Influence of Various Storage Media on Shear

Bond Strength and Enamel Fracture When

Debonding Ceramic Brackets: An In Vitro
Study
Robert Gittner, Ralf Mller-Hartwich, and Paul-Georg Jost-Brinkmann
This study aimed to investigate the influence of different storage media on the
shear bond strength and the risk of enamel fracture of human teeth measured
in vitro. A total of 360 teeth stored in 96% ethanol and 360 teeth stored in 0.1%
thymol solution were bonded with Fascination and Fascination2 brackets
(Dentaurum, Ispringen, Germany) (360 per group) using 3 different light curing
units and 3 different adhesives. Debonding was performed according to International Standards Organization specification DIN EN ISO 10477 using a universal testing machine with a crosshead speed of 1 mm/min. The teeth stored
in 0.1% thymol solution showed significantly higher shear bond strengths (P <
0.001, MannWhitney-U test) (median, 16.7 MPa) than teeth stored in 96%
ethanol (median, 13.2 MPa). The teeth stored in 0.1% thymol solution showed
significantly less enamel fractures than the teeth stored in 96% ethanol solution
(P < 0.001, KruskalWallis test). The storage medium significantly influences
the shear bond strength, measured in vitro on human teeth. For shear bond
strength testing 0.1% thymol solution is to be preferred to 96% ethanol. However, even with thymol as the storage medium the enamel fracture rate seems
to be higher than that in vivo. (Semin Orthod 2010;16:49-54.) 2010 Elsevier
Inc. All rights reserved.

ixed appliances are an inherent part of

present orthodontic therapy. The bonding
of brackets is a routine procedure in the fixed
appliance therapy, since the introduction of the
acid-etch technique by Buonocore1 and the introduction of the bracket-bonding technique by
Newman.2 Manufacturers produce brackets
from various materials: metal, polycarbonate, or

From the Department of Orthodontics, Dentofacial Orthopedics

and Pedodontics, Center for Dental and Craniofacial Sciences,
CharitUniversittsmedizin Berlin, Germany.
This study was supported in part by Dentaurum J. P. Winkelstroeter KG, Ispringen, Germany.
Address correspondence to Paul-Georg Jost-Brinkmann, Prof. Dr.
med. dent., Department of Orthodontics, Dentofacial Orthopedics
and Pedodontics, Center for Dental and Craniofacial Sciences,
CharitUniversittsmedizin Berlin, Amannshauser Strae 4 6,
14197 Berlin, Germany; E-mail: paul-g.jost-brinkmann@charite.de
2010 Elsevier Inc. All rights reserved.
1073-8746/10/1601-0$30.00/0
doi:10.1053/j.sodo.2009.12.004

ceramic. Stainless steel brackets are functionally

faultless but they have some esthetic disadvantages. The demand for unobtrusive attachments
is high in todays society with its increased esthetic demands. In the 1970s the polycarbonate
brackets were introduced to meet these requirements, but they show some disadvantages such as
higher bracket loss than stainless steel brackets,
occasional bracket wing fractures, and bracket
staining.3 Additionally, the torque transmission
is unsatisfactory due to bracket slot distortion.4
In recent years the most esthetic brackets are
made from ceramic material. Although ceramic
brackets provide higher bond strengths and a
higher color stability,5-8 they also have a poor
reputation for having a higher risk of enamel
fracturesat least in vitro.8-22 Metal brackets can
deform up to 20%, which allows them to be
peeled off, but ceramic brackets are much stiffer
than metal brackets and have a maximal elastic
deformation below 1%.23 Thus, all the forces

Seminars in Orthodontics, Vol 16, No 1 (March), 2010: pp 49-54

49

50

Gittner, Mller-Hartwich, and Jost-Brinkmann

which are produced while debonding ceramic

brackets are transferred directly to the enamel.
Many in vitro studies have been carried out to
investigate the shear bond strength and the risk
of enamel fracture of various (ceramic) bracketadhesive combinations.
Although the influence of storage media cannot be excluded in in vitro studies, there are no
conclusive data in the literature concerning this
issue.

Objective
The aim of the present study was to investigate
the influence of different storage media on
the shear bond strength and the risk of
enamel fracture of human teeth measured in
vitro.

Methods
Teeth
Thousands of human teeth stored in 96% ethanol for an unknown period were delivered by
a commercial disposal contractor of dental
waste. A total of 180 first upper premolars and
180 lower incisors were selected. The other
360 teeth (180 first upper premolars, 180
lower incisors) were collected by about 80 dentists and stored in provided vessels with 0.1%
thymol solution. All teeth chosen for this study
had a sound buccal and/or labial enamel surface free of caries.

Brackets
The ceramic brackets Fascination and Fascination2 (Dentaurum, Ispringen, Germany) were
used. Both brackets are polycrystalline brackets
made of aluminum oxide.

Adhesives
Three different adhesives were used:
1. The light-activated ConTec LC (Dentaurum).
2. The light-activated Transbond XT (3M
Unitek, Landsberg, Germany).
3. The dual-curing ConTec Duo (Dentaurum).

Curing Units
Three different curing units were used:

1. The quartz-tungsten halogen light curing

unit ConTec Light (Dentaurum).
2. The plasma arc curing unit (PAC, American
Dental Technologies, Corpus Christi, TX).
3. The light emitting diodecuring unit Elipar
FreeLight (3M ESPE, Seefeld, Germany).

Tooth Preparation
The roots of the teeth were cut off with a watercooled diamond cutting wheel. The crowns were
subsequently cleaned with a fluoride-free polishing paste (SuperPolish, KerrHawe, Bioggio, Switzerland) and a rotating brush for 10 seconds. The
teeth were then thoroughly rinsed and air-dried.

Bracket Bonding
The buccal and/or labial enamel was etched for 60
seconds with 37% orthophosphoric acid (ConTec
Etch, Dentaurum). The etching gel was rinsed off
thoroughly with a multifunctional syringe and
dried with oil-free compressed air until the enamel
surface appeared chalky. The primer was applied
with a nylon brush for dental use (ds paint brush,
Demedis, Langen, Germany) and then gently
blown with oil-free compressed air. The brackets
were bonded using 1 of the 3 adhesives. The curing times with the quartz-tungsten halogen unit
(ConTec Light, Dentaurum) were 20 seconds. A
10-second curing was performed with the plasma
arc curing unit (PAC, American Dental Technologies) and the light emitting diode curing unit
(Elipar FreeLight, 3M ESPE). The number of
samples per group (with same type of tooth, same
storage medium, same bracket, same adhesive,
same curing unit) was n 10.

Tooth Embedding
As the debonding plunger should encounter the
bracket at a defined distance of 0.5 mm from the
enamel surface, the teeth had to be embedded
in a special manner. A custom-made positioning
device that included a full-slot size stylus that was
engaged in the bracket slot was used to embed
the bonded teeth in preproduced specimens.
The specimens were made of polyurethane (ebaflott, ebalta, Rothenburg ob der Tauber, Germany) with a cavity that allowed positioning of
the teeth in the specimens (Fig 1), so that the
height of the bracket base surface was same as
that of the front wall of the specimen (Fig 2).

Effect of Storage Media on Shear Bond Strength and Enamel Fracture

Figure 1. Tooth with bonded bracket positioned in

the specimen (ebaflott, ebalta) using the positioning
device and an elastic (rubber band) to keep the
bracket and the tooth on the stylus. The previously
mixed 2-component polyurethane (SG130/PUR11,
ebalta) is applied using a syringe with an irrigation
needle. 1 front wall of the specimen; 2 elastic.

The teeth were fixed in the specimens with another 2-component-polyurethane containing SG
130 and PUR 11 (ebalta). Subsequently, the
specimens were numbered so that they could be
identified later. Between bonding and debonding the teeth were stored in distilled water at
room temperature for 24 0.5 hours.

Debonding
The brackets were debonded according to International Standards Organization specification
DIN EN ISO 10477 using a universal testing
machine (464 L, Erichsen, Hemer, Germany)
with a crosshead speed of 1 mm/min in an occlu-

51

Figure 3. Shear bond strengths measured on teeth

stored in different media.

sogingival direction. The measured debonding

force (in N) was divided by the bracket base area
(according to the manufacturers information) to
obtain the shear bond strength in MPa. The
enamel surfaces were subsequently evaluated using a stereomicroscope (10 and 40 magnification). The size of the enamel fractures were estimated and scored according to the following
criteria:
0 no enamel fracture;
1 size of the enamel fracture surface
one-third of the bracket base surface;
2 size of the enamel fracture surface
two-thirds of the bracket base surface but
one-third of the bracket base surface; and
3 size of the enamel fracture surface
two-thirds of the bracket base surface.
The statistical analysis and the graphical presentation were obtained with the SPSS 16.0 software
for personal computers. Nonparametric tests
(MannWhitney-U test, KruskalWallis test) were
used, because the data were not normally distributed,
as ascertained with the KolmogorovSmirnov test.

Results
Figure 2. The tooth with bonded bracket is positioned
in the specimen, so that the bracket base surface is at the
same height as the front wall (1) of the specimen. The
elastic (2) was cut once the acrylic was set.

The storage of teeth significantly influenced the

shear bond strength, as illustrated in Figure 3.
The teeth stored in 0.1% thymol solution
showed significantly higher shear bond strength

52

Gittner, Mller-Hartwich, and Jost-Brinkmann

Figure 4. Size of enamel fractures measured on teeth

stored in different media. 0 no enamel fracture,
1 size of the enamel fracture surface one-third of
the bracket base surface, 2 size of the enamel
fracture surface two-thirds of the bracket base surface but one-third of the bracket base surface, and
3 size of the enamel fracture surface two-thirds of
the bracket base surface.

(P 0.001, MannWhitney-U test) (median,

16.72 MPa) than teeth stored in 96% ethanol
(median, 13.15 MPa).
The teeth stored in 0.1% thymol solution
showed significantly less (P 0.001, Kruskal
Wallis Test) enamel fractures (26.9%) than
teeth stored in 96% ethanol (45.3 %), as shown
in Figure 4.

Discussion
Numerous in vitro studies have been carried out
to investigate the shear bond strengths of ceramic brackets with different adhesives or to
evaluate the risk of enamel fractures of various
bracket-adhesive combinations. In vitro studies
are very popular as constancy of parameters can
be maintained, which is a precondition for comparison of similar studies.
The literature reports on various storage media, such as 70% ethanol,13,16,24 0.1% thymol
solution,9,25,26 or 10% formalin solution27 to
prevent bacterial growth. The use of phosphate
buffered 0.9% saline solution6 or tap water28 has
also been described in other studies. Although
the storage medium may have an effect on the
shear bond strength and the risk of enamel frac-

tures, there are no data in the literature regarding this issue. A possible reason for the lower
shear bond strength and the higher risk of
enamel fractures of human teeth stored in 96%
ethanol could be dehydration of the enamel
caused by the osmotic gradient. Mature enamel
contains 12% by volume and 4% by weight water. The major part of the water is bound to
apatite crystals in form of the hydration shell
and only a fourth can be found in the organic
matrix of the enamel.29
The physical properties of the enamel are
influenced by dehydration.30 Wang et al31 discussed an effect of the storage in 70% ethanol
on the chemical composition of the enamel
causing a reduction in bond strengths and an
increased incidence of enamel fractures. In contrast, there are studies with teeth stored in 70%
ethanol that negate an increased risk of enamel
fractures;13,16,24 however, the extrapolation of
these study results to the results of the present
study is limited due to the different ethanol
concentrations. In addition, one has to consider
that extracted teeth are much drier than vital
teeth in vivo, and therefore more vulnerable to
enamel fractures,17 which is probably the reason
for the higher enamel fracture rates in vitro than
in vivo.
As carious lesions were criteria for exclusion, the teeth were extracted for orthodontic
or periodontal reasons, so that young permanent teeth (extracted for orthodontic reasons)
as well as old permanent teeth (extracted for
periodontal reasons) were used in this study.
The age of the teeth also has an effect on the
results as Sheen and Wang32 ascertained that
older permanent teeth showed significantly
higher bond strength than younger permanent teeth. As the percentage of young and
old teeth in the 2 different storage media were
probably the same, one can compare the results for the 2 storage media.
Considerable effort was put into reproducibly
embedding the teeth to ensure a uniform
debonding direction for all samples, as Klocke
and Kahl-Nieke33,34 observed significantly different shear bond strengths if the debonding force
direction varied.
Joseph and Rossouw14 reported on 40%
enamel fractures after the storage of teeth in
70% ethanol. The enamel fracture rates in their
study (40%) and in the present study (45.3%)

Effect of Storage Media on Shear Bond Strength and Enamel Fracture

are almost the same. Forsberg and Hagberg6

stored the teeth in a phosphate buffered 0.9%
saline solution and found enamel fractures in
17.6% of the sample. Merrill et al28 observed a
fracture rate of 10% after storing their teeth in
tap water. However, it must be emphasized that
the storage media in these studies6,28 do not
prevent bacterial growth, and therefore can only
be used for short-term storage, even though the
enamel fracture rates are lower in comparison
with storage in 0.1% thymol solution. The
enamel fracture rates reported in the literature
cannot be appropriately referenced when comparing the different storage media because different ceramic brackets were debonded in the
various studies.
Perhaps tooth storage in a 2% glutaraldehyde
solution was even better than storage in 0.1%
thymol solution as Lee et al35 found no significant differences between storage in distilled water (control group) and in 2% glutaraldehyde
solution when testing shear bond strength of
composite to bovine dentin.
In the present investigation various combinations of brackets, adhesives, curing light units
and bracket bonding on 2 different types of
teeth were supposed to produce representative
data for a wide variety of conditions, although
these parameters surely also had an effect on the
shear bond strengths. However, the conditions
for samples stored in the same storage medium
were all the same, so that the results can be
compared for the 2 storage media.

Conclusions
The storage medium significantly influences the
shear bond strength, measured in vitro on human teeth. Storage in 96% ethanol causes a
dehydration of the enamel, which is probably
the reason for reduced shear bond strength and
the frequent occurrence of enamel fractures.
Consequently, for shear bond strength testing
0.1% thymol solution is to be preferred to 96%
ethanol. However, even with thymol as the storage medium the enamel fracture rate appears to
be higher than that in vivo.17

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