SeolBi Lee
5th year, group 11Comparison of orthodontic brackets failure bonded with and
without primer during orthodontic treatment: a systematic
review
Master’s ThesisSupervisor
Doctor Arūnas Vasiliauskas
LITHUANIAN UNIVERSITY OF HEALTH SCIENCES MEDICAL ACADEMY
FACULTY OF ODONTOLOGY CLINIC OF ORTHODONTICS
Comparison of orthodontic brackets failure bonded with and without primer during orthodontic treatment: a systematic review
Master’s Thesis
The thesis was done
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EVALUATION TABLE OF THE MASTER’S THESIS
OF THE TYPE OF SYSTEMIC REVIEW OF SCIENTIFIC LITERATURE
Evaluation: ... Reviewer: ...
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No. MT parts MT evaluation aspects
Compliance with MT requirements and evaluation Yes Partially No 1 Summary (0.5 point)
Is summary informative and in compliance with
the thesis content and requirements? 0.3 0.1 0 2 Are keywords in compliance with the thesis
essence? 0.2 0.1 0
3
Introduc- tion, aim and tasks
(1 point)
Are the novelty, relevance and significance of the
work justified in the introduction of the thesis? 0.4 0.2 0 4 Are the problem, hypothesis, aim and tasks formed
clearly and properly? 0.4 0.2 0
5 Are the aim and tasks interrelated? 0.2 0.1 0
6 Selection criteria of the studies, search methods and strategy (3.4 points)
Is the protocol of systemic review present? 0.6 0.3 0
7
Were the eligibility criteria of articles for the selected protocol determined (e.g., year, language, publication condition, etc.)
0.4 0.2 0
8
Are all the information sources (databases with dates of coverage, contact with study authors to identify additional studies) described and is the last search day indicated?
0.2 0.1 0
9
Is the electronic search strategy described in such a way that it could be repeated (year of search, the last search day; keywords and their combinations; number of found and selected articles according to the combinations of keywords)?
0.4 0.1 0
10
Is the selection process of studies (screening, eligibility, included in systemic review or, if applicable, included in the meta-analysis) described?
0.4 0.2 0
11 Is the data extraction method from the articles(types of investigations, participants, interventions, analysed factors, indexes)
described?
12
Are all the variables (for which data were sought and any assumptions and simplifications made) listed and defined?
0.4 0.2 0
13 Are the methods, which were used to evaluate therisk of bias of individual studies and how this 0.2 0.1 0
information is to be used in data synthesis, described?
14 Were the principal summary measures (risk ratio,
difference in means) stated? 0.4 0.2 0
15
Systemization and analysis of
data (2.2 points)
Is the number of studies screened: included upon assessment for eligibility and excluded upon giving the reasons in each stage of exclusion presented?
0.6 0.3 0
16
Are the characteristics of studies presented in the included articles, according to which the data were extracted (e.g., study size, follow-up period, type of respondents) presented?
0.6 0.3 0
17
Are the evaluations of beneficial or harmful outcomes for each study presented? (a) simple summary data for each intervention group; b) effect estimates and confidence intervals)
0.4 0.2 0
18
Are the extracted and systemized data from studies presented in the tables according to individual tasks?
0.6 0.3 0
19
Discussion (1.4 points)
Are the main findings summarized and is their
relevance indicated? 0.4 0.2 0
20 Are the limitations of the performed systemicreview discussed? 0.4 0.2 0
21 Does author present the interpretation of theresults? 0.4 0.2 0
22
Conclusions (0.5 points)
Do the conclusions reflect the topic, aim and tasks
of the Master’s thesis? 0.2 0.1 0
23 Are the conclusions based on the analysed
material? 0.2 0.1 0
24 Are the conclusions clear and laconic? 0.1 0.1 0
References (1 point)
requirements?
26
Are the links of the references to the text correct? Are the literature sources cited correctly and precisely?
0.2 0.1 0
27 Is the scientific level of references suitable forMaster’s thesis? 0.2 0.1 0
28
Do the cited sources not older than 10 years old form at least 70% of sources, and the not older than 5 years – at least 40%?
0.2 0.1 0
Additional sections, which may increase the collected number of points 29 Annexes Do the presented annexes help to understand the
analysed topic? +0.2 +0.1 0
30
Practical
recommen-dations
Are the practical recommendations suggested and
are they related to the received results? +0.4 +0.2 0
31
Were additional methods of data analysis and their results used and described (sensitivity analyses, meta-regression)?
+1 +0.5 0
32
Was meta-analysis applied? Are the selected statistical methods indicated? Are the results of each meta-analysis presented?
+2 +1 0
General requirements, non-compliance with which reduce the number of points 33
General requirements
Is the thesis volume sufficient (excluding annexes)?
15-20 pages (-2 points)
<15 pages (-5 points)
34 Is the thesis volume increased
artificially? -2 points -1 point
35 Does the thesis structure satisfy therequirements of Master’s thesis? -1 point -2 points
36 Is the thesis written in correct language,scientifically, logically and laconically? -0.5 point -1 points
37 Are there any grammatical, style or
computer literacy-related mistakes? -2 points -1 points 38 Is text consistent, integral, and are the
volumes of its structural parts balanced? -0.2 point -0.5 points 39 Amount of plagiarism in the thesis. >20% (not evaluated)
40
Is the content (names of sections and sub - sections and enumeration of pages) in compliance with the thesis structure and aims?
-0.2 point -0.5 points
41
Are the names of the thesis parts in compliance with the text? Are the titles of sections and sub-sections distinguished logically and correctly?
-0.2 point -0.5 points
42 Are there explanations of the key terms
and abbreviations (if needed)? -0.2 point -0.5 points
43
Is the quality of the thesis typography (quality of printing, visual aids, binding) good?
-0.2 point -0.5 points
*In total (maximum 10 points):
*Remark: the amount of collected points may exceed 10 points.
Reviewer’s comments: ___________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________ ___________________________
TABLE OF CONTENTS
1. SUMMARY………1
2. INTRODUCTION………. 2
3. SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY… ………5
4. SYSTEMIZATION AND ANALYSIS OF DATA ……….. 8
5. RESULTS ……….. 10
5.1 With primer versus without primer ……….. 10
5.2 Maxillary vs mandibular……… 11 5.3 Anterior vs posterior ………. 11 6. DISCUSSION ……….... 14 7. CONCLUSIONS………..17 8. PRACTICAL RECOMENDATION ………..18 9. REFERENCES………19 10. ANNEXES………21
1. SUMMARY
Objectives: The aim of this systematic review was to evaluate adhesive bonding with primer or
without primer and to compare orthodontic brackets failure during orthodontic treatment.
Methods: Electronic database, Pubmed was searched and screened including studies performed
from January 2009 to March 2019. Cochrane Collaboration was used to assess quality, risk of bias , and meta-analysis in the included studies. Keywords searched were “Orthodontic brackets failure”, “Primer”, “Bonding”, “Adhesive technique”
Results: The five studies included in the final synthesis, three were categorized as randomized
clinical trials (RCTs) with low risk of bias, one prospective study with moderate risk of bias, whereas one study could not categorized with high risk of bias. The number of patients ranged from 20 to 92 with the mean age from 10.5 to 18.7 years. The male to female ration was 103:153. In all the studies, the number of brackets used ranged from 385 to 1615. The rate of orthodontic all of brackets failure range wa 4.3% to 13.5% in the selected studies. The detachment of brackets with primer or without primer had no statistically significant difference.
Conclusion: Brackets failure bonded with and without primer during orthodontic treatment showed
no significant difference in a clinical setting. There was no statistically significant difference between maxillary and mandibular arch bracket failure. Posterior region has more brackets failure comparing to anterior brackets.
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2. INTRODUCTION
The main components of the fixed orthodontic appliances are brackets that attached to the teeth using different types of adhesives. Adhesive systems are used mainly for fixation of accessories, such as brackets and buccal tubes, directly on the surface of the enamel, a procedure that presents advantages and disadvantages (Annex 1) according to its nature, with conventional systems being the most widely used [1]. Conventional orthodontic bonding system is usually a tri-step procedure involving etching, priming and bonding (Table 1). Primer has primary function is to improve the effectiveness of the final bond [2]. Secondarily, they are also insist to protect the enamel from the consequent demineralization by the acid-etching and to reduce marginal leakage.
In orthodontic fixed appliance treatment bracket failure is one of the most important variable of treatment duration. Along with patient compliance, treatment variation phases, extractions, appliance selection, and underlying malocclusions. Bracket failure may arise temporarily delay the originally planned succession of wires, and multiple failures might reflect a low level of patient compliance. Additionally, keeping the fixed appliance phase as short as possible is in the best interest of both the patient and orthodontist. Therefore, it is important to control effectively all factors that could prolong treatment duration. The bonding performance of orthodontic appliances differs depending on factors such as tooth type and position, type of bonding agents and curing methods (Annex 1), bracket mesh types and materials (Annex 2) as well as aging and attrition of the bond in oral conditions. Likely decalcification of teeth and the resultant caries are problems in orthodontic patients with poor oral hygiene [3].
The aim of this systematic review study is to compare and evaluate the orthodontic brackets failure patterns by adhesive system bonded with primer or without primer. If the data enable to do the meta -analysis would be performed.
Tasks of this study :
1. to evaluate bracket failure by bonded with primer or without primer. 2. to compare brackets failure by maxilla and mandible.
3
Table 1. Bonding procedure [4, 5]
Cleaning Pre-treatment - mouth is complicated by saliva, acquired pellicle, different organic and inorganic components of enamel and dentin. Removal of salivary pellicle and contaminants removed by material pumice is use. Cleaning improves wetting of bonding surface.
Enamel conditioning
Etching
Rinsing After etching the enamel surface should be throughly rinsed with a continuous stream of water spray for 5-10 sec. So that acid is completely washed off.
Drying Proper drying which will produce frosty, white appearance. Contamination of the etched and dried enamel surface by saliva, moisture or blood can prevent proper bonding. If any contamination occurs, repeat the procedure.
Sealing Sealant, Primer, Intermediate resin low viscosity resin which is applied prior to bonding. After etching a thin layer of sealant may be painted over entire enamel surface. Its best applied with a small foam pellet of brush and it should be thin and even.
Bonding
I-Generation Buonocore (1956) : resin containing glycerophosphoric acid dimethacrylate Bowen : bonding chelation of bonding agent to calcium of dentine.
Poor dentine bonding Poor bond strenght
II-Generation late 1970’s : incorporated halophosphorous esters of unfilled resins
Weak bond strength
III-Generation late 1980’s : partially removed or modified smear layer. Bonding smear layer softening resin cures which forms hard surface. Unfilled resin adhesive is applied, attaching cured primer to the composite resin.
4
IV-Generation total etch technique : complete removal of the smear layer is achieved
3 steps
V-Generation one bottle system : Primer and adhesives are combined into one solution. high bond strength values both to the etched enamel and dentin due to adhesive lateral branches and hybrid layer formation
2 steps - Self priming adhesive
VI-Generation etching was not required at least at the dentinal interface they contained dentin conditioning agent as one of their components multiple components, multiple steps
2 steps - Self etching primer
VII-Gerneration late 1990’s and early 2000’s : all in one, I-bond (etching, priming, I-bonding)
single step
VIII-Generation self etching self adhering flowable composite, the need for separate bonding application step with composites for direct restorative procedures
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3. SELECTION CRITERIA OF THE STUDIES. SEARCH METHODS AND STRATEGY 3.1 Search strategies
Electronic database Pubmed was searched and screened including studies performed from January 2009 up to the last week of March 2019. Only studies published in the English language was included. The databases were searched using the following keywords: “Orthodontic brackets failure”, “Primer”, “Bonding”, “Adhesive technique”
3.2 Study selection
All the studies investigating brackets failure during orthodontic treatment with fixed appliances were included. Studies were required to report the incidence of brackets failure as five of the studies outcomes. Based on the titles and abstracts, 160 articles were initially identified. 52 studies were found not relevant to objective about this review. After excluding duplicates and screening the abstracts, therefore, a total of 5 articles were included in the final study.
Details of study selection process and results of the literature search as per PRISMA guidances presented in Figure 1. Characteristics of included studies displayed in Table 2.
3.3 Data extraction
The titles and abstracts were screened to exclude irrelevant articles. Full texts of the potential articles were then evaluated to identify eligible studies. Following data were extracted from the included studies: author(s), year of publication, study design, bonding technique used, total number of brackets used, follow-up period and in vitro study extracted.
3.4 Quality assessment
Evaluated the quality of all the selected studies using the Cochrane Collaboration’s tool was used to assess the risk of bias in the included studies. Risk of bias was presented as low, unclear, or high for the each included study. Risk of bias is presented as a diagram in Figure 3. Almost all the included studies had a low risk of bias[ 2, 6, 7, 8] one study has a high risk of bias [9].
3.5 Outcome measure
The outcome evaluated in this systematic review was the compare of brackets failure with primer or without primer during fixed orthodontic treatment.
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3.6 Meta-analysis
A meta-analysis was performed to combine comparable results in with primer and without primer outcomes from each studies using Review Manager (version 5.3, Copenhagen: Nordic Cochrane Centre, Cochrane Collaboration, 2008). Odds ratios were used for dichotomous data.
3.7 Protocol
This systematic review was organized by the PRISMA statement. The review searched online database “PubMed”. The followed keywords and their combinations were applied searched in Orthodontic brackets failure AND Adhesive technique, Orthodontic brackets failure AND Primer, Orthodontic brackets failure AND Bonding. The included studies were full text, perfomed on humans only, written in English language. The articles publication date from January 2009 to March 2019. In total 52 articles made out when searching by the keywords. Titles and abstracts were screened competent, to exclude unrelated articles. The remaining articles of full text were analyzed and related to the topic of the review were qualified and included in the study.
3.8 Inclusion criteria:
Studies written in English. Not older than 10 years. Full text articles.
Study design: Randomized controlled trials, controlled trial, prospective studies. Studies including humans.
Studies in which fixed appliances bonded with primer or without primer. Full complement of erupted permanent teeth present.
No deleterious habits; good oral hygiene; absence of any buccal surface caries.
3.9Exclusion criteria:
Not English language articles. No full text articles.
Studies not on human.
Case reports, animal studies, discussions, abstracts, extracted teeth.
7 Partially erupted teeth, second and third molars.
Patient who need ortho-surgical treatment or tooth extractions for correction of malocclusion. Patients with several buccal restorations or congenital enamel defects, and hypodontia.
Studies with banded attachments.
Treatment follow-up period less than 6 months.
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4. SYSTEMIZATION AND ANALYSIS OF DATA
The electronic searches identified 160 titles and abstracts. After excluding duplicates and screening the abstracts, 108 studies were not found relevant to objective the review. Further 28 articles were excluded due to not matching the inclusion criteria. Therefore, a total of 5 studies were included in the final synthesis. Figure 1. presents details of study selection process and results of the literature search as per PRISMA guidelines. Figure 2 presents risk of bias summary and in Figure 3. bias presented as percentages across all included studies.
Fig. 2. Risk of bias summary: Author’s judgements about each risk of bias item for each included
studies.
Fig. 3. Risk of bias; review author’s judgments about each risk of bias item presented as
9 Characteristics of included studies: Table 2. displays the characteristics of all included studies. Among the 5 included studies, three studies were categorized as randomized controlled trials[2, 6, 7], one study prospective clinical trial[8] and one study did not report about the study design[9]. Trials originated from the Brazil, India, UK, Sweden, and Saudi.
The number of patients ranged from 20 to 92 with the mean age from 10.5 to 18.7 years. The male to female ration was 103:153. In most of the included studies, patients were distributed as class I, II, and III malocclusion, and metal, stainless steel brackets were used. In all the studies, the number of brackets used ranged from 385 to 1615. All of the studies firstly aligning with Nickel Titanium arch wire to use. Four studies compared the brackets bonded with primer and without primer detachment during orthodontic treatment, one studies about conventional adhesive system with primer and flowable composite that without primer.
4.1 Incidence of orthodontic brackets failure: The rate of orthodontic all of brackets failure range
from 4.3% to 13.5% in the selected studies. The follow-up period after bonding of brackets ranged from 6 months to 30 months. The details are provided in Table 1.
Overall bracket failures details a 6 months detachment incidence of 5.5% to 7.1% were given in two included studies[7, 9]. One study reported 12-months incidence 13.5%[2]. One study reported 18-months incidence (4.3% )[6]. Other one study reported 30-months incidence (6.1%)[8]. Four of the studies detachment rate were lesser than 10% its clinically acceptable percent but, one of the study detachment rate was higher than 10% [3].
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5. RESULTS 5.1 With primer versus without primer
All of the including studies results of bonding brackets with primer or without primer showed no statistically significant difference[2, 6, 7, 8, 9]. Brackets failures with primer group range from 2% to 11.1%, comparing group without primer brackets failure range from 5.5% to 15.8% [2, 6, 7, 8, 9]. Romano et al. clinical trial study about two different enamel pretreatment conditions without primer result showed no statistically significant differences(p=0.0821)[9]. Also Rai et al. clinical trial the bond failure rate in the primer and non primer group was 5.79% and 6.32% respectively with no statistically significant difference (p=0.879)[6]. According Nandhra et al. the bracket failure rate at 12 months for bonding with primer 11.1% and without primer was 15.8%. The difference in the percentage failure rate between the two groups was 4.7%. That indicates brackets bonded without primer 1.47 times more to fail than with primer. However, bonding without primer is shown has no significant difference between the bonding with primer as the p value is greater than 0.05 (p=0.08)[2]. From the Bazargani et al. results of bonding brackets with or without primer did not differ significantly in a clinical setting (p=0.063)[6]. Krishnanet al. trial revealed identically same as above the studies and there was no significant difference in terms of bracket failure risk over the 6 month between groups(p=0.242, hazard ratio=0.69;95% confidence interval 0.35-1.40;log rank test P=0.251)[7]. Five studies results could be pooled for meta-analysis results (Figure 4). shows the results of the meta-analysis. Outcomes of analysis brackets failure effect on using primer or without primer showed no significant difference between the two groups (p=0.18).
Fig. 4. Comparison of failure rate: with primer vs without primer.
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5.2 Maxillary vs mandibular
Maxillary and mandible arch brackets failure rates also showed no significant differences, with mandibular bonds failing more frequently [2, 7, 8, 9]. Only one study reported the failure rate was higher in the mandible than the maxilla (p<0.001)[6]. Maxilla detachment of brackets range from 0.8% to 14.9% and mandible detachment of brackets range from 2.3% to 12.4% accordingly [2, 6, 7, 8, 9].
5.3 Anterior vs posterior
The rate of anterior teeth bracket failure range from 0.5% to 7.4%. The posterior teeth detachment rate range from 2.6% to 6.1% [2, 7, 8, 9]. Posterior brackets (premolars) showed lesser (2.6%) failure rates compare with anterior brackets (4.5%). the log-rank test showed no significant differences between anterior and posterior brackets in terms of survival rate (p=0.488) [7]
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6. DISCUSSION
Efficient bracket bonding and low failure rates are important factors in orthodontic treatments, as a complete orthodontic treatment duration may last from 24 to 48 months[10]. The maximum number of bond failures occurred during the initial 6 months of treatment. There are three main causes of bond failure: firstly, any problem during bonding becomes evident in the beginning of the treatment, secondly, the initial period of the treatment is a time for adaptation of the patient to the diet and finally, there may be excessive occlusal forces during the initial stage of treatment [10]. Studies that evaluated bond strength analyzed different variables related to adhesive system (composite or resin-modified glass ionomer)(Annex 1), bonding surface (enamel, ceramic, or metal), bracket material (steel, ceramic, or plastic)(Annex 2), bracket type (conventional, self-ligating, or lingual), attachment base (with various mesh sizes and shapes), brace mesh or surface pretreatment (such as sandblasting), bracket placement force, enamel pretreatment (with protecting or bleaching agents), and enamel contaminants (such as blood or saliva)[11]. The effect of any of these factors may influence to brackets failure and when re-bond of orthodontic brackets.
Main findings
Between primer and non-primer group there were no statistically significant difference. The bond failure rates below 10% are generally considered clinically acceptable[12]. Excluding the use of primer could reduce the risk of occupational exposure to its un-polymerized components. Other advantage of not applying primer leads to working simple and decreased chair time by reducing the number of steps between etching and bonding. Saving time in orthodontic bonding it is important because the longer it takes to bond, the greater the possibility of moisture contamination that could result in bond failure. So choice of adhesive system improves the quality of bonding and efficiency of the operator by reducing the risk of salivary contamination during the bonding procedure. Flowable composite is that improves to be more economical it does not require a step of priming. Contrastively inin vitro study have been carried out to evaluate bonding strength while comparing flowable composite with conventional composite, studies concluded that conventional exhibited higher bond strengths in all the studies[13]. Meanwhile, adhesion forces should not be too strong in order to avoid enamel loss after detachment (40–50 MPa). Therefore, the ideal orthodontic biomaterial should have bonding forces included in the interval of 5–50 MPa, even if these limits are mostly theoretical[11]. In normal cases, bonding without primer seems to work as well as bonding with primer, but in cases in which the patient risks the brackets and exposes then to higher pressure, perhaps by biting on harder food or sweets, brackets bonded without primer appear to detach more easily than do ones bonded with primer.
15 Furthermore, the failure rate differences between upper and lower arch reported studies generally more brackets failure in lower arch. Potential reasons for this could include increased masticatory load on mandibular brackets. The challenge in maintaining the lower arch dry during bracket bonding, the higher initial crowding, and the occlusal interference may be the causes of greater failure[14]. In patients with a normal transverse arch relationship, brackets bonded in mandibular teeth have potential antagonists in centric relation, whereas maxillary brackets do not. In the lower arch, the appliance is steadily under the affect of the upper teeth during mastication. This could be an unfavorable factor for appliance retention and a reason for more frequent bond failure in the mandibular.
Many detailed studies reported that posterior teeth affected more bracket failures than brackets at anterior region. The explanation is the higher occlusal forces on posterior teeth and the difficulty of access and moisture control. Studies showed a significantly greater number of detachment in the posterior segments of the lower[15, 16]. According to Nazir et al. study reported that higher bracket failure rates occur in the posterior region molar bonds with a reported detachment rate of molar bonds (18.4%) and for molar bands (2.6%)[17]. This finding was statistically significant (p=0.002). No differences in discomfort were experienced by patients when banding or bonding first permanent molars as part of fixed appliance treatment[17]. Bonding over banding esthetically superior, faster, simple, less discomfort for the patient, arch length not increased by band material, allows more precise bracket placement, improved gingival health, and better access for cleaning.
In additional factor, the age influence to failure of brackets Bazargini et al. study was an actual difference in failure rate between age groups, the younger age group (10-13 years) had a failure rate higher than that of the older age group. The younger group (10-13 years) had a significantly higher bracket failure rate without primer (12.1%) than with primer (4.1%); moreover, higher risk (OR 3.5) of bracket failure without primer in the younger group. The older group (14-18 years) displayed no such difference, the failure rate being 2.3% without primer and 2.6 % with primer[6, 18]. Additionally, Barbosa et al. cross-sectional study an analysis on whether age (adolescent or adult) could influence bracket breakage showed that teenage presented more breakage than adults, and the comparison was statistically significant, (p = 0.02)[14].
The most common reasons cited by the patient for the bond failures were hard brushing and biting on a hard food substances. Another reason the saliva contamination prior to the application of a hydrophobic simplified conventional adhesive system was responsible for decreasing the immediate bond strength values of brackets cemented on the dental enamel[19]. To make certain adequate bond strength, the bonding surface of the teeth should be free of plaque, debris, and organic pellicle.
16 Cleaning of the tooth surface is most frequently performed using pumice prophylaxis[12]. Inin vivo studies, socioeconomic and dental status of patients, malocclusion classification and resultant mechanotherapy may affect the outcomes. Furthermore, masticatory forces varying with facial type, culturally influenced dietary habits, and sex differences may also influence the results[20].
The progression of bonding adhesive changes also has been seen in the bonding of orthodontic attachments(Annex 4). Developing from messy, slow-setting, weak powder and liquid adhesives bonding large brackets to enamel to single-paste, quick-setting adhesives that adhere to both enamel and non-enamel surfaces. The ability to bond fixed appliances to dentin, amalgam, porcelain, and zirconia with new-generation primers has made adult treatment easier and more esthetic.The ideal adhesive of the future would be hydrophilic, would not require acid etching of the enamel, and would have a shear bond strength value of over 20 MPa in both dry and wet fields[5].
Limitations
The choice of primer could be one of the explanatory factors underlying the differences in failure rates between the studies; differences between the operators could be another control. In addition, among the studies as heterogenous to patients’ selection criteria, outcome criteria, and follow-up time, cultural and dietary aspects of the participants should be accounted for. Another limitation is that the bracket-adhesive system on a tooth might have been exposed to higher forces because of the patient’s chewing pattern or nutritional habits, or the initial position of the tooth[21]. In this review did not assess the factors associated with malocclusion deep-bite, cross-bite, anterior crowding, and extraction. Comparison of bracket failure between with primer without primer results moderate heterogenous. The different factor could influence the result of failure rate factors that observe duration, different operator, force from arch wire type, patients’ dietary, biting habits.
The present review indicates brackets failure rate bonded with and without primer. However, better quality studies with larger samples are recommended to improve the evidence on the rates of brackets failure during orthodontic treatment.
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7. CONCLUSION
1. Brackets failure bonded with and without primer during orthodontic treatment showed no significant difference in a clinical setting.
2. There was no statistically significant difference between maxillary and mandibular arch bracket failure.
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8. PRACTICAL RECOMMENDATIONS
Treatment with young patient age recommend to use primer because the young patients are immature than older patients therefore they are careless about appliances. Posterior brackets better to place band bracket because bond brackets has more brackets failure occurred.
Proper appliance care and hygiene instructions provided by the orthodontist is important. Patient motivation and cooperation represents an important factor for orthodontic treatment success.
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9. REFERENCE
1. Claudino D. Adhesive system in orthodontics. Rev. Bras. Odontol. 2017, 74(1):72-73. 2. Nandhra SS, Littlewood SJ, Houghton N, Luther F, Prabhu J, Munyombwe T, Wood SR.
Do we need primer for orthodontic bonding? A randomized controlled trial. Eur J Orthod. 2015, 37(2);147-155.
3. Minick GT, Oesterle LJ, Newman SM, Shellhart WC. Bracket bond strengths of new adhesive systems. Am J of Orthod. and Dentofacial Orthop. 2009, 135:771-776.
4. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontic Appliances. in:Contemporary orthodontics 5th edition. UK:Elsvier;2012 P368-421
5. Gange P. The evolution of bonding in orthodontics. Am J of Orthod. and Dento facial Orthop. 2015, 147(4):s56-s63
6. Bazargani F, Magnuson A, Lothgren H, Kowalczyk A. Orthodontic bonding with and without primer: a randomized controlled trial. Eur J Orthod. 2016, 38(5):503-507.
7. Krishnan S, Pandian S, Rajapopal R. Six-month bracket failure rate with a flowable composite: A split-mouth randomized controlled trial. Dental Press J Orthod. 2017, 22(2):69-76
8. Rai AM. Evaluation of bracket failure rate in orthodontic patients bonded with and without primer. The Saudi J for Dental Research. 2015, 6:48-53
9. Romano FL, Correr AB, Sobrinho L, Magnani MB, Ruellas AC. Clinical evaluation of the failure rates of metallic brackets. J Appl Oral Sci. 2012, 20(2):228-234.
10. Domingues GC, Tortamano A, Moura Lopes LV, Catharino PCC, Morea Camiio. A comparative clinical study of the failure rate of orthodontic brackets bonded with two adhesive systems: Conventional and Self-Etching Primer (SEP). Dental Press J Orthod. 2013, 18(2)55-60.
11. Scribante A, Contreras-Bulnes R, Montasser MA, Vallittu PK. Orthodontics: Bracket materials, Adhesives Systems, and their Bond Strength. BioMed Research International 2016, 2016;1329814.doi: 10.1155/2016/1329814
12. Ozer M, Bayram M, Dincyurek C, Tokalak F. Clinical bond failure rates of adhesive precoated self-ligating brakcets using a self-etching primer. Angle Orthod. 2014, 84(6):1034-1040.
20 13. Vaheed NA, Gupta M, David SA, Sam G, Ramanna PK, Bhagvandas SC. In vitro analysis of shear bond strength and adhesive remnant index of stainless steel brackets with differenct adhesive systems to enamel. J Contemp. Dent. Pract. 2018, 19(9):1047-1051. 14. Barbosa IV, Ladewig VM, Almeida-Pedrin RR, Cardoso MA, Santiago Jr. JF, Conti ACCF.
The association between patient’s compliance and age with the bonding failure of orthodontic brackets: a cross-sectional study. Progress in Orthod. 2018, 19:11.
15. Menini A, Cozzani MS, Fondrini MF, Scribante A, Cozzani P, Gandini P. A 15-month evaluation of bond failures of orthodontic brackets bonded with direct versus indirect bonding technique: a clinical trial. Progress in Orthod. 2014, 15:70
16. Mohammed RE, Abass S, Abubakr NH, Mohammed ZMS. Comparing orthodontic bond failures of light-cured composite resin with chemical-cured composite resin: A 12-month clinical trial. Am J Orthod. Dentofacial Orthop. 2016, 150:290-4
17. Nazir M, Walsh T, Mandall NA, Matthew S, Fox D. Banding versus bonding of first permanent molars: a multi-centre randomized controlled trial. J of Orthod. 2011,38:81-89 18. Roelofs T, Merkens N, Roelofs J, Bronkhorst E, Breuning H. A retrospective survey of the
causes of bracket- and tube- bonding failures. Angle Orthodontist 2017, 87(1):111-117. 19. Robaski AW, Pamato S, Tomás-de Oliveira M, Pereira JR. Effect of saliva contamination
on cementation of orthodontic brackets using different adhesive systems. J Clin. Exp. Dent. 2017, 9(7):e919-24.
20. Pandis N, Theodore E. A comparative in vivo assessment of the long term failure rate of 2 self etching primers. Am J Orthod. Dentofacial Orthop. 2005, 128(1);96-8
21. Valik SK, Domirbas E. Effect of light-cured filled sealant on the bond failure rate of orthodontic brackets in vivo. Am J Orthod. Dentofacial Orthop. 2009, 135(2);144.e1-144.e4.
22. Vijayakumar RK, Fagadeep R, Ahamed F, Kamma A, Surech K. How and why of orthodontic bond failures: an in vivo study. J Pharm Bioallied Sci. 2014, 6(suppl 1):s85-S89. 23. Reynolds IR. A review of Direct orthodontic bonding. British J of Orthod. 2016, 2(3):171
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10. ANNEXES Annex 1. Adhesive systems advantages and disadvantages [4]
System Advantages Disadvantages Conventional Higher adhesive bonding
strength; clinical performance known over several decades;
subtypes with hydrophilic characteristics
Greater demineralization and loss of enamel structure;
difficulty in removing remnants from the enamel
surface
Self-etching Less demineralization and loss of enamel structure than
conventional systems; reduction of steps and working
time; technical simplication
Lower adhesion bonding strength than in the conventional system; greater technical sensitivity; difficulty
in removing the enamel
Glass ionomer biocompatible; fluoride release and recharge capability; less demineralization and loss of
enamel structure than conventional and self-etching
methods; easy to remove the enamel
lower adhesion bonding strength than in the conventional and self-etching systems; sensitive to humidity during curing; little is known about the clinical performance
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Annex 2. Bracket materials
Material Explanation
Steel Has mesh-backed brackets, use of small, less noticable metal bases helps avoid gingival
irritation
Ceramic Combine the aesthetics of plastic and the reliability of metal brackets
Plastic Used mainly for aesthetic reasons. Pure plastic brackets lack strength to resist distortion and
breakage, wire slot wear, uptake of water, discoloratin , need for compatible bonding
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Annex 3. Adhesive technique direct and indirect advantages and disadvantages. [22, 23] Technique Advantages Disadvantages
Direct 1.Improved aesthetics. 2. Ease of manipulation and decreased patient discomfort.
3. The need of separation of adjacent teeth is eliminated. 4. Permits improved oral
hygiene, at the gingival margin. 5. Decreased soft tissue
irritation. 6. Reduced risk of
decalcification
which may occur under bands. 7. Caries is more easily
detected and treated. 8. The need to close post
treatment band space (if considered desirable) is
eliminated.
9. The possibility of exact mechanical pqsitioning of
brackets is facilitated. I 0. Misplaced, partially erupted teeth may readily be
brought under control.
I. Satisfactory adhesives are often difficult to remove.
2. The surface area of attachment available for retention is
greatly reduced. 3. Lack of approximal
protection
of teeth during treatment, especially during Stage III
Begg procedures.
Indirect 1. accurate and consistent bracket positioning for the posterior continues to pose a
problem because of inaccessibility
1. the occluso-gingival insertion of the transfer tray
causes the adhesive coated brackets to scape along the tooth surface resulting in uneven distribution, rather than perpendicular placement.
2. opaque trays were used the putty covering the palatal side prevent the light from entering the palatal and occlusal aspect
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Annex 4. Orthodontic bonding timeline. MMA, Methyl methacrylate; PMMA, poly-methyl
