Bonding agents

Based on the polymerization initiation

mechanism:

• Chemically activated (self cured ) :two paste

or one paste
• Light cured ( photo cured )
• Dual cured (chemically activated and light
cured
• Thermo cured
 Chemically activated orthodontic adhesive
systems
• These adhesives employ benzoyl as an initiator and tertiary
aromatic amine such as dimethy-p-toluidene as activator
• Initiation occurs from the mixing of the paste and liquid
components of these systems and free radicals are formed by
multi step processes
• Chemically cured two phase systems:
• Polymerization is initiated by mixing of liquid and paste
• Clinical handling is laborious; time consuming
• Properties
• Increased exposure of the components to the air induces
oxygen inhibition
• Mixing introduces defects due to trapping of air and formation
of voids
• Concise (3M)
 Chemically cured one phase system
• Application of the liquid component on the enamel and on the
bracket base.
• No mixing is involved
• Clinical handling: - efficient application ;limitation in time
requirements

• Properties
• Limited data is available on the bond strength and degree of
curing
• Inhomogeneous Patten of curing due to the sandwich involved
• Enamel bracket sides of the polymer is more polymerized than
the middle of the bracket

• System 1(ormco)
• Unite (3M)
 Visible light cured
• The photo initiator in these systems is
camphoroquinone and a reducing amine
• Polymerization is initated by exposure to light curing
source
Clinical handling
• Provides increased working time and bracket
placement time.
• Curing should be done from the incisal and cervical
margins
Properties
• The degree of cure of a stain less steel brackets
bonded with light cured adhesive is comparable to
that of a transparent aesthetic bracket
 Dual cure
• Polymerization is initiation is achieved by through
exposure to light and the reaction progress following a
chemically cured pattern
Clinical handling
• Combines the disadvantages of handling both light
cured and chemical cured materials.
• Most time consuming application
Properties
• Increased degree of cure and bond strength ,but of
questionable clinical significance
• Ideal for bonding molar tubes
 Moisture active

• Polymerization – cyanoacrylate, no liquid

component is involved. Polymerization is
initiated on exposure to water
Clinical handling
• One step procedure-intentionally the surface
of the tooth must be wetted
• One of the study has shown acceptable bond
strength
• Smart bond (Gestenco)
 Moisture resistant

• Primer compatible with the use of the

adhesive
• Clinical handling
• Application of primer on wet enamel surface
• Trans bond MIP(3M)
GENERATIONS IN BONDING
AGENTS

190 9
 First Generation
• These contained N-phenylglycine and glycidyl
methacrylate or NPG-GMA.

• NPG-GMA is a bifunctional molecule or coupling

agent.

• This means that one end of this molecule bonds

to dentin while the other bonds (polymerizes) to
composite resin.

• The bond strengths of these early systems were

only 1 to 3 MPa.
190 10
 Second Generation
• In the late1970s, the second-generation systems
were introduced.
• The majority of these incorporated
halophosphorous esters of unfilled resins such as
bisphenol- A glycidyl methacrylate, or bis-GMA,
or hydroxyethyl methacrylate, or HEMA.
• The mechanism by which these bonded to dentin
were postulated to be through an ionic bond to
calcium by chlorophosphate groups.
• These were weak bonds with a range of 2-7 Mpa
• Dentin was not etched.
190 11
 Third Generation
• Three step systems.
• Dentin etching was introduced by Fusuyama.
• Followed by a primer application.
• Application of an unfilled resin.

190 12
190 13
 Fourth Generation

• Fusayama and colleagues tried to

simplify bonding to enamel and dentin
by total etching the preparation with
40 percent phosphoric acid.
• The mineralized tissues of the
peritubular and intertubular dentin are
dissolved by the acidic action; the
initial surface penetration exposes the
collagen fibers. 190 14
• In this area, for a depth of 2 to 4 micrometers,
hybridization takes place, and resin tags can
seal the tubule orifices firmly.

• The formation of resin tags and adhesive

lateral branches complete the bonding
mechanism between the adhesive material
and etched dentin substrate.

190 15
 Fifth Generation
• Unique feature is the combination of the priming
and bond resin application steps, resulting in a one
component formula.
• Most commonly used and probably the most
successful system.
• These bonding systems create a mechanical
interlocking with etched dentin by means of
resin tags, adhesive lateral branches and
hybrid layer formation..
190 16
 Sixth Generation
• They are self etching adhesives ( Etch & prime
simultaneously).
• They involve a somewhat different mechanism in that, as
soon as the decalcification process is initiated, the infusion
of the evacuated spaces by dentin bonding agent is begun.
• As a result, the potential for residual vacancies amongst the
collagenous fibers is dramatically reduced or eliminated
altogether.
• The bonding agent is either applied after the self etching
primer or mixed together before single application.

190 17
 Seventh Generation

etchant
Etchant + Primer + = All in one
Adhesive
adhesive

Etchant Primer Adhesive

•Self etching adhesives with no mixing

•One step self etch system
190 18
 Eighth generation

It is dual-cured and works with all light-,

self- or dual-cured resins
– It works in a self-cured mode without
any light – great for endo
– It takes only 35 sec. from start to finish
– It needs only one coat
• Reinforced with nano particles for
permanent bond strength
190 19
190 20
Generation of Bonding agents Composition

First generation N-Phenyl glycine glycidyl methacrylate

Ex : Cervident Mechanism –chem bond by chelating with Ca+

Second generation Attempt to bond chemically to tooth – organic/inorg

Ex: Clearfil Bond system Included AA, cyanoacrylate, carboxylic grp, poor BS

Third generation To modify smear layer, included weaker acids 2% nitric

Ex : Tenure acid, maleic acid.

Fourth generation Multistep concept – total etch,complete smear layer

Ex: Scotch Bond multipurpose removal- hybridization, 37% phosp acid -15sec
Primer-HEMA, adhesive – BisGMA, UDMA

Fifth generation SEP bonding systems (etchant+primer) 1 bottle,Visible

Ex: Single Bond light cured or Dual cure composites

Sixth generation SEP - etchant+primer, Resin reinforced GIC;

Ex:Clearfil SE Bond Compomers, UDA based composites

Seventh generation
5/1/2019 100 Adhesive – all in 1 bottle
Etchant +primer+ 21
Ex : I Bond Cyanoacrylates
 b. Enamel Pre-treatment – Acid etching
Procedure :
- After drying the tooth a conditioning solution or gel (37%
phosphoric acid ) is applied lightly over enamel surface
with a pellet or brush for 15-60 sec.
- Enchant is rinsed off with abundant water spray for
about 15 sec.

Mechanism of action :
Creates pores – resin penetrates creating tag like
extensions aids in bonding

5/1/2019 100 22
Dry the tooth thoroughly to obtain dull frosty white
appearance.

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Etching time :
-15 -30 sec etching is adequate for young permanent
teeth, whereas 60 sec are needed for permanent teeth.
-
-Tooth with exposed dentin should be coated with
Ca(OH)2 paste before etching.

5/1/2019 100 24
Fluoride and etching :
-It has been reported that fluoride content of tooth has
no effect on etching time .
- Davidson reported that fluoride is important in
decreasing enamel solubility. Fluoridated enamel has a
highly acid resistant layer of 2-4 um thickness which may
sometimes resist even 3 min etch. So avoiding fluoride
application shortly prior to bonding is recommended.
R. Lehman and Davidson in AJO-DO 1981
- Garcia Godey et al reported that addition of 0.5% NaF2
to 60% phosphoric acid gel produced significantly higher
bond strength than 30% phosphoric acid without fluoride.
5/1/2019 100 25
Enamel lost during etching :
Zachrisson - Routine etching with 37% phosphoric acid
removes 3-10μm of surface enamel.
Gwinnett et al -50% Phosphoric acid removes 5 – 25μm
of enamel.
Fitzpatrick and Silverstone - 30% phosphoric acid for
90 sec removes enamel with a mean of 9.9μm.

5/1/2019 100 26
TYPES OF ETCHING PATTERN

TYPE 1 : loss of enamel prism centers.

TYPE 2: prism edges lost.

TYPE 3: map like appearance.

TYPE 4 : Granulation of enamel with

numerous holes

5/1/2019 100 27
Enamel after 15% phosphoric Enamel after 37% phosphoric
acid etching acid etching

15
second
s

30
second
s

60
second
s
5/1/2019 100 28
AIR ABRASION
-Its a older technique of enamel pretreatment
- It uses abrading with 50 μm or 90 μm particles of
aluminium oxide for 3 sec at 10mm distance.
- Air abrasion significantly decreases bond strength .

37% Phosporic acid

Aluminium oxide (90 um)

5/1/2019 100 29
 Crystal growth technique – an alternative to acid
etching ??
Crystal growth conditioner - Polyacrylic acid solution
containing residual sulfate ion, lithium salt, potassium,
sulphate salts – with basic solution. Results in dense
growth of needle shaped crystals – “Spherulitic pattern”

5/1/2019 100 30
LASER ETCHING
-This concept was proposed in 1993 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.
- Pulsed Nd/ YAG as laser source .
Mechanism :
-In hard tissues of the tooth, pulsated lasers are used due to
their thermo-mechanical effects .
- Micro-explosions can occur depending on increased
propulsion as a result of pulsations 100-350 μs at the
nanosecond level,
-with a cooling system which prevents the formation of
plasma and the occurrence of microscopic mechanical
ruptures - sufficient mechanical effect can be obtained.
- Etching pattern obtained – Similar to type I – honeycomb
appearance
5/1/2019 100 31
Disadvantage :
-High laser produces heat in sufficient magnitude to
cause at least localized pulpal infection and possible
irreversible damage to pulpal tissue immediately
opposite the site of laser irradiation.

5/1/2019 100 32
MOISTURE INSENSITIVE PRIMERS (MIP)
Generally available as a primer formulation

-In order to reduce the bond failure rates under moisture contamination,
hydrophilic primers that can bond in wet fields were introduced.

-Useful in difficult anatomical areas like second molar , lingual surfaces of

lower teeth, partially erupted teeth and surgically exposed teeth.

-An aqueous solution of methacrylate functionalised polyalkenoic acid

copolymer and hydroxyethyl-methacrylate. (Used earlier in hydrophilic
dentin bonding systems).

Commercially available MIP - Transbond and Assure

Composition of Transbond
• Ethyl alcohol 30-40% ( Solvent )
• Bis-GMA
• HEMA – Hydroxy ethyl methacrylate ( main Hydrophilic component )
• CDMA – Citric acid( allows greater cross linking )
5/1/2019 100 33
• GDMA – Diluent + hydrophilic monomer (Hydrophilic
monomer takes oral fluid and so fluoride uptake
• Acidic Co-polymer - Greater cross linking
• CPQ / Amine - Photo initiator
• Water – solvent

5/1/2019 100 34
SELF ETCHING PRIMERS (SEP)

- Self-etching primers ,which combine acid and primer, carry

out bonding procedures by simultaneously etching and
infiltrating the enamel surface.
-They ease the bonding procedure by reducing chair time and
eliminating side-effects of etching.
- Ex : First Step (Reliance Orthodontics, IL),
Transbond Plus ( 3M Unitek, CA),
Prompt L-Pop (3MESPE,Germany)

Mechanism :
- The active component of the SEPs is the methacrylated
phosphoric acid ester that dissolves calcium from
hydroxyapatite. The removed calcium forms a complex when
the primer polymerizes.
5/1/2019 100 35
-Etching and monomer penetration to the exposed
enamel rods are simultaneous, and the depth of
penetration is equal.
-This simultaneous conditioning 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

SEP provided significantly lower (but clinically

acceptable) shear bond strength (mean, 7.1 ± 4.4 MPa)
when compared with a conventional etch/priming
technique before bonding brackets with Transbond XT
adhesive paste.
5/1/2019 100 36
190 37
 adhesive curing units
• Halogen Light curing Units (80’s)
• High energy Laser curing systems (90’s >)
• Plasma Arc Curing Units (2001 & >)
• LED Curing Units (2002 & > )

108 38
 Halogen Light curing Units
• Halogen bulbs have a limited effective lifetime of
approximately 40-100 hours.

• High temperatures cause a gradual degradation of the

halogen bulb, reflector, and filter, reducing the intensity of the
light output and thus the unit’s effectiveness in curing
composite resins.

• The clinical implication is that with an aging light-curing unit,

adhesives will be less well cured, with poorer physical
properties and an increased risk of bond failure.

108 39
• The options of light source available for the
orthodontist are -

Conventional and fast halogen lights: In light-

initiated bonding resins the curing process
begins when photoinitiator is activated.

• Most photoinitiator systems use

camphoroquinone as the absorber, with the
absorption maximum in the blue region of
the visible light spectrum at a wavelength
of 470 nm.
190 40
• Until recently, the most common method of
delivering blue light has been halogen-based
light-curing units.

• Halogen bulbs produce light when electric

energy heats a small tungsten filament to high
temperatures. Despite their common use,
halogen bulbs have 190
several disadvantages - 41
• The light power output is less than 1% of the consumed
electric power, and halogen bulbs have a limited lifetime of
about 100 hours because of degradation of the components
of the bulb by the high heat generated.

• The halogen lights can cure orthodontic composite resins in

20 seconds and light-cured resin-modified GICs in 40 seconds
per bracket.

190 42
• Fast halogens have significantly higher
intensity output than other current halogen
lights, and this is accomplished by using
higher-output lamps or using turbo tips that
focus the light and concentrate it into a
smaller area,thus curing time can be reduced
to half that of conventional halogens.

190 43
190 44
• Plasma arc lights: In the mid-1990s, the xenon
plasma arc lamp was introduced for high-
intensity curing of composite materials in
restorative dentistry.

• This lamp has a tungsten anode and a cathode

in a quartz tube filled with xenon gas.

190 45
• When an electric current is passed through
xenon, the gas becomes ionized and forms a
plasma made up of negatively and positively
charged particles and generates an intense
white-light.

• Plasma arc lights are contained in base units

rather than in guns because of the high voltage
used and heat generated & the light guide is stiff
because of the gel inside.
190 46
• The white light is filtered to blue wavelengths,
with a narrow spectrum between 430 and 490
nm.

• The advantage of the high-intensity light is that

the amount of light energy needed for
polymerization of the composite resin can be
delivered in a much shorter time.

• Exposure times of 3 to 5 seconds for metal

brackets and even shorter time for ceramic
brackets is sufficient.190 47
 Plasma Arc Curing Units
Advantages
• Overall time reduction – 2 mins for whole arch
• Immediate bond strength appears to be very high
• No enamel damage on debonding
• Re - bonding of brackets is easy

Disadvantages
• Light emitted from plasma arc device is so powerful that both
the operator and assistant should wear protective glasses

108 48
• Reducing curing time from 6 to 2 seconds resulted in a
significant decrease in mean bond strength of premolar
brackets.

• Time saved is the significant advantage of plasma curing

lights.

108 49
 LED Curing Units
• The most recent light source category is the LED sources.

• LEDs has doped semiconducting materials that transform

current into light of a specific wavelength.

• They are much smaller and lighter than conventional bulbs.

They offer high shock and vibration resistance, as there is no
filament to be damaged, and their relatively low power
consumption makes them suitable for portable use in cordless
devices.

108 50
• LEDs have lifetimes of more than10,000 hours and
experience little degradation of light output over this time—a
distinct advantage over halogen bulbs

• LEDs require no filters to produce blue light. The spectral

output of these LEDs falls mainly within the absorption
spectrum of the camphoroquinone photoinitiator (400-500nm)
of most dental composites.

• LED sources have been found to produce a depth of cure

significantly greater than that achieved with a conventional
halogen light.

108 51
• LED curing of 20 and 40 seconds yields statistically
similar results to curing of 40 seconds by conventional
halogen light sources.
• The longer life span and more consistent light output
of LEDs compared with halogen bulb technology show
promise for its use in orthodontics.

• New-generation LEDs with higher-intensity diodes may

shorten the curing times further has recommended
curing times of 10 seconds for metal and 5 seconds for
ceramic brackets.
190 52
• In conclusion regarding the use of different light
sources -
• The light source and adhesive must be compatible.
• All new light sources cure resins faster than
conventional halogen lights.
• Fast halogen sources are more brand specific but
generate low heat and are less expensive than LEDs
& Plasma arc lights offer the shortest curing times
but are expensive & generate heat.
• Light-emitting diodes have small size, are cordless,
generate minimal heat, and perform favorably
compared with conventional and fast halogen
sources. 190 53