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Вестник РУДН. Серия: МЕДИЦИНА 2024;28(1)
RUDN Journal of MEDICINE. ISSN 2313-0245 (Print). ISSN 2313-0261 (Online) http://journals.rudn.ru/medicine
DOI: 10.22363/2313-0245-2024-28-1-35-45 EDN: UJULTW
ORIGINAL RESEARCH ОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕ
Study of various adhesive systems' bond strength for bracket placement
Hayan Almokaddam ® Nikolay S. Tuturov Imad Katbeh®
RUDN University, Moscow, Russian Federation CE3 Hayanalmokaddam5@gmail.com
Abstract. Relevance. Today, the dental market offers a large selection of adhesive systems developed based on various concepts. Improving adhesive technology in orthodontic practice is aimed at simplifying methods of use, improving the composition and ability of adhesion of orthodontic elements to the tooth structure. The aim of this study is to compare the shear bonding strength of different generations of adhesive systems for metal brackets placement. Materials and Methods. The study sample consisted of 40 recently extracted human upper premolars. The premolars were divided into four groups 10 each. The first group used the bond Transbond XT 3M Unitek (USA), the second — Beauty Ortho Bond (Japan), the third — Tetric N bond Universal (Vivapen) (USA) with acid etching with phosphoric acid (LI), the fourth — Tetric N bond Universal (Vivapen) (USA) without acid etching with phosphoric acid. The study used metal brackets for upper premolars (Gemini Bracket MBT, 3M Unitek, USA) with a micro-patterned base, the area of which was defined as 10.61 mm2. Mechanical shear strength tests were carried out using the Instron Universal Test machine (USA). One-way analysis of variance and the TUKEY test were used to examine significant differences in adhesive strength and shear strength between study groups. Results and Discussion. The highest adhesive shear strength was established when using the Transbond XT adhesive system (12.28 MPa) and the Tetric N Bond Universal system using the total etching (12.66 MPa) and self-etching (11.44 MPa) techniques; statistically significant differences between these adhesives were not detected. The second group of Beauty Ortho Bond (5.34 MPa) demonstrated the lowest adhesion force among the studied adhesives, with a statistically significant difference from the other groups. Conclusion: This study concluded that there are no notable differences in the comparison of the universal system with or without etching with the Transbond system. Regarding the use of the beauty Ortho bond, it obtained the lowest strength with significant difference from the remaining groups.
Keywords: adhesive system, orthodontic adhesive, adhesive bond strength, enamel etching, self-etching adhesive, bracket placement
Funding. The authors received no financial support for the research, authorship, and publication of this article.
Author contributions. Tuturov N.S. — concept and design of research; Almokaddam H. — concept and design of research, literature review, data processing, collection and processing of materials; Katbeh I. — statistical data processing, writing text.
© Almokaddam H., Tuturov N.S., Katbeh I., 2024
0 0 I This work is licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by-nc/4.0/legalcode
All authors have made significant contributions to the development concepts, research and manuscript preparation, read and approved final version before publication.
Conflict of interest statement. The authors declare no conflict of interest.
Acknowledgements — not applicable.
Ethics approval — not applicable.
Consent for publication — not applicable.
Received 06.01.2024. Accepted 08.02.2024.
For citation: Almokaddam H, Tuturov NS, Katbeh I. Study of various adhesive systems' bond strength for bracket placement. RUDN Journal of Medicine. 2024;28(1):35-45. doi: 10.22363/2313-0245-2024-28-1-35-45
Introduction
In 1955, Dr. Michael Buonocore introduced the enamel acid etching technique as a preliminary preparation of bonding surfaces to achieve better adhesion [1, 2]. It was first discovered that the application of phosphoric acid to the enamel surface significantly improves the strong bond due to the formation of mi-croporosity.
This technique has become widespread not only in orthodontic practice, but also in various areas of clinical dentistry.
However, treating the enamel surface with phosphoric acid causes the decomposition of the crystalline layer, respectively, destroying the enamel, as well as increasing the surface porosity caused by etching and the retention of resinous protrusions inside the enamel, leads to discoloration and pigmentation. Enamel damage is facilitated by the process of removing braces and removing residual adhesive from the tooth enamel after the end of orthodontic treatment. Since the main task of an orthodontist is to maintain the integrity of tooth enamel after braces are removed, except for its deformation [3-5] some undesirable aspects of this technique have caused great concern among researchers and practitioners. Thus, various adhesive systems have been developed.
The first and most common development is resin [6, 7]. However, the main drawback of this system is the limited working time [8-11], due to which the abutments are not able to comfortably handle the resin
and, accordingly, incorrect placement of the brackets on the tooth surface [12-16]. The desire to form a strong bond by reducing enamel damage and minimizing orthodontic manipulation led to the development of the image-processed adhesive system.
In 1979, photocuring adhesives were first used in the laboratory as an orthodontic adhesive, and the research was completed five years later. Thus, the curing of the adhesive under the abutment base occurs upon direct exposure to light from different directions with an ultraviolet lamp [17] and the penetration of visible light into the dental tissues [18, 19].
Tavas and Watles showed that transmission of visible light through enamel allows the photostable resin to cure under a metal arch base. One of the most important features of this system is to allow the orthodontist to place the braces in the correct place on the tooth surface [20-23]. This reduces the need to adjust the tooth axis at the end of treatment.
The main problem with dental binders is their ability to bond effectively to substrates of various characteristics. The enamel requires acid etching, usually from 30 % to 40 % phosphoric acid, before applying a liquid adhesive resin. Typical processes include etching with acid, application of a liquid adhesive resin, micromechanical and crosslinking for durability. These multistage binders have been on the market since the early 1990s and today can still be considered "gold standard" adhesives [24].
In response to market demand for simplified bonding procedures, self-etching adhesive has been significantly developed in line with broader simplification trends. Innovations in the form of starter materials and self-etching adhesives are aimed at mitigating the negative effects of excessive etching, excessive or insufficient conditioning. An advantage of using self-etching adhesives is that there is no need to remove the smear layer and smear plugs beforehand, as these systems can adapt the tooth surface to the adhesive [25].
Manufacturers are constantly introducing new adhesive systems for ease of use, improved texture, and ability to bond to tooth structure. As a result, researchers feel compelled to carefully examine and confirm these claims. Previous studies have shown that the bonding effectiveness of some materials is very low, while the bonds of other materials are more stable [26, 27].
A new class of bonding system was introduced, as the manufacturer claims that it can be used in systems with full etching, self-etching, and selective etching (Tetric N Bond Universal Vivapen,).
Recently, a new type of single-stage bonding system has been introduced for patient care, classified as "universal" or "multi-mode", usable with or without acid pre-treatment. To overcome the low enamel bond strength reported for self-etching bonding systems, universal bonding systems can be used using either etching-with-rinse or self-etching methods [28].
According to Reynolds and his colleagues, the minimum adhesive limit capable of withstanding chewing force is (from 5,9 to 7,8) and the stronger bond (40-50) MPa increases the risk of damage to the enamel during disengagement.
The aim of this study is to compare the shear bonding strength of different generations of adhesive systems for metal brackets placement.
Materials and methods
The study sample consisted of 40 recently removed human upper premolars. The teeth were of normal shape and size, the surface was free from defects and distortions such as dysplasia, there were no calcifications, caries, restorations and defects visible to
the naked eye such as cracks and chips, and they were not subject to teeth whitening or fluoro diagnostics. The premolars were rinsed with running water, blood removed from them, the remnants of gum tissue and ligamentous fibers and left for storage for a week in packages containing 10 % formaldehyde solution to prevent bacterial accumulation on them. A root canal was used for mechanical fixation of teeth within acrylic resin cast in aluminum molds (cube-shaped, 10 cm long, 2 cm wide, 3 cm high) to the level of the enamel junction, bearing in mind that the longitudinal axis of the crown is perpendicular to the mold. Then expose the entire vestibular surface and return it to distilled water to ensure the hardening of the acrylic resin. The study used metal brackets for upper premolars (Gemini Bracket MBT, 3M Unitek, USA) with a micro-patterned base, the area of which was defined as 10.61 mm2. After the teeth were removed from the distilled water, they were thoroughly dried with compressed air, then the vestibular surfaces of each premolar are brushed for 5-10 seconds with the brush to remove tartar and pumice powder, rinsed with a stream of water and compressed air for 5-10 seconds, then dried again with compressed air. This process was repeated on all teeth.
The first group used Transbond XT 3M Unitek.
Teeth were treated with 37 % phosphoric acid for 30 seconds, then rinsed thoroughly with a stream of water and dried with compressed air for 10 seconds until a uniform chalky spot appeared. Then a thin layer of base material Transbond XT 3M Unitek monovia, CA, USA. was applied to the etched area with a clean brush, a second layer of adhesive (Transbond XT 3M Unitek) was applied to the bracket base and glued to the marked area parallel to the longitudinal axis, removing excess glue from the edges of the base of the arch, taking care not to change the position of the arch. Then a light curing is performed for 30 seconds.
The second group used Beauty Ortho Bond (Japan).
It is a self-adhesive system that releases fluoride components, allowing brackets to be placed in one step, according to the company's instructions, applying the solution to the surface with a clean brush for three seconds without pre-etching the enamel. Then the enamel
is dried with light pressure and the brackets are glued with a special paste from the same manufacturer. Then a light curing is performed for 20 seconds.
The third group the brackets are bonded using Tetric N bond Universal (Vivapen).
Teeth were treated with 37 % phosphoric acid for 30 seconds, and then rinsed thoroughly with a stream of water and compressed air for 10 seconds until a uniform chalky appearance appeared. Then, a thin layer of Tetric N bond Universal was applied with a clean brush to the prepared area, and Tetric N bond Universal (Vivapen) adhesive putty was applied to the base of the bracket and glued to the marked area parallel to the length of the longitudinal axis, removing excess adhesive (Table 1). Along the edges of the base of the mount, bearing in mind that the position of the mount does not shift or reposition if necessary, and light cured within 30 seconds.
The fourth group is Tetric N bond Universal (Vivapen).
The same previous steps were performed in the third group, but without acid etching with phosphoric acid and only applying the basic bond while stirring for 5 seconds and then applying a light curing for 30 seconds.
All teeth were preserved after gluing in 4ml of distilled water in closed vessels for 24 hours.
Shear strength test method. Mechanical tests were performed on a standard test machine (Instron Universal Test). When the teeth were attached to the apparatus so that the base of the arch was parallel to the shear force, and with a sharp-end metal blade attached to the movable upper jaw of a mechanical test apparatus, an occlusal shear force was applied at a rate of 1 mm/min, and a shear force was applied, at which adhesion would not occur, and the occlusal force was applied. Recorded in kilograms, then converted to Newtons, then the shear-resisting adhesion force was
calculated according to the following equation: Adhesion shear-resistance force (MPa = force (newtons)) ^ arc base area (10.61) square millimeter.
Statistical analysis. Order to study the significant differences in the strength of adhesion and resistance to shear force between the study groups, one-way analysis of variance was used, and the TUKEY test, which is one of the methods of dimensional comparisons, provided that it is significant (F) in the table of analysis of variance and the most accurate to find out the reason for the significant differences If any, among the study groups. Before starting the analysis of variance, it is necessary to make sure of the conditions of the normal distribution of the dependent variable (on all study groups) and also check the homogeneity of the variance among them, where the Anderson-Darling test and the Leven test were used for each of them, respectively.
Results and discussion
1. Results of the normal distribution test
The results showed that the condition of the normal distribution was fulfilled for all study groups, where the value of the A-D test was estimated, 0,185, 0,105, 0,141, 0,187 with significance (P Value) of about 0,927, 0,85, 0,957, 0,873, all of which are greater than the level of significance (5 %) for groups from the first to the fourth respectively (fig. 1-4).
2. Results of the heterogeneity test
The results showed the condition of homogeneity of variance was fulfilled between the study groups, where the value of the Leven test was estimated at 0,149 (Fig. 5) (P_Value = 0.26 > 0.05) fig. (5).
Table 1
Statistical analysis
Method
Null hypothesis All variances are equal
Alternative hypothesis At least one variance is different
Significance level
95% Bonferroni Confidence Intervals for Standard Deviations
Sample N StDev CI
Transbond 10 4.53478 (2.51739, 10.8885)
Beauty ortho bond 10 1.91646 (1.06068, 4.6155)
Teric N bond Universal, Vivapen 10 4.68064 (2.47380, 11.8047)
the fourth group 10 4.17451 (2.12052, 10.9540)
Individual confidence level = 98.75 %
Fig. 1. Results of the Anderson-Darling normal distribution test group of the Transbond
¿466 Beauty ortho bond (Japan)
Fig. 2. Results of the Anderson-Darling normal distribution test group of the Beauty Ortho Bond
Probability Plot of Tetric N bond Universal rVivape
Normal
Tetric N bond Universal .Vrvape
Fig. 3. Results of the Anderson-Darling normal distribution test group of the Tetric N bond Universal
The fourth group
Fig. 4. Results of the Anderson-Darling normal distribution test group of the Tetric N bond Universal
121456T49
If intervoli do r>ot overtop, the corresponding ttdtvi ore signiftcorttty different-
Fig. 5. Levene's test multiple comparison intervals of the deviation
3. Results of the analysis of variance and Tukey test resistance to shear force between study groups where The results of the analysis of variance showed the value of (F) was estimated at 7.4 and the value of that significant differences in the strength of adhesion significance was estimated at 0,001 > 0,05 (Table 2).
Table 2
Results of the analysis of variance
Method
Null hypothesis All means are equal
Alternative hypothesis Not all means are equal
Significance level
Equal variances were assumed for the analysis
Analysis of Variance
Source Df Adj SS Adj MS F-Value P-Value
Factor 3 353.0 117.67 7.40 0.001
Error 36 572.1 15.89 - -
Total 39 925.1 - - -
Means
Factor N Mean StDev 95% Cl
Transbond 10 12.28 4.53 (9.72, 14.84)
Beauty ortho bond (Japan) 10 5.342 1.916 (2.785, 7.899)
Tetic N bond Universal, Vivape 10 12.66 4.68 (10.10, 15.21)
The fourth group 10 11.44 4.17 (8.89, 14.00)
Pooled StDev = 3.98660
The results of the analysis of variance showed the results of the TUKEY test are significant, the difference between the average strength of adhesion resistance to shear strength of the group Ortho BeautyBond (Japan) and the average of the rest of the
groups, and that decrease, for example, the difference was estimated at 6,938 between them and the group Transbond XT, with the significance of the differences at the level of significance was established (Table 3 and fig. 6, 7).
Table 3
Tukey tests results Grouping information Using the Tukey Method and 95 % confidence
Factor N Mean Grouping
Tetic N bond Universal, Vivape 10 12.66 -
Transbond 10 12.28 -
The fourth group 10 11.44 -
Beauty orth bond (Japan) 10 5.342 B
Tukey Simultaneous 95% CIs
Difference of Mtmi for Tumbond. Beduty ortho, _
Amity ortho ■ Tumbsnd \ »
T«rte N bfln - TrtnrbOnd ♦
th9 fourth group ■ Trjinsfcond *
Ttlrk N ben ■ *uuty ortho *
th» fourth group m^hjcv «m * -1
№9 fourth grouj». TaCnc N bon *
■«■Jo i w is
4 (V> irtHrvtf Ifoti rt« CQrlQtr /Pi DV COr'tipQfOs*} mtOfit flr* HpmfxOi&y (MflfT+r*.
Fig.6. Difference of means of Transbond, Beauty ortho, Tetric N bond, the fourth group
Interval Plot of Transbond, Beauty ortho,
95% G lor the Mian
The pooled standard deviation it vied to calcutött № intervals.
Fig. 7. 95 % CL for the mean
Conclusion
This study concluded, in the circumstances in which it was conducted, that there are no statistically significant differences when comparing the Universal system with or without etching with the Transbond system. As for the use of Beauty Ortho Bond, it achieved the lowest adhesion force with a statistically significant difference from the rest of the groups, and this could make its use weak in practice, as the acceptable average strength is from 5.9 to 7.8 MPa. The average adhesive force in this study was 5.3 MPa.
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Исследование прочности соединения адгезивных систем различных поколений для фиксации брекетов
Х. Алмокаддам® Н.С. Тутуров®, И. Катбех®
Российский университет дружбы народов, г. Москва, Российская Федерация И Hayanalmokaddam5@gmail.com
Аннотация. Актуальность. На сегодняшний день на стоматологическом рынке представлен большой выбор адгезивных систем, разработанных на базе различных концептуальных платформ. Совершенствование адгезивных систем в ортодонтической практике направлено на упрощение способов использования, улучшение состава и способности адгезии ортодонтических элементов к структуре зуба. Цель исследования — сравнения адгезионной прочности на сдвиг адгезивных систем различных поколений для фиксации металлических брекетов. Материалы и методы. Выборка исследования состояла из 40 недавно удаленных верхних премоляров по медицинским показаниям. Премоляры были разделены на четыре группы, по 10 в каждой. В первой группе была использована адгезивная система пятого поколения Transbond XT 3M Unitek (США), во второй — самопротравливающий адгезив Beauty Ortho Bond (Япония), в третьей —
универсальная система Tetric N Bond Universal (Vivapen) с предварительным травлением эмали фосфорной кислотой, четвертая — Tetric N Bond Universal (Vivapen) (США) в технике самопротравливания. В исследовании применялись металлические брекеты для верхних премоляров (Gemini Bracket MBT, 3M Unitek, США) с микроотгравированным основанием площадь которого была определена как 10,61 мм2. Испытания на механическую прочность на сдвиг проводились на универсальной испытательной машине Instron (США). Однофакторный дисперсионный анализ и тест TUKEY использовались для изучения значительных различий в прочности адгезии на сдвиг между исследовательскими группами. Результаты и обсуждение. Наиболее высокий показатель адгезионной прочности на сдвиг установлена при применении адгезивной системы Transbond XT (12,28 МПа) и универсальной системы Tetric N Bond Universal в технике тотального протравливания (12,66 МПа) и самопротравливания (11,44 МПа), статистически значимых различий между этими адгезивами не выявлено. Наименьшую силу адгезии среди исследуемых адгезивов продемонстрировала вторая группа Beauty Ortho Bond (5,34 МПа), при статистически значимом отличии от остальных групп. Выводы. Это исследование пришло к выводу, что нет заметных различий при сравнении универсальной системы с травлением или без него с системой Transbond. Что касается использования системой Beauty Ortho, то она показала наименьшую прочность со значительным отличием от остальных групп.
Ключевые слова: адгезивная система, ортодонтический адгезив, адгезионная прочность, протравливание эмали, самопротравливающий адгезив, фиксация брекетов
Информация о финансировании. Авторы заявляют об отсутствии внешнего финансирования.
Вклад авторов. Тутуров Н.С. — концепция и дизайн исследования; Алмокаддам Х. - концепция исследования, обработка данных, обзор литературы; Катбех И. — статистическая обработка данных, написание текста. Все авторы внесли существенный вклад в разработку концепции, проведение исследования и подготовку статьи, прочли и одобрили финальную версию перед публикацией.
Информация о конфликте интересов. Авторы заявляют об отсутствии конфликта интересов. Этическое утверждение — не применимо. Благодарности — не применимо.
Информированное согласие на публикацию — не применимо.
Поступила 06.01.2024. Принята 08.02.2024.
Для цитирования: Almokaddam H., Tuturov N.S., Katbeh I. Study of various adhesive systems' bond strength for bracket placement // Вестник Российского университета дружбы народов. Серия: Медицина. 2024. Т. 28. № 1. С. 35-45. doi:10.22363/2313-0245-2024-28-1-35-45
Corresponding author: Hayan Almokaddam — PhD student of The Department of Pediatric Dentistry Orthodontics, Institute of Medicine, RUDN University, 117198, Miklukho- Maklaya str., 6, Moscow, Russian Federation. E-mail: Hayanalmokaddam5@gmail.co Almokaddam H. ORCID 0000-0002-5131-8401 Tuturov N.S. ORCID 0000-0001-8048-5703 Katbeh I. ORCID 0000-0002-4591-7694
Ответственный за переписку: Хайян Алмокаддам — аспирант кафедры стоматологии детского возраста и ортодонтии,
медицинский институт РУДН, Российская Федерация, 117198, г. Москва, ул. Миклухо-Маклая, д. 8. E-mail:
Hayanalmokaddam5@gmail.com
Алмокаддам Х. ORCID 0000-0002-5131-8401
Тутуров Н.С. SPIN 4892-3880; ORCID0000-0001-8048-5703
Катбех И. SPIN 8267-2898; ORCID 0000-0002-4591-7694
