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Structure/property relationships

in orthodontic ceramics 3
S. Zinelis, W. Brantley

3.1 Introduction
The demand for esthetic brackets has increased over the last three decades as more
adult patients request orthodontic treatment. To cover this demand the orthodontic in-
dustry has developed plastic and ceramic brackets, lingual brackets, and orthodontic
aligners made of thermoplastic materials. Despite the increased esthetic results, all
of the aforementioned devices have their limitations.
Plastic brackets were introduced in the early 1970s, but they suffered from slot
distortion and creep deformation because of mechanical loading; water absorption
and discoloration were other important limitations.1,2 In the late 1980s, ceramic
brackets made of polycrystalline or monocrystalline (sapphire) alumina, and later
of polycrystalline zirconia, were introduced in the orthodontic market.1,3e5 Ceramic
brackets could successfully withstand orthodontic forces and were free of discolor-
ation and stain complications.2 However, low fracture toughness, increased friction
between ceramic slots and metallic wires, and enamel fracture after debonding
remained among their drawbacks.6,7 Consideration of manufacturing processes,
compositions, and inherent physical and mechanical properties of the ceramic mate-
rials involved is essential to understand several issues related to their clinical
performance.

3.2 Raw materials and manufacturing processes


for ceramic brackets
Contemporary ceramic brackets are mostly made of high-purity alumina in single-
crystal (monocrystalline) sapphire form or polycrystalline form, with signicant differ-
ences in their mechanical and optical properties. Although there are a few zirconia
brackets available, their use is limited because of increased friction coefcient,8 less
transparency, a yellowish tint, and lower shear bond strength compared to alumina
brackets.1,9 Accordingly, this chapter will focus on the alumina ceramic brackets.
The manufacturing process for polycrystalline alumina brackets starts with the mix-
ing of alumina particles (average of 0.3 mm size) with a binder. The mixture is molded
in an oversized shape of the bracket to compensate for shrinkage after ring, which
takes place at high temperatures (>1800 C). During ring, the binder is burned out,
and the alumina particles are sintered (i.e., solid-state fusion without melting),
providing the bracket with a polycrystalline alumina structure. Afterward the slot is

Orthodontic Applications of Biomaterials. http://dx.doi.org/10.1016/B978-0-08-100383-1.00003-5


Copyright 2017 Elsevier Ltd. All rights reserved.
62 Orthodontic Applications of Biomaterials

manufactured by milling with diamond cutting tools, and nally a special heat treat-
ment is applied to remove residual stresses resulting from the milling and surface im-
perfections created during the manufacturing process.1 The single-crystal brackets are
manufactured by milling high-purity single-crystal alumina bars. The milling is
accomplished by diamond cutting, ultrasonic cutting, or Nd:YAG lasers. Similar to
the manufacturing process of polycrystalline alumina brackets, a heat treatment is per-
formed for the single-crystal brackets to remove residual stresses. However, the poly-
crystalline alumina brackets contain more impurities in their microstructure because of
the need for binder to hold the particles together during the sintering process.1
Fig 3.1 illustrates some commercially available ceramic brackets. In an effort to
enhance chemical bonding with adhesive resins, glass phases are added in alumina
brackets to promote bonding with silane-coupling agents.10 The glassy phases bond
chemically with the silane, which also has a free end that can react with acrylic resins.
Representative spectra from X-ray energy-dispersive spectrometric analyses for a pure
alumina bracket are presented in Fig 3.2(a) and for another alumina bracket with Si and
Na additions in Fig 3.2(b). For polycrystalline alumina brackets, internal pores and
other defects have been identied by micro X-ray tomography analysis (Fig 3.3).
These imperfections may arise from incompletely sintered alumina particles, gas inclu-
sions, and other sources during the manufacturing process.

Figure 3.1 Polycrystalline alumina brackets with different levels of optical translucency. (Left
to right: Inspire ICE (Ormco), Virgine (Dentalline), Clarity (3M Unitek), Maia (Natural
Orthodontics), and Terga Ceramic (Royal Orthodontics)).

3.3 Optical properties of ceramic brackets


The optical properties of ceramic brackets are their major advantage over metallic
brackets for esthetics-conscious patients. Polycrystalline alumina brackets exhibit infe-
rior optical clarity compared to single-crystal brackets because of light scattering pro-
cesses at grain boundaries, variation in refractive index with crystallographic
directions within grains, and the presence of impurities.1,7 All these factors result in
some degree of opacity. Although increasing the grain size has a positive effect on
the optical clarity of alumina, when the grain size reaches about 30 mm, the material
becomes weaker. In contrast, the single-crystal alumina brackets demonstrate excellent
Structure/property relationships in orthodontic ceramics 63

(a) cps/eV
10 Al
9
8
7
6
5
4
3
O
2
1
0
0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
KeV
(b) cps/eV
Al

25

20

15

O
10

5 Si
Na
0
0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
KeV
Figure 3.2 Representative energy-dispersive spectrometric spectra from a pure alumina bracket
(a) and from a bracket with Si and Na in its formulation (b).

optical clarity because of the absence of grain boundaries and fewer impurities arising
from the manufacturing process.10 Fig 3.4 provides a comparison of direct light trans-
mittance for several alumina brackets, and it is evident that the single-crystal brackets
are superior to the polycrystalline brackets.11 The same trend was veried for diffuse
light transmittance, presented in Fig 3.5.12 Both types of alumina brackets provide sub-
stantial stability in light transmission and reection after articial aging.13
However, the optical properties of ceramic brackets, beyond their esthetic appearance,
may adversely affect the properties of light-cured adhesive resins by hindering the curing
due to the scattering of light at the grain boundaries and the reduction in intensity of light
passing through the bracket structure.14 Measurements at the peak optical absorption
wavelength (468 nm) of the photoinitiator camphorquinone indicated that the direct light
transmittance for single-crystal alumina brackets was around 35% and less than 5% for
64 Orthodontic Applications of Biomaterials

0 mm 2.0 4.0 0 mm 2.0 4.0

2.0 2.0

4.0 4.0

Figure 3.3 Two horizontal layers of a ceramic bracket at different elevations after
microcomputerized X-ray tomography analysis. Both layers contain internal defects, indicated
by the arrows. The red lines in the inset gures indicate the elevation of each horizontal layer.
The vertical and horizontal scales are shown in millimeters.

Direct light transmittance mode


Transmittance (%)
0 5 10 15 20 25 30 35 40
Radiance (American Orthodontics)
Pure (Ortho Technology)
Illusion (Ortho Organizers)
Brackets

Translux (Aditek Itma)


Clarity (3M Unitek)
Iceram (Orthometric)
Signature (Rocky Mountain Orthodontics)
Monocrystalline
Mystique (GAC)
Polycrystalline
Allure (GAC)

Figure 3.4 Percentage of direct light transmittance for monocrystalline and polycrystalline
ceramic brackets.

polycrystalline alumina brackets; the latter attributed to light scattering at grain bound-
aries.1 However, when the same products were tested in the diffuse light transmittance
mode at the same wavelength, the percentage transmittance values were increased four
times for the polycrystalline brackets and two times for the single-crystal brackets. It is
worthwhile to note that the bracket products with lower direct light transmittance have
similar low values of diffuse light transmittance. It has been proposed that a critical value
of 30e40% for light transmittance through the ceramic brackets must be achieved for
adequate polymerization of the adhesive resin.1
Structure/property relationships in orthodontic ceramics 65

Transmittance (%)
0 10 20 30 40 50 60 70 80

Inspire Ice (3M Unitek)

Crystalline V (Tomy)
Brackets

Clarity (3M Unitek)

Monocrystalline
Luxi II (Rocky Mountain Orthodontics) Polycrystalline

Figure 3.5 Percentage of diffuse light transmittance for monocrystalline and polycrystalline
alumina brackets.

3.4 Mechanical properties of ceramic brackets and


clinical implications
Alumina brackets have varying mechanical properties because of the effects of grain
boundaries, impurities, and internal defects arising from the manufacturing process.
Table 3.1 provides selected mechanical properties of single-crystal and polycrystalline
alumina. It can be seen that polycrystalline alumina has inferior values other than for
fracture toughness.

Mechanical properties of monocrystalline and


Table 3.1
polycrystalline alumina1,10,15
Property Monocrystalline Polycrystalline

Modulus of elasticity (GPa) 430 390


Bending strength (MPa) 630 280
Compressive strength (MPa) 2100e4100 2400
Tensile strength (MPa) 1800e2600 210e310
1/2
Fracture toughness KIc (MPa$m ) 2.3 5e6

3.4.1 Fracture strength


Fracture strength is the ability of a material to resist failure and is designated specif-
ically according to the mode of applied loading, such as tensile, compressive, or
66 Orthodontic Applications of Biomaterials

bending. Polycrystalline alumina is much weaker than monocrystalline alumina


(Table 3.1), which is stronger than stainless steel.10,16 The fracture strength of ceramic
brackets is crucially dependent on the surface quality. Grooves, scratches, and other
imperfections will drastically reduce the fracture strength,10,17e19 and thus the surface
nishing has a signicant effect on fracture strength of ceramic brackets.

3.4.2 Fracture toughness


Fracture toughness is a fundamental materials property, indicating the strain energye
absorbing ability of a material prior to fracture. The higher the fracture toughness, the
higher the material resistance to crack propagation. Crystalline ceramics, such as
alumina, have complex crystal structures along with strong, directional, covalent
atomic bonding. These factors hinder the movement of dislocations that provides
the mechanism for permanent deformation of metallic materials, as discussed in
Chapter 1. Therefore, when ceramic materials are loaded to their maximum elastic
stress, the interatomic bonds break, and brittle fracture occurs through the mecha-
nism of crack propagation. The absence of plastic deformation is termed as brittle
fracture. The fracture toughness of alumina is 20e40 times lower than stainless
steel,17,20 implying that fracture is much more likely to occur in a ceramic bracket
than a metallic bracket. In polycrystalline ceramics the crack propagation follows
an irregular path along the weaker grain boundaries rather than across the grains.
Consequently, polycrystalline alumina has higher fracture toughness than monocrys-
talline alumina.
The brittle nature of ceramic brackets has been associated with the higher incidence
of bracket failure during the debonding process after the end of orthodontic treat-
ment.18,21 The combination of brittleness and hardness of ceramic brackets, along
with high bond strength to enamel, results in two signicant clinical complications
during orthodontic therapy. The rst is bracket fracture during debonding, and the sec-
ond is enamel fracture during debonding.3,22

3.4.3 Hardness
In general, ceramics are well known for high hardness, and alumina ceramic brackets
are much harder than metallic brackets and tooth enamel.16 The considerable differ-
ence in hardness will induce rapid wear of human enamel when there is contact of
opposing teeth with the ceramic brackets.17,22,23 The enamel damage when the
opposing teeth come in contact with single-crystal alumina brackets is higher
compared to that in polycrystalline alumina brackets.17 It is considered that contact
of teeth with ceramic brackets must be eliminated to avoid abrasion of human enamel,
which can be achieved in two ways. The rst approach is the coverage of the occlusal
surfaces of ceramic brackets with special elastomeric rings. The second approach is the
application of techniques that minimize the adverse effects of parafunctional habits of
patients and thereby eliminate occlusal interferences.16,24
Structure/property relationships in orthodontic ceramics 67

3.5 Base characteristics of ceramic brackets


The clinical importance of bracket base morphology is twofold. The rst is related to
the fact that the longevity and integrity of the adhesive bond to enamel depend strongly
on the base characteristics. The second is associated with the effect of base character-
istics on enamel damage after debonding of the ceramic brackets, as previously
described. In general, the bonding mechanisms that have been implemented by man-
ufacturers are classied into three major categories:
1. mechanical retention employing undercuts and grooves that provide interlocking;
2. chemical coating which enhances bond strength by chemical bonding with the adhesive
resin; and
3. micromechanical retention using surface features in the micron size range, such as spherical
particles, protruding crystals, and grooves, to increase retention with resin.
Examples of the rst manufacturer strategy are illustrated in Fig. 3.6. The base
morphology utilizes large recesses such as grooves and undercuts, as shown in (a),
(c), and (e), to provide mechanical bonding to the adhesive resin. In some commercial
products, this surface pattern is combined with the presence of a silane layer to increase
further the bond strength with enamel.25
The second strategy employs brackets with a smooth base surface where the
bonding with adhesive resin relies on a chemical coating. A silane layer is applied
on the surface and used as a coupling agent between the inert alumina and the adhesive
resin to promote chemical adhesion. It has been previously reported that this technol-
ogy provided even higher bond strength compared to mechanical retention.25
The third category uses a rough base to provide micromechanical retention to the
adhesive resin,26 as illustrated in Fig. 3.7. The surface consists of spherical particles,
as shown in (a) and (b) or sharp-edged randomly oriented crystals, as shown in (c) and
(d). This type of micromechanical bonding does not appear to provide sites of prob-
lematic local stress concentrations, thus developing a more homogeneous shear stress
distribution over the entire underlying adhesive resin.1
Initially the manufacturers of ceramic brackets tried to modify their products to
achieve the highest possible bond strengths to the adhesive resin and enamel, since
inadvertent premature debonding during treatment would be an unpleasant event for
the orthodontist and patient. However, after an increasing number of reports for cohe-
sive enamel fracture after debonding of ceramic brackets, the manufacturers modied
the bonding mechanism by employing the following new strategies:
1. reduction of mechanical retention by decreasing the number of protruding features with a
simultaneous increase in their size;
2. combination of a low elastic modulus material with the rigid ceramic bracket to yield a more
exible base to facilitate debonding; and
3. elimination of chemical bonding, which had previously been accomplished with the silane
coating.

Although these latter strategies have reduced the incidence of enamel fracture, this
complication has still not been eliminated. Manufacturers often focus in product
68 Orthodontic Applications of Biomaterials

(a) (b)

(c) (d)

(e) (f)

Figure 3.6 Bases of ceramic brackets shown in (a), (c), and (e) use various designs of surface
grooves to increase mechanical retention to the adhesive resin (original magnication  25).
(b) Details of surface grooves in (a) at higher magnication (original magnication  78).
(d) Details of the at surface for (c) and (f) details of the at surface for (e), where the grain
boundaries of polycrystalline alumina have been revealed (original magnication  1000).
Structure/property relationships in orthodontic ceramics 69

(a) (b)

(c) (d)

Figure 3.7 Bases of ceramic brackets with rough surfaces, shown at low magnication in
(a) and (c), for promoting micromechanical retention to the adhesive resin. (b) Details of (a),
showing the spherical particles (original magnication 1000). (d) Details of (c), showing the
sharp-edged crystal protrusions used to promote micromechanical retention (original
magnication 200).

information literature on the debonding features of their ceramic brackets, aiming to


overcome the past negative publicity about this aspect.1

3.6 Concluding remarks


Ceramic brackets have become popular esthetic devices that are extensively used in
orthodontic practice. Although both types of alumina brackets are commercially avail-
able, the majority of contemporary alumina ceramic brackets are made of polycrystal-
line, rather than single-crystal alumina. Based on clinical experience, ceramic brackets
are characterized as devices that allow adequate force control over the long period of
orthodontic treatment, are durable, and have low risk for discoloration.27 However,
breakage of ceramic brackets, associated with their brittle nature, is an inherent
70 Orthodontic Applications of Biomaterials

problem and can occur during treatment or the debonding process.3,28 Manufacturers
have employed a variety of strategies to minimize the fracture of the ceramic brackets
during debonding. Despite these concerns, the introduction of alumina ceramic
brackets has been an important development that has expanded contemporary ortho-
dontic treatment, notably for adult patients who are strongly concerned about esthetics.

References
1. Eliades T, Eliades G, Brantley W. Orthodontic brackets. In: Brantley WA, Eliades T,
editors. Orthodontic materials. Stuttgard: Thieme; 2001. p. 151e69.
2. Jena A, Duggal R, Mehtora A. Physical properties and clinical characteristics of ceramic
brackets: a comprehensive review. Trends Biomater Artic Organs 2007;20:101e15.
3. Winchester LJ. Bond strengths of ve different ceramic brackets: an in vitro study. Eur J
Orthod 1991;13:293e305.
4. Harris AM, Joseph VP, Rossouw PE. Shear peel bond strengths of esthetic orthodontic
brackets. Am J Orthod Dentofac Orthop 1992;102:215e9.
5. Eliades T. Orthodontic materials research and applications: part 2. Current status and
projected future developments in materials and biocompatibility. Am J Orthod Dentofac
Orthop 2007;131:253e62.
6. Karamouzos A, Athanasiou AE, Papadopoulos MA. Clinical characteristics and properties
of ceramic brackets: a comprehensive review. Am J Orthod Dentofac Orthop 1997;112:
34e40.
7. Bishara SE, Fehr DE. Ceramic brackets: something old, something new, a review. Semin
Orthod 1997;3:178e88.
8. Keith O, Kusy RP, Whitley JQ. Zirconia brackets: an evaluation of morphology and
coefcients of friction. Am J Orthod Dentofac Orthop 1994;106:605e14.
9. Springate SD, Winchester LJ. An evaluation of zirconium oxide brackets: a preliminary
laboratory and clinical report. Br J Orthod 1991;18:203e9.
10. Swartz ML. Ceramic brackets. J Clin Orthod 1988;22:82e8.
11. Lopes Filho H, Maia LE, Araujo MV, Ruellas AC. Inuence of optical properties of esthetic
brackets (color, translucence, and uorescence) on visual perception. Am J Orthod Dentofac
Orthop 2012;141:460e7.
12. Lee YK. Colour and translucency of tooth-coloured orthodontic brackets. Eur J Orthod
2008;30:205e10.
13. Lee YK. Changes in the reected and transmitted color of esthetic brackets after thermal
cycling. Am J Orthod Dentofac Orthop 2008;133(641):e641e6.
14. Lim YK, Lee YK. Inuence of light transmittance and background reectance on the light
curing of adhesives used to bond esthetic brackets. Am J Orthod Dentofac Orthop 2007;
132(5):e17e24.
15. Mitamura Y, Wang Y. Fracture toughness of single crystal alumina in air and a simulated
body environment. J Biomed Mater Res 1994;28:813e7.
16. Birnie D. Ceramic brackets. Br J Orthod 1990;17:71e4.
17. Viazis AD, DeLong R, Bevis RR, Rudney JD, Pintado MR. Enamel abrasion from ceramic
orthodontic brackets under an articial oral environment. Am J Orthod Dentofac Orthop
1990;98:103e9.
Structure/property relationships in orthodontic ceramics 71

18. Scott Jr GE. Fracture toughness and surface cracksethe key to understanding ceramic
brackets. Angle Orthod 1988;58:5e8.
19. Holt MH, Nanda RS, Duncanson Jr MG. Fracture resistance of ceramic brackets during arch
wire torsion. Am J Orthod Dentofac Orthop 1991;99:287e93.
20. Ghafari J. Problems associated with ceramic brackets suggest limiting use to selected teeth.
Angle Orthod 1992;62:145e52.
21. Kusy RP. Morphology of polycrystalline alumina brackets and its relationship to fracture
toughness and strength. Angle Orthod 1988;58:197e203.
22. Jeiroudi MT. Enamel fracture caused by ceramic brackets. Am J Orthod Dentofac Orthop
1991;99:97e9.
23. Gibbs SL. Clinical performance of ceramic brackets: a survey of British orthodontists
experience. Br J Orthod 1992;19:191e7.
24. Douglass JB. Enamel wear caused by ceramic brackets. Am J Orthod Dentofac Orthop
1989;95:96e8.
25. Viazis AD, Cavanaugh G, Bevis RR. Bond strength of ceramic brackets under shear stress:
an in vitro report. Am J Orthod Dentofac Orthop 1990;98:214e21.
26. Eliades T, Lekka M, Eliades G, Brantley WA. Surface characterization of ceramic brackets:
a multitechnique approach. Am J Orthod Dentofac Orthop 1994;105:10e8.
27. Forsberg CM, Hagberg C. Shear bond strength of ceramic brackets with chemical or me-
chanical retention. Br J Orthod 1992;19:183e9.
28. Viazis AD, Chabot KA, Kucheria CS. Scanning electron microscope (SEM) evaluation of
clinical failures of single crystal ceramic brackets. Am J Orthod Dentofac Orthop 1993;103:
537e44.

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