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UPDATE
ORTHODONTIC ADHESIVES
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.i...
CONTENTS
 Introduction
 Common points about adhesives
 Materials used as adhesives
 Composites
 Generations of adhesi...
INTRODUCTION
 Tooth movement
 Attachment of brackets on tooth
 Banding
 Bonding
 Acid Etch technique – Buonocore – 19...
Benefits of bonding
 Aesthetics
 Easier plaque control
 Decreased irritation of gingival
tissues
 Absence of interprox...
Benefits of Bonding
PRACTITIONER:
 eliminates pre-treatment separation
of teeth & needless to mention it also
greatly dec...
ADHESION
“The state in which two surfaces are
held together by interfacial forces
which may consist of valence forces
or i...
ADHESIVE
“ is a material frequently a viscous fluid that
joins two surfaces together and solidifies
and therefore is able ...
SURFACE WETTING & CONTACT ANGLE
“WETTING” use a fluid that will flow and “wet” an
adherend
“CONTACT ANGLE” which is nothin...
MECHANISMS OF ADHESION
 MECHANICAL ADHESION
 ADSORPTION ADHESION
 DIFFUSION ADHESION
 ELECTROSTATIC ADHESION
www.india...
 MECHANICAL :
INTERLOCKING OF ADHESIVE WITH
IRREGULARITIES IN THE SURFACE OF
THE ADHEREND.
 ADSORPTION :
CHEMICAL BONDIN...
 ELECTROSTATIC:
THERE IS AN ELECTRICAL DOUBLE
LAYER AT THE INTERFACE OF A
METAL AND POLYMER THAT IS PART
OF THE TOTAL ADH...
Requirements for adhesive
systems
 Wetting: An adhesive must give
good wetting of the adherend.
 Thickness: Too great th...
 Viscosity: The adhesive should
have a suitable viscosity to enable
it to flow readily over the surface of
adherend
 Dim...
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
 E...
2 basic types resins for orthodontic bonding
Acrylic
Diacrylate resins
/ Based on Self-curing acrylics
/ Methylmethacrylat...
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- SIL...
TYPES-ACCORDING TO SIZE OF
FILLER PARTICLES
CONVENTIONAL 1-50 µm
MICROFILLED 0.04 µm
HYBRID
CLINCAL APPLICATION:
•LARGE...
ACTIVATION
CHEMICAL LIGHT CURED
Initiator Activator Uv-light Visible light
Benzoyl
peroxide
N,N’
DIMETHYL
P-TOLUIDENE
Benz...
CURING LIGHTS
Conventional curing lights
High performance halogen
lights (optilux 501)
Plasma Arc Lights (PAC)
Lasers
...
Conventional Curing lights: Use halogen
bulbs filtered to produce blue light.
Cure adhesives under bracket in 20-30 sec.
...
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Plasma arc lights:
generates a lot of heat and large fan is
required.
Adhesive is cured in 5 seconds under metal
bracket...
Led’s(LIGHT EMITTING DIODES)
1995 mills et al
Solid state light emitting diode technology
10 sec cure
Cool, safe light...
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Clinical application of composite
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Composition:
ENAMEL STUCTURE
Hardest mineralized tissue in body.
96% INORGANIC PORTION
Crystalline calcium hydroxy-apatit...
Structural unit of the enamel.
RODS &PRISMS.
KEY HOLE SHAPED.
CENTRAL BODY & EXTENSION TAIL.
INTERPRISMATIC MATERIAL.
ww...
MICROSCOPIC STRUCTURE
SCHEMATIC DIAGRAM
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ACID ETCHING:
REMOVAL OF SURFACE DEBRIS AIDS BONDING
PORES CREATED RESIN PENETRATES
CREATES TAG LIKE EXTENSIONS
MECHANICA...
Types of etchants
 Strong acids 37% phosphoric acid for 15
seconds
provides a strong bond
.
 Weak acids 2.5% nitric acid...
PATTERNS 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 TEETH
.
Fluoride ion Hydroxy–apatite crystal
Resistant to acid-dissolution
Caries
prevention
Hence ...
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 TH...
CONDITIONERS
ACID SOLUTIONS
CAPABLE OF DISSOLVING (OR) AT LEAST
SOLUBILIZING THE SMEAR LAYER.
HENCE MORE EXPOSURE OF DE...
Examples of Conditioners
/35%-37% Phosphoric acid
/10% Phosphoric acid
/maleic acid
/EDTA
/Citric acid + 3% ferric chlorid...
PRIMERS
Difunctional
Hydrophilic Hydrophobic
Unfilled methacrylate groups
Dentine RESIN
HEMA
Hydroxy ethyl methacrylate
ww...
GENERATIONS
OF
BONDING AGENTS
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RESIN CONTAINING
GLYCEROPHOSPHORIC ACID
DIMETHACRYLATE
BOWEN
N- PHENYL GLYCINE
&GLYCIDYL METHACRYLATE
(NPG-GMA)
BUONOCORE
...
II - GENERATION
(1978)
IONIC BONDING
DRAW BACK : BONDING TO SMEAR LAYER
REQUIRE MECHANICAL PREPARATION
Bis-GMA (or) HEMA
U...
PRINCIPLE: PARTIALLY REMOVED (OR)
MODIFIED THE SMEAR LAYER
ETCHING OPENS DENTINAL TUBULES
PRIMER
META (or) BPDM
MODIFIES S...
IV - GENERATION
COMPLETE REMOVAL OF SMEAR LAYER
HYBRIDIZATION:REPLACEMENT OF HYDROXY-
APATITE AND WATER IN THE SURFACE DEN...
V - GENERATION
SELF ETCHING PRIMERS
ONE –BOTTLE SYSTEM
•PRIMER AND ADHESIVES ARE COMBINED INTO ONE
SOLUTION
SHOW HIGH BOND...
VI - GENERATION
ETCHNG WAS NOT REQUIRED AT LEAST AT THE
DENTINAL INTERFACE
They contained dentin conditioning agent as
one...
VII - GENERATION
i-bondETCHING PRIMING
BONDING
Shear bond strength not affected –any type of curing
light
Similar adhesi...
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, str...
GIC ‘S
ADVANTAGES DISADVANTAGES
FLUORIDE RELEASE
HYDROGEL PHASES
MOISTURE
TOLERANCE
BOND STRENGTH
LESS THAN THAT
OF CO...
GIC’s used for BONDING TO
CERAMIC BRACKETS
CACCIAFESTA et al (1998) (european journal of
orthodontics)
The lower bond stre...
Polyacid +fluroalumino
silicate Glass particles
Monomer+photoinitiator
+light
Monomer+initiator+
catalyst
RMGIC’S
acid ...
ADVANTAGES:
 polymerization proceeds faster than acid-base
reaction resulting in improvement of physical
properties, espe...
polymerization of resin monomers hastens initial
hardening of RMGIC,s without interfering with
acid-base setting reaction...
Silver et al :AJO (1995)
Found excellent long term adhesion
with such materials in the absence of
enamel etching
BISHARA e...
BONDING
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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...
INDIRECT BONDING
 Placing brackets in a model
 Use template or tray to transfer
 Common agent – “No-mix” chemically
act...
Current categories of Adhesive bonding
According to Howard E. Srassler
(Compendium - June 2003 )
1.Total etch adhesive bon...
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
fol...
Pre-treatment
 Cleansing Improves wetting
 Acid etching Improves adhesion
micromechanical retention.
Pre-treatment is ne...
Salivary pellicle
When a tooth is cleaned in situ,
salivary proteins and glycoproteins with
a strong affinity for enamel v...
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
w...
Etch and deposit the primer
simultaneously
With this procedural sequence , it is
likely that the under filling of the
in...
Etching depth & the resin
penetration depth are identical
Can be used for metal & ceramic
brackets.
It is a hydrophilic...
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 initia...
Why Moisture control is
important?
 Surface energy reduced – less favourable
for bonding
 Porosities are plugged – reduc...
Commercially used MIPs
1. Transbond
2. Assure
Composition of Transbond
- Ethyl alcohol 30-40% ( Solvent )
- Bis-GMA
www.in...
- HEMA – Hydroxy ethyl methacrylate
( main Hydrophilic component )
- CDMA – Citric acid
( allows greater cross linking )
-...
-CPQ / Amine
-Photo initiator
- H2O - Solvent
( Water normally interferes with
adhesive if not removed.
But in Transbond, ...
Studies
 Wet Conditions
Higher bond strength with MIP in
1 & 24 hours
 Dry Conditions
Conventional primer showed
higher ...
THERE ARE OCCASIONS WHERE
IT IS DESIRED TO INCREASE THE
BOND STRENGTHS OF NO MIX-
ADHESIVES.
•NON COMPLAINT PATIENTS
•HYPO...
ADHESION PROMOTORS
Bond chemically to metal Intermediate resins
4-META
10-MDP
Sun Medical,s Superbond C&B
ALL-BOND2
Relian...
FLUORIDE RELEASING ADHESIVES
FLUORISED IONS CAN BE SUBSTITUTED
FOR HYDROXY GROUPS OF
HYDROXYAPATITE AND THESE
FLUORISED TE...
ADHESIVE PRECOATED BRACKETS
(1992)
UNITEK /3M
COOPER et al
Consistent quality and quantity of adhesive
Reduced waste
Ea...
ADHESIVE PRECOATED
BRACKETS
 Reduced Chair time
 Individual packaging- aids
identification and orientation
 Improved Cr...
“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...
 Adding Gypsum, Lithium Salt, Potassium,
Sulphate salts – with basic solution
 Lithium Salt – better bond strength
Resul...
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OTHER BRACKET BONDING
SURFACES.
CERAMIC VARIETIES
GOLD
AMALGAM
VENEERS
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DORON HARARI et al (AJO) 2003
(BIFUNCTIONAL MOLECULE)
Porcelain facets Adhesives
BONDING TO NON ENAMEL SURFACES
“PORCELAIN...
BONDING TO CERAMIC
RESTORATIONS
Fine diamond bur
Sandblasting
Micro-etching with alumino
silicates
5%HCL
Silica coati...
Buyukyilmaz T AND Zachrisson (1998)
ANGLE ORTHODONTIST
In bonding to gold intra oral sandblasting
is superior to rougheni...
BONDING TO AMALGAM
Intra-oral sandblasting for 2-4
seconds at a distance of 10mm.
Use a META intermediate resin
with a s...
BONDING TO VENEERS
Kao and johston(1991)journal of prosthetic
dentistry.
Reported fracture incidence on debonding
orthodon...
Conclusion
/ Two primary strategies – Total etch & self etch
/ Both has advantages & disadvantages
/ Total etch – the only...
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ADHESIVES CAN BE
CLASSIFIED ACCORDING
TO
TOLERANCE OF MOISTURE
BANDING (or) BONDING
METHOD OF CURING
METHOD OF DISPENS...
ACCORDING TO THE METHOD OF DISPENSING
PASTE /PASTE SYSTEMS SINGLE PASTE (OR)NO MIX
ADHESIVES (Syringe) Light Cured
Initiat...
Delport & grobler (1988)
Odegaard & segner (1988)
Bradburn & ponder(1992)
AJO
Little difference in the bond
strength betwe...
According to tolerance of moisture
HYDROPHOBIC e.g./ conventional BIS-GMA
These adhesives require etching and absolute
dr...
Multicure
Resin modified -3M UNITEK
BANDING ADHESIVES
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ACCORDING TO METHOD OF
CURING
CHEMICALCURED
e.g Fuji I(conventional GIC)
LIGHT CURED
e.g Transbond XL
DUAL CURE
e.g Rel...
POLYMERIZATION:
Chemical cure in 4 minutes by light in 30 seconds.
The material can be “SNAP SET” in 10 sec by light
cure ...
ADVANTAGES
COMMAND SETTING
EXTENDED WORKING TIME
Smith & Shivpuja (1993)AJO
Evaluated dual cure adhesives and
gave simi...
LASER
(Light Amplification of stimulated
emission of Radiation)
Von Praun Holfer and Arbell, Angle Orthodontist, 1993
Nd:Y...
ADVANTAGES
1)Esthetically superior
2)Faster and simpler
Less discomfort for the patient
Arch length is not increased by ba...
Disadvantages
1)However a bonded bracket has a weaker
attachment than a cemented band .
2)Better oral hygiene is not guara...
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FOUR MECHANISMS OF
RESIN ADHESION TO
THE TOOTH
STRUCTURE
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MECHANICAL
DIFFUSION
ADSORPTION
A COMBINATION
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DIFFUSION:
PRECIPITATION OF SUBSTANCES ON
THE TOOTH SURFACES TO WHICH RESIN
MONOMERS CAN BOND MECHANICALLY (OR)
CHEMICALLY...
COMBINATION:
OF THE PREVIOUS THREE
MECHANISMS.
ADSORPTION:
CHEMICAL BONDING TO THE
INORGANIC COMPONENT (HYDROXY-APATITE) O...
Fluoride compared in our department
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Thank you
For more details please visit
www.indiandentalac...
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Orthodontic adhesives/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.


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Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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Orthodontic adhesives/certified fixed orthodontic courses by Indian dental academy

  1. 1. UPDATE ORTHODONTIC ADHESIVES INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 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. 3. INTRODUCTION  Tooth movement  Attachment of brackets on tooth  Banding  Bonding  Acid Etch technique – Buonocore – 1955  Newman – Epoxy resin 1965 www.indiandentalacademy.com
  4. 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. 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. 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. 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. 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. 9. MECHANISMS OF ADHESION  MECHANICAL ADHESION  ADSORPTION ADHESION  DIFFUSION ADHESION  ELECTROSTATIC ADHESION www.indiandentalacademy.com
  10. 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. 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. 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. 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. 14. GIC COMPOSITE RESIN MODIDIFIED GIC COMPOMER PMCR’s (Poly-acid modified resin) MATERIALS www.indiandentalacademy.com
  15. 15. COMPOSITE RESINS Types Components Method of activation  Chemical  Light cure Curing lights Clinical application  Etching  Enamel Bonding  Dentine Bondingwww.indiandentalacademy.com
  16. 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
  17. 17. COMPONENTS •PRINCIPLE •DILUENT •FILLERS •COUPLING AGENTS •INITIATOR /ACTIVATOR COMPONENTS www.indiandentalacademy.com
  18. 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. 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. 20. ACTIVATION CHEMICAL LIGHT CURED Initiator Activator Uv-light Visible light Benzoyl peroxide N,N’ DIMETHYL P-TOLUIDENE Benzoynmethyl ether CAMPHORO QUINONE www.indiandentalacademy.com
  21. 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. 22. 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 www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. 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 www.indiandentalacademy.com
  25. 25. Led’s(LIGHT EMITTING DIODES) 1995 mills et al Solid state light emitting diode technology 10 sec cure Cool, safe light, no damage to the tooth pulp e.g.Ledmax-4 www.indiandentalacademy.com
  26. 26. www.indiandentalacademy.com
  27. 27. Clinical application of composite www.indiandentalacademy.com
  28. 28. Composition: ENAMEL STUCTURE Hardest mineralized tissue in body. 96% INORGANIC PORTION Crystalline calcium hydroxy-apatite crystals 4% ORGANIC MATERIAL & WATER www.indiandentalacademy.com
  29. 29. Structural unit of the enamel. RODS &PRISMS. KEY HOLE SHAPED. CENTRAL BODY & EXTENSION TAIL. INTERPRISMATIC MATERIAL. www.indiandentalacademy.com
  30. 30. MICROSCOPIC STRUCTURE SCHEMATIC DIAGRAM www.indiandentalacademy.com
  31. 31. 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 www.indiandentalacademy.com
  32. 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. 33. PATTERNS OF ACID ETCHING www.indiandentalacademy.com
  34. 34. Type 1- Intraprismatic – removal of prism cores www.indiandentalacademy.com
  35. 35. Type 2 – Interprismatic – removal of prism peripheries www.indiandentalacademy.com
  36. 36. Type 3 – both type 1 & 2 www.indiandentalacademy.com
  37. 37. ETCHING 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. 38. Dentine Bonding  Disadvantages of Dentine Bonding  Smear Layer  Moist dentine www.indiandentalacademy.com
  39. 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. 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. 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. 42. PRIMERS Difunctional Hydrophilic Hydrophobic Unfilled methacrylate groups Dentine RESIN HEMA Hydroxy ethyl methacrylate www.indiandentalacademy.com
  43. 43. GENERATIONS OF BONDING AGENTS www.indiandentalacademy.com
  44. 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. 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. 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. 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. 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. 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. 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. 51. GIC COMPOSITE RESIN MODIDIFIED GIC COMPOMER PMCR’s (Poly-acid modified resin) MATERIALS www.indiandentalacademy.com
  52. 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. 53. 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. www.indiandentalacademy.com
  54. 54. GIC’s used for BONDING TO CERAMIC BRACKETS CACCIAFESTA et al (1998) (european journal of orthodontics) The lower bond strength of glass ionomer cements might be advantageous with ceramic brackets where high bond strengths have been associated with enamel damage. www.indiandentalacademy.com
  55. 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. 56. ADVANTAGES:  polymerization proceeds faster than acid-base reaction resulting in improvement of physical properties, especially resistance.  RMGIC-tolerates moisture similar to GIC’s. Improved physical properties & more stable hydrogel phases compared with GIC’s www.indiandentalacademy.com
  57. 57. 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 www.indiandentalacademy.com
  58. 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
  59. 59. BONDING www.indiandentalacademy.com
  60. 60. Bonding Direct Indirect www.indiandentalacademy.com
  61. 61. DIRECT BONDING  Easier, Faster  Less expensive  Drawbacks  proper positioning is crucial.  Has to be done rapidly and accurately. www.indiandentalacademy.com
  62. 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. 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. 64. Total Etch Adhesive bonding www.indiandentalacademy.com
  65. 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. 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. 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. 68. CLEANSING Removal of salivary pellicle & contaminants Material used – Pumice Improves wetting www.indiandentalacademy.com
  69. 69. CLEANSING WITH PUMICE www.indiandentalacademy.com
  70. 70. CLEANED TEETH ISOLATED AND READY FOR ETCHING www.indiandentalacademy.com
  71. 71. APPLICATION OF ETCHANT WITH SMALL COTTON WOOL. www.indiandentalacademy.com
  72. 72. WASH ETCHED SURFACES QUICKLY-20 SECONDS. www.indiandentalacademy.com
  73. 73. APPLY RESIN TO PREPARED ENAMEL SURFACES. www.indiandentalacademy.com
  74. 74. APPLY RESIN TO THE BRACKET BASE www.indiandentalacademy.com
  75. 75. APPLY BONDING COMPOSITE MATERIAL TO THE BRACKET BASE. www.indiandentalacademy.com
  76. 76. PLACING BRACKET ON TOOTH. www.indiandentalacademy.com
  77. 77. PROBE USED TO CHECK THE BRACKET POSITION TO THE LONG AXIS OF TOOTH www.indiandentalacademy.com
  78. 78. BRACKETS IN POSITION. www.indiandentalacademy.com
  79. 79. Self – etch adhesive system www.indiandentalacademy.com
  80. 80. SELF ETCHING PRIMERS EXPOSES ENAMEL RODS PENETRATES INTO THE EXPOSED RODS ETCHANT PRIMERS METHACRYLATE BASE BIFUNCTIONAL www.indiandentalacademy.com
  81. 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. 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. 83. TRANSBOND PLUS – “SEP” www.indiandentalacademy.com
  84. 84. STEP -1 www.indiandentalacademy.com
  85. 85. STEP -2 www.indiandentalacademy.com
  86. 86. STEP-3 www.indiandentalacademy.com
  87. 87. STEP- 4 www.indiandentalacademy.com
  88. 88. STEP - 5 www.indiandentalacademy.com
  89. 89. STEP-6 www.indiandentalacademy.com
  90. 90. STEP-7 www.indiandentalacademy.com
  91. 91. STEP-8 www.indiandentalacademy.com
  92. 92. STEP- 9 www.indiandentalacademy.com
  93. 93. www.indiandentalacademy.com
  94. 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. 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. 96. Commercially used MIPs 1. Transbond 2. Assure Composition of Transbond - Ethyl alcohol 30-40% ( Solvent ) - Bis-GMA www.indiandentalacademy.com
  97. 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. 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. 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. 100. THERE ARE OCCASIONS WHERE IT IS DESIRED TO INCREASE THE BOND STRENGTHS OF NO MIX- ADHESIVES. •NON COMPLAINT PATIENTS •HYPOCALCIFIED TOOTH •FLOUROSED ENAMEL www.indiandentalacademy.com
  101. 101. ADHESION PROMOTORS Bond chemically to metal Intermediate resins 4-META 10-MDP Sun Medical,s Superbond C&B ALL-BOND2 Reliance metal primer www.indiandentalacademy.com
  102. 102. 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 www.indiandentalacademy.com
  103. 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. 104. ADHESIVE PRECOATED BRACKETS  Reduced Chair time  Individual packaging- aids identification and orientation  Improved Cross-infection control www.indiandentalacademy.com
  105. 105. “APC” BRACKETS www.indiandentalacademy.com
  106. 106. PICK PLACE CURE www.indiandentalacademy.com
  107. 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. 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
  109. 109. www.indiandentalacademy.com
  110. 110. OTHER BRACKET BONDING SURFACES. CERAMIC VARIETIES GOLD AMALGAM VENEERS www.indiandentalacademy.com
  111. 111. 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 surfaceswww.indiandentalacademy.com
  112. 112. BONDING TO CERAMIC RESTORATIONS Fine diamond bur Sandblasting Micro-etching with alumino silicates 5%HCL Silica coating Surface conditioning methods www.indiandentalacademy.com
  113. 113. 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 www.indiandentalacademy.com
  114. 114. 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. www.indiandentalacademy.com
  115. 115. 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.www.indiandentalacademy.com
  116. 116. 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 www.indiandentalacademy.com
  117. 117. www.indiandentalacademy.com
  118. 118. www.indiandentalacademy.com
  119. 119. www.indiandentalacademy.com
  120. 120. www.indiandentalacademy.com
  121. 121. ADHESIVES CAN BE CLASSIFIED ACCORDING TO TOLERANCE OF MOISTURE BANDING (or) BONDING METHOD OF CURING METHOD OF DISPENSING www.indiandentalacademy.com
  122. 122. 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) www.indiandentalacademy.com
  123. 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. 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. 125. Multicure Resin modified -3M UNITEK BANDING ADHESIVES www.indiandentalacademy.com
  126. 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. 127. 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. DUAL CURE CHEMICAL CURE + LIGHT CURE e.g. reliance phase II dual cure. www.indiandentalacademy.com
  128. 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. 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. 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. 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
  132. 132. www.indiandentalacademy.com
  133. 133. FOUR MECHANISMS OF RESIN ADHESION TO THE TOOTH STRUCTURE www.indiandentalacademy.com
  134. 134. MECHANICAL DIFFUSION ADSORPTION A COMBINATION www.indiandentalacademy.com
  135. 135. 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. www.indiandentalacademy.com
  136. 136. 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. www.indiandentalacademy.com
  137. 137. Fluoride compared in our department www.indiandentalacademy.com Thank you For more details please visit www.indiandentalacademy.com

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