Bonding i /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Bonding i /certified fixed orthodontic courses by Indian dental academy

  1. 1. BONDING IN ORTHODONTICS – II INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. CONTENTS 1. 2. 3. 4. 5. 6. 7. Evolution of bonding agents Banding Indirect bonding Bonding to special surfaces Bond strength Debonding Decalcification and demineralization www.indiandentalacademy.com
  3. 3. EVOLUTION OF BONDING MATERIALS “An appliance which cannot be made transparent or toothcolored should at least be made smaller.” www.indiandentalacademy.com
  4. 4. Schange’s adjustable clamp band Angle’s retraction screw 1871 - W.E. MAGILL – Zinc oxycloride www.indiandentalacademy.com
  5. 5.        Laborious, time-consuming, skill Partially erupted teeth Decalcification /discoloration Gingival irritation Unaesthetic Need of separators Closure of band spaces – “What you see is not what you get” www.indiandentalacademy.com
  6. 6. www.indiandentalacademy.com
  7. 7. 3 major developments that made bonding of attachments to teeth possible – 1. BUONOCORE 1955 – improved retention of methyl methacrylate to enamel – 85% phosphoric acid for 30 seconds 2. BOWEN 1962 – bis Glycidyl methacrylate – more stable and greater strength 3. NEWMAN 1965 – first to acid etch and bond orthodontic brackets with epoxy resin www.indiandentalacademy.com
  8. 8. Orthodontic attachments had to be cemented on teeth instead of the intermediary bands Methylmethacrylate monomer –MMA – first material to be used  Catalyst – Benzoyl peroxide –BPO  Powder-liquid system  In use in restorative dentistry • Poor adhesion - Polymerization shrinkage • Pulpal irritation www.indiandentalacademy.com
  9. 9. BUONOCORE (1955) –  Improved retention of methyl methacrylate to enamel – 85% phosphoric acid for 30 seconds  Not successful for orthodontic purposes – • Occlusal force • Wide range of oral thermal change • Wet environment www.indiandentalacademy.com
  10. 10. G. V. NEWMAN (1965)  Bonded plastic brackets with epoxy resins  Start of direct bonding procedure  For short-term treatment with anterior brackets  Did not replace ‘metal-band’ system www.indiandentalacademy.com
  11. 11. First commercially available orthodontic adhesives 1. OIS Adhesive system – OIS company in 1969 2. Bracket Bond – GAC in 1970  MMA -BPO-amine catalyst system  Weak Adhesion  Early 70s - all adhesives consisted of MMA - it bonded chemically to plastic brackets – in vogue www.indiandentalacademy.com
  12. 12. Fujio Miura and associates in 1971 –  Introduced – ORTHOMITE  MMA - Tri–N–Butyl Borane (catalyst)  Increased adhesive strength  Coupling agent – ‘silane’ methacryloxypropyltrimethoxysilane  Increased adhesive penetration • Chemically bonded to adhesive • Affinity to enamel www.indiandentalacademy.com
  13. 13. Merits of MMA adhesives: 1. Plastic brackets 2. Good storage stability 3. Increased working time – brush-on / dip-in 4. Elimination of sealant - good penetration into enamel surface 5. Less damage during debonding www.indiandentalacademy.com
  14. 14. Demerits of MMA adhesives: 1. Fluctuating proportion of powder-liquid depending on operator 2. Poor mechanical interlocking to metal bracket bases www.indiandentalacademy.com
  15. 15. Metal brackets enter the scene   Plastic – worry about enamel-adhesive Enamel-adhesive & adhesive-bracket Adhesive-bracket -Mesh, perforated pad , foil mesh Enamel-adhesive – • Increased hardness of adhesive • MMA BisGMA • Filler material - TEGDMA www.indiandentalacademy.com
  16. 16. Bisphenol Glycidyl Dimethacrylate (Bis-GMA)    BOWEN 1962 • Greater strength • Lower water absorption • Less polymerization shrinkage 2-paste system Strongest adhesives for metal brackets www.indiandentalacademy.com
  17. 17. FILLERS:  Reduce viscosity of resin  Reduce polymerization shrinkage  Quartz, silica glass particles  3 - 20 microns - abrasion resistance  0.2 – 0.3 microns - smooth surface - less plaque retention Adhesives with large particle fillers recommended for extra bond strength, but careful removal of excess is mandatory www.indiandentalacademy.com
  18. 18. Di/triethyl glycol dimethacrylate (TEGDMA) www.indiandentalacademy.com
  19. 19.  Merit and demerit of Bis-GMA – hardness  Poor penetration due to increased viscosity – dilute with MMA  Plastic brackets could not be used – primer for partially dissolving added  Active life less than powder liquid system www.indiandentalacademy.com
  20. 20.  In 1974 – ORTHOMITE II – 20% more  HNPM – hydroxynapthoxypropylmethacrylate  Eliminated silane  4 - META – methacryloxyethyl trimellitate anhydride  ORTHOMITE SUPER BOND www.indiandentalacademy.com
  21. 21. 4 - META  Plastic & metal  PRE-PRIMED brackets  Base was primed with adhesive  Bracket base covered with PMMA powder  Base dipped in monomer and pressed onto etched surface.  Bond strength less than manual application www.indiandentalacademy.com
  22. 22. Orthodontic adhesives are variations of Adhesives  Direct-restorative materials used in restorative dentistry Late 20th century –direct restorative biomaterials 1. Resin-matrix – originated in U.S. 2. Salt-matrix – U.K. www.indiandentalacademy.com
  23. 23. RESIN MATRIX: Classification 1. According to organic matrix components A. Acrylic resins – MMA Ex. ORTHOMITE, GENIE B. Diacrylate resins- BisGMA Ex.CONCISE, PHASE II According to polymerisation mechanism – A. Chemically activated B. Light-cured C. Dual-cured D. Thermocured www.indiandentalacademy.com
  24. 24. A. CHEMICALLY ACTIVATED:  Chemically-cured/ Auto-cured / Self-cured  Used since beginning of bonding  Most-widely used ortho adhesives  Two-paste / one-paste  Two-paste system:  Initiator- Benzyl peroxide in monomer  Activator- tertiary amine – dihydroxyethyl –ptoluidine www.indiandentalacademy.com
  25. 25. Ex. Concise (3M)  Good bond strength  Laborious  Time-consuming  Increased air-exposure- oxygen inhibition  Defects – air entrapment, voids www.indiandentalacademy.com
  26. 26. One-paste system:  One adhesive component applied to bracket base and other on tooth surface – catalyst gradient  No-mixing  Bracket positioned accurately - pressed firmly into place  Curing occurs – 30-60 secs  Ex. Rely-a-bond, System 1+, Unite www.indiandentalacademy.com
  27. 27.  Procedure simplified  Fast  Efficient  Little long term information available on bond strength  Inhomogeneous polymerisation – sandwich technique  Enamel and bracket side more polymerized  Liquid activators – toxic, allergic reactions www.indiandentalacademy.com
  28. 28. B. LIGHT-CURED: Visible-light cured Camphoroquinone Cure from incisal and gingival areas  Increased working time  Ideal for educational purpose  DC same as Chemical-cure; same for metal and ceramic brackets  Photocuring time-consuming www.indiandentalacademy.com
  29. 29. C. DUAL-CURED: Intiation – exposure to light Propagation – chemically cured  Advantages of light and chemically cured  Improved surface and bulk material properties  Highest DC, bond strength  Ideal for bonding molar tubes  Most time-consuming  Bulk defect due to mixing www.indiandentalacademy.com
  30. 30. D. THERMO-CURED:  Exposure to heat  Superior properties  Not for direct but only indirect bonding www.indiandentalacademy.com
  31. 31. Adhesives acting in the presence of water – 1. 2. MOISTURE-RESISTANT – - can bond in presence of water - saliva, gingival fluid – contaminants - ex. Transbond MIP MOISTURE-ACTIVE – - need water for bonding - enamel surface intentionally made wet - Cyanoacrylate – no liquid, only paste - ex. Smartbond www.indiandentalacademy.com
  32. 32. CYANOACRYLATES:   Ethyl-cyanoacrylate – Smartbond-orthodontic bracket adhesive (1991) Other uses • Automobiles,Circuit boards,Light aircraft • Fracture fixation • Skin sutures • Cardiac surgery • Guided tissue regeneration www.indiandentalacademy.com
  33. 33.  Crabb and Wilson – 1971- compared with polycarboxylate cement – poor performance and bond strength, unsuitable for clinical use  Howells and Jones – 1994 – poor performance on storage in saline for a week  Krishnan et al – 1994 –equal to Bis-GMA when kept in 37oC for 24 hours www.indiandentalacademy.com
  34. 34.  THOMAS W. - JCO 2000 - Compared the shear bond strength and debonding effects of SmartBond & Rely-a-bond • Smart-Bond’s strength was significantly higher • No danger of fracturing the enamel • Polycarbonate bracket - work only if they are pretreated with water www.indiandentalacademy.com
  35. 35. Ideal characteristics of Bonding medium: 1. Non-toxic 2. Adequate working and setting time 3. Moderate viscosity 4. Ability to wet etched surface 5. Sufficient tensile and compressive strength retain bracket & ease of debonding 6. Resist decomposition in the oral environment Antimicrobial 7. www.indiandentalacademy.com
  36. 36. Evaluation of antimicrobial properties of orthodontic composite resin combined with benzalkonium chloride Othman et al,AJO Sep2002  The antimicrobial agent benzalkonium chloride added to a chemically cured composite resin  Anti microbial benefits and bond strength of the modified composite were evaluated. www.indiandentalacademy.com
  37. 37. Results:  No significant difference between the tensile bond strength between modified composite and the original product  The incorporated BAC added to anti microbial properties of original composite without altering it’s mechanical properties www.indiandentalacademy.com
  38. 38. SALT MATRIX: CEMENTS IN ORTHODONTICS: 2. Desirable properties: 1. Adequate working and setting time 2. High tensile, compressive and shear stress 3. Resistant to dissolution 4. Clinically acceptable bond strength 5. Low Adhesive Remnant Index (ARI) on debonding 6. Anticariogenic potential www.indiandentalacademy.com
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  41. 41. ZINC PHOSPHATE: Oldest of the luting cements  Powder and liquid system  Film thickness of 20 microns  Efficient mixing characteristics  Mechanical adhesion  Pulpal irritant - highly acidic  May cause decalcification of enamel resulting in white spots  www.indiandentalacademy.com
  42. 42. ZINC SILICOPHOSPHATE:   Addition of silicate glass Superior strength and fluoride releasing property Extremely acidic  High solubility  No longer used  www.indiandentalacademy.com
  43. 43. ZINC POLYCARBOXYLATE CEMENT:  Introduced by Smith in 1968  First cement system that developed a chemical bond to the tooth structure.  Early 70s –Durelon – poor bond strength  Combined desirable properties of Znphosphate & ZOE www.indiandentalacademy.com
  44. 44.  Acid-base reaction Chemical bond to tooth  Fluoride release  Shorter setting time  Viscous liquid – less efficient mixing characteristics - PSEUDOELASTIC  www.indiandentalacademy.com
  45. 45. GLASS IONOMER CEMENTS:  Developed and introduced in 1974 byWilson, Kent and Smith.  To combine strength and fluoride release of silicophosphate and adhesive efficiency of carboxylate  Group of materials that use silicate glass powder and an aqueous solution of Polyalkeonic acids www.indiandentalacademy.com
  46. 46. Setting reaction:  Surface of glass particles is attacked by acid  Ca, Al, Na, Fl ions-leached into aqueous medium  Next 24 hours a new phase forms in which aluminium ions become bound within the cement matrix leading to a more rigid set cement  NaF uniformly dispersed in the set cement.  Unreacted portion of glass particles sheathed by silica gel. www.indiandentalacademy.com
  47. 47.  Unreacted powder particles surrounded by a silica gel in an amorphous matrix of hydrated Ca++ and Al+++ polysalts.  During initial reaction if mix contaminated by additional water or ambient air - dissolution of matrix - weak and more soluble cement  Adhesion- chelation of carboxyl groups of polyacids with Ca in apatite of enamel & dentin www.indiandentalacademy.com
  48. 48. Biological properties : Chemical adhesion  Bacteriostatic or bactericidal due to fluoride release.  Acid - less irritating to the surrounding tissues  Enamel etching for luting bands not required  Reduces demineralization  Highest strength  Least solubility  Bonds to enamel and base metals  www.indiandentalacademy.com
  49. 49. www.indiandentalacademy.com
  50. 50. Drawbacks:      Moisture sensitivity Low early strength Polymerizable resin functional groups added Impart additional curing process Allow the bulk of the material to mature through the acid-base reaction. RESIN MODIFIED GLASS IONOMER CEMENT www.indiandentalacademy.com
  51. 51. Nicholson (Quint Int 1977) “Resin modified GIC’s are those materials that are modified by the inclusion of resin, generally to make them partly photocurable” W.M. Tay (Dental update 95) “These are hybrid materials that retain significant acid base reaction as a part of their overall curing process” www.indiandentalacademy.com
  52. 52. Advantages of RMGIC’s over GIC’s: 1. 2. 3. 4. 5. 6. Sufficiently long working time controlled in command to a snap set by photocuring. Improved setting characteristics. Protect the acid base balance from problem of water balance. Rapid development of early strength. Fluoride release greater. Diametral strength high (20 Mpa compared to 6. 6 Mpa) www.indiandentalacademy.com
  53. 53. Disadvantages of RMGIC’s over GIC’s: 1. Biocompatibility is controversial. 2. Setting shrinkage is higher leading to increased microleakage and poor marginal adaptation Brands • Fuji Ortho LC • Photacfil – ESPE • Vitrebond – 3M  www.indiandentalacademy.com
  54. 54. In 1986 – White described a method of bonding orthodontic brackets to the enamel surfaces of teeth, with a glass ionomer cement.  Poor strength  Isolation of newly bonded teeth  Light arch-wires immediately after bonding www.indiandentalacademy.com
  55. 55. Bond strength and durability of glass ionomer cements used as bonding agents - AJO July 1989 -Klockowski, Davis, Joynt, Wieczkowski, and MacDo  Compared GICs (Ketac-fil, Ketac-cem and Chelon) with Rely-A-Bond (no-mix autopolymerising) which served as a standard in a clinical study. www.indiandentalacademy.com
  56. 56. Results:  Bond strength of GICs was significantly less when compared to Rely-A-bond.  Less reduction of bond strength of GICs on recycling – lesser than Rely-A-bond on recycling  Failures involved cohesion within cement or adhesion involving the enamel - easily scraped off from the enamel surface without causing much damage. www.indiandentalacademy.com
  57. 57.  Cook -1990 compared the in vivo bond strength of a glass ionomer cement, Ketac (ESPE Premier Denbol Products, Norristown, Pa.), with a composite resin bonding agent – 12% failure rate  Fajen et al- 1990 evaluated the bond strength of three glass ionomer cements against a composite resin in vitro www.indiandentalacademy.com
  58. 58.  Fricker - 1994, worked with Fuji II LC glass ionomer cement (GC Corp., Kyoto, Japan) – • Same rate of success bonding brackets to enamel surfaces as he did with composite cements. • Dentine conditioner was utilized for ten seconds www.indiandentalacademy.com
  59. 59.  Kusy - discussed the damage to teeth on debonding after using composite bonding resins. • “When is stronger better?” • Use of glass ionomer cements for orthodontic bonding procedures - do not need etching or damage the enamel during debonding. www.indiandentalacademy.com
  60. 60. A new light-cured glass ionomer cement that bonds brackets to teeth without etching in the presence of saliva -AJO-DO SEP 1995 -Silverman, Cohen     Used a new Resin modified GIC Fuji Ortho LC Light-cured, resin-reinforced glass ionomer cement 3 mechanisms of setting www.indiandentalacademy.com
  61. 61. Advantages:       Saves significant amount of chair time. Eliminates working in a dry field. Eliminates etching and priming enamel surfaces. Fluoride release protects teeth against decalcification. Repairs are quick and easy. Increased patient and operator comfort. www.indiandentalacademy.com
  62. 62. Evaluation of fluoride release from an orthodontic bonding system – AJO-DO Aug 1991 -Samir E. Bishara, Edward J. Swift, Jr., Daniel C. N. Chan,  Light-activated fluoride-releasing - FluorEver OBA  Tensile bond strength was significantly less – 1/3 – 1/2 of conventional (chan et al) www.indiandentalacademy.com
  63. 63.   Fluoride ion release – 2.6ppm on day 1 0.42ppm on day 2 0.04ppm on day 43 However , decrease in enamel decalcification was observed. www.indiandentalacademy.com
  64. 64. BANDING “Feel the pinch” www.indiandentalacademy.com
  65. 65. Advantages of banding    Stronger Protect against interproximal caries Easier to recement and deband 1. CUSTOM-MADE • Indirect • Direct 1. PRE-FORMED www.indiandentalacademy.com
  66. 66. BANDING PROCEDURE 1. CUSTOM-MADE BANDS: 1. Band-pinching 2. Band-cementation 1. BAND-PINCHING:  ‘Food-trap for cariogenic debris’  Exacting proximity between tooth and band  Poorly fitting band – ‘island in a sea of cement’. www.indiandentalacademy.com
  67. 67. BAND MATERIAL: Precious metal Chrome-cobalt alloy Stainless steel Size: Thickness Incisors Width 0.003 – 0.004” 0.125” Premolars & Canines 0.004” 0.150” Molars 0.180 – 0.200” 0.005 – 0.006” www.indiandentalacademy.com
  68. 68. REQUIREMENTS: 1. Greatest strength and durability with minimum of bulk 2. Soft enough to permit close adaptation 3. Strong enough to withstand stresses 4. Polishable 5. Corrosion and tarnish resistant 6. Biocompatible www.indiandentalacademy.com
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  73. 73. 2. BAND-CEMENTATION: Do not depend on cement for retention ‘Drive fit’ www.indiandentalacademy.com
  74. 74. Universal scaler parallel to band margin and not perpendicular www.indiandentalacademy.com
  75. 75. 2. PRE-FORMED BANDS: Band selection:  Casts  Variations – anatomy, tapered crowns, extra cusps, restorations  One size larger than the one that seems to fit the tooth – prevents wasteful distortion of bands www.indiandentalacademy.com
  76. 76. Band fitting:  First - finger pressure - only on mesial and distal sides  Amalgam plugger / band pusher – 2/3rd  Bite pressure through biting stick – facial and lingual  Final seating pressure – • Maxillary – palatal side of tooth • Mandibular – buccal side of tooth www.indiandentalacademy.com
  77. 77. Checklist: All cusps on banded teeth equally visible Band margin – •Just below marginal ridge •Above the contact point Buccal attachment accurately positioned Open occlusal margins crimped towards tooth www.indiandentalacademy.com
  78. 78. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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