BONDING IN

ORTHODONTICS
BONDING = Adhesion + attachments
Bonding is based on mechanical locking of an
adhesive to irregularities in enamel surface of
tooth and to mechanical locks formed in the base
of orthodontics attachments. Successful bonding
depends upon
Tooth surface and its preparation
Design of attachment base
Bonding material itself.

EVOLUTION OF BONDING
SYSTEM
1956- 85% Phosphoric acid by Buonocore.
1965 Epoxy Resin by newman
1968 Smith introduced zinc poly acrylate cement
Around 1970s
Miura et al (acrylic resin with modified trialkyl
borone catalyst
Diacrylate resin
Most widely used (Bowens resin or bis GMA)

1983 Smith and maijer 100% bond strength

when metallic particles were fused onto bracket base
1995- Silvermen introduce LC GIC in orthodontic
bonding procedure.
1999 John M. Powers hybrid GIC & resin cement
when band material are air abraded.
2000 Thomas W. Ortendahl Ethyl - cynoacrylates

ADHESIVE REMNANT INDEX

(ARTUN & BERGLAND 1984)
Score
0 = No adhesive remaining on teeth.
1 = < 50% adhesive remaining on teeth.
2 = > 50% adhesive remaining on teeth.
3 = All adhesive remaining on teeth

BOND FAILURE
CLASSIFICATION (TAKAMI
ITOH (1999))
Type A = Adhesive enamel interface failure
Type B = Cohesive failure inside adhesive
Type C = Adhesive bracket interface failure
Type A = Common with bracket bonded with GIC
Type C = Common with bracket bonded with
composite.

ADVANTAGES

Esthetically superior
Faster and simpler
Less discomfort
Arch length is not increased by band material
Allows more precise bracket placement
More hygienic than band
Partially erupted teeth can be controlled
Mesiodistal enamel reduction is possible during treatment
Attachment may be bonded to artificial tooth surfaces.

 Interproximal areas are accessible for composite

build ups
Caries risk under loose bands is eliminated
No band spaces are present at the end of treatment
Bracket may be recycled further reducing the cost
Lingual brackets can be used when patient rejects
visible orthodontic appliances.

DISADVANTAGES
Bonded bracket has a weaker attachment than a
cemented band
Some bonding adhesives are not sufficiently strong
Better access for cleaning doesnt necessarily
guaranty better oral hygiene and improve gingival
condition, if excess adhesive extends beyond the
bracket base.
Protection against inter proximal caries is absent
Rebonding requires more time than re cementing
bands
Debonding is more time consuming than debanding

Most common problem by inexperienced

practitioners

Loosening of brackets
Inaccurate bracket placement
Decalcification during treatment
Time consuming aspect of debonding

ORTHODONTIC ADHESIVE
MATERIALS
First material was acrylic resin, soon replaced by diacrylates known as composite resin.

CLASSIFICATION BASED ON GENERATION

1st
Generation

Mid 70s

Acrylic resin & Epoxy resin

2nd
Generation

Late 70s

U. V light cured acrylic and composites

3rd
Generation

Early 80s

Composite resin 2 paste system

4th
Generation

Mid 80s

Composite resin 1 paste system

5th
Generation

Mid 80s

Visible light cure composite, dual care

composite

6th
Generation

1995

7th
Generation

2000

Resin reinforced GIC light cure, dual

care, tri cured, compomers, UDA based
composite
Cynoacrylates

CLASSIFICATION BASED ON
BONDING SYSTEM
Acrylic Resin based system
Self cured
U.V. light cured
Composite resin based on bis-GMA system
a. Chemically cured
1. Two paste system
ex.
Concise
phase II

2. Single paste or no mix system

ex. Rely a bond
advantage
System 1+

b. Visible light cure system

ex. Transbond XT
Light bond
Polar light
transilluminate

c. Dual care system / 2 paste

ex. Band - lock

3. Glass Ionomer based system

a. conventional GIC
ex.
Ketac cem
Fuji I/II
b. Resin reinforced GIC
1.chemically settable
ex.
Advance, Fuji ortho
2. VLC RRGI (Tricure)
ex.
Fuji ortho LC
c. Poly acid modified composite resin/ compomers
ex.
Dyract orthodontic/ dual cured / single
paste GIC
Ultra band lok
compoglass

4. Cynoacrylate based system

ex

Smart bond
Fluoride releasing system light bond
Transilluminate
Ideal requirements

o
o
o
o
o
o
o
o
o
o

Should be easy to handle

Should wet tooth surface
Should polymerize well
Should form reliable bond to enamel and be strong enough to
withstand tensile and shearing stress
It must be easy to remove after treatment without causing any damage
to enamel
It must be bio compatible
Optimal bond strength is 7 Mpa
Tavas and watt (1984) debonding force greater than 58 N
There should not be enamel loss during placement of bracket and
debonding
It should not be very techniques sensitive

ACRYLIC RESIN
1st material to be used in orthodontic. They had good
flow and wettability. Lacking sufficient bond
strength. High degree of polymerization
shrinkage.
Chemically they are linear-cross linked polymer of
methaceylic acid
ex. Orthomite, Genie

EPOXY RESIN
Epoxy resin polymerisation reaction lead to give a 3
dimensional cross-linkage, with improved greater
strength, lower water sorption and less
polymerization shrinkage, but less wettability to
tooth surface.
It was Bowan who combined acrylic resin with
epoxy resin and give rise to Bis-GMA system,
which was later named as composite resin.

COMPOSITE RESIN
This Bis-GMA resin has some amount of
polymerisation shrinkage and lack of sufficient
strength which was compensated by addition of
fillers of various particle sizes. Some new
compositer resin have matrix other than Bis-GMA
like UDA and TEGDMA.
Polymerization of composite resin
Chemical reaction
Activation by U.V or visible light
Heat

Chemically activated system polymerizes as a result of

two component being brought together.
Composition
Adhesive Pastes
Bis-GMA Matrix
Colloidal Silica Filler
Benzoyl peroxide Initiator
Hydroquinone Inhibitor
Primer Liquid
N, N dimethytoludine Activator
HEMA
TEG DMA
Methacrylate monomer

The light activated system Polymerized upon

exposure to light to appropriate wavelength.
U-V light 364-637nm
Visible light 440-480 nm
Ultraviolet light is not used now due to retinal damage &
more time required for curing.
Visible light has great advantage of greater curing in lesser
time
Allows more accurate bracket placement

Composition
Paste
Bis GMA Matrix
Calloidal silica Filler
Camphorquinone - photo initiator
0.15% dimethyl aminoethyl methaacrylate Accelerator
0.01% butylated hydroxy toluene inhibitor
Primer liquid
Methacrylate monomer
TEG DMA
Upon exposure initiator accelerator get activated by absorbing photon
energy giving rise to chemical reaction which results in material
polymerisation.

LIMITATION OF COMPOSITE RESIN

Acid-etching is necessary, which led to enamel
surface loss and decalcification.
Loss of enamel during debonding
Composite resin do not bond to plastic bracket
Not advocated for ceramic brackets

GLASS IONOMER BASED

SYSTEM
Conventional Glass Ionomer
Wilson and Kent (1992) introduced this cement by
combining
powder of silicate cement & liquid of
polycarboxylate cement.
Chemistry
Its formed from the reaction of ionleachable calcium
aluminosilicate glass powder containing fluoride and
polyalkeonic acid
Bond strength less than composite.
The research workers which led to development of new
class of material that was combination of composite resin
and glass ionomer.

Mc lean et al (1994) classified these material as

o Resin reinforced GIC 12% HEMA, ex Fuji ortho
o Poly acid modified composite resin 33% HEMA, ex Dyract
orthodontic
Resin reinforced glass ionomer (Silver man)
Advantage over composite resin
No Acid etching and priming of the enamel surface
Eliminates the need for working in dry field.
Fluoride release protects against decalcification.
Patient and operator comfort.
Poly acid modified composite resin or compomer
Advantages
Bond strength comparable to light cure composite
No effect of moisture contamination
Limitations
Need for etching
No fluoride release

Cynoacrylate (ethyl cynoacrylate)

Used as Super glue in the manufacture of automobile and light air
craft.
In medicine it is used for
Fracture fixation
Skin suture
Cardiac surgery
In dentistry Cyno-veneer luting agent,
ex. Smart bond . (Bond Strength 20-25MPA)
Advantages
Shear strength reaches after 2-3 min and reaches maximum after 24hr.
Polymerisation starts only in the presence of pressure & moisture.
Thinner the adhesive layer stronger the bond.
No water sorption & no discoloration
Bonds on composite & ceramic surfaces
Can be used with metal & plastic brackets
Bio compatible
No danger of fracturing enamel during debonding

XENON ARC LIGHT CURING

Advantages over VLC
Curing time to only 2 sec/ tooth which lessen pulpal damage
Ability to cure through enamel
Higher degree of polymerization

CRYSTAL GROWTH SYSTEM

(ALTERTATIVE TO ACID ETCHING)
Given by smith & cortez (1973)
Crystal growth relies on the creation of micro-mechanical, crystalline,
retentive surface on enamel to which bonding adhesives are applied.
Maijer & Smith ( 1979) introduced sulphated polyacrylic solution for
crystal growth.
Pizzaro (1991) investigated effects of pottasium, lithium and magnesium
as agents, lithium agents was found particularly promising agent.

Advantages
Enamel surfaces in minimally affected during
bonding/debonding.
Achieves chemically adequate bond strength
Few if any resin tags left behind in the enamel.

BONDING PROCEDURE
The steps involved are
Cleaning
Enamel conditioning
Sealing
Bonding
Cleaning : Thompson and Way (1991) recommended small bristle brush for more
effective and less damaging cleaning.
Enamel conditioning
Moisture control
Lip expanders
Saliva ejector
Tonque guard with bite blocks
Salivary duct abstractors
Gadgets that combine several of these
Cotton or guaze rolls
Antisialogogues

Enamel Pretreatment
After the operating field has been isolated the teeth to be
bonded are dried and the conditioning solorgel (usually
37% phasphoric acid) is then lightly applied ever enamel
surface for 15 to 60 sec. When etching solution used the
surface must be kept moist to avoid damaging enamel rods.
Care must be taken not to rub the liquid on to teeth. Next
the teeth are thoroughly dried to obtain dull, frosty
appearance.

Fluoridated phosphoric acid sol & Gel provide similar etching effect
similar to non-fluoridated ones, give adequate bond stregth.
Sealing After the teeth are completely dry and appear frosty white, then
layer of sealant is painted over entire, etched enamel surfaced with a
single gingivioincisal stroke. Excess sealant may cause drifting of
bracket and enamel topography.
Bonding
Steps in bonding
Transfer of bracket Bracket is holded with reverse action tweezer
and then adhesive is applied to the back of bonding base. Bracket is
immediately placed on the tooth close of its correct position.
Positioning A placement scaler is used to position the bracket
mesiodistally and in ciso-gingivally. Mouth mirror will aid in
horizontal positioning, particularly on rotated premolar
Fitting - with one point contact, the bracket is pushed firmly towards
the tooth surface. The tight fit will result in good bond strength.

Removal of excess It is most important to remove the excess adhesive to prevent or

minimize gingival irritation and plaque build up around the periphery of the
bonding base. Not to disturb the bracket position during setting (ZACHRISSON)
advocates removal of excess after setting with oval or tappered TC burs

Brackets
Types : Plastic based, Ceramic based and metal (S.S, Gold coated and Titanium)
Plastic Brackets
These are made of ply carbonate and are used mainly for esthetic reason.
Disadvantages
Lack strength to resist distortion and breakage
Uptake of water
Discolaration

Ceramic brackets
These are machined from mono crystalline or poly crystalline
aluminium oxide.
Advantages
Resist staining and discolouration

Ceramic bracket bond to enamel by two mechanism.

Mechanical retention via indentation or under cuts in the base.
Chemical bonding by means of silane coupling agent.
Disadvantages
The frictional resistance between orthodontic wire and ceramic bracket
is greater. More recent ceramic bracket have a steel slot to reduce
friction.
Ceramic bracket are more brittle
Ceramic bracket causes enamel wear of opposing teeth.
They are more difficult to debond than steel bracket.

Metal Bracket
Rely on mechanical retention for bonding and mesh gauze is the conventional
method of providing this retention.
Disadvantages
Corrosion of metal brackets
Black and green stain
Bonding to crown and restoration
Micro etcher which uses 50 micron millimeter or 90 micron millimeter tan
aluminimum oxide particle at approx 7kg /cm2 pressure
Bonding to Porcelin
Procedure
Isolate the working field
Deglaze an area slightly larger than bracket base by sand blasting with 50
micron millimeter aluminium oxide for 3 sec.
Etch the porcelin with 9.6% Hydrofloric acid gel for 2 min.
Carefully remove the gel with cotton rolls, then rinse using high volume
suction.
Immediately dry with air, and bond bracket.

Bonding to amalgam
Improved technique for bonding to amalgam restoration may
involve.
Modification of metal surface
Use of intermediate resin that improve bond strength
New adhesive resin that bond chemically to non-precious
as well as precious metal.
Bonding to small restoration
Sand blast the amalgam alloy with 50 micron millimeter
aluminium oxide for 3 sec.
Acid etching with 37% phosphoric acid
Apply sealants and bond with composite resin.

Bonding to large restoration

Sand blasting the amalgam filling with 50 micron
millimeter Aluminium oxide for 3 sec.
Apply a uniform coat of reliance metal primer and wait for
30sec.
Apply sealant and bond with concise.
Bonding to gold
Different new techniques, including sand blasting, electrolytic
tin plating or plating with gallium tin solution and new
adhesive that bond chemically to precious metal.
Bonding to composite restorative
Roughened surface of old composite restoration appear to
be clinically successful in most instances.

INDIRECT BONDING
In this technique brackets are attached to teeth on patients models,
transferred to the mouth. With some sort of tray into which bracket
become incorporated and then bonding simultaneously.
Advantages
Brackets can be more accurately placed
Saves clinical chair time.
Disadvantages
o Disturbance in polymerization
o Removal of excess adhesive is difficult
o Higher failure rates.
Techniques
Indirect bonding with silicone transfer trays
Indirect bonding with double sealant techniques

REBONDING
The loose bracket is removed from archwire.
Any adhesive remaining on the tooth
surface is removed with TC bur. The
adhesive remaining on the loose bracket is
treated by sand blasting. The tooth is then
etched with ultra etch 35% phosphoric acid
gel for 15 to 30 sec. After sealing bracket is
rebonded. The neighboring bracket are
religated first and then rebonded bracket is
ligated.

RECYCLING
The Main goal of recycling process is to remove the adhesive
from the bracket completely without damaging or
distorting the dimension of bracket slot.
Commercial processes employ heat (about 450oC) to burn
off the resin, following by electro polishing to remove the
oxide build or they use solvent stripping combined with
high frequency vibrations and only flash electro polishing.

DEBONDING
Objective of debonding are to remove the attachment and all
the adhesive resin from the tooth and restore the surface as
closely as possible to its pretreatment condition.
Clinical Procedure
Divided into two stages
Bracket removal
Removal of residual adhesive
Bracket Removal (Steel bracket)
Original method was to place the tip of twin beaked pliers
against the mesial and distal edges of bonding base and cut
the bracket off between the tooth and base.
A gentle technique is to squeeze the bracket wing
mesiodistally and lift the bracket off with a peel force.

Ceramic Bracket

The preferred mechanical debonding is to lift the

bracket off with peripheral force application.

Thermal debonding

Use of laser
Removal of Residual adhesive
The removal of excessive adhesive may be accomplished by
Scraping with a very sharp or bond removing pliers or with
a scaler.
Using a suitable bur and contra angle approx 30,000 rpm is
optimal for rapid adhesive material without damaging
enamel. When all the adhesive has been removed, the tooth
surface may be polished with pumice.s

AMOUNT OF ENAMEL LOST

DURING BONDING & DEBONDING
Initial prophylaxis - Rubber cup 5 micron millimeter
- Bristle brush 10 micron millimeter

Acid etching

3-10 micron millimeter

During debonding- high speed burs 2 micron millimeter

- low speed TC burs 10 micron millimeter

Total enamel loss - 30 micron millimeter

60 micronmillimeter

Kuraray Dental Introduces a New Adhesive bonding agent :

CLEARFIL PROTECT BOND
Features and benefits
Antibacterial cavity cleansing properties
Low post operative sensitivity
High bond strength
Fast and simple procedure (no rinsing)
Fluoride releasing properties
Clinical indications
Direct restorations using light-cured composite resin or compomer
Cavity sealing as a pretreatment for indirect restorations
Treatment of hypersensitive and / or exposed root surfaces
Intraoral repairs of fractured crowns / bridges made of porcelain, hybrid
ceramics or composite resin using light-cured composite resin
Surface treatment of prosthetic appliances made of porcelain, hybrid
ceramics and cured composite resin.
Core build ups using light-or dual-cured composite resin
Cavity sealing under amalgam restorations

BONDED RETAINERS
Permanent maintenance of the achieved orthodontic results
after successful treatment of malocclusion is of
paramount importance for a clinician.
Fixed bonded retainer increased suddenly due to its
following advantage.
i.
ii.
iii.
iv.
v.

Completely invisible
Comfortable to patient
Reduce need for long term patient co-operation
Easy to maintain oral hygiene
Prolonged semipermanent and even permanent retention can be
provided

Purpose
1. To prevent incisor re-crowding
2. To hold the achieved lower incisor position in space
3. To keep the rotation center in the incisor area when a mandibular
anterior growth rotation tendency is present

Types of bonded retainers

Bonded lingual canine to canine retainer

Bonded lingual premolar to premolar retainer
Direct contact splinting
Flexible spiral wire retainers
Direct bonded labial retainers

Bonded Lingual Canine to Canine Retainer

Purpose
To prevent incisor re crowding
To hold the achieved lower incisor position in space
To keep the rotation in the incisor area when a madibular
anterior growth rotation tendency is present

Direct contact splinting

To prevent post orthodontic space reopening between teeth
Failure
Fracture of adhesive occurred within a few weeks or months
when ever segments larger than two teeth were splinted.
Flexible spiral wire retainers
Clinical experience and differential retention philosophy
have demonstrated the need for two types of bonded wire
retainer.
Thick wire (0.030 inch diameter)
Thin wire (0.0215 inch diameter)

ADVANTAGES
They may allow safe retention of treatment results
when proper retention is difficult, or even
impossible with traditional removable appliance.
They allow slight movement of all bonded teeth
and segments of teeth. Apparently this is the main
reason for the excellent long term results.
They are invisible
They are neat and clean
They can be placed out of occlusion in most
instances.
They can be used alone. Or in combination with
removable retainer.

DISADVANTAGES
Good oral hygiene of patient is mandatory
Daily flossing in each interdental space is
recommended

OTHER APPLICATIONS OF BONDING

IN ORTHODONTICS
Bonded space maintainers
Bonded single tooth replacement
Splinting of traumatized teeth
Composite build-ups and porcelain laminate
veneers

REFERENCE
TEXT : GRABER AND VANARSDALL
TEXT : CONTEMPORARY ORTHODONTICS PROFFIT
TEXT : TEXT BOOK OF ORTHODONTIC MATERIALS WILLIAM
BRANDLY & THEODORE ELIADES
TEXT : TEXT BOOK OF OPERATIVE DENTISTRY STERDUVANT

JOURNALS
JOHN. M. POWER : BONDING OF HYBRID IONOMERS AND
RESIN CEMENTS TO MODIFIED ORTHODONTICS BAND
MATERIALS. AJO. DO 1999 : 115; 143-7.
THOMAS. W. ORTHENDAHL : A NEW ORTHODONTIC
BONDING ADHESIVE. JCO JAN 2000 VOL 34, NO : 1
LOPEZ : RETENTIVE SHEAR BOND STRENGHTH OF VARIOUS
BONDING ATTACHMENT BASE AJO : 1980 : 77, 669-78.
TAVAS AND WATT : A VISIBLE LIGHT ACTIVATED BONDING
MATERIAL BJO : 1984 : 11 : 33-37

 BUZITTA : BOND STRENGHT AJO 81 ; 87; 1982

SILVERMAN : A NEW LIGHT CURED GIC THAT BONDS
BRACKET TO TEETH WITHOUT ETCHING IN PRESENCE OF
SALIVA. AJO DO 1995; 108; 135-6.
ARTUN AND BERGLAND; CRYSTAL GROWTH. AJO 85; 333-40
SURENDRA PATEL : A MODIFIED VLC COMPOSITE RESIN FOR
DIRECT BONDING. JCO 1999, 33 NO 8.
VITTORIO CACCIA FESTA : A XENON ARC LIGHT CURING
UNIT FOR BONDING AND BLEACHING. JCO FEBRUARY 2000,
34 NO 2.
ROBERT. A. MILLER LABORATORY AND CLINICAL
EVALUATION OF A SELF-ETCHING PRIMER. JCO JANUARY
2001, 35 NO 1.