Orthodontic Adhesives / Orthodontic Courses by Indian Dental Academy

UPDATE
ORTHODONTIC ADHESIVES

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

CONTENTS
Introduction
Common points about adhesives
Materials used as adhesives
Composites
Generations of adhesive
Other adhesive materials
Clinical application of adhesives
Bonding in Orthodontics
Updates
Conclusion

INTRODUCTION
Tooth movement

Attachment of brackets on tooth
Banding
Bonding
Acid Etch technique Buonocore 1955
Newman Epoxy resin 1965
Benefits of bonding
Aesthetics
Easier plaque control
Decreased irritation of gingival
tissues
Absence of interproximal space after
the completion of treatment.

PATIENT:
Benefits of Bonding
PRACTITIONER:

eliminates pre-treatment separation
of teeth & needless to mention it also
greatly decreases chair side time.

direct bonding makes it easier to
detect & treat dental caries

ADHESION
The state in which two surfaces are
held together by interfacial forces
which may consist of valence forces
or interlocking forces or both

ADHESIVE
is a material frequently a viscous fluid that
joins two surfaces together and solidifies
and therefore is able to transfer a load from
one surface to the other.

ADHEREND
Material to which an adhesive is
applied is called Adherend

SURFACE WETTING & CONTACT ANGLE
WETTING use a fluid that will flow and wet an
adherend
CONTACT ANGLE which is nothing but an angle
formed by the adhesive with the adherend at
their interface.
IMPORTANCE
The smaller the contact angle, the better able,
is the adhesive to fill in irregularities in the
surface of the adherend.

MECHANISMS OF ADHESION
MECHANICAL ADHESION
ADSORPTION ADHESION
DIFFUSION ADHESION
ELECTROSTATIC ADHESION
MECHANICAL :
INTERLOCKING OF ADHESIVE WITH
IRREGULARITIES IN THE SURFACE OF
THE ADHEREND.

ADSORPTION :
CHEMICAL BONDING BETWEEN THE
ADHESIVE AND ADHEREND
ELECTROSTATIC:
THERE IS AN ELECTRICAL DOUBLE
LAYER AT THE INTERFACE OF A
METAL AND POLYMER THAT IS PART
OF THE TOTAL ADHESIVE SYSTEM
DIFFUSION :
INTERLOCKING BETWEEN MOBILE
MOLECULES, SUCH AS THE ADHESION
OF TWO POLYMERS THROUGH
DIFFUSION OF POLYMER CHAIN ENDS
ACROSS AN INTERFACE.
Requirements for adhesive
systems
Wetting: An adhesive must give
good wetting of the adherend.

Thickness: Too great thickness
can lead to poor bond strength.

Strength: of the set adhesive
must be taken into consideration.

Viscosity: The adhesive should
have a suitable viscosity to enable
it to flow readily over the surface of
adherend
Dimensional Stability: The setting
time of the adhesive should occur
without excessive dimensional
changes i.e.., little expansion or
contraction.
GIC
COMPOSITE
RESIN
MODIDIFIED
GIC
COMPOMER
PMCRs (Poly-acid
modified resin)
MATERIALS
COMPOSITE RESINS
Types
Components
Method of activation
Chemical
Light cure
Curing lights
Clinical application
Etching
Enamel Bonding
Dentine Bonding

2 basic types resins for orthodontic bonding
Acrylic
Diacrylate resins
/ Based on Self-curing acrylics

/ Methylmethacrylate monomer &
ultra fine powder

/ form linear polymers only

/ filled or unfilled forms

/ e.g Orthomite, Genie

/ Plastic brackets
/ Based on acrylic modified Epoxy
resin

/ Bis GMA or Bowens resin

/ Polymerised also by cross linking
into 3 dimensional network

/ Cross linking greater strength

/ filled or unfilled forms

/ e. g Concise, Phase II
COMPONENTS
PRINCIPLE
DILUENT
FILLERS
COUPLING AGENTS
INITIATOR /ACTIVATOR COMPONENTS
COMPOSITES
RESINS FILLERS
Bis-GMA /
URETHANE-
DIMETHACRYLATE
TEGMA-REDUCES
VISCOSITY
QUARTZ
FUSED SILICA
ALUMINO- SILICATES
BARIUM OXIDES
Coupling agent:
vinylsilane helps the filler and polymer for
reinforcement to occur .
TYPES-ACCORDING TO SIZE OF
FILLER PARTICLES

CONVENTIONAL 1-50 m
MICROFILLED 0.04 m
HYBRID
CLINCAL APPLICATION:
LARGER FILLER PARTICLES-EXTRA BOND STRENGTH.
CAREFUL REMOVAL IS NECESSARY DUE TO
ACCUMULATION OF PLAQUE.
ACTIVATION
CHEMICAL
LIGHT CURED
Initiator
Activator
Uv-light
Visible light
Benzoyl
peroxide
N,N
DIMETHYL
P-TOLUIDENE
Benzoynmethyl
ether
CAMPHORO
QUINONE
CURING LIGHTS
Conventional curing lights
High performance halogen
lights (optilux 501)
Plasma Arc Lights (PAC)
Lasers
LEDs (Light emitting diode)
Conventional Curing lights: Use halogen
bulbs filtered to produce blue light.
Cure adhesives under bracket in 20-30 sec.
High performance halogen curing
lights:
80 watts 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
L
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
Laser lights:
emits monochromatic coherent light
source
Generate lot of heat
cumbersome
Leds(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
Clinical application of composite

Composition:

ENAMEL STUCTURE
Hardest mineralized tissue in body.

96% INORGANIC PORTION
Crystalline calcium hydroxy-apatite crystals

4% ORGANIC MATERIAL & WATER
Structural unit of the enamel.

RODS &PRISMS.
KEY HOLE SHAPED.
CENTRAL BODY & EXTENSION TAIL.

INTERPRISMATIC MATERIAL.
MICROSCOPIC STRUCTURE
SCHEMATIC DIAGRAM
ACID ETCHING:

REMOVAL OF SURFACE DEBRIS
AIDS BONDING
PORES CREATED
RESIN PENETRATES
CREATES TAG LIKE EXTENSIONS
MECHANICAL INTERLOCKING
INCREASES SURFACE ENERGY OF ENAMEL
IMPROVES WETTING.
Acid Etching
Types of etchants
Strong acids 37% phosphoric acid for 15
seconds
provides a strong bond
.
Weak acids 2.5% nitric acid (or)
17% maleic acid for 30-60
seconds

PATTERNS OF ACID ETCHING
Type 1- Intraprismatic
removal of prism cores
Type 2 Interprismatic
removal of prism peripheries
Type 3 both type 1 & 2
ETCHING IN FLUORIDATED TEETH

.
Fluoride ion

Hydroxyapatite crystal
Resistant to acid-dissolution
Caries
prevention
Hence fluoridated teeth requires longer
etching time.
Dentine Bonding
Disadvantages of Dentine Bonding

Smear Layer

Moist dentine

SMEAR LAYER

WHEN WE PREPARE THE TOOTH , THE DENTINAL
SURFACE WITH OTHER PARTICLES FORM A SMEAR
LAYER WHICH WILL PREVENT THE COMPOSITE
BONDING
CONDITIONERS
ACID SOLUTIONS
CAPABLE OF DISSOLVING (OR) AT LEAST
SOLUBILIZING THE SMEAR LAYER.
HENCE MORE EXPOSURE OF DENTINE TO
BONDING SYSTEMS.
REMOVAL OF SMEAR LAYER
Examples of Conditioners

/35%-37% Phosphoric acid
/10% Phosphoric acid
/maleic acid
/EDTA
/Citric acid + 3% ferric chloride

37% phosphoric acid is a good
etchant and conditioner.
PRIMERS
Difunctional
Hydrophilic
Hydrophobic
Unfilled methacrylate groups
Dentine
RESIN
HEMA
Hydroxy ethyl methacrylate
GENERATIONS
OF
BONDING AGENTS
RESIN CONTAINING
GLYCEROPHOSPHORIC ACID
DIMETHACRYLATE

BOWEN
N- PHENYL GLYCINE
&GLYCIDYL METHACRYLATE
(NPG-GMA)
BUONOCORE
(1956)
DRAWBACK
POOR DENTINE BONDING
ENAMEL BONDING IS GOOD.
I - GENERATION
Bonding- Chelation of bonding agent to calcium of dentine
II - GENERATION
(1978)

IONIC BONDING
DRAW BACK : BONDING TO SMEAR LAYER

REQUIRE MECHANICAL PREPARATION

Bis-GMA (or) HEMA
Unfilled resins
Calcium in dentine
PRINCIPLE:
PARTIALLY REMOVED (OR)
MODIFIED THE SMEAR LAYER
ETCHING OPENS DENTINAL TUBULES
PRIMER
META (or) BPDM
MODIFIES SMEAR
LAYER
ATTACHES TO
COMPOSITES
DRAWBACK: PRIMER , DOES NOT PENETRATE THE SMEAR
LAYER
ADHESIVE RETENTION DECREASES AFTER
SOME TIME
III - GENERATION
IV - GENERATION
COMPLETE REMOVAL OF SMEAR LAYER
HYBRIDIZATION:REPLACEMENT OF HYDROXY-
APATITE AND WATER IN THE SURFACE DENTIN WITH
RESIN

HYBRID :RESIN IN COMBINATION WITH REMAINING
COLLAGEN FIBRE.
TOTAL - ETCH TECHNIQUE.
MOIST DENTINE CONCEPT.

V - GENERATION
SELF ETCHING PRIMERS
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.
VI - GENERATION
ETCHNG WAS NOT REQUIRED AT LEAST AT THE
DENTINAL INTERFACE
They contained dentin conditioning agent as
one of their components
Drawbacks: Multiple components
Multiple steps
VII - GENERATION
i-bond
ETCHING PRIMING
BONDING
Shear bond strength not affected any type of curing
light
Similar adhesion to prepared and unprepared
enamel
Desensitizers were added.

GIC
COMPOSITE
RESIN
MODIDIFIED
GIC
COMPOMER
PMCRs (Poly-acid
modified resin)
MATERIALS
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.
GLASS IONOMER CEMENTS
Invented -1969 reported 1971 by WILSON AND KENT
POWDER LIQUID
poly alkenoic acid
(carboxyl containing acid)
Flouroalumino
silicate glass
GIC S
ADVANTAGES DISADVANTAGES
FLUORIDE RELEASE
HYDROGEL PHASES
MOISTURE
TOLERANCE
BOND STRENGTH
LESS THAN THAT
OF COMPOSITE.
HYDROGEL PHASE:
Responsible for the uptake and release
of added environmental fluoride from
topical gels, rinses & dentifrices.
GICs 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.

Polyacid +fluroalumino
silicate Glass particles
Monomer+photoinitiator
+light
Monomer+initiator+
catalyst

RMGICS
acid base

polymerization (light
initiated)
polymerization (chemical
initiator)
COMPONENTS REACTION TYPE
ADVANTAGES:
polymerization proceeds faster than acid-base

reaction resulting in improvement of physical

properties, especially resistance.

RMGIC-tolerates moisture similar to GICs.

Improved physical properties & more stable
hydrogel phases compared with GICs

polymerization of resin monomers hastens initial
hardening of RMGIC,s without interfering with
acid-base setting reactions (or) any other properties.

Micromechanical interlock
after polymerization

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
STUDIES :
BONDING
Bonding
Direct 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
Current categories of Adhesive bonding

According to Howard E. Srassler
(Compendium - June 2003 )
1.Total etch adhesive bonding
2. Self etch adhesive bonding
Total Etch Adhesive bonding
1)Cleansing
2)Enamel conditioning or acid etching
3)Priming
4)Bonding

Bonding or adhesion to the
enamel is done in the
following procedure .
Pre-treatment
Cleansing Improves wetting

Acid etching Improves adhesion
micromechanical retention.

Pre-treatment is necessary as mouth is
complicated by saliva ,acquired pellicle ,
different organic and inorganic
components of enamel and dentin.

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
CLEANSING WITH PUMICE
CLEANED TEETH ISOLATED AND
READY FOR ETCHING
APPLICATION OF ETCHANT WITH
SMALL COTTON WOOL.
WASH ETCHED SURFACES
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 THE BRACKET
POSITION TO THE LONG AXIS OF TOOTH
BRACKETS IN POSITION.
Self etch adhesive system
EXPOSES ENAMEL
RODS
PENETRATES
INTO THE
EXPOSED RODS

ETCHANT

PRIMERS
METHACRYLATE BASE
BIFUNCTIONAL
Etch and deposit the primer
simultaneously
With this procedural sequence , it is
likely that the under filling of the
inorganic depleted zones will not
occur.
1 unit contains enough material for one
arch.
Etching depth & the resin
penetration depth are identical
Can be used for metal & ceramic
brackets.
It is a hydrophilic primer-
tolerates both moist & wet
conditions.
TRANSBOND PLUS SEP
STEP -1
STEP -2
STEP-3
STEP- 4
STEP - 5
STEP-6
STEP-7
STEP-8
STEP- 9
Moisture Insensitive Primer
Bonding can be done in the presence of
Moist environment.

Requires moisture for the initiation of
polymerization.
MIP,s
Arndt kloche et. al. Angle orthodontist
2003 August.
Hydrophilic primer from 3rd generation
Why Moisture control is
important?
Surface energy reduced less favourable
for bonding
Porosities are plugged reduced no of
tags
Difficult anatomical areas
2
nd
molar
Lingual surfaces of lower teeth
Partially erupted teeth
Surgically exposed teeth
Commercially used MIPs

1. Transbond
2. 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 )

- 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-
ADHESIVES.

NON COMPLAINT PATIENTS
HYPOCALCIFIED TOOTH
FLOUROSED ENAMEL
ADHESION PROMOTORS
Bond chemically to metal Intermediate resins
4-META
10-MDP
Sun Medical,s Superbond C&B
ALL-BOND2
Reliance metal primer
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
ADHESIVE PRECOATED BRACKETS
(1992)
UNITEK /3M
COOPER et al
Consistent quality and quantity of adhesive
Reduced waste
Easier clean up

Same composition as in
transbond adhesive
ADHESIVE PRECOATED
BRACKETS
Reduced Chair time
Individual packaging- aids
identification and orientation
Improved Cross-infection control

APC BRACKETS
PICK
PLACE
CURE
Crystal growth technique.
/ Aim to achieve micromechanical Crystalline
retentive surface on the enamel

( J Dent Research , Smith & Cartz, 1973 )
AVOIDING DAMAGE OF ACID ETCH TECHNIQUE
Adding Gypsum, Lithium Salt, Potassium,
Sulphate salts with basic solution
Lithium Salt better bond strength
Result dense growth of needle shaped
crystals Spherulitic pattern
/ Material Polyacrylic acid solution containing
residual sulfate ion
OTHER BRACKET BONDING
SURFACES.
CERAMIC VARIETIES
GOLD
AMALGAM
VENEERS
DORON HARARI et al (AJO) 2003
(BIFUNCTIONAL MOLECULE)
Porcelain facets
Adhesives
BONDING TO NON ENAMEL SURFACES
PORCELAIN
BONDING OF CERAMIC BRACKETS
MECHANICAL RETENTION OF ADHESIVE TO BRACKET
BASE
PREPARING THE PORCELAIN SURFACE
SILANE COUPLING AGENT
9.6%HF gels -2-4 minutes are used for etching
porcelain surfaces www.indiandentalacademy.com
BONDING TO CERAMIC
RESTORATIONS
Fine diamond bur
Sandblasting
Micro-etching with alumino
silicates
5%HCL
Silica coating
Surface conditioning methods


Buyukyilmaz T AND Zachrisson (1998)
ANGLE ORTHODONTIST
In bonding to gold intra oral sandblasting
is superior to roughening with
diamond bur
Tin plating improves bond strengths but only
marginally . This procedure is not
recommended by the FDA and hence not
recommended for orthodontic purposes.
BONDING TO GOLD
BONDING TO AMALGAM

Intra-oral sandblasting for 2-4
seconds at a distance of 10mm.
Use a META intermediate resin
with a short curing time such
as reliance metal primer.
BONDING TO VENEERS
Kao and johston(1991)journal of prosthetic
dentistry.
Reported fracture incidence on debonding
orthodontic brackets from porcelain veneers
Lee knight et al (1991)AJO
IT may be worth using a ceramic reinforced
resin bracket , such as ormco spirit or GAC
Elan , on veneers as these brackets are
extremely easy to debond.
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
ADHESIVES CAN BE
CLASSIFIED ACCORDING
TO
TOLERANCE OF MOISTURE
BANDING (or) BONDING
METHOD OF CURING
METHOD OF DISPENSING
ACCORDING TO THE METHOD OF DISPENSING
PASTE /PASTE SYSTEMS
SINGLE PASTE (OR)NO MIX
ADHESIVES (Syringe) Light Cured
Initiator Activator
Benzoyl
peroxide
Tertiary
amine
U-V Light Visible Light
Eg: Chemically activated
resins
Eg: Light activated Composite
resins
Benzoyn
Methyl Ether
Camphoroquinone
(diketone)
Delport & grobler (1988)
Odegaard & segner (1988)
Bradburn & ponder(1992)
AJO
Little difference in the bond
strength between paste/paste &
no mix adhesives.
According to tolerance of moisture
HYDROPHOBIC e.g./ conventional BIS-GMA
These adhesives require etching and absolute
dry environment
HYDROPHILLIC e.g./GICS RMGICS
Achieves chemical adhesion without etching
and tolerates a little moisture
According to bishara et al (1997) AJO
etching is required for bond strength.
Multicure
Resin modified -3M UNITEK
CHEMICALCURED
e.g Fuji I (conventional GIC)
LIGHT CURED
e.g Transbond XL
DUAL CURE
e.g Reliance phase II dual
POLYMERIZATION:
Chemical cure in 4 minutes by light in 30 seconds.
The material can be SNAP SET in 10 sec by light
cure and then allowed to cure chemically.
CHEMICAL CURE + LIGHT CURE
e.g. reliance phase II dual cure.
ADVANTAGES
COMMAND SETTING
EXTENDED WORKING TIME
Smith & Shivpuja (1993)AJO
Evaluated dual cure adhesives and
gave similar bond strengths to chemically
cured and light cured materials.
LASER
(Light Amplification of stimulated
emission of Radiation)

Von Praun Holfer and Arbell, Angle Orthodontist, 1993

Nd:YAG ( Neodymium Ytrium Aluminium Garment
Laser) - to etch Enamel
/ Conversion of Light energy to thermal energy

/ Thermally induced changes within Enamel to a
Depth of 16 to 20 microns

ADVANTAGES
1)Esthetically superior
2)Faster and simpler
Less discomfort for the patient
Arch length is not increased by band
material and no band spaces to close at
the end of treatment .
Better access for cleaning
Mesiodistal enamel reduction is
possible during treatment. www.indiandentalacademy.com
Disadvantages
1)However a bonded bracket has a weaker
attachment than a cemented band .
2)Better oral hygiene is not guaranteed
especially if excess adhesive extends
beyond the bracket base.
3)Rebonding a loose bracket requires more
preparation than rebonding a loose band
FOUR MECHANISMS OF
RESIN ADHESION TO
THE TOOTH
STRUCTURE
MECHANICAL
DIFFUSION
ADSORPTION
A COMBINATION
DIFFUSION:
PRECIPITATION OF SUBSTANCES ON
THE TOOTH SURFACES TO WHICH RESIN
MONOMERS CAN BOND MECHANICALLY (OR)
CHEMICALLY.
MECHANICAL:
PENETRATION OF RESIN &
FORMATION OF RESIN TAGS WITHIN THE
TOOTH SURFACE.
COMBINATION:
OF THE PREVIOUS THREE
MECHANISMS.
ADSORPTION:
CHEMICAL BONDING TO THE
INORGANIC COMPONENT (HYDROXY-APATITE) OR
ORGANIC COMPONENT MAINLY TYPE I OF
COLLAGEN TOOTH STRUCTURE.
Fluoride compared in our department

Thank you

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