Banding and Bonding in

Orthodontics

Moderator: Dr PRAVEEN
Presented By: N. SHWETA 1
 • Banding: Background
Contents: Ideal characteristics
Indications and contraindications
Types of bands
Steps in band formation
Advantages and disadvantages of banding
• Bonding: History
Advantages and disadvantages of bonding
Basis of bonding
Types of bonding
Steps in bonding
Bonding to non tooth surfaces
Rebonding and recycling
Debonding
Bonded retainers
Other applications of bonding
Banding Vs Bonding
2
• References
Background:

3
Ideal Characteristics:

• It should fit the contours of the tooth as closely as possible

• Should not extend subgingivally any more than necessary

• Band material should resist deformation under stresses in the

mouth

• Resist tarnish and corrosion

• Should not cause occlusal interference

4
Indications for Banding:

 Teeth that will receive heavy intermittent forces

 Teeth that requires both labial and lingual attachments

 Teeth with short clinical crowns

 Teeth with extensive restorations

 Appliances that require soldering attachments

5
Contraindications:

• Anterior regions- unaesthetic

• Patients with high caries risk

• Periodontally compromised patients

6
 Types of Bands

Custom fabricated Pre formed bands

bands

7
 Band formation
Direct band formation Indirect band technique

8
 Steps in Direct banding
Step 1: Tooth Separation

Separating Elastomeric separators

springs (doughnuts)

9
Other methods of tooth separation:

Soft brass wire:

10
Elastic thread separator:

11
Dumbbell separator:

12
Step 2: Selection of Band Material
Thickness of band material

Thinner band material- 0.010 x 3.80 mm- Anterior teeth

Thicker band material:
0.12 x 4.55 mm- Premolars
0.15 x 4.55 mm- Molars

Type of material:

Gold
Stainless steel
Chrome alloy
13
Step 3: Band Pinching and Fitting
It requires various armamentarium:
Band forming plier Johnson contouring plier

14
15
 Fitting of pre formed bands
Band seater Band pusher

16
Fitting of pre formed bands

17
• Gingival margin: extends 0.5 to 1mm into
gingival sulcus

• Occlusal margin: should be 1mm below the

proximal ridges

• Buccal margin: It should be just below the

level where the opposing cusps touch the
grooves

• Lingual Margin: Placed just below the

deepest portion of the lingual developmental
groove
18
Step 4: Fixing attachments

• Buccal tubes
• Lingual button
• Lingual tubes
• Lingual sheaths
19
Methods of fixing attachments to the band:

• Soldering

• Spot welding

• Laser welding

20
Spot welding:

• Typical values for the pulse are 2-6 volts for 1/25-1/50th of a
second at 250-750 amperes

21
Disadvantages of spot welding:

• Improper current, duration and pressure can lead to over and under
welding

• Under welding- detachment of the auxiliaries

• Over welding- Yields a weak joint

Joint more prone to corrosion due to weld decay

• Extensive damage to the microstructure of the metal

22
Laser welding:

• Laser generates a coherent, high intensity impulse of light

that can be focused.

• By selecting the duration and intensity of impulse, metals

can be melted in small regions without extensive
microstructural damage

• Argon gas is generally recommended when laser

welding stainless steel. Improper argon flow will lead
to oxidation of the metal

23
Advantages of laser welding:
• Extremely accurate
• Welding of complicated joint geometries can be done
• Low thermal distortion
• Cavity free welds
• Large working distance- welding up to 500mm distance and
also to inaccessible parts
• Welds dissimilar metals
• Narrow heat affected zone
Disadvantages:
• Expensive equipment and maintenance cost
• Rapid cooling may cause cracking in some metals
24
Step 5: Cementation
3 steps of Band Cementation:

• Wax is applied on the tubes to prevent clogging

of the tubes and attachments. The tooth is
isolated

• A cement spatula is used to apply the cement to

the bands and an even layer is applied over the
inner side of the band

• Band is placed and positioned via finger

pressure. Band pusher is finally used to seat the
band. Excess cement is wiped off. The cement
is light cured or allowed to set, before violating
the isolation. 25
Luting Cements:

Zinc phosphate cement:

Zinc polycarboxylate:

26
Glass ionomer cement:

(Current products and practice, orthodontic

cements, Nicola Johnson, JO Sep 2000) 27
Resin modified GIC:

Hybrid-Acid based CaAI/ GIC:

• Ceramir C & B (Doxa Dental AB, Uppsala, Sweden)

• Hybrid composition comprising of calcium aluminate and glass

ionomer components mixed with distilled water

28
Adhesive Resin cements:

Acid modified composite resin cement:

29
30
Indirect banding:

• Elastomeric impression made, casts are poured and a die is fabricated

31
(John T. Lindquist (1959) Indirect Band Technic. The Angle Orthodontist: April 1959, Vol. 29, No. 2, pp. 114-122)
• Band construction and die re-assembly

32
Advantages of banding:

• Good attachment to tooth surface than a bonded attachment

• Protection against inter proximal caries in a well contoured band

• Lingual auxiliaries can be easily attached

• Reattachment of the loosened band is easy

• Superior reliability due to better resistance to occlusal

interferences

33
Disadvantages:

 Precise bracket placement not possible

 The placement is difficult especially in aberrant tooth
shapes
 Risk of enamel decalcification and caries
 Band material may cause increase in arch length
 Unesthetic
 Patient discomfort
 Repeated manipulation can lead to distortion of the band
 Time consuming
 Technique sensitive

34
History:
• 1955- Buonocore demonstrated the acid etch technique using 85%
phosphoric acid.
• 1965- Advent of epoxy resin bonding.
• 1968- Smith introduced Zinc Polyacrylate cement.
• Around 1970- Miura et al described an acrylic resin Orthomite.
Bowen’s resin or bisGMA was designed.
• 1977- First detailed post treatment evaluation of direct bonding
was published.
• 1979- Survey in US found that 93% of orthodontists used
bonding for bracket attachment.

35
Advantages of Bonding:

 Aesthetically superior
 Faster and simpler
 Less discomfort for the patient
 Arch length not increased by the band material
 Precise bracket placement
 Improved gingival condition
 Mesiodistal enamel reduction possible during treatment
 Interproximal areas are accessible for composite build-ups
 No band spaces to close at the end of treatment
 Brackets can be recycled

36
Disadvantages:

 A bonded bracket has a weaker attachment than a cemented band

 Better access for cleaning does not necessarily guarantee better oral
hygiene

 Protection against inter proximal caries is absent

 Not indicated when heavier forces are applied

 Rebonding a loose bracket requires more preparation

 Debonding is difficult and time consuming

37
Basis of Bonding:

38
 Types of bonding
Direct bonding Indirect bonding

39
 Steps in Direct Bonding
Step 1: Cleaning

 Done with pumice

 To remove plaque and organic pellicle

Enamel Deprotenization:
• Use of 5.25% Sodium hypochlorite for 60 seconds as a deprotenizing agent
before etching gives good results

• Enamel deprotenization with 10% papain gel increases shear bond strength

40
Step 2: Enamel conditioning
Moisture control:

 Lip expanders and Cheek retractors

 Saliva ejectors
 Tongue guards and bite blocks
 Salivary duct obstructers
 Cotton gauze and rolls
 Antisialogauges

41
Enamel Pre-treatment:
Acid etching:

Acids used: 37% phosphoric acid

10% maleic acid
50% tannic acid
50% citric acid

Duration: 15-60 seconds using 37% phosphoric acid

42
Shear bond strength and acid etching:
• Etching with 30-40% of phosphoric acid produces the highest bond
strength to enamel ( Wang et al AO 1994)
• The use of 10% maleic acid results in a lower bond strength (
Powers and Kim, Semin orthod 1997)

• Use of 50% tannic acid for 90 seconds showed bond strengths comparable
to 37% Phosphoric acid for 15 seconds

• 50% citric acid for 1 minute did not result in attainment of adequate bond
strength
( Comparative evaluation of Tannic, citric and phosphoric acids as etching agents for direct bonding, JIOS 2002)

• Decreasing etching time between 30 and 10 seconds does not affect bond
strength (11mpa) , whereas etching for 0-5 seconds reduces bond strength
(less than 3 mpa) significantly 43
Fluorides and bond strengths:

• Teeth with higher concentrations of fluorides are more resistant

to acid etching and may require extended etching time

• In a group of severe and moderate fluorosis of teeth, the bond

strength was about 40% lower than the bond strength of normal
teeth

• But mild to moderate fluorosis did not affect the bond strength

44
Procedure:

45
• Characteristics of the enamel surface are
altered by acid dissolution, which creates
micro porosities that result in a
micromechanical bond.

• This surface irregularity is clinically

observed as the well known “frosty”
appearance.
46
Iatrogenic effects of etching:
• Fracture and cracking of enamel upon debonding

• Increased surface porosity- risk of possible staining

• Loss of acquired fluoride in outer 10 micro meter of enamel surface

• Loss of enamel during etching about 10-20 micro meter of enamel

• Resin tags retained in enamel- possible discolouration

• Rough surface, if over etched.

47
Other Methods of Enamel Pre treatment

• Crystal bonding

• Air abrasion

• Laser etching

48
Crystal bonding:
• Developed by Maijer and smith at the university of Toronto

• An alternate to etching enamel for retention of an adhesive is to grow crystals on the

enamel surface

• It involves application to enamel of a poly acrylic acid solution containing sulfate ions,
which causes growth of calcium sulfate dihydate crystals on the enamel surface. These
crystals retain the adhesive.

• Advantages:
Easier debonding
Less residual adhesive
Less damage to enamel

• Bond strength was found to be 60-80% less than with conventional acid etching.
Maijer and smith, AJO 1982 49
Air abrasion:
• Also referred as micro etching, in which particles of 50 or 90 micro meter
aluminium oxide are propelled against the surface of enamel by high air
pressure (7 kg/cm), causing abrasion of the surface

• It is done using intra oral sand blasters. Duration- 3 seconds

• It could also be an alternative to pumicing the teeth before etching

• If the patient is allergic to aluminium oxide, then silicon carbide can be

used.

• Sand blasting without acid etching produces lower bond strengths, while the
combination of the two produces bond strengths higher than acid etched
enamel.
50
Laser etching:

• The application of laser energy to an enamel surface

causes localized melting and ablation

• Laser etching of enamel by neodymium- yttrium

aluminium garnet (Nd:YAG) laser typically produces
lower bond strengths than does acid etching

• Carbon dioxide laser etching of enamel have shown that

bond strengths of 10 Mpa can be obtained reliably

51
Step 3: Sealing
• Application of a thin layer of bonding agent (sealant, primer)
over the entire etched enamel surface is suggested by all the
manufacturers.

• If excessive, the coating should be thinned by a gentle air burst.

A thick layer may cause "drifting“ before curing is initiated and
may interfere with the precise adaptation of the bracket base.

• Separate curing of the bonding agent is not necessary,

even when light -cured products are used. The layer may be
Pre cured in difficult-to-reach areas where moisture contamination
is likely.

• Reapplication of the sealed layer is not

required when saliva contamination occurs, but the area
should be air-dried before bracket placement.

52
Self etching primers:

53
Comparison of the efficacy of a conventional primer and a self-etching primer
Int Orthod. 2016 Jun;14(2):195-205
INTRODUCTION:
In orthodontic practice, the bonding protocol makes use of a primer between the bracket and the enamel surface to create a reliable bond.
In order to optimize the technique and reduce bonding time, a new group of primers has been introduced in orthodontics: the self-etching
primers (SEP). The aim of this work was to compare their efficacy with that of a traditional primer.
MATERIALS AND METHOD:
This study is a single-center, single-blind, clinical trial using the SEP system on teeth 14 and 25 and the Ortho-Solo(®) system (traditional
hydrophilic primer) on teeth 24 and 15 in the same patient. The study population was composed of 100 patients treated in a private
orthodontic office in Casablanca. Recruitment for this sample included all patients treated orthodontically without extractions, possessing
teeth that were considered healthy, with no occlusal interferences; on the other hand, all patients with mental or physical disabilities, those
aged under 14 and those with poor orodental hygiene were excluded from the study. The Kaplan-Meier test was used to compare results.
RESULTS:
The bond failure rates for the two groups were 7.5% in the SEP group and 9% in the Ortho-Solo(®) group. The difference between these
two adhesive systems was not statistically significant (P=0.34). Concerning the type of bond failure, the comparison again shows no
statistically significant difference (P=0.44). In both systems, cohesive failures concerned only 2% of all the brackets bonded.
DISCUSSION:
The clinical trial was performed with a crossover design to avoid bias due to chewing patterns, a factor that is responsible for most of the
failures noted in the study. The results of the studies by Miller and Buyukyilmaz, and some others, are in agreement with our results.
However other in vivo and in vitro studies contradict our results, showing higher bond failure rates with the self-etching system.
CONCLUSION:
SEP is as effective as a traditional hydrophilic adhesive and, in addition, possesses advantages in terms of ergonomics and chair-time. The
literature confirms the data of this clinical trial and recommends the use of SEP; the only remaining limitation is its high cost

54
Effects of different orthodontic primers on enamel demineralization around orthodontic brackets
J Orofac Orthop. 2015 Sep;76(5):421-30
AIM:
The purpose of this work is to evaluate the effectiveness of one self-etching and two filled orthodontic primers on enamel
demineralization around orthodontic brackets.

METHODS:
Brackets were bonded to 84 bovine teeth and the vestibular enamel surfaces covered with acid-resistant nail varnish exposing 1
mm of space on each side of the bracket base. The teeth were allocated to four groups, using either Transbond XT conventional
primer on etched enamel (group 1), Transbond Plus Self-Etching Primer on untreated enamel (group 2), Pro Seal filled resin
primer on etched enamel (group 3), or Opal Seal filled resin primer on etched enamel (group 4). Each tooth was subjected to
15,000 strokes of brushing followed by exposure to an acid challenge. Calcium-ion release from each sample was calculated
using atomic absorption spectrophotometry. Data were analyzed using one-way ANOVA and a post hoc Tukey test. Differences
were considered statistically significant at p ≤ 0.05.

RESULTS:
Statistically significant differences were observed between the four groups (p < 0.001). No significant difference was found
between the controls (group 1) and the Opal Seal group. Higher calcium release was observed in the Pro Seal group and the
self-etching primer group compared to the controls. The highest calcium release was recorded in the self-etching primer group.

CONCLUSION:
Filled sealants may not have a protective effect against enamel demineralization. Transbond Plus Self-Etching Primer should be
used cautiously, considering the risk of demineralization involved in its application. 55
Moisture insensitive primers

• In an attempt to reduce the bond failure rates under moisture contaminations,

hydrophilic primers that can bond in wet fields (Transbond MIP, 3M/Unitek, Monrovia,
California and Assure, Reliance Orthodontics, Itasca, Illinois) have been introduced as a
potential solution

• Useful in difficult moisture control situations

• The hydrophilic resin sealants or primers polymerize in the presence of a slight amount
of water, but they will not compensate routinely for saliva contamination.

56
Step 4: Bonding

a) Transfer

b) Positioning

c) Fitting

d) Removal of excess

57
Transfer:

58
Positioning:

59
Fitting:

60
Removal of excess and light curing:

61
Excess material causing Large or small oval tungsten carbide bur can be
gingival irritation used to remove the excess material
62
Types of adhesives:
Glass Ionomer cements:
• They adhere to both enamel and metal.
• These cements release fluoride and therefore may prevent enamel
decalcification
• Glass ionomer cements can be removed with
much less difficulty than composite resin after debonding,
because the cement remaining on the tooth surface can be
desiccated by simply air drying it, thus rendering it more friable.
• Poor bond strength and is not used anymore
• Increased setting time
63
Self curing acrylic resins:

• They are of two types: acrylic and diacrylate resins

• Acrylic resin consists of a methylmethacrylate monomer and an

ultrafine powder

• Diacrylates are based on acrylic modified epoxy resins ie BisGMA

• Both types exist as filled and unfilled form, of which filled diacrylate
resins of BisGMA has the best physical properties and are strongest
adhesives for metal brackets

64
No mix adhesives:
• They set when one paste under light pressure is brought together with the primer fluid on
the etched enamel and the back of the bracket

• Thus one adhesive component is applied to the bracket base while another is applied to
the dried etched tooth

• As soon as it is precisely positioned, the bracket is pressed firmly into place and setting
occurs in 30-60 seconds

• Long term information about their bond strength is not available

• In vitro studies have shown that the liquid activators of this system are toxic and allergic
reactions have been reported.

65
Enamel shear bond strength of two orthodontic self-etching bonding systems compared to
TransbondTM XT, J Orofac Orthop, 2016

Objective: The aim of this in vitro study was to compare the shear bond strength (SBS) and Adhesive Remnant Index (ARI)
scores of two self-etching no-mix adhesives (Prompt L-PopTM and ScotchbondTM) for orthodontic appliances to the
commonly used total etch system Transbond XTTM (in combination with phosphoric acid).
Materials and methods: In all, 60 human premolars were randomly divided into three groups of 20 specimens each. In group 1
(control), brackets were bonded with TransbondTM XT primer. Prompt L-PopTM (group 2) and ScotchbondTM Universal
(group 3) were used in the experimental groups.
Lower premolar brackets were bonded by light curing the adhesive. After 24 h of storage, the shear bond strength (SBS) was
measured using a Zwicki 1120 testing machine. The adhesive remnant index (ARI) was determined under 109 magnification.
The Kruskal–Wallis test was used to statistically compare the SBS and the ARI scores.
Results :No significant differences in the SBS between any of the experimental groups were detected (group 1: 15.49 ± 3.28
MPa; group 2: 13.89 ± 4.95 MPa; group 3: 14.35 ± 3.56 MPa; p = 0.489), nor were there any significant differences in the ARI
scores (p = 0.368).
Conclusions: Using the two self-etching no-mix adhesives(Prompt L-PopTM and ScotchbondTM) for orthodontic appliances
does not affect either the SBS or ARI scores in comparison with the commonly used total-etch system TransbondTM XT. In
addition, ScotchbondTM Universal supports bonding on all types of surfaces (enamel, metal, composite, and porcelain) with no
need for additional primers. It might therefore be helpful for simplifying bonding in orthodontic procedures.

66
Moisture active adhesives:

• Moisture active adhesives require rather than tolerate the presence of

moisture for proper polymerization

• They are available as pastes and require no bonding agent

• A recent product based on cyanoacrylate formulation ( smart bond)

has demonstrated superior properties, excellent in vitro performance
and easy clinical application without need for etching and sealing.

67
Visible light polymerized resins:

• The light-initiated resins by now have become the most popular adhesives
• They are usually dual cure resins with light initiators and a chemical catalyst
• These resins offer the advantage of extended, though not indefinite, working time.
• Maximum curing depth of light-activated resins depends on the composition of the
composite, the light source, and the exposure time.
• Bond strength for light-activated materials is reported to be comparable in vitro to
those of chemically cured composites.
• Fluoride-releasing, visible light–curing adhesives are also available
• Metallic and ceramic brackets pre coated with light cured composite and stored in
suitable containers are practical in use and are becoming increasingly more popular
• Such brackets have consistent quality of adhesive, reduced flash, reduced waste,
improved cross-infection control and adequate bond strength
• Recently, some pre coated brands (APC Plus, 3M/Unitek) are provided with a
colour change adhesive for easier and more thorough flash clean up.
68
Light sources:
• Conventional and fast halogen lights:

69
• Argon lasers

• Plasma arc lights 70

The Effect of Argon Laser Irradiation on Demineralization Resistance of Human
Enamel Adjacent to Orthodontic Brackets: An In Vitro Study (Angle Orthod 2003;73:249–
258.)
On the basis of this in vitro study, the following conclusions were made.

• Brackets cured with the argon laser for five seconds yielded bond strengths similar to a 40-second
conventional light-cured control group.

• Brackets cured with the argon laser for 10 seconds resulted in significantly lower mean lesion depth when
compared with a visible light control.

• Clinical appearance of decalcification is not a good indicator of lesion depth.

• Argon lasers used for bonding orthodontic brackets would save a significant amount of chair time while
conferring some demineralization resistance upon the enamel.

• Well-controlled randomized clinical trials are needed to investigate the argon laser’s efficacy in reducing white
spot demineralization during orthodontic treatment.

• Further research into the correlation between lesion depths and clinical appearance as well as in vivo
monitoring of demineralization would have great importance in orthodontics. 71
• Light emitting diodes (LED):

72
73
Indirect bonding
using a clear tray:

74
Indirect bonding using
light cured base
composite:

75
Reasons for differences in bond strength between direct and indirect
bonding techniques:

• The bracket bases may be fitted closer to the tooth surfaces with
one point contact with scaler than when a transfer tray is place
over the teeth

• A totally undisturbed setting is obtained easily with direct

bonding

76
Bonding to crowns and restorations:
Porcelain crowns:

77
Amalgam filling:

78
Bonding to gold:

79
Bonding to composite restorations:

80
Rebonding and Recycling:
• Heat (450 deg) used to burn off resin, followed by electro polishing
• Sandblasting

81
 In Vitro Tensile Bond Strengths of a Resin
Composite Orthodontic Adhesive to Different Types
of Reconditioned Metal Brackets Prepared for
Rebonding

Treatment Bond Strength MPa

New bracket 10
Ground to metal with green stone 6
Chemical reconditioning 7
Thermal reconditioning 8

Orthodontic Adhesives and Bond Strength Testing, Semin orthod 1997;3; 147-156 82
Debonding:

 Bracket removal

 Removal of residual adhesive

83
Methods of Bracket removal:

 Mechanical

 Electro thermal

 Laser

 Ultrasonic

84
 Mechanical
Steel brackets Ceramic brackets

85
 Lift off debonding plier

Weingart plier

Pistol grip debonding

instrument

Bracket removal
plier
86
Ceramic bracket design showing a vertical scribe line
placed in the base of the appliance for ease of removal or debonding

87
What is the best method for debonding metallic brackets from the patient’s
perspective? Pithon et al. Progress in Orthodontics (2015) 16:17
Background: The aim of this clinical investigation was to compare the level of discomfort reported by patients during
the removal of orthodontic metallic brackets performed with four different debonding instruments.

Methods: The sample examined in this split-mouth study comprised a total of 70 patients (840 teeth). Four different
methods of bracket removal were used: lift-off debonding instrument (LODI), straight cutter plier (SC), how plier (HP),
and bracket removal plier (BRP). Prior to debonding with all experimental methods, the archwire was removed. Before
appliance removal, each patient was instructed about the study objectives. It was explained that at the end of debonding
in each quadrant, it would be necessary to assess the discomfort of the procedure using a visual analog scale (VAS).
This scale was composed of a millimeter ruler scoring from 0 to 10, in which 0 = a lot of pain, 5 =moderate pain, and
10 = painless. The level of significance was predetermined at 5 % (p = 0.05), and the data were analyzed using the BioEstat
5.0 software (BioEstat, Belém, Brazil).

Results: The pain scores with SC were significantly higher than in all other methods. There were no significant
differences between HP and BRP pain scores, and the LODI group showed the lowest pain scores. Statistically,
significant differences were observed in the ARI between the four debonding methods.

Limitations: The biggest limitation of this study is that each tooth was not assessed individually.

Conclusions: Patients reported lower levels of pain and discomfort when metallic brackets were removed with the
LODI. The use of a straight cutter plier caused the highest pain and discomfort scores during debonding. 88
Electro thermal:

89
Histological evaluation after electrothermal debonding of ceramic brackets
Indian Journal of Dental Research, 25(2), 2014

Aim: To evaluate the histological changes following electrothermal debonding (ETD) of ceramic brackets.

Materials and Methods: A total of 50 first premolar teeth from 14 patients were divided into two groups: Group I
consisted of 20 teeth which served as control, and the brackets were debonded using conventional pliers. (7 teeth were
extracted 24 hours after conventional debonding, 7 teeth were extracted 28 to 32 days after conventional debonding and 6
teeth were extracted 56-60 days after conventional debonding). Group II consisted of 30 teeth and the brackets were
debonded using the ETD unit. (10 teeth were extracted 24 hours after ETD, 10 teeth were extracted 28 to 32 days after
ETD and 10 teeth were extracted 56-60 days after ETD. Immediately after extraction, the teeth were sectioned and
prepared for histological examination.

Results: The pulp was normal in most samples of the control group. In group II, mild inflammation was observed in the
24 hour sample while the 28 to 32 day sample showed signs of healing. The 56-60 day sample showed that the pulp was
similar to the control group in 6 out of the 10 samples.

Conclusion: The ETD of ceramic brackets did not affect the pulp and the changes which were observed, were reversible
in nature.

90
Laser:

• The use of laser eliminates problems like enamel tear outs,

bracket failures and pain

• According to Tocchio et al (AJODO 1993), laser energy can

degrade the adhesive resin by three ways:

Thermal softening
Thermal ablation
Thermal photoablation

• It decreases debonding force and less time consuming

91
Diode laser debonding of ceramic brackets, Am J Orthod Dentofacial Orthop 2010;138:458-62

Introduction: Our objective was to investigate the effectiveness of debonding ceramic brackets with a diode
laser. Methods: Two types of ceramic brackets (monocrystalline and polycrystalline) were bonded to bovine
maxillary central incisors. The diode laser was applied to brackets in the experimental groups for 3 seconds.
Shear bond strength and thermal effects on the pulp chamber were assessed at 2 laser energy levels: 2 and 5 Wper
square centimeter. Analysis of variance (ANOVA) was used to determine significant differences in shear
bond strength values.

Results: The diode laser was ineffective with polycrystalline brackets and effective with
monocrystalline brackets in significantly (P\0.05) lowering the shear bond strength. There were no significant
adhesive remnant index score differences between any groups tested.

Conclusions: Diode laser use significantly decreased the debonding force required for monocrystalline brackets
without increasing the pulp chamber temperature significantly. Diode lasers did not significantly decrease the
debonding force required for polycrystalline brackets.

92
Effects of CO2 laser debonding of a ceramic bracket on the mechanical properties of enamel
Angle Orthod. 2010;80:1029–1035.

Objective: To investigate the effects of CO2 laser debonding of a ceramic bracket on the
mechanical properties of tooth enamel.
Materials and Methods: Fifty-three human premolars were used in this study. The temperature
changes of cross-sectioned specimens during laser irradiation were monitored with an infrared
thermographic microscope system. Different laser output settings (3, 4, 5, and 6 W) were
compared. The shear bond strength of brackets after laser irradiation was measured for specimens
bonded with a conventional etch and rinse adhesive or with a self-etching adhesive, and the
adhesive remnant index score was calculated. The hardness and elastic modulus of crosssectioned
enamel after laser irradiation were investigated by the nanoindentation test. Data were
compared by one-way and two-way analysis of variance, followed by the Scheffe´ test.
Results: The temperature of enamel increased by about 200uC under CO2 laser irradiation with a
relatively high output (5 and 6 W), and a temperature increase of about 100uC to 150uC was seen
under laser irradiation with a low output (3 and 4 W). The bracket shear bond strength decreased
under all laser irradiation conditions. The hardness and elastic modulus of enamel were not
affected by CO2 laser debonding.
Conclusion: CO2 laser debonding may not cause iatrogenic damage to enamel.
93
Ultrasonic:

94
Orthodontic bracket removal Using conventional and ultrasonic debonding techniques,
enamel loss, and time requirements ,AM J ORTHOD DENTOFAC ORTHOP 1993;103:258-66

The results of this study indicated that

(1)enamel loss as a result of orthodontic bracket removal is minimized by first

removing the bracket with the debonding pliers, followed by ultrasonic removal
of the residual composite (group 2)

(2) the tooth surface was not significantly affected when either the combined
debonding pliers and cleaning and ultrasonic clean-up technique (group 2) or the
Ultrasonic debonding using a technique (group 3) were used

(3) using the debonding pliers followed with the ultrasonic removal of the residual
composite (group 2) required significantly less time than the other two techniques

95
96
Removal of residual adhesive:

• Ultrasonic scaler

• Scraping with sharp bond removing plier

• Burs

97
Adhesive remnant index(ARI):

98
99
Effects of debonding on the enamel:

 Enamel loss

 Enamel tear outs

 Enamel cracks or fracture lines

 Adhesive remnant wear

100
Enamel loss:
Initial prophylaxis- Bristle brush- 10 microns
Rubber cup- 5 microns

Clean up of resins- Hand instruments- 5-8 microns

Rotary instruments- 10-25 microns

Enamel tearouts:
Small filler particles- May penetrate dissolved
enamel prism and reinforces the adhesive tags

Macro fillers-Create a more natural break point

at enamel adhesive interface
101
Enamel cracks:

• Vertical cracks were commonest with

horizontal cracks and oblique cracks were few
• Commonly located in the maxillary central
incisors

Adhesive remnant wear:

• Only thin films of adhesives showed any reduction in size

• Excess adhesive remnants promotes discolouration and plaque deposition

• Always remove any large accumulations of adhesive

102
Influence on enamel by various debonding instruments:
Enamel surface index:

• Score 0- Instrument tested left the tooth surface with intact perikymata

• Score 1- Satisfactory smooth surface – plain cut and spiral fluted TC bur operated at
25,000 rpm

• Score 2- Several considerable scratches that can be polished away – Fine sandpaper
disks

• Score 3- Similar scratches as score 2, but it could not be polished away- rubber
wheel

• Score 4- Course scratches and deeply marred appearance- Diamond instruments

(Am j orthod. 1979, Enamel surface appearance after various bonding techniques, Zachrisson) 103
 Tungsten carbide bur
Rubber wheel Sand paper disc and pumice

104
Bonded retainers:
• Bonded lingual retainers
• Direct bonded labial retainers

Bonded lingual retainers:  Mandibular canine to canine retainer bar

 Direct contact wire splinting
 Flexible wire retainers
 Hold retainers for individual tooth

Wires used: • Thick- 0.030-0.032 inch

• Thin- 0.0215 inch

105
 Method of fabrication
Direct
Indirect

106
Other Applications of Bonding in Orthodontics:

• Space maintainers

• Semi permanent single tooth replacements

• Trauma fixation

• Resin build ups for tooth size and shape problems

107
Banding Vs Bonding

108
Banding versus bonding of first permanent molars: a multi-centre randomized
controlled trial, Journal of Orthodontics, Vol. 38, 2011, 81–89
Objective: To assess the effectiveness of banding versus bonding of first permanent molars during fixed appliance treatment; in
terms of attachment failure, patient discomfort and post-treatment enamel demineralization.
Design: Multi-centre randomized clinical trial.
Setting: One District General Hospital Orthodontic Department and two Specialist Orthodontic Practices.
Participants: Orthodontic patients aged between 10 and 18 years old, randomly allocated to either receive molar bands (n540)
or molar bonds (n540).
Method: Bands were cemented with a conventional glass ionomer cement and tubes were bonded with light-cured composite to
all four first permanent molar teeth for each subject. Attachments were reviewed at each recall appointment to assess loosening
or loss. The clinical end point of the trial was the day of appliance debond. Enamel demineralization at debond was assessed
using the modified International Caries Assessment and Detection System (ICDAS).
Results: The first time failure rate for molar bonds was 18.4% and 2.6% for molar bands (P50.0002). Survival analysis
demonstrated molar bonds were more likely to fail compared with molar bands. First permanent molars with bonded tubes
experienced more demineralization than those with cemented bands (P50.027). There was no statistically significant difference
in discomfort experienced by patients after banding or bonding first permanent molars (P.0.05).
Conclusion: This study shows that as part of fixed appliance therapy, American Orthodontics photoetched first permanent
molar bands cemented with 3M ESPE Ketac-Cem perform better than American Orthodontics low profile photo-etched and
mesh-based first permanent molar tubes bonded with 3M Unitek Transbond XT in terms of failure behaviour and molar
enamel demineralization.
109
References:
• Contemporary Orthodontics, William R Proffit, 5th edition
• Orthodontics, Current Principles and Technique, Thomas M Graber,
Brainers F Swain
• Orthodontics, Current Principles and Technique, Graber, Vanarsdall, Vig,
5th edition
• Handbook of Orthodontics, Robert E Moyers, 4th edition
• Current Therapy in Orthodontics, Ravindra Nanda, Sunil Kapila
• Textbook of Orthodontics, Sameer E Bishara
• Textbook of Pedodontics, Shobha Tandon, 2nd edition
• Banding versus bonding of first permanent molars: a multi-centre
randomized controlled trial, Journal of Orthodontics, Vol. 38, 2011, 81–89
• Am j orthod. 1979, Enamel surface appearance after various bonding
techniques, Zachrisson 110
• AM J ORTHOD DENTOFAC ORTHOP 1993;103:258-66
• Angle Orthod. 2010;80:1029–1035
• Am J Orthod Dentofacial Orthop 2010;138:458-62
• Indian Journal of Dental Research, 25(2), 2014
• Pithon et al, Progress in Orthodontics 2015, 16:17
• Orthodontic Adhesives and Bond Strength Testing, Semin orthod 1997;3;
147-156
• Enamel shear bond strength of two orthodontic self-etching bonding systems
compared to TransbondTM XT, J Orofac Orthop, 2016
• Powers and Kim, Semin orthod 1997
• John T. Lindquist (1959) Indirect Band Technic. The Angle Orthodontist:
April 1959, Vol. 29, No. 2, pp. 114-122
• Current products and practice, orthodontic cements, Nicola Johnson, JO Sep
2000
111
 The larger the island of knowledge, the
longer the shoreline of wonder!

Thank you!! 112