{"id":3387,"date":"2015-10-25T08:04:36","date_gmt":"2015-10-25T08:04:36","guid":{"rendered":"http:\/\/biomedpharmajournal.org\/?p=3387"},"modified":"2020-04-25T09:37:42","modified_gmt":"2020-04-25T09:37:42","slug":"enamel-pretreatment-before-bonding-in-orthodontics-a-literature-review","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol8octoberspledition\/enamel-pretreatment-before-bonding-in-orthodontics-a-literature-review\/","title":{"rendered":"Enamel Pretreatment Before Bonding in Orthodontics &#8211; A Literature Review"},"content":{"rendered":"<p><strong>Introduction<\/strong><\/p>\n<p><strong>History<\/strong><\/p>\n<p>One of the most important events in orthodontics appliance was the introduction of direct Bonding. This was the direct result of the pioneering work by Buonocore<sup>1<\/sup> in the 1950\u2019s . BUNOCORE\u00a0 introduced acid etching technique. He demonstrated increased adhesion produced by acid pretreatment of enamel USING 85%\u00a0 phosphoric acid for 30 seconds..This led to dramatic changes in practice of orthodontics<\/p>\n<ul>\n<li>In 1956 R.L. Bowen did the initial work on bis-GMA resin systems (Known as Bowen\u2019s formula).<\/li>\n<li>Sadler (1958): Attempts to cement orthodontic attachments directly to enamel without etching have been recorded. Sadler tested nine materials (four dental cements, one rubber base cement, two metal adhesives and two general purpose adhesives) but these were all unsuccessful.<\/li>\n<li>Bowen (1962) developed a new resin system, Bisphenol-A-Glycidyl dimethacrylate commonly known as BIS-GMA and is often referred to as \u201cBowen\u2019s Resin\u201d.<\/li>\n<li>1965-with the advent of epoxy resin bonding George Newman, one of Dr. Buonocore\u2019s contemporaries developed similar methods to bond orthodontic brackets directly to the enamel of teeth (Newman. Snyder and Wilson, 1968) and \u00a0began to\u00a0 apply these findings to direct bonding of orthodontic attachments<\/li>\n<li>Retief also described an epoxy resin system to withstand orthodontic forces.<\/li>\n<li>Smith in 1968 introduced zinc polyacrylate cement and bracket bonding with this cement.<\/li>\n<li>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.In early 1970s considerable no, of preliminary reports were published on different commercially available direct &amp;indirect bonding system.<\/li>\n<\/ul>\n<p>A survey conducted by \u00a0ZACHRISSON<sup>2<\/sup> and LEONARD GOERLICK<sup>20 <\/sup>in 1979 JCO revealed almost 93% of orthodontists started bonding brackets (at least in anteriors )instead of banding<\/p>\n<p><strong>Advantages of Bonding<\/strong><\/p>\n<ol>\n<li>Esthetically superior. Faster &amp; Simpler.<\/li>\n<li>Less discomfort for the patient<\/li>\n<li>Arch length is not increased by band material.<\/li>\n<li>Allows more precise bracket placement even in tooth with aberrant shape.<\/li>\n<li>Improved gingival health.<\/li>\n<li>Better access for cleaning .<\/li>\n<li>Mesiodistal enamel reduction possible during treatment.<\/li>\n<li>Interproximal areas are accessible for composite buildup.<\/li>\n<li>Caries risk under loose bands is eliminated.Interproximal caries can be detected &amp; treated.<\/li>\n<li>No band spaces to close at end of treatment.<\/li>\n<li>Brackets can be recycled further reducing the cost.<\/li>\n<li>Invisible lingual brackets can be used when esthetic is important.<\/li>\n<li>Attachments can be bonded to fixed bridgeworks.<\/li>\n<\/ol>\n<p><strong>Disadvantages<\/strong><\/p>\n<ol>\n<li>Bonded brackets have weaker attachments than cemented band.<\/li>\n<li>If excess adhesive extends beyond bracket base increases risk of\u00a0\u00a0 plaque accumulation<\/li>\n<li>Protection against interproximal caries of well contoured cemented brackets is absent.<\/li>\n<li>Bonding generally not indicated when lingual auxillaries or headgear required.<\/li>\n<li>Rebonding loose brackets require more preparation than rebanding loose bands.<\/li>\n<li>Debonding- more time consuming due to more difficult removal of adhesives.<\/li>\n<li>Evidence based decalcification&amp; white spot lesion occurs more following bonding than banding<\/li>\n<\/ol>\n<p><strong>Basic Procedure in Etching<\/strong><\/p>\n<p>Bonding 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.<\/p>\n<p><strong>Cleaning<\/strong><\/p>\n<ul>\n<li>Thorough cleaning of teeth to remove plaque &amp;organic pellicle that normally forms on teeth is mandatory.though authors <sup>3<\/sup>, have questioned conventional pumice polishing<\/li>\n<li>Materials used are water slurry of pumice or prophylaxis paste with rotary instruments like rubber cup or small polishing brush.Reisner<sup>4<\/sup> found more consistent results with the use of tungsten carbide bur at slow speed(25000 rpm) than with pumicing<\/li>\n<\/ul>\n<p><strong>Enamel Conditioning<\/strong><\/p>\n<p><strong>Moisture control<\/strong><\/p>\n<p><strong style=\"line-height: 1.5;\">Enamel pretreatment<\/strong><\/p>\n<p>After drying the tooth apply a conditioning solution or gel<sup>5<\/sup> ( usually 37% to 50% phosphoric acid ) lightly over enamel surface with a pellet or brush for 15-60 sec.<\/p>\n<p>Enchant is rinsed off with abundant water spray for about 15 sec. If salivary contamination occurs rinse with water spray &amp; re etch for another 30 sec .<\/p>\n<p>Dry the tooth thoroughly to obtain dull frosty white appearance. If not re etch<\/p>\n<p>Cervical enamel because of its different morphology,might look different than incisal portion<sup>6.<\/sup>so they need not be re itched in order to produce uniform appearance.<\/p>\n<p><strong>Histology<\/strong><\/p>\n<p>Lehman &amp; Davidson\u00a0\u00a0 AJO\u00a0 1981.When enamel is etched with phosphoric acid of high percentage like 50% it forms monocalcium phosphate monohydrate on the surface which is highly soluble in water &amp; can be completely washed away leaving a roughness of larger surface area.There are 4 types of enamel appearance after various pre treatment<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3388\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig1-150x150.jpg\" alt=\"Figure 1: Honey comb appearance with loss of enamel prism centers.\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig1-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig1-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig1.jpg 450w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure\u00a01: Honey comb appearance with loss of enamel prism <\/strong><strong>centers.<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig1.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3389\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_T2-150x150.jpg\" alt=\"Figure 2 : Cobblestone appearance with prism edges lost.\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_T2-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_T2-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_T2.jpg 484w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 2 :<\/strong> <strong>Cobblestone appearance\u00a0 with prism edges lost.<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_T2.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3390\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig3-150x150.jpg\" alt=\"Pitted enamel with maplike appearance.\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig3-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig3-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig3.jpg 432w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 3: Pitted enamel with maplike appearance.<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig3.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3391\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig4-150x150.jpg\" alt=\"Figure 4: Granulation of enamel with numerous holes\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig4-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig4-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig4.jpg 411w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 4: Granulation of enamel with numerous holes<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig4.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Duration of Etching<\/strong><\/p>\n<p>In AJO-DO 1980 Nordenwall<sup>7<\/sup><\/p>\n<p>Reported that 15 sec etching is adequate for young permanent teeth ,whereas\u00a0 60 sec are needed for permanent teeth.\u00a0\u00a0 Same author in 1981\u00a0\u00a0 that there is no\u00a0 significant differences appear between etching solution or gel. But gel provides better control for restricting the etched area but requires more thorough rinsing afterward.<\/p>\n<p><strong>Changes in Enamel After Etching<sup>8<\/sup>:<\/strong><\/p>\n<p>Microporosity within the enamel and<\/p>\n<p>Reduces surface tension and allows the resin to penetrae and polymerize within the etched enamel rods.<\/p>\n<p>Standard etchant dissolves about 5-10mm<sup>24<\/sup> of enamel surface and creates a zone of etched enamel rods for about 15-25mm.<\/p>\n<p>Etching process creates calcium monophosphate and calcium sulfate by-products that must be removed by a vigorous water rinse<\/p>\n<p><strong>Histological changes\u00a0 in Enamel After Etching<\/strong> <sup>15,16<\/sup><\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3392\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig5-150x150.jpg\" alt=\"Figure 5\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig5-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig5-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig5.jpg 596w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 5<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig5.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3393\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig6-150x150.jpg\" alt=\"Figure 6\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig6-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig6-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig6.jpg 588w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 6<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig6.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3395\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig71-150x150.jpg\" alt=\"Figure 7\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig71-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig71-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig71.jpg 575w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 7<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig71.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Air Abrasion<\/strong><\/p>\n<p>Its\u00a0 a older technique of enamel pretreatment introduced as early as 1940 by Dr. Robert black..It uses abrading with 50 um or 90 um particles of aluminium oxide for 3 sec at 10mm distance..AJO-DO 1997 Marc .E. Olsen<sup>9 <\/sup>et al\u00a0 reported that air abrasion significantly decreases bond strength &amp; on debonding leaves no adhesive on enamel surface. So it is not recommended.<\/p>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3396\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig8-150x150.jpg\" alt=\"Figure 8\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig8-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig8-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig8.jpg 271w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 8<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig8.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Crystal growth Theory<sup>10,11:<\/sup><\/strong><\/p>\n<p>Jon Arton in AJO-DO 1984 reported crystal growth conditioning \u00a0after use of polyacrylic acid with residual\u00a0 sulphate provided retention areas in enamel similar to phosphoric acid etching with less risk enamel damage at debonding<\/p>\n<p>Phosphoric acid etched enamel surface Crystal growth on enamel surface<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3397\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig9-150x150.jpg\" alt=\"Figure 9\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig9-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig9-256x256.jpg 256w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig9.jpg 265w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 9<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig9.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Effect of Fluoride<\/strong><\/p>\n<p>Though Zachrisson reports fluoride content\u00a0 of tooth has no effect on etching time.. Lehman&amp;\u00a0 Davidson in AJO-DO 1981\u00a0 reported that fluoride\u00a0 is important in decreasing enamel solubility<sup>17. <\/sup>Fluoridated enamel<sup>12<\/sup> has highly acid resistant layer of 2-4 um thickness which may sometimes resist even 3 min etch. So avoiding fluoride application shortly prior to bonding is recommended.<\/p>\n<p>Clinical and laboratory studies<sup>8 <\/sup>have shown that extra etching time is not necessary when teeth have been pretreated wuth fluoride.<\/p>\n<p>Fluridated phosphoric acid solutions<sup>22, 23<\/sup>or gels provide an overall morphologic etching effect similar to non fluridated ones and give adequate bond strength in direct bonding procedures<\/p>\n<p><strong>Self Etching Primer<\/strong><\/p>\n<p>Bonding usually contains 4 steps.<\/p>\n<ol>\n<li>Cleaning<\/li>\n<li>Conditioning<\/li>\n<li>Primer application.<\/li>\n<li>Adhesive application prior to bracket placement.<\/li>\n<\/ol>\n<p>Use of self etching primers<sup>13,14,18<\/sup>combines the conditioning &amp; priming into single step<\/p>\n<p>It contains methacrylated phosphoric acid ester formed when phosphoric acid&amp; methacrylate groups are combined into a molecule that etches &amp; primes simultaneously.<\/p>\n<p>Phosphoric etched enamel\u00a0 surface :\u00a0 More dissolution &amp; finely roughened\u00a0 surface<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3398\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig10-150x150.jpg\" alt=\"Figure 10\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig10-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig10.jpg 284w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 10<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig10.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>Self etching primed surface; Less disolution &amp; enamel surface almost flat &amp; presence of minutes holes<\/p>\n<p>&nbsp;<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3399\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig11-150x150.jpg\" alt=\"Figure 11\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig11-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig11.jpg 285w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 11<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig11.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><strong>Advantages<\/strong><\/p>\n<ol>\n<li>Decreases chair time<\/li>\n<li>Decreases technique sensitivity.<\/li>\n<\/ol>\n<p>Bishara <sup>19<\/sup>reported that there are more adhesive \u00a0remaining\u00a0 on tooth surface after debonding when self etching primer is used than with conventional\u00a0 etching<\/p>\n<p><strong>Disadvantages<\/strong><\/p>\n<ol>\n<li>It has significantly less bond strength when compared conventional etching\u00a0 &amp; priming 2 step procedure. Supported by \u00a0\u00a0Aljibouri et al EJO 2003<\/li>\n<li>Bishara in AJO-DO 2002 also concluded that SEP produces less bond strength with are without saliva contamination<\/li>\n<li>His study showed that<\/li>\n<\/ol>\n<ul>\n<li>SEP Without saliva contamination\u00a0\u00a0 \u00a0\u00a0\u2013 6 Mpa<\/li>\n<li>Contamination before primer \u2013 4.8 Mpa<\/li>\n<li>Contamination after primer \u2013 4.8 Mpa<\/li>\n<li>Contamination before &amp; after primer \u2013 1.7 MPa<\/li>\n<\/ul>\n<p>Rielco yamada et al in ANGLE 2002 reported that composite resin with SEP has less bond strength than when used with conventional 2 step etching . But its comparable with that of RMGIC after polyacrylic acid<\/p>\n<p>Ram Kumar Gandhi et al in AJO-DO 2001 reported SEP produce more\u00a0 bond strength with used light activated composite than with chemically cured\u00a0 resin.<\/p>\n<p>IN ANGLE 2002\u00a0 SEP produces less enamel dissolutions than\u00a0 phosphoric acid or polyacrylic acid . This might have led to decrease in bond strength.<\/p>\n<p>IN AJO-DO 2003 Ryan .W. Arnold et al \u00a0and showed no significant diff,\u00a0 in bond strength occurred\u00a0 between\u00a0 SEP &amp; conventional etching..<\/p>\n<p><strong>Amount of Enamel Iost During Etching<\/strong><\/p>\n<ul>\n<li>Zachrisson- Routine etching with 37% phosphoric acid removes 3-10 um of surface enamel.<\/li>\n<li>Gwinnett et al -50% Phosphoric acid removes 5 \u2013 25 um of enamel.<\/li>\n<li>Fitzpatrick &amp; way and by Silverstone\u00a0 reported that 30% phosphoric acid for 90 sec removes enamel with a mean of 9.9 um<\/li>\n<li>Leebrown &amp; Way \u201337% phosphoric acid in 90 secs removes a mean of 3 u ( 0.2 +11.2 um)<\/li>\n<li>With the SEPs, the median enamel loss was significantly lower, at 0.27\u00b5 m the range was 0.03 to 0.74\u00b5m.<\/li>\n<li>Scanning microscopy revealed that self \u2013 etching primer produced less dissolution of enamel surface compared with phosphoric acid. Enamel loss\u00a0 (Hosein et al AJO 2004)<\/li>\n<\/ul>\n<p><strong>First Generation<\/strong><\/p>\n<ul>\n<li>BUONOCORE (1956) \u2013 Demondtsrated the use of a Glycerophosphoric acid dimethacrylate \u2013 containing resin, would bond to acid etching dentine.<\/li>\n<li>BOWEN (1965), tried\u00a0 N \u2013 phenylglycine and glycidyl methacrylate .<\/li>\n<li>Bonding occured due to the interaction of this bifunctional resin with the calcium ions of hydroxyapatite.<\/li>\n<li>Drawback \u2013 Poor bond strength (1 to 3 MPa ).<\/li>\n<li>The first commercial system of this type \u2013 Cervident, SS White<\/li>\n<\/ul>\n<p><strong>Second Generation<\/strong><\/p>\n<ul>\n<li>In the late 1970\u2019s the second generation system were introduced.<\/li>\n<li>Incorporated halophosphorous esters of unfilled resins such as bisphenol \u2013 A glycidal methacrelate or bis \u2013 GMA, or hydroxyethyl methacrylate, or HEMA.<\/li>\n<li>Bonded to dentine through an ionic bond to calcium by chlorophosphate groups.<\/li>\n<li>Weak bond strength, but significant improvement over first generation.<\/li>\n<li>Scotch Bond (3M Dental ), Clearfil (Kuraray Co. Japan)<\/li>\n<\/ul>\n<p><strong>Third Generation<\/strong><\/p>\n<ul>\n<li>The primer contains hydrophilic resin monomers which include hydroxyethyl trimellitate anhydride, or 4\u2013META, and biphenyl dimethacrylate or BPDM.<\/li>\n<li>The primers contain a hydrophilic group that infiltrates smear layer, modifying it and promoting adhesion to dentin.<\/li>\n<li>The phosphate primer modifies the smear layer by softening and cures, forming a hard surface. Following, the unfilled resin adhesive is applied, attaching cured primer to the composite resin.<\/li>\n<li>Drawback \u2013 Bonding to smear layer &#8211; covered dentine was not very successful.<\/li>\n<li>Mirage bond, Scotch bond 2, Prisma Universal bond 2 and 3.<\/li>\n<\/ul>\n<p><strong>Fourth Generation<\/strong><\/p>\n<ul>\n<li>The use of the total etch technique is one of the main characteristics of fourth generation bonding system, here complete removal of the smear layer is achieved.<\/li>\n<li>The Total etch technique permits the etching of enamel and dentine simultaneously using 40% phosphoric acid for 15 to 20 seconds. The surface must be left moist to avoid collagen collapse.<\/li>\n<li>The application of hydrophilic primer solution can infiltrate collagen network forming the hybrid layer. According to Nakabayashi (1982) the hybrid layer is defined as \u201cthe structure formed in dental hard tissues by demineralization of the surface and subsurface, followed by infiltration of monomer and subsequent polymerization.<\/li>\n<li>All bound -2 (BISCO),\u00a0 Scotch bond Multipurpose (3M).<\/li>\n<\/ul>\n<p><strong>Fifth Generation<\/strong><\/p>\n<ul>\n<li>Consist of two different types of adhesive materials the so called \u201cone bottle\u201d systems and the self etching primer bonding system.<\/li>\n<li>ONE BOTTLE SYSTEMS combined the primer and adhesives into one solution to be applied after etching. Total etching was done with 35 &#8211; 37% phosphoric acid for 15 to 20 secs.<\/li>\n<li>SELF ETCHING PRIMER was developed by Watanabe and Nakabayashi. It is a aqueous solution of 20% phenyl \u2013 P in 30% HEMA.<\/li>\n<li>An acidic primer combines the etchant with the primer in one application, Contains both acid (Phenyl \u2013 p) and the primer ( HEMA and dimethacrylate).<\/li>\n<li>Clearfil liner bond V (Kuraray)<\/li>\n<li>Mega bond (Kuraray)<\/li>\n<li>Prompt \u2013 L \u2013 Pop ( 3M UniteK )<\/li>\n<li>First step (Reliance)<\/li>\n<li>Transbond Plus ( Unitek 3m )<\/li>\n<li>Ideal 1 (GAC )<\/li>\n<li>One up Bond F ( Tokuyama)<\/li>\n<li>Adv \u2013 The combination of etching and priming steps reduce the working time.<\/li>\n<li>Single bond (3M), One step (BISCO)<\/li>\n<\/ul>\n<p><strong>Sixth Generation<\/strong><\/p>\n<ul>\n<li>Recently several bonding system were developed and these systems are characterised by the possibility to achieve the proper bond to enamel and dentine using only one solution. These should really be one &#8211; step bonding.<\/li>\n<li>Unfortunately, the first evaluations of these new system showed a sufficient bond to a conditioned dentin while the bond with enamel was less effective.This may be due to systems are composed of an acidic solution cannot be kept in place, must be refreshed continuously and have a pK that is not enough to properly etch enamel.<\/li>\n<li>Prompt &#8211; L &#8211; Pop (ESPE, Germany).<\/li>\n<\/ul>\n<p><strong>Seventh Generation<\/strong><\/p>\n<p>The trend in the latest generation of dental bonding systems is to\u00a0 reduce the number of components and clinical placement steps. The introduction of 1 Bond, a single \u2013 bottle adhesive system, is the latest to new generation materials that combines etchant, adhesive and desensitizer one component.<\/p>\n<p><strong>New Concepts in Etching<\/strong><\/p>\n<p><strong>Laser Etching<\/strong><strong>\u00a0 <\/strong><\/p>\n<p>The application of laser energy to an enamel surfaces causes localized melting and ablation.<\/p>\n<p>Results primarily from the micro-explosion of entrapped water in the enamel,some melting of the hydroxyapatite crystals.This new concept was proposed in 1993.Angle by J.A.Von Fraunhofer. He showed at 3 watts for 12\u00a0 sec laser etching produced acceptable bond strength though significantly less than conventional acid etching. He used Nd\/ YAG as laser source .Serder Usumuz et al in AJO-DO 2002 used ErCr ; YSGG as the hydrokinetic laser system for acid etching &amp; came to the same conclusion.<\/p>\n<table style=\"width: 70%;\" border=\"1\" cellpadding=\"5\">\n<tbody>\n<tr>\n<td style=\"text-align: center;\"><img decoding=\"async\" class=\"alignnone size-thumbnail wp-image-3400\" src=\"https:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig12-150x150.jpg\" alt=\"Figure 12\" width=\"150\" height=\"150\" srcset=\"https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig12-150x150.jpg 150w, https:\/\/biomedpharmajournal.org\/staging\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig12.jpg 576w\" sizes=\"(max-width: 150px) 100vw, 150px\" \/><\/td>\n<td><strong>Figure 12<\/strong><\/p>\n<p><a href=\"http:\/\/biomedpharmajournal.org\/wp-content\/uploads\/2016\/01\/Vol_Spl_ENA_Prem_fig12.jpg\" target=\"_blank\">Click here to View figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>But major disadvantage as reported by Fraunhofer is that high laser produces heat in sufficient magnitude to cause at least localized pulpal infection &amp; possible irreversible damage to pulpal tissue immediately opposite the site of laser irradiation.<\/p>\n<p><strong>Effect of Fluoride<\/strong><\/p>\n<p>Though Zachrisson reports fluoride content\u00a0 of tooth has no effect on etching time R. Lehman&amp;\u00a0 Davidson in AJO-DO 1981\u00a0 reported that fluoride\u00a0 is important in decreasing enamel solubility. Fluoridated enamel has highly acid resistant layer of 2-4 um thickness which may sometimes resist even 3 min etch. So avoiding fluoride application shortly prior to bonding is recommended.<\/p>\n<p>But In AJO-DO Garcia Godey et al reported that addition of 0.5% NaF2 to 60% phosphoric acid gel produced significantly higher bond strength than 30% phosphoric acid without fluoride.<\/p>\n<p><strong>Bonding To Crowns &amp; Restorations<\/strong><\/p>\n<p><strong>Amalgam Restorations &amp; Crowns<\/strong><\/p>\n<p><strong>Methods used are<\/strong><\/p>\n<ol>\n<li>Modifying metal surface<\/li>\n<li>Use of intermediate resin<\/li>\n<li>New adhesive resins that bond chemically to non-precious as well as precious metals<\/li>\n<\/ol>\n<p>Recommended procedure\u00a0 By Zachrisson in ANGLE 98 &amp; AJO-DO 2000<\/p>\n<ol>\n<li>Intra oral sandblasting amalgam alloy with 50 micron aluminium oxide for 3 sec as supported by Sperder In AJO-DO 1999<\/li>\n<li>. If small restorations, then condition the surrounding\u00a0 enamel with 37% phosphoric acid for 30 sec<\/li>\n<li>If large restoration or in crowns create a window &amp; restore it with composite resin &amp; continue the same process<\/li>\n<li>Apply reliance or any metal primer that has 4-META &amp; wait for 30 sec<\/li>\n<li>Bond with concise resin<\/li>\n<\/ol>\n<p><strong>Bonding To Porcelin<\/strong><\/p>\n<p>Many in vitro studies has been conducted by Zachrisson &amp; many others which gave controversial results in clinical practice.<\/p>\n<p><strong>Procedure<\/strong><\/p>\n<ol>\n<li>Surface is to be roughened with sandpaper discs<\/li>\n<li>8-9.6%HF acid gel applied for 2 min( HF is not effective when bonding to high alumina porcelins &amp; glass ceramics)<\/li>\n<li>Silane coupling agent is optional.In vitro studies shows increased bond strength with silane addition.But clinically silane produce insignificant support to bond strength<\/li>\n<\/ol>\n<p><strong>Use concise resin for bonding<\/strong><\/p>\n<p>AJO-DO 1998 Zachrisson showed HF produce extensive in depth penetrating pattern .But diamond roughening &amp; microetching produce only surface peeling.<\/p>\n<p>AJO \u2013DO 2004 Mutlu Ozean et al\u00a0 superior bond strength is obtained when ceramic surface is pretreated with silica coating &amp; silanization giving about 13.6 MPa particularly with polycarbonate brackets<\/p>\n<p><strong>Iotrogenic Effect of Etching<\/strong><\/p>\n<ol>\n<li>Fracture and cracking of enamel upon debonding .<\/li>\n<li>Increased surface porosity &#8211; possible staining<\/li>\n<li>Loss of acquired fluoride in outer 10 mm of enamel surface .<\/li>\n<li>Loss of enamel during etching .<\/li>\n<li>Resin tags retained in enamel &#8211; causing discoloration of resin.<\/li>\n<li>Rougher surface if over &#8211; etched.<\/li>\n<\/ol>\n<p><strong>References<\/strong><\/p>\n<ol>\n<li>BuonocoreMG:A simple method of increasing the adhesion of acrylic filling materials to enamel surface,J Dental Res 34: 849,1955<\/li>\n<li>Zachrisson:a post treatment evaluation of direct bonding in orthodontics,Am J Orthod 71:173,1977<\/li>\n<li>Swartz ML: why prophy before bonding? Clinical impressions 3:11,1994<\/li>\n<li>ReisnerKR,levitt HL: Enamel preparation for orthodontic bonding:a comparision between use of sandblaster and current techniques, Am J orthod 111: 366,1997<\/li>\n<li>Brannstrom: Etching of young permanent teeth with acid gel, Am J Orthod 82: 379, 1982<\/li>\n<li>Arakawa : The effect of acid etching on cervical region of the buccal surface of the human premolar,with special reference to direct bonding techniques,Am J Orthod 76:201,1979<\/li>\n<li>Nordenvall KJ,Brannstrom: Etching of deciduous teeth and young and old permanent teeth: A comparision between 15 and 60 seconds of etching,Am J Orthod 78: 99,1980<\/li>\n<li>Nordenvall KJ,Brannstrom:Effect of various pretreatment methods of enamel in bonding procedures: Am J Orthod 74:134,1978<\/li>\n<li>Olsen ME,Bishara SE: Comparision of shear bond strength and surface structure between conventional acid etching and air abrasion of human enamel ,Am J Orthod 112: 502,1997<\/li>\n<li>Artun J Bergland S: clinical trials with crstal growth conditioning as an alternative to acid \u2013etch pretreatment ,Am J Orthod 85: 333,1984<\/li>\n<li>Read MJF,Fergusan JW,Watts DC: Direct bonding :crystal growth as an alternative for acid etching?Eur J Orthod: 8:118,1986<\/li>\n<li>12 Buyukiyalmaz T,Karaman :the effect of tensile bond strength of orthodontic brackets of titanium tetrafluride application after acid etching Am J Orthod108:256,1995<\/li>\n<li>Buyukiyalmaz T,Karaman :Effect of Self Etching primers on bond strength : Are they reliable?Angle Orthod 73:64-70,2003<\/li>\n<li>.Bishara SE,Oonsombat C,et al: Comparision of the shear bond strength of 2 self etch primer\/adhesive systems Am J Orthod :125: 348-350,2004<\/li>\n<li>Gardner A, Hobson R. Variations in acid-etch patterns with different acids and etch times. Am J Orthod Dentofacial Orthop 2001;120:64-7.<\/li>\n<li>26. Surmont P, Dermaut L, Martens L, Moors M. Comparison in shear bond strength of orthodontic brackets between five bonding systems related to different etching times: an in vitro study. Am J Orthod Dentofacial Orthop 1992;101:414-9.<\/li>\n<li>Benson PE, Shah AA, Millett DT, Dyer F, Parkin N, Vine RS.Fluorides, orthodontics and demineralization: a systematic review.J Orthod 2005;32:102-14.<\/li>\n<li>Velo S, Carano A, Carano A. Self-etching vs. traditional bonding systems in orthodontics: an in vitro study. Orthod Craniofac Res 2002;5:166-9.<\/li>\n<li>Bishara SE, VonWald L, Laffoon JF, Warren JJ. Effect of a self-etch primer\/adhesive on the shear bond strength of orthodontic brackets. Am J Orthod Dentofacial Orthop 2001;119:621-4.<\/li>\n<li>Reynolds IR. A review of direct orthodontic bonding. Br J Orthod 1979;2:171-8.<\/li>\n<li>4. Trites B, Foley TF, Banting D. Bond strength comparison of 2self-etching primers over a 3-month storage period. Am J Orthod Dentofacial Orthop 2004;126:709-16<\/li>\n<li>Garsia-Gordy F;HubbardGW,Storey AT: Effect of a fluoridated etching gel on enamel morphology and shear bond strength of orthodontic brackets,Am J Orthod 100;163,1991<\/li>\n<li>Meng CL,Wang WN,Yeh IS: Fluoridated etching on orthodontic bonding,Am J Orthod112: 259,1997<\/li>\n<li>Thompson IR,Way DC: Enamel loss due to prophylaxis and multiple bonding\/debonding of orthodontic attachments,Am J Orthod 79:282,1981<\/li>\n<li>Osorio R, Toledano M, Garcia-Godoy F. Bracket bonding with15- or 60-second etching and adhesive remaining on enamel after debonding. Angle Orthod 1999;69:45-8.<\/li>\n<li>Shinchi MJ, Soma K, Nakabayashi N. The effect of phosphoricacid concentration on resin tag length and bond strength of a photo-cured resin to acid-etched enamel. Dent Mater 2000;16:324-9.<\/li>\n<li>Trites B, Foley TF, Banting D. Bond strength comparison of 2self-etching primers over a 3-month storage period. Am J Orthod Dentofacial Orthop 2004;126:709-16.<\/li>\n<li>Whitlock BO III, Eick JD, Ackerman RJ Jr, Glaros AG, ChappellRP. Shear strength of ceramic brackets bonded to porcelain.Am J Orthod Dentofacial Orthop 1994;106:358-64<\/li>\n<li>Mandall NA, Millett DT, Mattick CR, Hickman J, WorthingtonHV, Macfarlane TV. Orthodontic adhesives: a systematic review.J Orthod 2002;29:205-10.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Introduction History One of the most important events in orthodontics  [&#8230;]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-3387","post","type-post","status-publish","format-standard","hentry","category-vol8octoberspledition"],"_links":{"self":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3387","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/comments?post=3387"}],"version-history":[{"count":4,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3387\/revisions"}],"predecessor-version":[{"id":33067,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/posts\/3387\/revisions\/33067"}],"wp:attachment":[{"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/media?parent=3387"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/categories?post=3387"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/biomedpharmajournal.org\/staging\/wp-json\/wp\/v2\/tags?post=3387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}