GOOD MORNING

ORTHODONTIC
ADHESIVES
BY
DR.M.GREESHMA HARINI,
1ST YEAR POST GRADUATE,
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPEDICS.
CONTENTS:
1.INTRODUCTION
2.ABOUT ADHESIVES
3.MATERIALS USED AS
ADHESIVES
4.COMPOSITES
5.GENERATIONS IN ADHESIVES
6.OTHER ADHESIVE MATERIALS
7.CLINICAL APPLICATION
8.UPDATES
9.CONCLUSIONS
10.REFERENCES.
1.INTRODUCTION
• SUCCESS OF ORTHODONTIC TREATMENT IS GREATLY
DEPENDENT UPON ADHESION OR MECHANICAL
BONDING CHARACTERISTICS OF ADHESIVES.

A CLEAR UNDERSTANDING OF THE

FEATURES ,BENEFITS AND LIMITATIONS IS REQUIRED
TO CHOOSE MATERIAL AND OBTAIN OPTIMAL
RESULTS.
2. ABOUT ADHESIVES
DEFINITION:
Adhesive:
A material that can join substances together, resist
separation and transmit loads across the bond.

Adherend :
Surface or substrate to which material is applied.
.
Adhesion or Bonding :
The forces or energies between atoms or molecules at an
interface that hold two phases together.
The American Society for Testing and
Materials (specification D 907)

Adhesion is defined as “The state in which

two surfaces are held together by interfacial
forces which may consist of valence forces
or interlocking forces or both.”
MECHANISM OF BONDING :
1. Physical - based on secondary forces
– Vander Waals forces, hydrogen bonds, dispersion forces
( specially when surfaces are smooth and polished )
2. Chemical - based on primary forces
– covalent, ionic, metallic bonds.
3. Mechanical -based on penetration of one material into
another at microscopic level
(when surfaces are rough).
In dentistry, bonding of resins to tooth structure is a
result of four possible mechanisms, as follows:

1. Mechanical—penetration of resin and formation of

resin tags within the tooth surface
2. Adsorption—chemical bonding to the inorganic
component (hydroxyapatite) or organic components
(mainly type I collagen) of tooth structure
3. Diffusion—precipitation of substances on the tooth
surfaces to high resin monomers can bond
mechanically or chemically
4. A combination of the previous three mechanisms
 Factors Affecting Adhesion :

1.Wetting is an expression of the attractive forces between

molecules of adhesive and adherend.
2.Surface Contamination
Cleaner the surface, better is the adhesion.
Lesser the water content, better is the adhesion.

A good wetting ensures good adhesion

3.Contact Angle
The angle formed between the surface of a liquid drop and
its adherent surface .
Stronger the attraction between adhesive and adherent, smaller
is the contact angle.
Zero contact angle is the best to obtain wetting.

Lesser is the contact angle, better is the adhesion

(A) Good wetting; (B) Partial wetting; (C) Nonwetting
4.SURFACE ENERGY :

Surface energy quantifies the disruption of intermolecular bonds

that occurs when a surface is created.

It is also called as surface free energy or interfacial free energy.

In simple language, surface energy can be defined as the work

per unit area done by the force that creates the new surface.

More surface energy results in better adhesion.

Ideal characteristics of Bonding adhesives
1. Non toxicity
2. Adequate working & setting time
3. Moderate viscosity
4. Sufficient tensile and compressive strength
5. Ability to wet etched surface
6. Resist decomposition in the oral environment
7. Dimensionally stable
The evolution of bonding in orthodontics:

In the mid-1960s,Dr George Newman and professor Fujio Miura,

pioneered the bonding of orthodontic brackets to enamel.

In early 1970s,Miura developed bonding to etching enamel using a

restorative filling material orthomite, and found that the bond strength
decreased with time as a result of exposure to oral fluids.

PAUL GANGE ; THE EVOLUTION OF BONDING IN ORTHODONTICS (AM J ORTHOD

DENTOFACIAL ORTHOP 2015;147:S56-63)
NEWMAN, worked on epoxy resins, and concluded
“That epoxy resins ,did not experience significant
polymerization shrinkage when setting , and have the same
coefficient of thermal expansion as enamel , and were cross-
linked to minimize water absorption.”

Paul Gange ; The evolution of bonding in orthodontics (Am J Orthod Dentofacial

Orthop 2015;147:S56-63)
RITIEF ET AL DEVELOPED A MESH GRID WELDED ONTO
FLATTENED STAINLESS STEEL BAND MATERIAL WITH A
METAL BRACKET WELD TO IT AND THE DRAW BACK IS
WELD SPOTS ON THE MESH BASE PREVENTS ADHESIVE
FROM FLOWING BETWEEN THE MESH AND FOIL PAD,
PERFORATED
RESULTING IN REDUCED MECHANICAL RETENTION. METAL BRACKET BASE

IN 1974,DENTSPLY/CAULK INTRODUCED THE FIRST

SINGLE PASTE UV LIGHT CURABLE BRACKET ADHESIVE,
THE USE OF THESE UV LIGHT CURED SYSTEMS WAS CUT
SHORT, WHEN IT WAS DISCOVERED THAT THEY ARE
HARMFUL TO EXPOSED SKIN AND EYES, SOME TIMES
EVEN RESULT IN BURNED SOFT TISSUE.

Paul Gange ; The evolution of bonding in orthodontics (Am J Orthod Dentofacial Orthop
2015;147:S56-63)
IN 1979,ORMCO,DEVELOPED AND PATENTED A
TECHNIQUE TO BRAZE MESH TO A METAL FOIL
PAD, ELIMINATING STRENGTH REDUCING
WELD SPOTS, THIS DESIGN ALLOWED THE
ADHESIVE TO PENETRATE BETWEEN THE MESH,
THUS INCREASING MECHANICAL RETENTION.

IN THE EARLY 1980S,VISIBLE LIGHT CURED

RESTORATIVE MATERIALS WERE INTRODUCED,
WITH A VISIBLE LIGHT RANGE OF 440-480NM FOIL MESH METAL BRACKET
BASE
WITH A QUARTZ TUNGSTEN HALOGEN LIGHT,
MAKING THEM SAFE FOR EXPOSED EYES AND
SKIN.

Paul Gange ; The evolution of bonding in orthodontics (Am J Orthod Dentofacial

Orthop 2015;147:S56-63)
IN 1995,SILVERMAN ET AL DEVELOPED A TECHNIQUE FOR BONDING
METAL BRACKETS TO WET ENAMEL WITH NO ACID ETCHING USING
FUJI ORTHO DUAL CARE GLASS IONOMER CEMENT.

IN 2000,SELF ETCHING PRIMERS BECAME EFFECTIVE IN

CONDITIONING ENAMEL AND DENTIN, SUCH AS TRANSBOND PLUS
(3M UNITEK) AND SEP(RELIANCE ORTHODONTIC PRODUCTS).

IN 2005, LED PRO SEAL, WAS INTRODUCED TO ACCOMMODATE THE

CLINICIAN USING THE NEW, CORDLESS LIGHT EMITTING DIODE
LIGHTS THAT EMITTED A PHOTON BETWEEN 440 AND 480NM.

Paul Gange ; The evolution of bonding in orthodontics (Am J Orthod Dentofacial Orthop
2015;147:S56-63)
In 2010,Select Defence (classone orthodontics,Carlsbad,calif) was
introduced as an enamel sealant contained selenium, as an
antimicrobial.

In the past decade, one has witnessed unprecedented progress in

bonding to enamel with various material techniques and auxiliaries
involving glass ionomer bonding, self-etching primers and new
powerful light-curing sources.

Paul Gange ; The evolution of bonding in orthodontics (Am J Orthod Dentofacial Orthop
2015;147:S56-63)
NANO-DENTISTRY: it is the science and
technology of maintaining near perfect oral health
through the use of nanomaterials.

NANOTECHNOLOGY

Has led to the development of a new composite

resin characterized by containing nano particles
measuring approximately 25 nm and nano
aggregates of approximately 75 nm,, which are
made up of zirconium/silica or nano silica
particles.

Paul Gange ; The evolution of bonding in orthodontics (Am J Orthod Dentofacial Orthop 2015;147:S56-
63)
Paul Gange ; The evolution of bonding in orthodontics (Am J Orthod Dentofacial Orthop 2015;147:S56-
63)
3.MATERIALS USED AS
ADHESIVES
TYPES :

1.Glass Ionomer Cement (GIC)

2.COMPOSITE RESINS
3.COMPOSITE RESIN MODIFIED GIC
4.COMPOMER PMCR’s
(Poly-acid modified resin) MATERIALS
4.COMPOSITES
 COMPOSITE RESINS
TYPES
COMPONENTS
METHODS
CHEMICAL
LIGHT CURE
CURING LIGHTS
CLINICAL APPIICATION
ETCHING
ENAMEL BONDING
DENTINE BONDING
2 basic types of resins for orthodontic bonding:
1. Acrylic Diacrylate resins
Based on Self-curing acrylics
Methyl methacrylate monomer & ultra fine powder
form linear polymers only
filled or unfilled forms
e.g. Orthomite, Genie
Plastic brackets
2 . Acrylic modified Epoxy resin
Bis GMA or Bowen’s resin
Polymerised also by cross linking into 3 dimensional network
Cross linking – greater strength
filled or unfilled forms
e. g Concise, Phase II
COMPONENTS

•RESINS
•FILLERS
•COUPLING AGENTS
•INITIATOR /ACTIVATOR
RESINS
Bis-GMA / URETHANE- DIMETHACRYLATE
TEGMA-REDUCES VISCOSITY
FILLERS
QUARTZ
FUSED SILICA
ALUMINO- SILICATES
BARIUM OXIDES
Coupling agent:
vinyl silane –helps the filler and polymer for
reinforcement to occur .
• ACTIVATION
1.CHEMICAL
Initiator - Benzoyl peroxide
Activator - N,N’ DIMETHYL P-TOLUIDENE

2. LIGHT CURED
Uv-light - Benzoyl methyl ether
Visible light - CAMPHORO QUINONE 
TYPES-ACCORDING TO SIZE OF FILLER
PARTICLES
1.traditional-8-12micro meters
2.hybrid (small particle) 0.5-3
3.hydrid (all purpose) 0.4-1
4.Microfilled 0.04-4

CLINCAL APPLICATION:
•LARGER FILLER PARTICLES-EXTRA BOND
STRENGTH.
• CURING LIGHTS

1.Conventional curing lights

2.High performance halogen lights (optilux 501)
3.plasma Arc Lights (PAC)
4.Lasers
5.LED’s (Light emitting diode)
 1.Conventional Curing lights :
Use halogen bulbs filtered to produce blue light.
Cure adhesives under bracket in 20-30 sec.

2.Tungsten/quartz/halogen bulb :
Cures under metal brackets in 8 seconds and under ceramic
brackets in 5 seconds.
Has boost mode to increase the output up to 1000 watts.
hence allows metal brackets to be cured in 5 seconds.
3.Plasma arc lights:
generates a lot of heat and large fan is required.
Adhesive is cured in 5 seconds under metal brackets and 3
seconds under ceramic brackets.
4.Laser lights:
emits monochromatic coherent light source.
Generate lot of heat
cumbersome
5.Led’s (LIGHT EMITTING DIODES)
1995 mills et al
Solid state light emitting diode technology
10 sec cure
Cool, safe light, no damage to the tooth pulp
e.g.Ledmax-4
7.CLINICAL APPLICATION OF
COMPOSITE
ENAMEL:
Hardest mineralized tissue in body.
Composition:
96% INORGANIC PORTION
Crystalline calcium hydroxy-apatite crystals
4% ORGANIC MATERIAL & WATER.

Structural unit of the enamel:

1.RODS &PRISMS.
KEY HOLE SHAPED.
CENTRAL BODY & EXTENSION TAIL.
2.INTERPRISMATIC MATERIAL.
 MICROSCOPIC STRUCTURE

SCHEMATIC
REPRESENTATION
Etching:
It is the process of increasing the surface reactivity by
demineralizing the superficial calcium layer and thus creating the
enamel tags. These tags are responsible for micromechanical
bonding between tooth and restorative resin.

FORMATION OF MICRO TAGS AND MACRO TAGS

WHEN BONDING AGENT IS APPLIED TO ETCHED TOOTH SURFACE
ENAMEL BONDING:

Adhesion to enamel is achieved

through acid etching of the highly
mineralized tissue.

In 1955, Buonocore proposed that

acids can be used to alter the
surface of enamel to render it
“more receptive to bonding”. He Dr. Michael Buonocore (1955)
was the first to describe acid etch introduced acid etching – Used 85%
Ortho phosphoric acid.
technique for enamel bonding.
Patterns of acid etching:

There are 5 types of enamel appearance Acc to Silver stone after

various pretreatment

TYPE 1
Honey comb appearance with
loss of enamel prism centers.

TYPE 2
Cobblestone appearance
with prism edges lost.
 TYPE 3
Pitted enamel with map
like appearance.

TYPE 4
Granulation of enamel
with numerous holes.
 TYPE-V
 Shows no prism outline
 Enamel surface is extremely flat and smooth
 They lack micro irregularities for penetration
• Acid used: 37% phosphoric acid
Etching time: 15-20 seconds
• Form of acid: Liquid or gel(Gel form preferred) applied by
syringe or brush
• Effects of etching: Three-dimensional microtopography
at the enamel surface resulting in frosty white appearance
of etched enamel.
• Bonding agent used: BISGMA or UDMA

• Bond strength: 15 to 25 MPa

• Bonding mechanism: Etching produces micropores into
which there is mechanical interlocking of the resin.
 DIFFERENCE IN APPEARANCE OF
ETCHED AND UNETCHED ENAMEL RODS
If the Dentin Surface is Made Too Dry?

OVER DRYING OF DENTIN CAUSES COLLAPSE OF COLLAGEN

FIBRES AND THUS INEFFECTIVE PENETRATION OF ADHESIVE
If the Dentin Surface is Too Wet ?

IF DENTIN IS OVER WET, PRESENCE OF WATER DILUTES THE

MONOMER AND COMPETES IT FOR SITES IN COLLAGEN NETWORK.
THIS LOWERS THE BOND STRENGTH
Definition:
Smear layer is defined as mineralized debris
produced by reduction or instrumentation of enamel,
dentin or cementum.
Hybridization (Given by Nakabayachi in 1982)
Hybridization is the process of formation of a hybrid layer.
Hybrid layer is phenomenon of formation of resin
interlocking
in the demineralized dentin surface . When dentin
is treated with a conditioner, it exposes the collagen fibril
network with interfibrillar micro porosities. When primer is
applied, these spaces are filled with low viscosity monomer.
This layer formed by demineralization of dentin, infiltration
of monomer and subsequent polymerization is called hybrid
layer/resin reinforced layer. This hybrid layer is responsible
for micromechanical bonding between tooth and resin.
Dentine Bonding agent:

MECHANISM OF BONDING:

In a bonding agent, hydrophilic end

displaces the dentinal fluid to wet the
surface and hydrophobic end bonds to
the composite resin
Ideal Requirement of Dentin Bonding Agent

• Provide optimal bond strength similar to bond

strength of composite resin
• Biocompatibility
• Long-term stability
• Attain high bond strength early
• Be easy to apply and not be technique sensitive
5. GENERATIONS IN
ADHESIVES
Classification review of dental adhesive systems; frm IV generation to the universal type

Evolution of bonding adhesives

 I - GENERATION

Buonocore (1956)
Resin containing glycerophosphoric acid dimethacrylate
Bowen
N- phenyl glycine &glycidyl methacrylate (NPG-GMA)
Bonding- chelation of bonding agent to calcium of dentine
•DRAWBACK
•Poor dentine bonding
•Enamel bonding is good.
•Poor bond strength (1 to 3 MPa ).
The first commercial system of this type – Cervident, SS White
 I I- GENERATION

Late 1970’s
• Incorporated halophosphorousesters of unfilled resins
• bis – GMA : bisphenol – A glycidyl methacrylate
• HEMA : hydroxyethyl methacrylate

• Bonding- through an ionic bond to calcium by chlorophosphite

groups.

• Weak bond strength

• Scotch Bond (3M Dental )
• Clearfil (Kuraray Co. Japan)
 III - GENERATION

• Late 1980’s, principle- partially removed or modified smear

layer
• The primer contains hydrophilic resin monomers which include
– 4–META : hydroxyethyl trimellitateanhydride OR
– BPDM : biphenyl dimethacrylate
• Hydrophilic group infiltrates smear layer
• Bonding : Smear layer softening – resin cures which forms hard
surface. Unfilled resin adhesive is applied, attaching cured primer to
the composite resin.
• Drawback – Bonding to smear layer
 Mirage bond
 Scotch bond
 Prisma Universal bond 2 and 3
 IV - GENERATION
•Total etch technique
•Complete removal of the smear
layer is achieved
•40% phosphoric acid for 15 to 20
seconds
•Bond Strength – 17-25 Mpa
All bound -2 (BISCO)
Scotch bond Multipurpose (3M)
Optibond FL (Kerr)
 V - GENERATION
ONE –BOTTLE SYSTEM
•Primer and adhesives are combined into one solution

•Show high bond strength values both to the etched

enamel
and dentin due to adhesive lateral branches and
hybrid
layer formation.
•Totaletching was done with 35 - 37% phosphoricacid
for 15 to 20 secs.
•Bond Strength – 20-25Mpa
Single bond (3M), Onestep (BISCO),Primeand Bond
(Dentsply)
 VI - GENERATION
•Etching was not required at least at the Dentinal interface they
contained dentin conditioning agent as one of their components
Drawbacks:
•Multiple components
•Multiple steps

type I and II sixth generation bonding agent. 6th generation self-etch adhesive
 VII - GENERATION
Late 1990’s & early 2000’s
•All in ONE
•I - Bond
•Etching
•Priming
•Bonding
 EIGHTH GENERATION

• A self etching self adhering flowable composite technology

eliminates the need for separate bonding application step
with composites for direct restorative procedures.
• Stable nanofiller that will not settle out of dispersion.
• Highly functionlised SiO2
• Nano Particle - < 20nm
• Bond Strength – 30Mpa
• Curing time – 35 sec
• Vertise flow (Kerr), Single Bond, Optic Bond Solo Plus,
Adper Single Bond 2 adhesive, Futurabond DC, Voco,
Germany 3M
6.OTHER ADHESIVE
MATERIALS
GLASS IONOMER CEMENTS
Invented -1969 reported 1971 by WILSON AND KENT
POWDER LIQUID

Fluoroalumino silicate glass poly alkenoic acid

(carboxyl containing acid)
Setting Reaction: The hydrogen ions of the acid attack the glass particles
in the presence of water releasing calcium, strontium, and aluminium
ions. The metal ions combine with the carboxylic group of the polyacid to
form the polyacid salts matrix and the glass surface is changed to a silica
hydrogel.
HYDROGEL PHASE: responsible for the uptake and
release of added environmental fluoride from topical gels,
rinses and dentifrices.
GICs have a weaker bond strength with higher bond failure
rates ,with a bond strength of 2.2-10 Mpa.
ADVANTAGES:-
fluoride release, hydrogel phases, moisture tolerance.
DISADVANTAGES:
bond strength less than that of composite
GIC’s used for BONDING TO CERAMIC BRACKETS

CACCIAFESTA et al (1998) (European journal of orthodontics)

The lower bond strength of glass ionomer cements might be

advantageous with ceramic brackets where high bond strengths
have been associated with enamel damage.
 RMGIC’S
COMPONENTS REACTION
TYPE

Polyacid +fluroalumino acid- base

silicate Glass particles

Monomer+photoinitiator +light polymerization

(light initiated)

Monomer+initiator+catalyst polymerization
(chemical cure)
ADVANTAGES:

1. Polymerization proceeds faster than acid-base resulting in

improvement of physical properties, especially resistance.

2. RMGIC-tolerates moisture similar to GIC’s.

3. Improved physical properties & more stable hydrogel phases

compared with GIC’s.

4. polymerization of resin monomers hastens initial hardening of

RMGIC,s without interfering with acid-base setting reactions (or)
any other properties.

5. Micromechanical interlock after polymerization.

STUDIES:

Silver et al :AJO (1995) Found excellent long term

adhesion with such materials in the absence of enamel
etching

BISHARA et al : AJO (1999)

Advised etching of enamel for sufficient bond strength
 
7.Clinical application
TYPES OF BONDING
1.Direct
2.Indirect
DIRECT BONDING
Easier, Faster , Less expensive
Drawbacks
proper positioning is crucial.
Has to be done rapidly and accurately.
INDIRECT BONDING
Placing brackets in a model
Use template or tray to transfer
Common agent – “No-mix” chemically activated materials
More useful in Lingual attachments
Bonding or adhesion to the enamel is done in the following
procedure :

1)Cleansing
2)Enamel conditioning or acid etching
3)Priming
4)Bonding
 Pre-treatment
Pre-treatment is necessary as mouth is complicated by
saliva ,acquired pellicle , different organic and inorganic
components of enamel and dentin.

Cleansing Improves wetting

Acid etching Improves adhesion

micromechanical retention
SALIVARY PELLICLE

When a tooth is cleaned in situ, salivary proteins and glycoproteins

with a strong affinity for enamel very quickly adsorb to the tooth
surface and form a very thin layer called salivary pellicle.

CLEANSING

Removal of salivary pellicle & contaminants

Material used – Pumice
Improves wetting
CLEANING WITH PUMICE

ISOLATION
1. MOISTURE CONTROL :

After the rinse, salivary control and maintenance of a dry working

field is absolutely necessary.
Many devices on the market accomplish this:
Lip expanders &cheek retractors
•Saliva ejectors
•Tongue guards with bite blocks
•Salivary duct obstructers
•Cotton or gauze rolls
•Antisialogogues
For simultaneous molar- to –molar bonding in both arches, a
technique using lip expanders, Dri-Angles(to restrict the flow of
saliva from parotid duct) and saliva ejectors works well.
Antisialagogues generally not indicated,when indicated
methantheline(banthine)tablets(50mg per 100lb body weight)in a sugar free
drink,15 minutes before bonding may provide adequate results.

Lip expander saliva ejector Tongue guard with bite bl0cks

APPLICATION OF ETCHANT
WITH SMALL COTTON
WOOL

RINSE OFF THE ETCHED

SURFACE QUICKLY -20
SECONDS
APPLY RESIN TO
PREPARED ENAMEL
SURFACES

APPLY RESIN TO THE

BRACKET BASE
APPLY BONDING COMPOSITE
MATERIAL TO THE BRACKET
BASE

PLACING BRACKET ON TOOTH

PROBE USED TO CHECK
BRACKETPOSITION TO THE
LONG AXIS OF TOOTH

BRACKETS IN POSITION
8. UPDATES
1. SELF ETCH ADHESIVE SYSTEM
2. MOISTURE INSENSITIVE PRIMER
(MIP’S)
3. ADHESION PROMOTORS
4. FLUORIDE RELEASING ADHESIVES
5. ADHESIVES PRECOATED BRACKETS
6. ANTIMICROBIAL ADHESIVES
1. SELF ETCH ADHESIVE
SYSTEM
What are self-etch primers?

Self-etch primers (SEPs) are gaining in popularity. It is

estimated that SEPs are routinely used by almost 30% of
practitioners in the United States.

These systems incorporate methacrylate phosphoric acid

esters; after application to the enamel, the phosphate group
dissolves and removes calcium ions from hydroxyapatite,
becoming incorporated in the network before the primer
polymerizes, neutralizing the acid.

The advantages of SEPs include:

n Reduced chairside time
n Reduced sensitivity to moisture.
TRANSBOND PLUS –
“SEP”
2.MOISTURE INSENSITIVE
PRIMERS
3.Moisture Insensitive Primer :

 
Bonding can be done in the presence of Moist
environment.
Requires moisture for the initiation of polymerization.
 
Commercially used MIPs
1. Transbond
2. Assure
 
• Why Moisture control is important?

Surface energy reduced – less favourable for

bonding

Porosities are plugged – reduced no of tags

Difficult anatomical areas :

2nd molar
Lingual surfaces of lower teeth
Partially erupted teeth
Surgically exposed teeth.
Composition of Transbond:

– Ethyl alcohol 30-40% ( Solvent )

- Bis-GMA
- HEMA – Hydroxy ethyl methacrylate ( main Hydrophilic
component )
- CDMA – Citric acid ( allows greater cross linking )
- GDMA – Diluent + hydrophilic monomer / Same function as
CDMA / The Hydrophilic monomer takes Oral fluid & so fluoride
uptake
- Acidic Co-polymer / Greater cross linking
 -CPQ / Amine -Photo initiator
- H2O - Solvent ( Water normally interferes with adhesive if not
removed. But in Transbond, Water induces Partial ionization of
Carboxyl groups & an inert dilution effect without Activating any
setting mechanism )
STUDIES :
Wet Conditions Higher bond strength with MIP in 1 & 24 hours
Dry Conditions Conventional primer showed higher strength in
1 & 24 hours
Robert A Miller ( Orthodontic perspectives, 1998)
Ramkumar Grandhi et al ( orthodon dentofacial orthop, 2001)
 
THERE ARE OCCASIONS WHERE IT IS DESIRED TO INCREASE THE
BOND STRENGTHS OF NO MIX-BOND
•NON COMPLAINT PATIENTS
•HYPOCALCIFIED TOOTH
•FLOUROSED ENAMEL
3. ADHESION PROMOTORS
3. ADHESION PROMOTORS:
Bond chemically to metal - 4-META 10-MDP - Sun
Medical's Superbond C&B
Bond chemically to metal Intermediate resins - ALL-
BOND2 - Reliance metal primer

The shear bond strength was increased from 9.0Mpa FOR

THE CONTROL TO 13.3Mpa (an increase of 48%) when
adhesion promotors used.

Adhesion promoters , their effect on bond strength of metal brackets –AJO 1995
4. FLUORIDE RELEASING
ADHESIVES
A.FLUORIDE RELEASING ADHESIVES
FLUORISED IONS CAN BE SUBSTITUTED FOR
HYDROXY GROUPS OF HYDROXYAPATITE AND
THESE FLUORISED TEETH ARE MORE
RESISTANT TO DENTAL CARIES.

RMGIC - FUJI ortho LC

PMCR - Transbond XT,3M s
B.FLOURIDE RELEASING
RECHARGABLE ADHESIVES:

One of the recent primers releases fluoride filled with 38%

glass ionomer fillers, coupled with nanofillers for long-
lasting strength . This primer also has recharge ability, and
this feature gives the clinician the chance to apply it
repeatedly to increase its effectiveness.

EXAMPLE: Opal Seal, Ultra dent Products, South Jordan, Utah

 Effects of different fluoride recharging protocols on fluoride ion
release from various orthodontic adhesives
Sug-Joon Ahn a, Shin-Jae Lee a, Dong-Yul Lee b, Bum-Soon Lim
Objective: The purpose of this study was to find the most effective fluoride
recharging protocol for orthodontic adhesives.
Methods: Five orthodontic adhesives were used: a non-fluoride-releasing composite,
a fluoride-releasing composite, a polyacid-modified composite (compomer), and
two resin-modified glass-ionomer cements (RMGICs). Each specimen was placed
into deionized water (DW) and the initial fluoride ion release was measured for 2
months. Each specimen was then subjected to four different treatments to simulate a
fluoride recharge:1000ppm NaF solution, acidulated phosphate fluorideNgel (APF),
fluoride containing dentifrice and DW(control).After topical fluoride treatment,
each specimen was submitted to fluoride re-release tests.
Results: Fluoride-containing adhesives initially showed higher
rates of fluoride ion release, but significantly declined to lower
levels. The overall cumulative fluoride ion release during the
initial period was RMGICs > compomer > fluoride-containing
composite > non-fluoride-releasing composite. After topical
fluoride treatment, the amount of fluoride ion rereleased was
proportional to the amount of fluoride ion previously released
from the adhesives. However, the amount of fluoride ions
released only lasted for 2 days and then returned to the levels
before fluoride application. The overall cumulative fluoride ion
rerelease according to the fluoride treatments was APF and
NaF solution > dentifrice.
Conclusion: This study suggests that using the
combination of RMGICs and a fluoride containing
mouth rinse solution is the most effective protocol for
long-term fluoride rerelease from orthodontic
adhesives, given the difficulty of routine use of APF at
home, although all topical fluoride treatments can
recharge fluoride ion in adhesives.
5. ADHESIVES PRECOATED
BRACKETS
 UNITEK /3M
COOPER et al
Consistent quality and quantity of adhesive
Reduced waste
Easier clean up
Same composition as in transbond adhesive
Reduced Chair time
Individual packaging- aids identification and
orientation
Improved Cross-infection control
APC” BRACKETS
1.PICK
2.PLACE
3.CURE
1.PICK 2.PLACE

3.CURE
 6.ANTIMICROBIAL ADHESIVES:

Orthodontic adhesives with antimicrobial and remineralizing properties

may be an alternative to control white spot lesions around brackets.
THE AIM OF THIS STUDY : TO DEVELOP AN EXPERIMENTAL
ORTHODONTIC ADHESIVE CONTAINING BORON NITRIDE
NANOTUBES (BNNT) AND ALKYL TRIMETHYL AMMONIUM
BROMIDE (ATAB). METHACRYLATE (BISGMA AND TEGDMA)
MONOMERS WERE USED TO FORMULATE THE ADHESIVES. 

Significant reduction in bacterial growth was observed in the GBNNT/ATAB. No

statistical difference was found for shear bond strength. Mineral deposition
was found in GBNNT, GATAB, and GBNNT/ATAB groups after 14 and 28 days. The
addition of 0.2% BNNT/ATAB to an experimental orthodontic adhesive
inhibited bacterial growth and induced mineral deposition without affecting
the properties of the material.

 
 
Antibacterial and Remineralizing Fillers in Experimental Orthodontic Adhesives
Carolina Jung Ferreira 
OTHER BRACKET BONDING SURFACES:

1.ENAMEL OF DECIDUOUS TEETH

2.FLUOROSED ENAMEL
3.BLEACHED ENAMEL
4.PORCELAIN
5.GOLD
6.AMALGAM
7.COMPOSITE
DEBONDING:

DEFINITION:

TO REMOVE THE ATTACHMENT & ALL ADHESIVE RESIN FROM TOOTH

SURFACE AND RESTORE THE SURFACE AS CLOSELY AS POSSIBLE TO ITS
PRE TREATMENT CONDITION. WITHOUT INDUCING IATROGENIC DAMAGE.

CLINICAL DEBONDING PROCEDURE MAY BE DIVIDED INTO TWO STAGES:

1.BRACKET REMOVAL

2.REMOVAL OF RESIDUAL ADHESIVE

BRACKET REMOVAL
Metal brackets
-debonding pliers
Ceramic brackets
-pliers
-thermal debonding
-lasers
• Thermal debonding:

It is another method which contains application of controlled

heat to resin that bonds the brackets.
Powder – liquid material has significantly lower debonding
temperature of about 45 degree C
No mix paste requires 60-170 degree C .
LASER DEBONDING:
Compact debonding instrument allows a-traumatic debonding
Co2 and Nd:YAG lasers.
Heat produced is localized and control.
More suitable for ceramic brackets.
Removal of residual adhesive :
1.scaler
2. scraping with a sharp band or bond removing plier
3. Burs
- dome shaped TC bur
-ultrafine diamond bur
- stone finishing bur
Adhesive remnant index :

Given by ARTUN and Bergland

Used to evaluate the amount of adhesive left on tooth structure

Score o: No adhesive left on the tooth

Score 1: Less than half of the adhesive left
Score 2: More than half of the adhesive left
Score 3: All adhesive left on the tooth, with distinct impression
of mesh bracket.
Amount of enamel loss during Debonding :
Depends on :
• Types of instruments used
• Type of primer & resin used
• Bond failure interface.

For prophylaxis:
With bristle brush – 10 millimicron enamel is lost, With rubber cup – 5
millimicron enamel is removed.

Resins:
Unfilled – 5 to 8 millimicron lost with hand instruments, Total loss of
enamel is 20 to 40 millimicron.
Filled – 10 millimicron with low speed TC bur. 20millimicron with
high speed bur & green rubber wheel.

Total of 10 to 25 millimicron with rotary instrument .

• ENAMEL TEAR OUTS:
1. It is likely to occur with resins having small filler particles. Might be
due to greater penetration depth with small particles.
2.Upon debonding small fillers would reinforce the adhesive tags. &
bond failure occurs at bracket adhesive interface.
ENAMEL CRACKS:
They occur as split lines in enamel. A sharp sound sometimes heard upon
removal of bonded brackets could be reflected in the creation of enamel
cracks.
Vertical cracks are more common .
Few horizontal & oblique cracks are observed.
More noticeable cracks are in upper central incisor.
BOND STRENGTH
Definition : It is the force obtained at bond failure divided by superficial surface
area.
FACTORS AFFECTING BOND STRENGTH :
1.IMPROPER PROCEDURE:
• Pumicing has no effect on composite resin but decreases bond strength
significantly with the use of RMGIC
2. MOISTURE CONTROL:
•Presence of water or saliva or blood contamination significantly decreases bond
strength.
Possible mechanism is presence of high mucous protein content & enzymes in
saliva would likely result in increased degradation of reactions in the adhesive &
this affect bond strength.
3. TYPES OF PRIMER USED:
•Conventional etching & priming 2 step procedure has highest bond strength .
• Bishara in ANGLE 2002 concluded that fluoride releasing SEP has
significantly lower shear bond strength than conventional 2 step procedure.

4.TYPES OF ADHESIVES USED:

• Composite resin gives highest bond strength . Its followed by RMGIC . 1st &
2nd generation GIC gives least bond strength.

5. TIME OF CURING:
• By Akra Kumori et al .AJO-DO 1999: Delayed exposure decrease bond
strength.
• Bishara et al .AJO-DO 2000 :Increasing curing time for additional 5 – 10 sec
increases bond strength of RMGIC
6.LOCATION OF BRACKETS:
• Bracket failure is more common in lower arch than in upper arch
• Posteriors are more susceptible than anteriors
• Premolars has highest prevalence for bond failure.
• Upper incisors are least affected.
• Bond failures are more in crowded teeth with complex design
than spaced teeth with simpler design.

7. TYPES OF BRACKETS USED:

Ceramic brackets yield highest bond strength.
Metal brackets has comparable bond strength.
Plastic brackets yield lowest bond strength.
How and why of orthodontic bond failures: An in vivo study
R. K. Vijayakumar, Raju Jagadeep, Fayyaz Ahamed, Aprose Kanna, and K. Suresh
8.TYPES OF BRACKETS BASES:
Bracket base with circular concave discs showed highest bond
strength, Bracket base with horizontal retention grooves concave
provides moderate bond strength .
Conventional bracket base with larger mesh spacing produce better
bond strength.
Oliver Sorrel et al in AJO-DO 2002: Reported laser structured
bracket base provides 2 times higher bond strength than simple foil
mesh. Also bond failure likely to occur at enamel / Adhesive interface
but with acceptable enamel damage.

9.RECYCLED BRACKETS:
Recycled brackets has decreased bond strength.
BOND STRENGTH
The value of bond strength plays an important role
in the bonding of brackets.
Reynolds et al. found that minimum amount of
bond strength for resistance to debonding is
between 5.9 to 7.8 MPA.

REYNOLDS I.R. A REVIEW OF DIRECT ORTHODONTIC BONDING. BORTHOD. 1975; 2: 171-178

EFFECTS OF BONDING ON TEETH &
PERIODONTIUM

White spot lesions (WSL ): They are early carious lesions

first seen as white spots in caries susceptible region usually
around bracket margin especially in gingival 3rd of teeth.

Treatment with fixed appliance makes conventional oral

hygiene for plaque removal more difficult & thus increases
cariogenic challenge on surfaces that normally show low
prevalence for Caries.
EFFECT ON PERIODONTIUM:
EXCESS ADHESIVE ESPECIALLY IN GINGIVAL 3RD OF TOOTH CAUSES
INFLAMMATION OF PERIODONTIUM & REMAINS THROUGHOUT TREATMENT.

KENT.L, KNOERNSCHILD ET AL,IN1999 AJO-DO Demonstrated p.gingivalis ,

e.coli polysaccharides exhibit a high affinity for orthodontic brackets

especially ss when compared with ceramic , plastic or gold brackets . This
increases inflammation of tissues adjacent to brackets.
CONCLUSION :
Two primary strategies – Total etch & self etch
Both has advantages & disadvantages

Total etch – the only adhesive system with long term data to support

Profession moving towards Self etch or all-in-one systems

Clinical success of bonding – in the hands of the clinician

• REFERENCES:
1. Sturdevants art and science of operative dentistry-5th edition.

2. Paul Gange.The evolution of orthodontics.AM J Orthod Dentofafacial Orthop

2015;147:s56-63.

3.Phillips science of dental materials 12 th edition.

4. E. Sofan et al. Classification review of dental adhesive systems: from the IV

generation to the universal type

5. N. A. Mandall etal ,Orthodontic Adhesives for Fixed Appliances: A Review

of
Available Systems Dent Update 2019; 46: 742–758

6. Reynolds I.R. A review of direct orthodontic bonding. BOrthod. 1975; 2: 

171-178

7. How and why of orthodontic bond failures: An in vivo study

R. K. Vijayakumar, Raju Jagadeep, Fayyaz Ahamed, Aprose Kanna, and K.
Suresh
8. Oliver Sorrel et al in AJO-DO 2002 Conventional bracket base with larger mesh
spacing produce better bond strength.

9.Kent.L, Knoernschild et al,In1999 AJO-DOExcess adhesive especially in gingival 3rd of

tooth causes inflammation of periodontium & remains throughout treatment.

10. Carolina Jung Ferreira et al ,Antibacterial and Remineralizing Fillers in Experimental

Orthodontic Adhesives2019 Feb 21;12(4):652.

11.Antibacterial and Remineralizing Fillers in Experimental Orthodontic Adhesives

Carolina Jung Ferreira 

12. Adhesion promoters , their effect on bond strength of metal brackets –AJO 1995

13. Effectiveness of an antibacterial primer used with adhesive-coated brackets on enamel

demineralization around brackets: an in vivo Aslihan Zeynep Oz1* , Abdullah Alper Oz1,
Sabahat Yazicioglu1 and Ozlem Sancaktar (2019).

14. Effects of different fluoride recharging protocols on fluoride ion release from various
orthodontic adhesives Sug-Joon Ahn a, Shin-Jae Lee a, Dong-Yul Lee b, Bum-Soon Lim.
THANK YOU