BONDING IN

ORTHODONTICS
Guided By: Dr Falguni Mehta
Professor & HOD Of Dept of Orthodontia
GDCH Ahmedabad.

CONTENTS
1. Introduction
2. History & Pioneers
3. Bonding Materials(Types)
-Self-cure
-Light-cure
-Dual-cure

4. Preparation for Bonding

5. Bonding techniques
a) Direct
b) Indirect -Labial & Lingual
6. Failures in Bonding

7. Microscopic structure of a good bond

8. Bonding procedures for-Hypo plastic teeth
-Porcelain crown
-Metal crown
9. Conclusion.

Bonding of attachments, eliminating the need

for bands, was a dream for many years before rather
abruptly becoming a routine clinical procedure in
the 1980s.
Banding is based on the mechanical/
chemical locking of an adhesive to irregularities in
the enamel surface, and to mechanical locks formed
in the base of orthodontic attachment.

Successful bonding in orthodontic, therefore,

requires careful attention of three components of
the system:
the tooth surface and its preparation,
the design of the attachment base and
the bonding material itself.

Advantages of bonding over banding

Optimal performance in bonding of orthodontic attachments
offers many advantages when compared conventional banding.
1. It is esthetically superior
2. It is faster and simpler.
3. Less discomfort for the patient
4. Arch length is not increased
5. Bonds are more hygienic than band, improved gingival and
periodontal condition
6. Partially erupted teeth can be controlled

7. Mesio-distal enamel reduction (proximal stripping) is

possible during treatment.
8. Attachments may be bonded to artificial tooth surfaces and to
fixed bridgework
9. Interproximal areas are accessible for complete buildups.
10.Caries risk under loose bands is eliminated.
11. No band spaces are present to close at the end of treatment.
12. Brackets may be recycled, further reducing the cost .

History & Pioneers

 The development of the bonding procedure has

revolutionized the use of fixed orthodontic
appliances.
Although the molars are the only teeth that are
commonly banded, many practitioners today
exclusively bond all fixed appliances including the
molar using bondable molar tubes.

Over the years, refinements have taken place both in the

bonding techniques as well as in the materials that
are used for bonding.
The history of Bonding goes back all the way to the
1950s and the acid-etch bonding technique has led
to dramatic changes in the practice of orthodontics

Buonocore in 1955 demonstrated increased adhesion by

acid pretreatment, using 85% Phosphoric acid.

Newman began to apply this finding to direct bonding of

orthodontic attachments.

Retief also described an epoxy resin system to withstand

orthodontic forces.

Smith in 1968 introduced zinc polyacrylate cement and

bracket bonding with this cement.

In 1971, Miura et al described an acrylic resin (ORTHOMITE),

using a modified trialkyl borane catalyst that proved successful for
bonding plastic brackets and in presence of moisture

Classificatio
I. According to Sturdevant
:
n
Based on matrix composition
- Bis GMA based
- UDMA based

2.Based on polymerization method

- Self curing
- Ultra violet light curing
- Visible light curing
- Dual curing
- Staged curing
Based on filler content
- Weight %
- Volume %

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4.Based on filler particle size

- Mega fill contains mega fillers
(very large individual filler particles).

- Macrofill contains macrofillers (10-100m)

- Midifill contains midifillers (1-10 m)

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- Minifill contains minifillers (0.1-1m)

- Micro fill- contains micro fillers (0.01 - 0.1 m)

- Nanofill contains nanofillers (0.005-0.01m)

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Hybrids composites with mixed

ranges of particle sizes ( largest
particle size range is used to define
the hybrid type e.g.. Minifill hybrid
contains mini micro fillers).
Homogeneous contain fillers,
uncured matrix material.

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Heterogeneous it includes
precured composites or other
unusual fillers.
Modified if it includes novel filler
modifications in addition to
conventional fillers (e.g.. Filler
modified homogeneous minifill)

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Based on Specific Handling Characteristics

- Packable composites
- Flowable
II According to Anusavice (Phillips) :
Based on particle size of major filler).
Traditional composites 8-12m
Microfilled composites 0.04-0.4m
Small particle filled composites 1-5m
Hybrid composites 0.6 - 1m
III According to Craig :
Type 1 : Polymer based materials suitable for
restorations involving occlusal surfaces.

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Type 2 : Other polymer based material

-Class 1 : self cured materials.
-Class 2 : light cured materials.
Group 1 energy applied intra orally.
Group 2 energy applied extra orally.
-Class 3 : dual cured materials.
According to Marzouk :
(Based on chronological development)
1) First generation composites :
Consist of macro ceramic reinforcing phases
Exhibits highest mechanical properties except for
high proportion of destructive wear and high
surface roughness

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2) Second generation composites.

Consist of colloidal micro ceramic phases in a
continuous resin phase.
Exhibits best surface texture of all composite resin.
Wear resistance better than 1st generation

3) Third generation composites :

Hybrid composite which is a combination of macro and
micro (colloidal) ceramic as reinforces (75:25 ratio)
Properties compromise between 1st and 2nd generation.

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4) Fourth

generation composites :

Are also hybrid type, but instead of macro ceramic fillers,these contains
heat-cured, irregularly shaped,
highly reinforced composite macro
particles with
reinforcing phase of micro (colloidal) ceramics.

Produce superior restorations.

Exhibits maximum shrinkage of all composites.

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5) Fifth generation composites :

A hybrid composite in which the continuous resin

phase is reinforced with micro ceramics (colloidal),
macro ceramics, spherical, highly reinforced heat
cured composite particles.
Spherical shape of the macro composite particles
will improve their wettability, and consequently,
their chemical bonding to the continuous phase
of the final composite.
Surface texture and wear comparable to 2nd
generation.
Physical and mechanical properties similar to
those of 4th generation

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6) Sixth generation composites :

Hybrid types in which the continuous phase is reinforced
with a combination of micro (colloidal) ceramics and
agglomerates of sintered micro (colloidal) ceramics.
Exhibits highest % of reinforcing particles of all composites.
Has best mechanical properties
Wear and surface texture similar to 4th generation.
Least shrinkage, due to minimum amount of continuous phase,
and also due to condemnable nature of their materials.

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Based on mode of supply :

i.Chemically cured paste paste system.
ii.Chemically cured or photo cured powder / liquid system.
iii.Chemically cured or photo cured paste liquid system.
iv. Photo cured one- paste system.
v. Photo cured one liquid system.
vi.Chemically cured three or four part system.

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BONDING TECHNIQUES
DIRECT BONDING

INDIRECT BONDING
LINGUAL BONDING
FACIAL BONDING

BONDING ADHESIVES
Composite resins

Glass Ionomer
Cements
Acrylic Resin

Chemical cure
Light cure
Dual cure

Compomer
Hybrid Ionomer

 Chemical cure adhesives are the ones in which two

components of adhesives interact.
The light-cure system is polymerized via exposure of a
high intensity visible light.
The dual cure system utilizes both chemical & light
system.
The choice depends upon personal performances
keeping in mind, however that orthodontic adhesives
are low film thickness, meaning that they have a higher
strength in a thin layer than in a thick

GIC
Glass-ionomer dental cements were invented in the late 1960s
by replacing the phosphoric acid solution
Recently introduced resin-modified glass ionomer cement s
(both chemical and light cured)
Bond to saliva-contaminated enamel surfaces without
phosphoric acid etching.
The liquid contains polyarcylic and maleic acid which remove
contaminants and change the enamel surface mechanically but
it will not create micromechanical retentions

The advantages of glass-ionomer cements are:

* Self-adhesion to both enamel and dentin.
* Fluoride release and re-release , without dis-integration.
* Thermal expansion co-efficient similar to dentin.
* No appreciable setting exotherm.
* Biocompatibility in appropriate host environments
Resin composite does not bond well to unetched enamel:
however.
Hybrid Glass ionomer orthodontic cement does
not require etching and has bond strength ranging from
8 to 25MPa.

BONDING
PROCEDURE

Bonding Procedure :
The steps involved in direct and indirect bracket
bonding on facial or lingual surfaces are as
follows,
Cleaning
Enamel conditioning
Sealing
Bonding

CLEANING
Cleaning is carried out with pumice in order
to remove plaque & organic pellicle.

Enamel conditioning
Moisture
control

Enamel
Pretreatment

Moisture control

Lip expanders and/or cheek retractors

saliva ejectors
Tongue guards with bite blocks
salivary duct obstructers
Cotton or gauze rolls
Antisailalogues

Regarding antisailagogues both tablets and injectable

solutions of different preparations, for example
Banthine, Pro-Banthine , atropine,surfate etc.) are
used
Generally not needed for most patients.
When indicated,
Banthine tablets (50 mg per 100 lb [45kg] body
weight in a sugar-free drink 15 minutes before
bonding may providing adequate results

Enamel pretreatment ( Etching )

After isolation, the conditioning solution or gel
(usually 37% phosphoric acid) is applied over the
enamel surface for 15 to 30 sec.
The etchants is rinsed off the teeth with abundant
water spray.
Next the teeth are thoroughly dried with a moistureand-oil-free air source to obtain the well-known dull,
frosty appearance
Care should to avoid salivary contamination.

Type and concentration of Acid

A. Liquid
B. Gel
Etching with 10% to 37% phosphoric acid
produces the highest bond strengths (28MPa) to
enamel.
The use of 10% Maleic Acid results in a
lower bond strength (18MPa).

DURATION OF ETCHING
Normally 15-30 sec etching time is preferred in
normal teeth, however shorter etching time causes
less enamel damage on debonding.
Hypominieralised tooth require 30-69 sec whereas in
flurosis etching time should be 60-90 sec

Clinically, the etching of enamel creates

1. Microporosity within the enamel and
2. Reduces surface tension and allows the resin to
penetrae and polymerize within the etched
enamel rods.

Standard etchant dissolves about 5-10m of enamel

surface and creates a zone of etched enamel rods for
about 15-25m.

Etching process creates calcium monophosphate and

calcium sulfate by-products that must be removed by a
vigorous water rinse

1. Fracture and cracking of enamel upon debonding .

2. Increased surface porosity - possible staining
3. Loss of acquired fluoride in outer 10 m of enamel surface.
4. Loss of enamel during etching .
5. Resin tags retained in enamel - causing discoloration of resin.
6. Rougher surface if over - etched.

SEALING
After etching a thin layer of primer is coated over the
etched enamel surface.
This make the surface more amenable to accept a
bond.
Mainly hydrophilic monomers,carried in solventAcetone, ethanol-water
Hydrophilic molecules HEMA (Hydroxy
ethylmethacrylate)
This wet the surface for better penetration of
monomer

Moisture -Resistant primers

Moisture resistant primer (Transbond) have been
used to bond tooth where moisture control is difficult.
This primer is a hydrophilic methacrylate
monomer.
Can be used even if enamel is contaminated
with saliva or moisture.
Bond strength is similar to resin composite
adhesive

BONDING PROCEDURE
The recommended bracket bonding procedure (with any
adhesive) consists of the following steps:
1. Transfer
2. Positioning
3. Fitting
4. Removal of excess.

TRANSFER
The bracket is gripped with bracket holder
Adhesive is applied to the base of the bracket
Then the bracket is placed on the tooth closed
to its correct position

POSITIONING
The correct position is determined by Boones
gauge which is kept perpendicular to long axis of
tooth.
The bracket is now correctly positioned mesiodistally & inciso-gingivally, to its final
predetermine position.

FITTING
The bracket is firmly pushed against the tooth
surface.
The tight fit will result in
Good bond strength
Little material to remove on debonding
Optimal adhesive penetration into bracket
backing
Reduce slide when excess material extrudes
peripherally

REMOVAL OF EXCESS
Excess adhesive is removed with the help
of scaler to minimize or prevent gingival
irritation or plaque build up

Indirect Bonding with Silicone Transfer

Trays.
1. Take an impression and pour a stone model. The model must be
dry. It may be marked on each tooth.
2. Select brackets for each tooth.
3. Apply water-soluble adhesive on each base or tooth.
4. Position the brackets on the model. Reposition if needed
5.Mix material according to the manufacturers instructions. Press the
putty onto the cemented brackets. Form the tray allowing sufficient
thickness for strength.

7. Trim the silicone tray and mark the midline.

8. Prepare the patients teeth as for a direct application.
9. Mix adhesive load it in a syringe and apply a sufficient
portion to the bonding bases.
11. Remove the tray after 10 minutes. The tray may be cut
longitudinally or transversely to reduce the risk of bracket
debonding when it is peeled off.
12. Complete the bonding carefully, remove excess
adhesive . Use oval or tapered TC bur,clean around each
bracket. Also inspect around the bracket pad for adhesive
voids (from too little adhesive, tray slide on the teeth or
delayed seating) and fill with a small mix of adhesive if
needed.

CURING

Classification of orthodontic adhesive

systems:
Based upon the polymerization initiation
mechanism.
* Chemically activated (Also termed chemically
cured, autocured or self-cured): two-paste or onepaste
* Light-cured (also termed photocured)
* Dual-cured (Chemically activated and light cured)

The most widely used resin commonly referred to as

Bowens resin or bis GMA (bisphenol A glycidyl
dimethacrylate), was designed to improve bond
strength and increase dimensional stability by crosslinking.

LIGHT CURED
Light-cure is used to initiate polymerization
and this depends upon several factors-the exposure time,
-the photoinitiator concentration
-the light intensity emitted by the curing
unit and the filler volume

DUAL CURE
This approach combines the advantages of rapid
initiation for photo polymerizing resins and high
conversion rates for chemically cured resins.
Here polymerization is induced through surface
exposure by visible light, and in bulk material occurs by
a chemical process.
Hence, both improved surface and bulk material
properties would be expected.
In a study, this has significantly higher bond strength
then chemical or light cure.

Bonding on plastic brackets

This are typically polycarbonate,although some are
reinforced fiber-glass or metal.
Bonding is typically mechanical
Disadvantage-1) Lack of strength to resist distortion
and breakage
2) Wire slot wear
3)Uptake of water and discoloration

The filler content of resin composite affects the

bond strength .
Highly filled resin composite bond better to metal
bracket.
Hybrid GIC have bond strengths lower than resin
composite

Retention of adhesives to ceramic brackets can

be mechanical or chemical or both.
Mechanical bonding requires indentations or
roughness caused by chemical etching with a 9.6%
hydrofluoric
Chemical bonding requires treatment with
silane. One end of the silane molecule bonds to the
ceramic, while the other end bonds to the carbon
-carbon double bonds available from the resin
composite adhesive.

 Harder then steel, causes enamel wear of the

opposing tooth
Difficult to debond
Surface is rougher, attracts plaque and stain
more easily.
Brittle in nature.

Coupling Agent
The coupling agent Gamma-methacryloxypropyl
trimethoxysilane (MPTS) is widely used for
promoting chemical adhesion
Bonding arises from two mechanism1.Silanol groups of the hydrolyzed silane adhere to
the hydration layer of the inorganic surface,
2.Methacrylate groups of silane copolymerize with
the methacrylate resin matrix, possibly forming
covalent bonds.

Bonding to porcelain.
For optimal bonding of orthodontic brackets and retainer wires to
porcelain surfaces, the following technique is recommended
1. Isolate the working field
2. Deglaze an area by sandblasting with 50 m aluminum oxide
for 3 seconds.
3. Etch the porcelain with 9.6% HF acid gel for 2 minutes.
4. Carefully remove the gel with Cotton roll then rinse.
5.Immediately dry and bond with highly filled bisGMA resin

BOND FAILURES

Possible causes of adhesive -enamel

bond failure
* Contamination.
* Insufficient rinsing of etchant .
* Inadequate drying of enamel surface precludes
penetration of resin.
* Over -etching demineralizes enamel, reduces depth of
resin tags penetration,
* Excessive force exerted on bracket from occlusion or
appliance.

* Movement of bracket during initial setting .

* Contaminated bracket mesh
* Adhesive not buttered into base firmly
* Activator not placed on bracket in paste-primer
system.
* Inadequate cure of light-cured resin composite
* special primer required (plastic brackets)

References:
1. Graber Varnasdall Xubair
2. Proffit

THANK YOU