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UPDATE
ORTHODONTIC
ADHESIVES
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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 www.indiandentalacademy.com
INTRODUCTION
 Tooth movement
 Attachment of brackets on tooth
 Banding
 Bonding
 Acid Etch technique – Buonocore – 1955
 Newman – Epoxy resin 1965
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Benefits of bonding
 Aesthetics
 Easier plaque control
 Decreased irritation of gingival
tissues
 Absence of interproximal space after
the completion of treatment.
PATIENT:
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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
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ADHESION
“The state in which two surfaces are
held together by interfacial forces
which may consist of valence forces
or interlocking forces or both”
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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
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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.
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MECHANISMS OF ADHESION
MECHANICAL ADHESION
ADSORPTION ADHESION
DIFFUSION ADHESION
ELECTROSTATIC ADHESION
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MECHANICAL :
INTERLOCKING OF ADHESIVE WITH
IRREGULARITIES IN THE SURFACE OF
THE ADHEREND.
ADSORPTION :
CHEMICAL BONDING BETWEEN THE
ADHESIVE AND ADHEREND
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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.
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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.www.indiandentalacademy.com
 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.
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GIC COMPOSITE
RESIN
MODIDIFIED
GIC
COMPOMER
PMCR’s (Poly-acid
modified resin)
MATERIALS
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COMPOSITE RESINS
 Types
 Components
 Method of activation
 Chemical
 Light cure
 Curing lights
 Clinical application
 Etching
 Enamel Bonding
 Dentine Bondingwww.indiandentalacademy.com
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 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
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COMPONENTS
•PRINCIPLE
•DILUENT
•FILLERS
•COUPLING AGENTS
•INITIATOR /ACTIVATOR COMPONENTS
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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 .
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TYPES-ACCORDING TO SIZE OF
FILLER PARTICLES
CONVENTIONAL 1-50 µm
MICROFILLED 0.04 µm
HYBRID
CLINCAL APPLICATION:
•LARGER FILLER PARTICLES-EXTRA BOND STRENGTH.
•CAREFUL REMOVAL IS NECESSARY DUE TO
ACCUMULATION OF PLAQUE.
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ACTIVATION
CHEMICAL LIGHT CURED
Initiator Activator Uv-lightUv-light Visible lightVisible light
Benzoyl
peroxide
N,N’
DIMETHYL
P-TOLUIDENE
Benzoynmethyl
ether
CAMPHORO
QUINONE
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CURING LIGHTS
Conventional curing lights
High performance halogen
lights (optilux 501)
Plasma Arc Lights (PAC)
Lasers
LED’s (Light emitting diode)
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Conventional Curing lights:Conventional Curing lights: Use halogenUse halogen
bulbs filtered to produce blue light.bulbs filtered to produce blue light.
Cure adhesives under bracket in 20-30 sec.Cure adhesives under bracket in 20-30 sec.
High performance halogen curingHigh performance halogen curing
lights:lights:
80 watts tungsten/quartz/halogen bulb80 watts tungsten/quartz/halogen bulb
Cures under metal brackets in 8 seconds andCures under metal brackets in 8 seconds and
under ceramic brackets in 5 seconds .under ceramic brackets in 5 seconds .
Has boost mode to increase the output up toHas boost mode to increase the output up to
1000 watts. hence allows metal brackets to be1000 watts. hence allows metal brackets to be
cured in 5 secondscured in 5 seconds
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Plasma arc lights:Plasma arc lights:
generates a lot of heat and large fan isgenerates a lot of heat and large fan is
required.required.
Adhesive is cured in 5 seconds under metalAdhesive is cured in 5 seconds under metal
brackets and 3 seconds under ceramic bracketsbrackets and 3 seconds under ceramic brackets
Laser lights:Laser lights:
emits monochromatic coherent lightemits monochromatic coherent light
sourcesource
Generate lot of heatGenerate lot of heat
cumbersomecumbersome
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Led’s(LIGHT EMITTING DIODES)Led’s(LIGHT EMITTING DIODES)
1995 mills et al1995 mills et al
Solid state light emitting diode technologySolid state light emitting diode technology
10 sec cure10 sec cure
Cool, safe light, no damage to the tooth pulpCool, safe light, no damage to the tooth pulp
e.g.Ledmax-4e.g.Ledmax-4
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Clinical application of composite
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Composition:
ENAMEL STUCTUREENAMEL STUCTURE
Hardest mineralized tissue in body.Hardest mineralized tissue in body.
96% INORGANIC PORTION
Crystalline calcium hydroxy-apatite crystals
4% ORGANIC MATERIAL & WATER
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Structural unit of the enamel.
RODS &PRISMS.
KEY HOLE SHAPED.
CENTRAL BODY & EXTENSION TAIL.
INTERPRISMATIC MATERIAL.
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MICROSCOPIC STRUCTURE
SCHEMATIC DIAGRAM
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ACID ETCHING:ACID ETCHING:
REMOVAL OF SURFACE DEBRISREMOVAL OF SURFACE DEBRIS AIDS BONDING
PORES CREATED RESIN PENETRATES
CREATES TAG LIKE EXTENSIONS
MECHANICAL INTERLOCKING
INCREASES SURFACE ENERGY OF ENAMEL
IMPROVES WETTING.
Acid Etching
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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
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PATTERNS OF ACID ETCHINGPATTERNS OF ACID ETCHING
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Type 1- Intraprismatic –
removal of prism cores
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Type 2 – Interprismatic –
removal of prism peripheries
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Type 3 – both type 1 & 2
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ETCHING IN FLUORIDATED TEETHETCHING IN FLUORIDATED TEETH
..
Fluoride ion Hydroxy–apatite crystal
Resistant to acid-dissolution
Caries
prevention
Hence fluoridated teeth requires longer
etching time.
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Dentine Bonding
 Disadvantages of Dentine Bonding
 Smear Layer
 Moist dentine
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SMEAR LAYER
WHEN WE PREPARE THE TOOTH , THE DENTINAL
SURFACE WITH OTHER PARTICLES FORM A SMEAR
LAYER WHICH WILL PREVENT THE COMPOSITE
BONDING
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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
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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.
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PRIMERS
Difunctional
Hydrophilic Hydrophobic
Unfilled methacrylate groupsUnfilled methacrylate groups
DentineDentine RESINRESIN
HEMAHEMA
Hydroxy ethyl methacrylateHydroxy ethyl methacrylate
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GENERATIONS
OF
BONDING AGENTS
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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
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II - GENERATION
(1978)
IONIC BONDING
DRAW BACK : BONDING TO SMEAR LAYER
REQUIRE MECHANICAL PREPARATION
Bis-GMA (or) HEMA
Unfilled resins
Calcium in dentine
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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
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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.
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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.
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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
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VII - GENERATION
i-bondETCHING PRIMING
BONDING
Shear bond strength not affected –any type of curing
light
Similar adhesion to prepared and unprepared
enamel
Desensitizers were added.
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GIC COMPOSITE
RESIN
MODIDIFIED
GIC
COMPOMER
PMCR’s (Poly-acid
modified resin)
MATERIALS
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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
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GIC ‘S
ADVANTAGES DISADVANTAGES
FLUORIDE RELEASEFLUORIDE RELEASE
HYDROGEL PHASESHYDROGEL PHASES
MOISTUREMOISTURE
TOLERANCETOLERANCE
BOND STRENGTHBOND STRENGTH
LESS THAN THATLESS THAN THAT
OF COMPOSITE.OF COMPOSITE.
HYDROGEL PHASE:
Responsible for the uptake and release
of added environmental fluoride from
topical gels, rinses & dentifrices.
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GIC’s used for BONDING TOGIC’s used for BONDING TO
CERAMIC BRACKETSCERAMIC BRACKETS
CACCIAFESTA et alCACCIAFESTA et al (1998) (european journal of(1998) (european journal of
orthodontics)orthodontics)
The lower bond strength of glass ionomerThe lower bond strength of glass ionomer
cements might be advantageous with ceramiccements might be advantageous with ceramic
brackets where high bond strengths havebrackets where high bond strengths have
been associated with enamel damage.been associated with enamel damage.
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Polyacid +fluroalumino
silicate Glass particles
Monomer+photoinitiator
+light
Monomer+initiator+
catalyst
RMGIC’S
acid –base
polymerization (light –
initiated)
polymerization (chemical
initiator)
COMPONENTS REACTION TYPE
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ADVANTAGESADVANTAGES::
 polymerization proceeds faster than acid-basepolymerization proceeds faster than acid-base
reaction resulting in improvement of physicalreaction resulting in improvement of physical
properties, especially resistance.properties, especially resistance.
 RMGIC-tolerates moisture similar to GIC’s.RMGIC-tolerates moisture similar to GIC’s.
Improved physical properties & more stableImproved physical properties & more stable
hydrogel phases compared with GIC’shydrogel phases compared with GIC’s
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polymerization of resin monomers hastens initialpolymerization of resin monomers hastens initial
hardening of RMGIC,s without interfering withhardening of RMGIC,s without interfering with
acid-base setting reactions (or) any other properties.acid-base setting reactions (or) any other properties.
Micromechanical interlockMicromechanical interlock
after polymerizationafter polymerization
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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 :
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BONDINGBONDING
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Bonding
Direct Indirect
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DIRECT BONDING
 Easier, Faster
 Less expensive
 Drawbacks
 proper positioning is crucial.
 Has to be done rapidly and accurately.
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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
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Current categories of Adhesive bonding
According to Howard E. Srassler
(Compendium - June 2003 )
1.Total etch adhesive bonding
2. Self – etch adhesive bonding
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Total Etch Adhesive bonding
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1)Cleansing
2)Enamel conditioning or acid etching
3)Priming
4)Bonding
Bonding or adhesion to the
enamel is done in the
following procedure .
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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.
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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.
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CLEANSING
Removal of salivary pellicle &
contaminants
Material used – Pumice
Improves wetting
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CLEANSING WITH PUMICE
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CLEANED TEETH ISOLATED AND
READY FOR ETCHING
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APPLICATION OF ETCHANT WITH
SMALL COTTON WOOL.
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WASH ETCHED SURFACES
QUICKLY-20 SECONDS.
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APPLY RESIN TO PREPARED ENAMEL
SURFACES.
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APPLY RESIN TO THE BRACKET BASE
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APPLY BONDING COMPOSITE
MATERIAL TO THE BRACKET BASE.
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PLACING BRACKET ON TOOTH.
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PROBE USED TO CHECK THE BRACKET
POSITION TO THE LONG AXIS OF TOOTH
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BRACKETS IN POSITION.
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Self – etch adhesive system
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SELF ETCHING
PRIMERS
EXPOSES ENAMEL
RODS
PENETRATES
INTO THE
EXPOSED RODS
ETCHANT PRIMERS
METHACRYLATE BASE
BIFUNCTIONAL
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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.
SELF ETCHING PRIMERS
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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.
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TRANSBOND PLUS – “SEP”
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STEP -1
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STEP -2
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STEP-3
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STEP- 4
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STEP - 5
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STEP-6
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STEP-7
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STEP-8
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STEP- 9
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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
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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
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Commercially used MIPs
1. Transbond
2. Assure
Composition of Transbond
- Ethyl alcohol 30-40% ( Solvent )
- Bis-GMA
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- 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 linkingwww.indiandentalacademy.com
-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 )
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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)
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THERE ARE OCCASIONS WHERETHERE ARE OCCASIONS WHERE
IT IS DESIRED TO INCREASE THEIT IS DESIRED TO INCREASE THE
BOND STRENGTHS OF NO MIX-BOND STRENGTHS OF NO MIX-
ADHESIVES.ADHESIVES.
•NON COMPLAINT PATIENTSNON COMPLAINT PATIENTS
•HYPOCALCIFIED TOOTHHYPOCALCIFIED TOOTH
•FLOUROSED ENAMELFLOUROSED ENAMEL
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ADHESION PROMOTORSADHESION PROMOTORS
Bond chemically to metalBond chemically to metal IntermediateIntermediate resinsresins
4-META4-META
10-MDP10-MDP
Sun Medical,s Superbond C&BSun Medical,s Superbond C&B
ALL-BOND2ALL-BOND2
Reliance metal primerReliance metal primer
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FLUORIDE RELEASING ADHESIVESFLUORIDE RELEASING ADHESIVES
FLUORISED IONS CAN BE SUBSTITUTEDFLUORISED IONS CAN BE SUBSTITUTED
FOR HYDROXY GROUPS OFFOR HYDROXY GROUPS OF
HYDROXYAPATITE AND THESEHYDROXYAPATITE AND THESE
FLUORISED TEETH ARE MORE RESISTANTFLUORISED TEETH ARE MORE RESISTANT
TO DENTAL CARIES.TO DENTAL CARIES.
RMGIC-FUJI ortho LCRMGIC-FUJI ortho LC
PMCR-Transbond XT,3M sPMCR-Transbond XT,3M s
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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
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ADHESIVE PRECOATED
BRACKETS
Reduced Chair time
Individual packaging- aids
identification and orientation
Improved Cross-infection control
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“APC” BRACKETS
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PICK
PLACE CURE
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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
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 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
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OTHER BRACKETOTHER BRACKET
BONDINGBONDING
SURFACES.SURFACES.
CERAMIC VARIETIESCERAMIC VARIETIES
GOLDGOLD
AMALGAMAMALGAM
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DORON HARARIDORON HARARI et al (AJO) 2003et al (AJO) 2003
(BIFUNCTIONAL MOLECULE)(BIFUNCTIONAL MOLECULE)
Porcelain facetsPorcelain facets AdhesivesAdhesives
BONDING TO NON ENAMEL SURFACESBONDING TO NON ENAMEL SURFACES
““PORCELAIN”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
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BONDING TO CERAMICBONDING TO CERAMIC
RESTORATIONSRESTORATIONS
Fine diamond burFine diamond bur
SandblastingSandblasting
Micro-etching with aluminoMicro-etching with alumino
silicatessilicates
5%HCL5%HCL
Silica coatingSilica coating
Surface conditioning methodsSurface conditioning methods
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BuyukyilmazBuyukyilmaz T AND ZachrissonT AND Zachrisson (1998)(1998)
ANGLE ORTHODONTISTANGLE ORTHODONTIST
In bonding to gold intra oralIn bonding to gold intra oral sandblastingsandblasting
is superior tois superior to roughening withroughening with
diamond burdiamond bur
Tin plating improves bond strengths butTin plating improves bond strengths but onlyonly
marginally . This procedure ismarginally . This procedure is notnot
recommended by the FDA and hencerecommended by the FDA and hence notnot
recommended for orthodonticrecommended for orthodontic purposes.purposes.
BONDING TO GOLD
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BONDING TO AMALGAMBONDING TO AMALGAM
Intra-oral sandblastingIntra-oral sandblasting for 2-4for 2-4
seconds at a distance ofseconds at a distance of 10mm.10mm.
Use aUse a METAMETA intermediate resinintermediate resin
withwith a short curing time sucha short curing time such asas
reliance metal primer.reliance metal primer.
www.indiandentalacademy.com
BONDING TO VENEERSBONDING TO VENEERS
Kao and johston(1991)journal of prostheticKao and johston(1991)journal of prosthetic
dentistry.dentistry.
Reported fracture incidence on debondingReported fracture incidence on debonding
orthodontic brackets from porcelain veneersorthodontic brackets from porcelain veneers
Lee –knight et al (1991)AJOLee –knight et al (1991)AJO
IT may be worth using a ceramic reinforcedIT may be worth using a ceramic reinforced
resin bracket , such as ormco spirit or GACresin bracket , such as ormco spirit or GAC
Elan , on veneers as these brackets areElan , on veneers as these brackets are
extremely easy to debond.extremely easy to debond.www.indiandentalacademy.com
ConclusionConclusion
/ 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
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
ADHESIVES CAN BEADHESIVES CAN BE
CLASSIFIED ACCORDINGCLASSIFIED ACCORDING
TOTO
TOLERANCE OF MOISTURETOLERANCE OF MOISTURE
BANDING (or) BONDINGBANDING (or) BONDING
METHOD OF CURINGMETHOD OF CURING
METHOD OF DISPENSINGMETHOD OF DISPENSING
www.indiandentalacademy.com
ACCORDING TO THE METHOD OF DISPENSINGACCORDING TO THE METHOD OF DISPENSING
PASTE /PASTE SYSTEMSPASTE /PASTE SYSTEMS SINGLE PASTE (OR)NO MIXSINGLE PASTE (OR)NO MIX
ADHESIVES (Syringe) Light CuredADHESIVES (Syringe) Light Cured
InitiatorInitiator ActivatorActivator
BenzoylBenzoyl
peroxideperoxide
TertiaryTertiary
amineamine
U-V LightU-V Light Visible LightVisible Light
Eg: Chemically activatedEg: Chemically activated
resinsresins
Eg: Light activated CompositeEg: Light activated Composite
resinsresins
Benzoyn
Methyl Ether
Camphoroquinone
(diketone)
www.indiandentalacademy.com
Delport & grobler (1988)
Odegaard & segner (1988)
Bradburn & ponder(1992)
AJO
Little difference in the bond
strength between paste/paste &
no mix adhesives.
www.indiandentalacademy.com
According to tolerance of moisture
HYDROPHOBIC e.g./ conventional BIS-GMA
These adhesives require etching and absolute
dry environment
HYDROPHILLIC e.g./GIC’S RMGIC’S
Achieves chemical adhesion without etching
and tolerates a little moisture
According to bishara et al (1997) AJO –
etching is required for bond strength.
www.indiandentalacademy.com
Multicure
Resin modified -3M UNITEK
BANDING ADHESIVES
www.indiandentalacademy.com
ACCORDING TO METHOD
OF CURING
CHEMICALCURED
e.g Fuji I(conventional GIC)
LIGHT CURED
e.g Transbond XL
DUAL CURE
e.g Reliance phase II dualwww.indiandentalacademy.com
POLYMERIZATION:
Chemical cure in 4 minutes by light in 30 seconds.
material can be “SNAP SET” in 10 sec by light c
and then allowed to cure chemically.
DUAL CURE
CHEMICAL CURE + LIGHT CURE
e.g. reliance phase II dual cure.
www.indiandentalacademy.com
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.
www.indiandentalacademy.com
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
www.indiandentalacademy.com
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
www.indiandentalacademy.com
www.indiandentalacademy.com
FOUR MECHANISMS OF
RESIN ADHESION TO
THE TOOTH
STRUCTURE
www.indiandentalacademy.com
MECHANICALMECHANICAL
DIFFUSIONDIFFUSION
ADSORPTIONADSORPTION
A COMBINATIONA COMBINATION
www.indiandentalacademy.com
DIFFUSION:DIFFUSION:
PRECIPITATION OF SUBSTANCES ONPRECIPITATION OF SUBSTANCES ON
THE TOOTH SURFACES TO WHICH RESINTHE TOOTH SURFACES TO WHICH RESIN
MONOMERS CAN BOND MECHANICALLY (OR)MONOMERS CAN BOND MECHANICALLY (OR)
CHEMICALLY.CHEMICALLY.
MECHANICAL:MECHANICAL:
PENETRATION OF RESIN &PENETRATION OF RESIN &
FORMATION OF RESIN TAGS WITHIN THEFORMATION OF RESIN TAGS WITHIN THE
TOOTH SURFACE.TOOTH SURFACE.
www.indiandentalacademy.com
COMBINATION:COMBINATION:
OF THE PREVIOUS THREEOF THE PREVIOUS THREE
MECHANISMS.MECHANISMS.
ADSORPTION:ADSORPTION:
CHEMICAL BONDING TO THECHEMICAL BONDING TO THE
INORGANIC COMPONENT (HYDROXY-APATITE) ORINORGANIC COMPONENT (HYDROXY-APATITE) OR
ORGANIC COMPONENT MAINLY TYPE I OFORGANIC COMPONENT MAINLY TYPE I OF
COLLAGEN TOOTH STRUCTURE.COLLAGEN TOOTH STRUCTURE.
www.indiandentalacademy.com
Fluoride compared in our departmentFluoride compared in our department
www.indiandentalacademy.com

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Adhesives

  • 2. 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 www.indiandentalacademy.com
  • 3. INTRODUCTION  Tooth movement  Attachment of brackets on tooth  Banding  Bonding  Acid Etch technique – Buonocore – 1955  Newman – Epoxy resin 1965 www.indiandentalacademy.com
  • 4. Benefits of bonding  Aesthetics  Easier plaque control  Decreased irritation of gingival tissues  Absence of interproximal space after the completion of treatment. PATIENT: www.indiandentalacademy.com
  • 5. 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 www.indiandentalacademy.com
  • 6. ADHESION “The state in which two surfaces are held together by interfacial forces which may consist of valence forces or interlocking forces or both” www.indiandentalacademy.com
  • 7. 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 www.indiandentalacademy.com
  • 8. 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. www.indiandentalacademy.com
  • 9. MECHANISMS OF ADHESION MECHANICAL ADHESION ADSORPTION ADHESION DIFFUSION ADHESION ELECTROSTATIC ADHESION www.indiandentalacademy.com
  • 10. MECHANICAL : INTERLOCKING OF ADHESIVE WITH IRREGULARITIES IN THE SURFACE OF THE ADHEREND. ADSORPTION : CHEMICAL BONDING BETWEEN THE ADHESIVE AND ADHEREND www.indiandentalacademy.com
  • 11. 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. www.indiandentalacademy.com
  • 12. 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.www.indiandentalacademy.com
  • 13.  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. www.indiandentalacademy.com
  • 14. GIC COMPOSITE RESIN MODIDIFIED GIC COMPOMER PMCR’s (Poly-acid modified resin) MATERIALS www.indiandentalacademy.com
  • 15. COMPOSITE RESINS  Types  Components  Method of activation  Chemical  Light cure  Curing lights  Clinical application  Etching  Enamel Bonding  Dentine Bondingwww.indiandentalacademy.com
  • 16. 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 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 www.indiandentalacademy.com
  • 18. 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 . www.indiandentalacademy.com
  • 19. TYPES-ACCORDING TO SIZE OF FILLER PARTICLES CONVENTIONAL 1-50 µm MICROFILLED 0.04 µm HYBRID CLINCAL APPLICATION: •LARGER FILLER PARTICLES-EXTRA BOND STRENGTH. •CAREFUL REMOVAL IS NECESSARY DUE TO ACCUMULATION OF PLAQUE. www.indiandentalacademy.com
  • 20. ACTIVATION CHEMICAL LIGHT CURED Initiator Activator Uv-lightUv-light Visible lightVisible light Benzoyl peroxide N,N’ DIMETHYL P-TOLUIDENE Benzoynmethyl ether CAMPHORO QUINONE www.indiandentalacademy.com
  • 21. CURING LIGHTS Conventional curing lights High performance halogen lights (optilux 501) Plasma Arc Lights (PAC) Lasers LED’s (Light emitting diode) www.indiandentalacademy.com
  • 22. Conventional Curing lights:Conventional Curing lights: Use halogenUse halogen bulbs filtered to produce blue light.bulbs filtered to produce blue light. Cure adhesives under bracket in 20-30 sec.Cure adhesives under bracket in 20-30 sec. High performance halogen curingHigh performance halogen curing lights:lights: 80 watts tungsten/quartz/halogen bulb80 watts tungsten/quartz/halogen bulb Cures under metal brackets in 8 seconds andCures under metal brackets in 8 seconds and under ceramic brackets in 5 seconds .under ceramic brackets in 5 seconds . Has boost mode to increase the output up toHas boost mode to increase the output up to 1000 watts. hence allows metal brackets to be1000 watts. hence allows metal brackets to be cured in 5 secondscured in 5 seconds www.indiandentalacademy.com
  • 24. Plasma arc lights:Plasma arc lights: generates a lot of heat and large fan isgenerates a lot of heat and large fan is required.required. Adhesive is cured in 5 seconds under metalAdhesive is cured in 5 seconds under metal brackets and 3 seconds under ceramic bracketsbrackets and 3 seconds under ceramic brackets Laser lights:Laser lights: emits monochromatic coherent lightemits monochromatic coherent light sourcesource Generate lot of heatGenerate lot of heat cumbersomecumbersome www.indiandentalacademy.com
  • 25. Led’s(LIGHT EMITTING DIODES)Led’s(LIGHT EMITTING DIODES) 1995 mills et al1995 mills et al Solid state light emitting diode technologySolid state light emitting diode technology 10 sec cure10 sec cure Cool, safe light, no damage to the tooth pulpCool, safe light, no damage to the tooth pulp e.g.Ledmax-4e.g.Ledmax-4 www.indiandentalacademy.com
  • 27. Clinical application of composite www.indiandentalacademy.com
  • 28. Composition: ENAMEL STUCTUREENAMEL STUCTURE Hardest mineralized tissue in body.Hardest mineralized tissue in body. 96% INORGANIC PORTION Crystalline calcium hydroxy-apatite crystals 4% ORGANIC MATERIAL & WATER www.indiandentalacademy.com
  • 29. Structural unit of the enamel. RODS &PRISMS. KEY HOLE SHAPED. CENTRAL BODY & EXTENSION TAIL. INTERPRISMATIC MATERIAL. www.indiandentalacademy.com
  • 31. ACID ETCHING:ACID ETCHING: REMOVAL OF SURFACE DEBRISREMOVAL OF SURFACE DEBRIS AIDS BONDING PORES CREATED RESIN PENETRATES CREATES TAG LIKE EXTENSIONS MECHANICAL INTERLOCKING INCREASES SURFACE ENERGY OF ENAMEL IMPROVES WETTING. Acid Etching www.indiandentalacademy.com
  • 32. 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 www.indiandentalacademy.com
  • 33. PATTERNS OF ACID ETCHINGPATTERNS OF ACID ETCHING www.indiandentalacademy.com
  • 34. Type 1- Intraprismatic – removal of prism cores www.indiandentalacademy.com
  • 35. Type 2 – Interprismatic – removal of prism peripheries www.indiandentalacademy.com
  • 36. Type 3 – both type 1 & 2 www.indiandentalacademy.com
  • 37. ETCHING IN FLUORIDATED TEETHETCHING IN FLUORIDATED TEETH .. Fluoride ion Hydroxy–apatite crystal Resistant to acid-dissolution Caries prevention Hence fluoridated teeth requires longer etching time. www.indiandentalacademy.com
  • 38. Dentine Bonding  Disadvantages of Dentine Bonding  Smear Layer  Moist dentine www.indiandentalacademy.com
  • 39. SMEAR LAYER WHEN WE PREPARE THE TOOTH , THE DENTINAL SURFACE WITH OTHER PARTICLES FORM A SMEAR LAYER WHICH WILL PREVENT THE COMPOSITE BONDING www.indiandentalacademy.com
  • 40. 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 www.indiandentalacademy.com
  • 41. 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. www.indiandentalacademy.com
  • 42. PRIMERS Difunctional Hydrophilic Hydrophobic Unfilled methacrylate groupsUnfilled methacrylate groups DentineDentine RESINRESIN HEMAHEMA Hydroxy ethyl methacrylateHydroxy ethyl methacrylate www.indiandentalacademy.com
  • 44. 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 www.indiandentalacademy.com
  • 45. II - GENERATION (1978) IONIC BONDING DRAW BACK : BONDING TO SMEAR LAYER REQUIRE MECHANICAL PREPARATION Bis-GMA (or) HEMA Unfilled resins Calcium in dentine www.indiandentalacademy.com
  • 46. 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 www.indiandentalacademy.com
  • 47. 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. www.indiandentalacademy.com
  • 48. 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. www.indiandentalacademy.com
  • 49. 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 www.indiandentalacademy.com
  • 50. VII - GENERATION i-bondETCHING PRIMING BONDING Shear bond strength not affected –any type of curing light Similar adhesion to prepared and unprepared enamel Desensitizers were added. www.indiandentalacademy.com
  • 51. GIC COMPOSITE RESIN MODIDIFIED GIC COMPOMER PMCR’s (Poly-acid modified resin) MATERIALS www.indiandentalacademy.com
  • 52. 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 www.indiandentalacademy.com
  • 53. GIC ‘S ADVANTAGES DISADVANTAGES FLUORIDE RELEASEFLUORIDE RELEASE HYDROGEL PHASESHYDROGEL PHASES MOISTUREMOISTURE TOLERANCETOLERANCE BOND STRENGTHBOND STRENGTH LESS THAN THATLESS THAN THAT OF COMPOSITE.OF COMPOSITE. HYDROGEL PHASE: Responsible for the uptake and release of added environmental fluoride from topical gels, rinses & dentifrices. www.indiandentalacademy.com
  • 54. GIC’s used for BONDING TOGIC’s used for BONDING TO CERAMIC BRACKETSCERAMIC BRACKETS CACCIAFESTA et alCACCIAFESTA et al (1998) (european journal of(1998) (european journal of orthodontics)orthodontics) The lower bond strength of glass ionomerThe lower bond strength of glass ionomer cements might be advantageous with ceramiccements might be advantageous with ceramic brackets where high bond strengths havebrackets where high bond strengths have been associated with enamel damage.been associated with enamel damage. www.indiandentalacademy.com
  • 55. Polyacid +fluroalumino silicate Glass particles Monomer+photoinitiator +light Monomer+initiator+ catalyst RMGIC’S acid –base polymerization (light – initiated) polymerization (chemical initiator) COMPONENTS REACTION TYPE www.indiandentalacademy.com
  • 56. ADVANTAGESADVANTAGES::  polymerization proceeds faster than acid-basepolymerization proceeds faster than acid-base reaction resulting in improvement of physicalreaction resulting in improvement of physical properties, especially resistance.properties, especially resistance.  RMGIC-tolerates moisture similar to GIC’s.RMGIC-tolerates moisture similar to GIC’s. Improved physical properties & more stableImproved physical properties & more stable hydrogel phases compared with GIC’shydrogel phases compared with GIC’s www.indiandentalacademy.com
  • 57. polymerization of resin monomers hastens initialpolymerization of resin monomers hastens initial hardening of RMGIC,s without interfering withhardening of RMGIC,s without interfering with acid-base setting reactions (or) any other properties.acid-base setting reactions (or) any other properties. Micromechanical interlockMicromechanical interlock after polymerizationafter polymerization www.indiandentalacademy.com
  • 58. 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 : www.indiandentalacademy.com
  • 61. DIRECT BONDING  Easier, Faster  Less expensive  Drawbacks  proper positioning is crucial.  Has to be done rapidly and accurately. www.indiandentalacademy.com
  • 62. 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 www.indiandentalacademy.com
  • 63. Current categories of Adhesive bonding According to Howard E. Srassler (Compendium - June 2003 ) 1.Total etch adhesive bonding 2. Self – etch adhesive bonding www.indiandentalacademy.com
  • 64. Total Etch Adhesive bonding www.indiandentalacademy.com
  • 65. 1)Cleansing 2)Enamel conditioning or acid etching 3)Priming 4)Bonding Bonding or adhesion to the enamel is done in the following procedure . www.indiandentalacademy.com
  • 66. 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. www.indiandentalacademy.com
  • 67. 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. www.indiandentalacademy.com
  • 68. CLEANSING Removal of salivary pellicle & contaminants Material used – Pumice Improves wetting www.indiandentalacademy.com
  • 70. CLEANED TEETH ISOLATED AND READY FOR ETCHING www.indiandentalacademy.com
  • 71. APPLICATION OF ETCHANT WITH SMALL COTTON WOOL. www.indiandentalacademy.com
  • 72. WASH ETCHED SURFACES QUICKLY-20 SECONDS. www.indiandentalacademy.com
  • 73. APPLY RESIN TO PREPARED ENAMEL SURFACES. www.indiandentalacademy.com
  • 74. APPLY RESIN TO THE BRACKET BASE www.indiandentalacademy.com
  • 75. APPLY BONDING COMPOSITE MATERIAL TO THE BRACKET BASE. www.indiandentalacademy.com
  • 76. PLACING BRACKET ON TOOTH. www.indiandentalacademy.com
  • 77. PROBE USED TO CHECK THE BRACKET POSITION TO THE LONG AXIS OF TOOTH www.indiandentalacademy.com
  • 79. Self – etch adhesive system www.indiandentalacademy.com
  • 80. SELF ETCHING PRIMERS EXPOSES ENAMEL RODS PENETRATES INTO THE EXPOSED RODS ETCHANT PRIMERS METHACRYLATE BASE BIFUNCTIONAL www.indiandentalacademy.com
  • 81. 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. SELF ETCHING PRIMERS www.indiandentalacademy.com
  • 82. 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. www.indiandentalacademy.com
  • 83. TRANSBOND PLUS – “SEP” www.indiandentalacademy.com
  • 94. 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 www.indiandentalacademy.com
  • 95. 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 www.indiandentalacademy.com
  • 96. Commercially used MIPs 1. Transbond 2. Assure Composition of Transbond - Ethyl alcohol 30-40% ( Solvent ) - Bis-GMA www.indiandentalacademy.com
  • 97. - 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 linkingwww.indiandentalacademy.com
  • 98. -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 ) www.indiandentalacademy.com
  • 99. 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) www.indiandentalacademy.com
  • 100. THERE ARE OCCASIONS WHERETHERE ARE OCCASIONS WHERE IT IS DESIRED TO INCREASE THEIT IS DESIRED TO INCREASE THE BOND STRENGTHS OF NO MIX-BOND STRENGTHS OF NO MIX- ADHESIVES.ADHESIVES. •NON COMPLAINT PATIENTSNON COMPLAINT PATIENTS •HYPOCALCIFIED TOOTHHYPOCALCIFIED TOOTH •FLOUROSED ENAMELFLOUROSED ENAMEL www.indiandentalacademy.com
  • 101. ADHESION PROMOTORSADHESION PROMOTORS Bond chemically to metalBond chemically to metal IntermediateIntermediate resinsresins 4-META4-META 10-MDP10-MDP Sun Medical,s Superbond C&BSun Medical,s Superbond C&B ALL-BOND2ALL-BOND2 Reliance metal primerReliance metal primer www.indiandentalacademy.com
  • 102. FLUORIDE RELEASING ADHESIVESFLUORIDE RELEASING ADHESIVES FLUORISED IONS CAN BE SUBSTITUTEDFLUORISED IONS CAN BE SUBSTITUTED FOR HYDROXY GROUPS OFFOR HYDROXY GROUPS OF HYDROXYAPATITE AND THESEHYDROXYAPATITE AND THESE FLUORISED TEETH ARE MORE RESISTANTFLUORISED TEETH ARE MORE RESISTANT TO DENTAL CARIES.TO DENTAL CARIES. RMGIC-FUJI ortho LCRMGIC-FUJI ortho LC PMCR-Transbond XT,3M sPMCR-Transbond XT,3M s www.indiandentalacademy.com
  • 103. 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 www.indiandentalacademy.com
  • 104. ADHESIVE PRECOATED BRACKETS Reduced Chair time Individual packaging- aids identification and orientation Improved Cross-infection control www.indiandentalacademy.com
  • 107. 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 www.indiandentalacademy.com
  • 108.  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 www.indiandentalacademy.com
  • 110. OTHER BRACKETOTHER BRACKET BONDINGBONDING SURFACES.SURFACES. CERAMIC VARIETIESCERAMIC VARIETIES GOLDGOLD AMALGAMAMALGAM VENEERSVENEERSwww.indiandentalacademy.com
  • 111. DORON HARARIDORON HARARI et al (AJO) 2003et al (AJO) 2003 (BIFUNCTIONAL MOLECULE)(BIFUNCTIONAL MOLECULE) Porcelain facetsPorcelain facets AdhesivesAdhesives BONDING TO NON ENAMEL SURFACESBONDING TO NON ENAMEL SURFACES ““PORCELAIN”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 surfaceswww.indiandentalacademy.com
  • 112. BONDING TO CERAMICBONDING TO CERAMIC RESTORATIONSRESTORATIONS Fine diamond burFine diamond bur SandblastingSandblasting Micro-etching with aluminoMicro-etching with alumino silicatessilicates 5%HCL5%HCL Silica coatingSilica coating Surface conditioning methodsSurface conditioning methods www.indiandentalacademy.com
  • 113. BuyukyilmazBuyukyilmaz T AND ZachrissonT AND Zachrisson (1998)(1998) ANGLE ORTHODONTISTANGLE ORTHODONTIST In bonding to gold intra oralIn bonding to gold intra oral sandblastingsandblasting is superior tois superior to roughening withroughening with diamond burdiamond bur Tin plating improves bond strengths butTin plating improves bond strengths but onlyonly marginally . This procedure ismarginally . This procedure is notnot recommended by the FDA and hencerecommended by the FDA and hence notnot recommended for orthodonticrecommended for orthodontic purposes.purposes. BONDING TO GOLD www.indiandentalacademy.com
  • 114. BONDING TO AMALGAMBONDING TO AMALGAM Intra-oral sandblastingIntra-oral sandblasting for 2-4for 2-4 seconds at a distance ofseconds at a distance of 10mm.10mm. Use aUse a METAMETA intermediate resinintermediate resin withwith a short curing time sucha short curing time such asas reliance metal primer.reliance metal primer. www.indiandentalacademy.com
  • 115. BONDING TO VENEERSBONDING TO VENEERS Kao and johston(1991)journal of prostheticKao and johston(1991)journal of prosthetic dentistry.dentistry. Reported fracture incidence on debondingReported fracture incidence on debonding orthodontic brackets from porcelain veneersorthodontic brackets from porcelain veneers Lee –knight et al (1991)AJOLee –knight et al (1991)AJO IT may be worth using a ceramic reinforcedIT may be worth using a ceramic reinforced resin bracket , such as ormco spirit or GACresin bracket , such as ormco spirit or GAC Elan , on veneers as these brackets areElan , on veneers as these brackets are extremely easy to debond.extremely easy to debond.www.indiandentalacademy.com
  • 116. ConclusionConclusion / 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 www.indiandentalacademy.com
  • 121. ADHESIVES CAN BEADHESIVES CAN BE CLASSIFIED ACCORDINGCLASSIFIED ACCORDING TOTO TOLERANCE OF MOISTURETOLERANCE OF MOISTURE BANDING (or) BONDINGBANDING (or) BONDING METHOD OF CURINGMETHOD OF CURING METHOD OF DISPENSINGMETHOD OF DISPENSING www.indiandentalacademy.com
  • 122. ACCORDING TO THE METHOD OF DISPENSINGACCORDING TO THE METHOD OF DISPENSING PASTE /PASTE SYSTEMSPASTE /PASTE SYSTEMS SINGLE PASTE (OR)NO MIXSINGLE PASTE (OR)NO MIX ADHESIVES (Syringe) Light CuredADHESIVES (Syringe) Light Cured InitiatorInitiator ActivatorActivator BenzoylBenzoyl peroxideperoxide TertiaryTertiary amineamine U-V LightU-V Light Visible LightVisible Light Eg: Chemically activatedEg: Chemically activated resinsresins Eg: Light activated CompositeEg: Light activated Composite resinsresins Benzoyn Methyl Ether Camphoroquinone (diketone) www.indiandentalacademy.com
  • 123. Delport & grobler (1988) Odegaard & segner (1988) Bradburn & ponder(1992) AJO Little difference in the bond strength between paste/paste & no mix adhesives. www.indiandentalacademy.com
  • 124. According to tolerance of moisture HYDROPHOBIC e.g./ conventional BIS-GMA These adhesives require etching and absolute dry environment HYDROPHILLIC e.g./GIC’S RMGIC’S Achieves chemical adhesion without etching and tolerates a little moisture According to bishara et al (1997) AJO – etching is required for bond strength. www.indiandentalacademy.com
  • 125. Multicure Resin modified -3M UNITEK BANDING ADHESIVES www.indiandentalacademy.com
  • 126. ACCORDING TO METHOD OF CURING CHEMICALCURED e.g Fuji I(conventional GIC) LIGHT CURED e.g Transbond XL DUAL CURE e.g Reliance phase II dualwww.indiandentalacademy.com
  • 127. POLYMERIZATION: Chemical cure in 4 minutes by light in 30 seconds. material can be “SNAP SET” in 10 sec by light c and then allowed to cure chemically. DUAL CURE CHEMICAL CURE + LIGHT CURE e.g. reliance phase II dual cure. www.indiandentalacademy.com
  • 128. 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. www.indiandentalacademy.com
  • 129. 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 www.indiandentalacademy.com
  • 130. 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
  • 131. 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 www.indiandentalacademy.com
  • 133. FOUR MECHANISMS OF RESIN ADHESION TO THE TOOTH STRUCTURE www.indiandentalacademy.com
  • 135. DIFFUSION:DIFFUSION: PRECIPITATION OF SUBSTANCES ONPRECIPITATION OF SUBSTANCES ON THE TOOTH SURFACES TO WHICH RESINTHE TOOTH SURFACES TO WHICH RESIN MONOMERS CAN BOND MECHANICALLY (OR)MONOMERS CAN BOND MECHANICALLY (OR) CHEMICALLY.CHEMICALLY. MECHANICAL:MECHANICAL: PENETRATION OF RESIN &PENETRATION OF RESIN & FORMATION OF RESIN TAGS WITHIN THEFORMATION OF RESIN TAGS WITHIN THE TOOTH SURFACE.TOOTH SURFACE. www.indiandentalacademy.com
  • 136. COMBINATION:COMBINATION: OF THE PREVIOUS THREEOF THE PREVIOUS THREE MECHANISMS.MECHANISMS. ADSORPTION:ADSORPTION: CHEMICAL BONDING TO THECHEMICAL BONDING TO THE INORGANIC COMPONENT (HYDROXY-APATITE) ORINORGANIC COMPONENT (HYDROXY-APATITE) OR ORGANIC COMPONENT MAINLY TYPE I OFORGANIC COMPONENT MAINLY TYPE I OF COLLAGEN TOOTH STRUCTURE.COLLAGEN TOOTH STRUCTURE. www.indiandentalacademy.com
  • 137. Fluoride compared in our departmentFluoride compared in our department www.indiandentalacademy.com