Unitek, Monrovia, Calif) were used in this study. The
average bracket base surface area was determined to be
12.2 mm2.
The brackets were bonded to the teeth according to 1
of 2 protocols. In group I (control group), 25 teeth were
etched with 37% phosphoric acid gel. The teeth were
thoroughly washed and dried. The sealant was applied;
the brackets were then bonded with Transbond XT (3M
Unitek) and light cured for 20 seconds, according to the
manufacturer’s instructions. In group II, the self-etch
primer Prompt L-Pop, which contains both the acid and
the primer, was placed on the enamel of 20 teeth for 15
seconds and gently evaporated with air, according to the
manufacturer’s instructions. Prompt L-Pop is predosed
so that it is used for only 1 application. For activation,
the 2 components are squeezed together, and the result-
ing mix can be applied directly on the tooth surface,
whether enamel or dentin (Fig 1). The brackets were
then bonded with Transbond XT and light cured for 20
seconds, as in group I. Each bracket was subjected to a
300-g compressive force with a force gauge (Correx Co,
Bern, Switzerland) for 10 seconds, after which excess
bonding resin was removed with a small scaler. All sam-
ples were stored in deionized water at 37°C for 48 hours.
Before debonding, the teeth were embedded in
acrylic in phenolic rings (Buehler Ltd, Lake Bluff, Ill).
A mounting jig was used to align the facial surface of the
tooth to be perpendicular with the bottom of the mold.
Each tooth was oriented with the use of the testing
device as a guide so that its labial surface was parallel to
the force during the shear strength test. A steel rod with
1 end flattened was attached to the crosshead of a Zwick
test machine (Zwick GmbH & Co, Ulm, Germany). An
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 119, Number 6
occlusogingival load was applied to the bracket, which
produced a shear force at the bracket-tooth interface. A
computer connected to the Zwick test machine recorded
the results of each test. Shear bond strengths were mea-
sured at a crosshead speed of 5 mm/min.
After being debonded, the teeth and brackets were
examined under ×10 magnification. Any adhesive that
remained after bracket removal was assessed according
to the modified adhesive remnant index (ARI) and
scored with respect to the amount of resin material that
adhered to the enamel surface.9 The ARI scale has a
range of 5 to 1 (5 = no composite remained on the
enamel; 4 = less than 10% of composite remained on
the tooth surface; 3 = more than 10% but less than 90%
of the composite remained on the tooth; 2 = more than
90% of the composite remained; 1 = all of the compos-
ite, with an impression of the bracket base, remained
on the tooth). The ARI scores were also used as a more
complex method of defining the site of bond failure
between the enamel, the adhesive, and the bracket base.
Statistical analysis
Descriptive statistics that included the mean, stan-
dard deviation, and minimum and maximum values
were calculated for each of the 2 test groups.
The Student t test was used to determine whether
significant differences were present in the bond
strength between the 2 groups. The chi-squared test
was also used to determine significant differences in
the ARI scores between the groups. Significance for all
statistical tests was predetermined at a probability
value of .05 or less.
RESULTS
The descriptive statistics for the shear bond
strengths of the 2 groups are presented in Table I.
The results of the Student t test indicated that the
shear bond strength when the self-etch primer was used
was significantly lower (P = .0038; mean, 7.1 ± 4.4
MPa) than when phosphoric acid and the primer were
used separately with the conventional adhesive system
(mean, 10.4 ± 2.8 MPa).
The results of the chi-squared comparisons for the
ARI indicated that there was a significant difference (P
= .006) between the group that was bonded with the
self-etch primer as compared with the control group.
With the use of the self-etch primer, there was a higher
frequency of ARI scores of 3, which indicated more
composite remained on the teeth (Table II).
DISCUSSION
The direct bonding of orthodontic brackets has rev-
olutionized and improved the clinical practice of ortho-
Bishara et al 623
dontic procedures. However, there is a need to further
improve the bonding procedure to save time and to
minimize enamel loss without jeopardizing the ability
to maintain a clinically useful bond strength. Tradi-
tionally, the use of acid etchants followed by a primer
has been an essential part of the bonding procedure of
composite adhesives to allow good wetting and pene-
tration of the sealant into the enamel surface.5,6 The
use of the new self-etching primers for orthodontic
purposes has not been fully evaluated. In general, these
new primers are thought to simplify the clinical han-
dling of adhesive systems by combining the etchant
and the primer in 1 application.1,3,8 The early acidic
primers were selectively compatible with certain adhe-
sives and, as a result, either produced significantly
lower bond strength or needed significantly more
working time.8
The present study evaluated the use of a new self-
etch primer as compared with the conventional bond-
ing procedure. The findings indicated that the use of a
self-etch primer to bond orthodontic brackets to the
enamel surface provided lower, but clinically accept-
able, shear bond forces (mean, 7.1 ± 4.4 MPa).10
This was an in vitro study; care should be taken in
the interpretation of the results, which may differ from
those results obtained in the oral environment. In addi-
tion, more research is needed to determine the shear
bond strength of these new self-etch primers in the first
30 minutes after bonding to simulate the time the ini-
tial archwires are tied. The type of adhesive used
(highly filled vs lightly filled) may also have a signifi-
cant effect on the shear bond strength.
CONCLUSION
By reducing the number of steps during bonding,
clinicians are able to save time and reduce the potential
for error and contamination during the bonding proce-
dure. The present results indicated that a newly intro-
duced self-etch primer, which contains both the enamel
etchant and primer, has the potential to successfully
bond orthodontic brackets.
We would like to express our appreciation to ESPE
Dental AG and 3M Unitek for supplying the materials
for this study.
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