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05. Published by Oxford University Press on behalf of the European Orthodontics Society.
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SUMMARY Aesthetics has become an essential element when choosing orthodontic fixed appliances. Most
metallic brackets used in orthodontic therapy are made from stainless steel (SS) with the appropriate
physical properties and good corrosion resistance, and are available as types 304, 316 and 17-4 PH SS.
However, localized corrosion of these materials can frequently occur in the oral environment. This study
was undertaken to evaluate the accuracy of sizing, microstructure, hardness, corrosion resistance,
Introduction
that are closer to the ideal, and have been used most
Orthodontic brackets are an essential component of frequently for fixed orthodontic treatment (Creekmore and
modern fixed appliances. In order to deliver the exact force Kunik, 1993; Arici and Regan, 1997; Bazakidou et al.,
from the wire to the teeth, brackets should have the correct 1997).
hardness and strength (Feldner et al., 1994; Flores et al., The majority of metal brackets are made from stainless
1994). They should have a smooth archwire slot to reduce steel (SS) (Maijer and Smith, 1982). Deguchi et al. (1996)
frictional resistance (Arici and Regan, 1997), and an reported on the properties of an experimental bracket
otherwise smooth surface to reduce plaque deposition made of titanium, and the corrosion behaviour of brackets
(Wheeler and Ackerman, 1983). Because most orthodontic made of 2205 duplex SS has been studied (Platt et al.,
brackets are produced with a three-dimensional prescription 1997). Recently, the recycling of brackets has been
for each tooth, they should be accurately manufactured to attempted, and while Wheeler and Ackerman (1983)
reflect this (Creekmore and Kunik, 1993). They should reported that the bond strength did not decrease, Maijer
also have a high corrosion resistance and good and Smith (1982) presented contradictory results showing
biocompatibility. that bond strength and corrosion resistance were markedly
Many efforts have been made since 1909 to improve decreased.
orthodontic brackets. Ceramic (Michael, 1988) and plastic Most orthodontic brackets are made from AISI type
have been introduced, but both have shown significant 304L SS. Such steel contains 18–20 per cent chromium and
disadvantages when used for orthodontic therapy. Plastic 8–10 per cent nickel with a small amount of manganese
brackets (Feldner et al., 1994) were found to be easily and silicon, and has a low carbon content, typically less
discoloured by water absorption and to have low deformation than 0.03 per cent. One manufacturer uses type 316L SS,
resistance to high applied torque. Ceramics brackets (Pratten which has a higher nickel content, 2–3 per cent molybdenum,
et al., 1990; Arici and Regan, 1997; Komori and Ishikawa, and a lower carbon content for better welding characteristics
1997; Olsen et al., 1997; Sinha and Nanda, 1997) proved to and improved intergranular corrosion resistance. Another
be too brittle and the part of the enamel layer bound by manufacturer uses type 17-4 PH SS, which has a higher
adhesive tended to be detached with the ceramic bracket mechanical property, and similar corrosion resistance to
when the bracket was removed from the teeth. However, type 304 SS. However, localized corrosion of these
metallic orthodontic brackets have demonstrated properties materials can frequently occur in the oral cavity due to
238 K.T. OH ET AL.
their low localized corrosion resistance in a solution compositions of these three groups of brackets are described
containing aggressive chloride ions. in Table 2.
Super SS is defined strictly as SS with a pitting resistance Rectangular 0.017 × 0.025 inch SS wire (Ormco,
equivalent (PRE) value above 40. The super SS (SR-50A) Glendora, USA) was used to examine the friction between
used in this study has localized corrosion resistance that is the brackets and orthodontic wire. Lig-a-Ties (TP
as good as the titanium alloys, because its passive film is Orthodontics, LaPorte, USA) was selected as the ligature
enhanced by the synergistic effect (Clayton and Lu, 1986; wire. Five samples were prepared for statistical analysis.
Kim, 1990) of high concentrations of nitrogen (0.331 per
cent) and molybdenum (6.77 per cent). It also has good
Method
mechanical properties due to a ‘solution strengthening
effect’. It is thought that these properties allow the material A measurescope (MM-11, Nikon, Kawasaki, Japan) was
to minimize the amount of metal ions released in the oral used to determine the size accuracy of each 10 brackets
Table 2 Chemical compositions of the orthodontic brackets used in this study (wt%).
Bracket C Si P S Ni Cr Mo Cu N Fe
SR-50A 0.025 0.80 0.024 0.006 19.43 23.23 6.77 – 0.331 Balanced
Mini-diamond 0.030 0.56 0.019 0.025 5.94 16.76 0.26 3.33 0.033 Balanced
Archist 0.028 0.59 0.026 0.003 10.12 18.15 0.17 – 0.029 Balanced
STAINLESS STEEL BRACKET 239
Bracket Internal size of the slot External vertical width Internal horizontal width External horizontal width
of the tie wing of the tie wing of the tie wing
a, b, c
Significant difference between materials at the same location (P < 0.05).
Table 5 Microhardness at each bracket surface (kg/cm2). Table 7 Frictional force between orthodontic bracket slot and
wire.
Code Slot Slot Tie Bracket Bracket
wall base wing body base Code 1 day 3 days 2 weeks 4 weeks
SR-50A 231 ± 6aC 233 ± 3aC 243 ± 7aB 228 ± 7aD 334 ± 14aA SR-50A 0.82 ± 0.31 0.65 ± 0.13 0.47 ± 0.14a 0.59 ± 0.19a
Mini-diamond 326 ± 19bA 315 ± 4bB 297 ± 13bD 309 ± 16bC 327 ± 10aA Mini-diamond 0.39 ± 0.21 0.99 ± 0.24a 0.66 ± 0.21a 0.84 ± 0.24a
Archist 306 ± 7cA 306 ± 3cA 301 ± 28bB 309 ± 8bA 333 ± 15aA Archist 0.54 ± 0.41 0.56 ± 0.29 0.80 ± 0.41a 0.71 ± 0.20
a, b, c
Significant difference between materials at the same location aSignificant difference between the incubation periods (P < 0.05).
(P < 0.05).
A, B, C, DSignificant difference between locations with the same material
a, b, c
Significant difference between materials in the corrosion test
(P < 0.05). Currently, orthodontic metallic appliances are made
Ecorr, corrosion potential; Rp, polarization resistance; Icorr, corrosion mainly of SS containing chromium and nickel. The
rate; mpy, mm per year. advantage of SS is primarily its low cost, greater strength,
higher modulus of elasticity, good formability and high
time (P < 0.05), while Archist showed no significant corrosion resistance in the mouth. Orthodontists have
difference at 3 days, but a significant increase at 2 weeks recognized these advantages, and as a result SS is used
(P < 0.05). extensively for bands, brackets and archwires (Wilkinson,
For the cytotoxicity results (Table 8), SR-50A, Mini- 1962). However, recently it has become apparent that there
diamond and Archist all demonstrated a mild response. is a need for even higher corrosion resistance, greater
Nevertheless, SR-50A showed the lowest response index. strength, improved formability and lower cytotoxicity.
Many attempts to satisfy those needs and improve the
properties of SS have been made. Super SS has been
Discussion
developed that has higher corrosion resistance and greater
Orthodontic metal brackets are made of materials with high mechanical strength than conventionally used SS
corrosion resistance. However, they can be corroded in the (Willenbruch et al., 1990; Olefjord and Clayton, 1991;
oral cavity while under conditions of low pH, the presence Halada et al., 1996). SS with a higher molybdenum and
of dental plaque, and a high chloride ion concentration. The nitrogen content than conventionally used SS and PRE
pH of the environment in which orthodontic brackets are values of over 40 is considered to belong to the group of
used has a significant effect on the rate of corrosion. When super SS. Especially, austenitic SS attracts attention for its
the bracket and wire are combined with a ligature wire or an high elongation and low temperature strength. The corrosion
elastomeric O-ring, crevice and galvanic corrosion can occur resistance of SS should be as high as possible in the human
in the oral cavity, and further types of corrosion may develop body, and its nickel content should be reduced to a minimum,
when the bracket is soldered to the metal band. Pitting because nickel is a known toxin and allergen (Fisher, 1986).
corrosion of orthodontic appliances is common due to the Nickel is one of the most common causes of allergic contact
aggressive action of Cl– ions in saliva, or from food and dermatitis, especially in females (Fisher and Rosenblum,
drink. Although chloride ion attack is probably the major 1982; Fisher, 1986; Bass et al., 1993). Tsalev and Zaprianov
cause of corrosion, bacteria and their waste products, and (1983) reported that nickel is a toxic element, but essential
selective interactions with gases, such as, oxygen and carbon in animal and humans, and a carcinogen, which induces
dioxide, may all contribute to the corrosion of orthodontic neoplasms in the respiratory system and in the nasal sinuses.
brackets in the mouth. The large population of bacteria and Some clinical evidence of carcinogenicity resulting from
fungi present in the oral environment may accelerate the implanted alloys is available in the literature (Smith, 1981;
corrosion of orthodontic appliances. Organic acids and Smith and Williams, 1982). However, because nickel has an
enzymes in particular may affect various metal brackets. essential role in the stabilization of the austenitic phase and
242 K.T. OH ET AL.
in the corrosion resistance of SS, it is difficult to totally which indicates that SR-50A has better corrosion resistance
exclude this metal. Chromium (Lugowski et al., 1987; than 17-4 PH and 304L SS. Corrosion pits were observed in
Klein, 1996) is essential to life and must be supplemented the Archist and Mini-diamond surfaces, but not in the SR-
as a trace element in the diets of humans and animals, and 50A surface. From the above results it is believed that these
to the corrosion resistance of SS. However, it is a recognized properties allow SR-50A to minimize the levels of metal
human allergen, as well as a human and animal carcinogen ions released into the oral cavity.
that most frequently results in respiratory cancers, and nasal The other problem related to the corrosion of an
tumours predominate. Hexavalent chromium is highly toxic orthodontic bracket is its frictional behaviour, which can
and allergenic. While chromium compounds are mutagenic wear the contact surface by relative motion of the two
in most bacterial and mammalian assays, hexavalent materials. As is generally known in the corrosion–wear
chromium has rarely been detected in in vivo and in vitro phenomenon, oxides formed by a chemical reaction on a
testing. Therefore, the purpose of this study was to evaluate surface can increase the frictional force. For this reason, if a
commonly used in orthodontics. The following results were Bazakidou E, Nanda R S, Duncanson Jr M G, Sinha P K 1997 Evaluation
of frictional resistance in esthetic brackets. American Journal of
obtained: Orthodontics and Dentofacial Orthopedics 112: 138–144
1. SR-50A had a higher polarization resistance than the Bockris J O, Khan S U M 1993 Surface electrochemistry. Plenum Press,
New York, p. 748
other tested samples, and the highest corrosion
resistance. The corrosion rates of SR-50A, Mini- Clayton C R, Lu Y C 1986 A bipolar model of the passivity of stainless
steel: the role of Mo addition. Journal of the Electrochemical Society
diamond and Archist in the artificial saliva solution 133: 2465–2473
were 0.9 × 10–3, 3.7 × 10–3 and 7.4 × 10–3 mpy, Creekmore T D, Kunik R L 1993 Straight wire: the next generation.
respectively. American Journal of Orthodontics and Dentofacial Orthopedics 104:
2. The frictional force of the SR-50A bracket decreased 8–20
with time, whereas that of Mini-diamond and Archist Deguchi T, Ito M, Obata A, Koh Y, Yamagishi T, Oshida Y 1996 Trial
production of titanium orthodontic brackets fabricated by metal injection
increased with time. Therefore, the SR-50A bracket molding (MIM) with sintering. Journal of Dental Research 75: 1491–
Smith D C, Williams D F 1982 Biocompatibility of dental materials. CRC Wheeler J J, Ackerman R J 1983 Bond strength of thermally recycled
Press, Boca Raton metal brackets. American Journal of Orthodontics 83: 181–186
Smith G K 1981 Systemic biocompatibility of implant materials. In: Wilkinson J V 1962 Some metallurgical aspects of orthodontic stainless
Williams D F (ed.) Systemic Aspects of Biocompatibility. CRC Press, steel. Angle Orthodontist 48: 192–206
Boca Raton, p. 1 Willenbruch R D, Clayton C R, Oversluizen M, Kim D, Lu Y C 1990 An
Tsalev D L, Zaprianov Z K 1983 Atomic absorption spectrometry in XPS and electrochemical study of the influence of molybdenum and
occupational and environmental health practice, Volume 1. CRC Press, nitrogen on the passivity of austenitic stainless steel. Corrosion Science
Boca Raton 31: 179–190