Original Article

Effect of Saliva Contamination on the Shear Bond

Strength of Orthodontic Brackets Bonded with a Self-
Etching Primer
Ma Dolores Campoya; Ascensión Vicenteb; Luis Alberto Bravoc

Abstract: This study evaluates the effect of saliva contamination at different stages of the
bonding brackets procedure using the self-etching primer Adper Prompt L-Pop (3M ESPE, Min-
neapolis, Minn) and the resin orthodontic adhesive system Transbond XT (3M). A total of 70
brackets were bonded to human extracted premolars, which were divided into four groups: group
1, uncontaminated (control); group 2, saliva application before priming; group 3, saliva application
after priming; and group 4, saliva application before and after priming. Shear bond strength was
measured with a universal test machine. The adhesive remnant on the tooth after debonding was
determined using image analysis equipment. Significant differences were only observed between
group 1 (12.42 6 3.27) and groups 2 (9.93 6 4.50) and 4 (9.59 6 2.92) (P , .05). Concerning
the adhesive remnant, no significant differences were found between the groups evaluated (P .
.05). (Angle Orthod 2005;75:865–869.)
Key Words: Self-etching primer; Shear bond strength; Saliva; Contamination; Brackets

INTRODUCTION Since the introduction of self-etching primers (SEPs)

Different investigations have evaluated the effect of
contamination through fluids, such as plasma, saliva,
water,1 and blood,2,3 on the bonding procedure, caus-
ing a decrease in bond strengths. Contamination ap-
pears to be one of the most important causes of ad-
hesive failures.
Saliva is the most frequently found contamination in
the clinic. Saliva contamination on enamel etched for
a duration of one second or more leaves a surface
layer of saliva on the enamel that is resistant to rins-
ing.4 Furthermore, when the etched enamel becomes
wet, most of the pores are blocked and the penetration
of resin is altered, resulting in resin tags of insufficient
number and length.5
a
Graduate Student, Docent Unit of Orthodontic, Dental Clinic,
University of Murcia, Murcia, Spain.
b
Assistant Professor, Docent Unit of Orthodontic, Dental Clin-
ic, University of Murcia, Murcia, Spain.
c
Titular Professor, Docent Unit of Orthodontic, Dental Clinic,
University of Murcia, Murcia, Spain.
Corresponding author: Ascensión Vicente, DDS, PhD, Docent
Unit of Orthodontic, Dental Clinic, University of Murcia, Hospital
Morales Meseguer, 2a planta, C/Marqués de los Vélez s/n, Mur-
cia, Murcia 30008, Spain
(e-mail: ascenvi@um.es)
Accepted: July 2004. Submitted: June 2004.
Q 2005 by The EH Angle Education and Research Foundation,
Inc.
as an alternative to the traditional acid-etch method,
many investigations have been carried out to evaluate
their efficacy. These new systems include combining
the conditioner and primer in only one product6; there-
fore, SEPs are of great interest. They imply an obvious
clinical advantage because they reduce both chair
time7 and the possible number of errors in intermediate
steps. SEPs were initially used on dentin, but subse-
quent investigations have confirmed their efficacy on
enamel8 and hence their orthodontic application.
There is controversy over the results reported by
different authors. Some studies observed shear bond
strengths similar to those obtained using the traditional
acid-etch technique.9,10 Other studies observed that
the bond strength of SEPs was lower.11,12 Still other
studies found that SEPs provided greater bond
strengths than the traditional system.13
Most SEPs incorporate the 2-hydroxyethyl methac-
rylate (HEMA) molecule in their composition. Because
of the hydrophilic properties of this molecule, it is in-
teresting to evaluate the effect of moisture contami-
nation on SEP, and authors such as Bishara et al,14
Cacciafesta et al,15 Larmour and Stirrups,16 Zeppieri et
al,17 and Rajagopal et al18 have carried out research
on this matter. However, further research is needed
because of the continuous introduction of new and im-
proved varieties of SEPs.

865 Angle Orthodontist, Vol 75, No 5, 2005

866
A new SEP has been recently introduced in the mar-
ket, Adper Prompt L-Pop (Adper PLP, 3M ESPE, Min-
neapolis, Minn). This SEP is the improved version of
its predecessor Promp L-Pop (3M ESPE). According
to the manufacturer, Adper PLP introduces a better
activation control and a perfected chemical composi-
tion.
This study evaluates the effect of saliva contami-
nation at different stages of the bonding procedure us-
ing the SEP Adper PLP (3M ESPE) and the resin or-
thodontic adhesive system Transbond XT (3M).
MATERIALS AND METHODS
Teeth
Seventy human upper premolars free from caries
and fillings were used. These had been extracted for
reasons unrelated to the objectives of this study and
with the informed consent of the patients. The project
has been approved by the Murcia University Bio-ethi-
cal Commission.
The teeth were washed in water to remove any trac-
es of blood and then placed in a 0.1% thymol solution.
Afterward, they were stored in distilled water, which
was changed periodically to avoid deterioration. In no
case was a tooth stored for more than a month after
extraction.
Brackets
Seventy metal upper premolar brackets were used
(Victory Series, 3M Unitek Dental Products, Monrovia,
Calif). The base area of each bracket was calculated
(mean 5 9.79 mm2) using image analysis equipment
and MIP 4 software (Micron Image Processing Soft-
ware, Digital Image Systems, Barcelona, Spain).
Bonding procedure
The 70 upper premolars were divided into four
groups, and brackets were bonded on the buccal sur-
face according to the instructions supplied by the man-
ufacturer of each product. For all groups, the buccal
surfaces were polished with a rubber cup and polish-
ing paste (Détartrine, Septodont, Saint-Maur, France).
Group 1 (n 5 25)—Uncontaminated (control). Adper
PLP was gently brushed onto the enamel for 15 sec-
onds with the disposable tools supplied with the sys-
tem. A moisture-free air source was used to deliver a
gentle burst of air to the primer. The SEP was light
cured for 10 seconds. Transbond XT paste was ap-
plied to the base of the bracket, which was then
pressed firmly on to the tooth. Excess adhesive was
removed from around the base of the bracket, and the
adhesive was light cured by positioning the light guide
Angle Orthodontist, Vol 75, No 5, 2005
CAMPOY, VICENTE, BRAVO
of an Ortholux XT lamp (3M Unitek Dental Products)
on each interproximal side for 10 seconds.
Group 2 (n 5 15)—Saliva application before prim-
ing. Human saliva was applied with a brush to the la-
bial surface until it was totally contaminated. Then, the
bracket was bonded with Adper PLP and Transbond
XT paste as in group 1.
Group 3 (n 5 15)—Saliva application after priming.
Adper PLP was gently brushed onto the enamel for 15
seconds with the disposable tools supplied with the
system. A moisture-free air source was used to deliver
a gentle burst of air to the primer. The SEP was light
cured for 10 seconds. Then, the enamel surface was
contaminated with saliva as in group 2. Afterward, the
bracket was bonded with Transbond XT paste as in
group 1.
Group 4 (n 5 15)—Saliva application before and af-
ter priming. The enamel surface was contaminated
with saliva as in group 2. Then, Adper PLP was gently
brushed onto the enamel for 15 seconds with the dis-
posable tools supplied with the system. A moisture-
free air source was used to deliver a gentle burst of
air to the primer. The SEP was light cured for 10 sec-
onds. Afterward, the contamination procedure was re-
peated once more. Then, the bracket was bonded with
Transbond XT paste as in group 1.
Saliva was collected from one of the authors of this
study, who was instructed to brush her teeth and not
to eat for one hour before the saliva was collected.
One coat of saliva was applied on the tooth with a
brush. After saliva contamination, the enamel surface
was not blown off.
Storage of test specimens
The specimens were immersed in distilled water at
a temperature of 378C for 24 hours.19
Bond strength test
Shear bond strength was measured with a universal
test machine (Autograph AGS-1KND, Shimadzu, Kyo-
to, Japan) with a one-kN load cell connected to a metal
rod with one end angled at 308. The crosshead speed
was one mm/min.19
The teeth were set at the base of the machine so
that the sharp end of the rod incised in the area be-
tween the base and the wings of the bracket, exerting
a force parallel to the tooth surface in an occlusoapical
direction.
The force required to debond each bracket was reg-
istered in newtons (N) and converted into megapas-
cals as a ratio of the force to debond to the surface
area of the bracket (MPa 5 N/mm2). We believe that
to properly compare different bond test studies in or-
thodontics, it is necessary to determine bond strength
EFFECT OF SALIVA ON THE BOND STRENGTH OF BRACKETS 867

TABLE 1. Shear Bond Strength (MPa)a

Group n Mean Standard Deviation Range
Control1 25 12.42 3.27 11.07–13.77
Contamination before priming2 15 9.93 4.50 7.44–12.42
Contamination after priming 15 11.61 2.74 10.09–13.13
Contamination before and after priming2 15 9.59 2.92 7.97–11.21
a
The results were evaluated using one-way analysis of variance and DMS test. Groups marked with different superscript numbers showed
significant differences with one another. The group unmarked by superscript did not show significant differences with any other group. P ,.05.

TABLE 2. Percentage of Tooth Area Occupied by Adhesivea

Group n Median Mean Standard Deviation Range
Control 25 16.25 19.14 9.68 15.14–23.13
Contamination before priming 15 22.27 26.14 21.86 14.03–38.25
Contamination after priming 15 19.66 20.65 19.60 9.79–31.50
Contamination before and after priming 15 18.42 19.54 19.84 8.55–30.52
a
Kruskal-Wallis test did not show significant differences between groups. P , .05.

because use of the debond force does not help com-
pare brackets with different geometries.
Percentage of tooth area occupied by adhesive
The percentage of the surface of the bracket base
covered by adhesive was determined using an image
analysis equipment (Sony dxc 151-ap video camera,
connected to an Olympus SZ11 microscope) and MIP
software.
The percentage of the area still occupied by adhe-
sive remaining on the tooth after debonding was ob-
tained by subtracting the area of adhesive covering
the bracket base from 100%.
Statistical analysis
The Kolmogorov-Smirnov normality test and the
Levene variance homogeneity test were applied to the
bond strength data. Because the data showed a nor-
mal distribution and there was homogeneity of vari-
ances, they were analyzed using one-way ANOVA,
finding those groups that were significantly different
with the Differences minimum significance, DMS, test
(P , .05).
The Kolmogorov-Smirnov test and the Levene ho-
mogeneity test of variances were applied to the data
for percentage of area of adhesive remaining on tooth.
As there was not homogeneity of variances or a nor-
mal distribution, they were analyzed using the Kruskal-
Wallis test (P , .05).
RESULTS
The one-way ANOVA test found significant differ-
ences (P 5 .04) in shear bond strength between the
different groups evaluated. The DMS test detected
these differences between the control group and the
group in which contamination occurred before priming
(P 5 .03) and the control group and the group which
was contaminated before and after priming (P 5 .01)
(Table 1).
The values of the percentage of tooth area occupied
by adhesive remnant are shown in Table 2. The Krus-
kal-Wallis did not show significant differences (P 5
.44) between the different groups.
DISCUSSION
This study evaluated the effect of saliva contami-
nation on the bond strength of Adper PLP at different
stages of the bonding procedure. This SEP contains
methacrylated phosphoric esters, Bisphenol A-glycidyl
methacrylate, Bis-GMA, initiators based on camphor-
quinone, water, HEMA, polyalkenoic acid, and stabiliz-
ers.
Significant differences were found between the con-
trol group and the group in which contamination oc-
curred before the application of Adper PLP. Although
the bond strength values of the group in which con-
tamination occurred before priming were not signifi-
cantly different from those in which contamination oc-
curred after priming, significant differences were not
found between this last group and the control group.
Adper PLP was light cured before contamination with
saliva, so penetration of the primer into the enamel
pores was not altered. This could explain why the re-
duction in bond strength at contamination after priming
was not as great as that before priming.
Significant differences were also observed between
the control group and the group in which saliva con-
tamination occurred before and after the application of
the SEP.
To our knowledge, there are no studies that evalu-
ate the effect of saliva contamination on Adper PLP.

Angle Orthodontist, Vol 75, No 5, 2005

868
However, there are similar investigations that evaluate
other SEPs. Bishara et al14 used the SEP Angel I (3M
ESPE). Our results concur with the results obtained by
these authors. They observed significant differences
between the control group and the group contaminat-
ed before and after priming. However, they also found
significant differences between the group contaminat-
ed before priming and the group in which contamina-
tion occurred before and after the application of the
SEP.
Cacciafesta et al15 studied Transbond Plus Self
Etching Primer (3M Unitek). Our results also concur
with the results obtained by these authors. They ob-
served significant differences between the control
group and the group contaminated before and after
priming. Furthermore, they found differences between
the control group and the group contaminated after
priming.
Larmour and Stirrups16 and Rajagopal et al18 eval-
uated the effect of saliva contamination before the ap-
plication of Transbond Plus Self Etching Primer (3M
Unitek), and once more, our results concur with theirs.
They found significant differences between the control
group and the group in which saliva contamination oc-
curred before priming.
Zeppieri et al17 found that saliva contamination at
different stages of the bonding brackets procedure did
not affect the bond strength of Transbond Plus Self
Etching Primer.
Therefore, we can appreciate that the results ob-
tained in these different studies are highly disparate.
The differences in results could be because of the ap-
plication of different products as well as the varied ma-
terials and methods used by each of the authors.
Regarding the adhesive remnant, no significant dif-
ferences were obtained between the groups evaluat-
ed. This result concurs with the results obtained by
Cacciafesta et al,15 Larmour and Stirrups,16 Zeppieri et
al,17 and Rajagopal et al.18
In our study we can observe that the bond strength
decreases from 12.42 MPa in the control group to 9.93
MPa in the group contaminated before priming and to
9.59 MPa in the group contaminated before and after
priming. The strengths of the last two groups were sig-
nificantly lower than the strengths of the control group.
However, the bond strength values of these two ex-
perimental groups are still greater than the estimated
values of 5.9 and 7.8 MPa suggested by Reynolds20
as the minimum values required for clinical needs.
However, we must be cautious when extrapolating in
vitro results to the clinical situation. Therefore, in vivo
research must be carried out to confirm laboratory re-
sults.
Angle Orthodontist, Vol 75, No 5, 2005
CAMPOY, VICENTE, BRAVO
CONCLUSIONS
• The greatest bond strength values were obtained
when contamination did not occur.
• Significant differences were observed between the
bond strengths of the control group and the group in
which contamination occurred before the application
of Adper PLP. Significant differences were also ob-
served between the control group and the group in
which saliva contamination occurred before and after
the application of the SEP.
• No significant differences were observed in the ad-
hesive remnant index between the groups evaluat-
ed.
• Our results suggest that contamination after photo-
curing of SEPs has a lesser influence on the reduc-
tion of the shear bond strength than contamination
before priming.
ACKNOWLEDGMENT
Our thanks are due to 3M Spain, who provided the brackets
and the adhesives free of charge.
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