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Comparison of the Shear Bond Strength of Metal Orthodontic Brackets Bonded to Long-term Water-aged and Fresh Porcelain and Composite Surfaces.

INTRODUCTION

The increase in the number of adult patients receiving orthodontic treatment presents new problems to the orthodontist (1). Inadequacy of the bond strength between the orthodontic attachments and teeth or restorations to withstand orthodontic forces will lead to low success rate with adverse consequences on the cost and duration of orthodontic treatment, efficiency of appliance, and patient comfort (2, 3). The presence of amalgam, composite, and porcelain restorations in the adult dentition causes difficulties in bonding of orthodontic attachments and in obtaining adequate bond strength (3, 4). Among these, porcelain and composite restorations are preferred more than amalgam due to their aesthetic appearance (4, 5).

While the porcelain materials, which have an inert structure, do not change very much in the oral environment, composite materials suffer degradation due to mechanical and chemical interactions (1, 5). The chemical bonding of a composite resin to another composite resin surface is enabled by the unreactive methacrylate groups, which are found in the oxygen-inhibited layer of the non-polymerized resin (4, 6). However, the reduction of these unreactive methacrylate groups with time and the intervention of instruments for polishing of composites reduce the bond strength between aged and fresh composite resins (6, 7). For this reason, the aging of restorations is very important with regard to orthodontic bonding.

The aging process is aimed to reproduce the hydrolytic degradation that occurs in the resin matrix and the silane-coated inorganic fillers formed under oral environment conditions (7). Although there is no standardized simulation method for aging, storage in liquid media, such as citric acid, ethanol, and water, immersion in boiling water, thermocycling, accelerated aging, and artificial saliva have been used (7, 8). In addition, studies evaluating the bond strength of aged restorations have reported that the duration of aging and the material itself are more important than the storage medium (9-11).

The aim of the present study was to compare the shear bond strength (SBS) of metal orthodontic brackets bonded to long-term water-aged and fresh porcelain and composite surfaces. To the best of our knowledge, there are no studies in the literature that have compared the SBS of metal orthodontic brackets bonded to aged and fresh porcelain and composite surfaces. The null hypothesis is that the aging processes of porcelain and composite surfaces have no effect on SBS of metal orthodontic brackets.

METHODS

Vitadur Alpha (VA) porcelain and nanofilled Filtek Ultimate (FU), nanohybrid Tetric EvoCeram (TEC), and microhybrid Gradia Direct Anterior (GDA) composites were evaluated in the present study. The details of the porcelain and composite materials used in the study are shown in Table 1. A stainless-steel metal mold with 2 mm long internal concavity with 1 cm diameter was used to prepare the porcelain and composite discs.

Porcelain disc preparation: VA porcelain discs were prepared by mixing 0.5 g of ceramic powder and 0.18 g of model liquid until a homogeneous slurry was obtained in accordance with the manufacturer's instructions. The obtained slurry was poured into the stainless-steel mold on a vibrator to avoid any residual air inside. Then, in the dental porcelain furnace (Centurion Q200; Ney, Yucaipa, CA, USA), the following baking cycle was performed: the slurry was dried at 600 [degrees]C for 1 min, heated to 960 [degrees]C with full vacuum at 60 [degrees]C/min, kept at 960 [degrees]C for 1 min, and then removed from the furnace and allowed to cool down at room temperature.

Composite disc preparation: The composite discs were prepared by putting the resin into the metal mold by placing the polyester matrix bands on the top and at the bottom and compressing between these two lamellae. Then, using an Elipar FreeLight S10 device (3M ESPE Dental Products, St. Paul, MN, USA), the resin was polymerized in a single direction for 20 s. After every five polymerization processes, the intensity of the light source was controlled by the intensity meter on the device. All porcelain and composite discs that were removed from the metal mold were subjected to surface treatment using 600, 800, 1000, and 1200 grit abrasive paper (Atlas, Kocaeli, Turkey), respectively.

At first, 10 discs were prepared from each material (n=40) and subjected to the aging procedure in distilled water for 5 years. Then, before initiating the study, 10 new discs were prepared from each material and stored in distilled water for 24 h for comparison.

Bracket Bonding Procedures

Porcelain disc surface preparation: The porcelain disc surfaces were conditioned with 9.6% hydrofluoric acid (Ultradent Products, South Jordan, UT, USA) for 60 s, then washed with water for 60 s, and dried with oil-free air spray (5).

Composite disc surface preparation: The composite disc surfaces were conditioned with 37% phosphoric acid (Condicionador Dental Gel; Dentsply, Rio de Janeiro, Brazil) for 30 s, then washed with water for 30 s, and dried with oil-free air spray (12).

Thereafter, 0.018-inch stainless steel lower incisor brackets (Gemini Roth System; 3M Unitek, Monrovia, CA, USA) were applied to the middle of the porcelain and composite disc surfaces using orthodontic primer and adhesive (Transbond XT; 3M Unitek). During bonding, to obtain a uniform adhesive thickness, each bracket was subjected to 300 g of force using a force gauge (Correx Co., Bern, Switzerland) for 10 s (13). A scaler was used to remove the excess resin overflow from the bracket base. Adhesives were polymerized using a LED light source (Elipar FreeLight 2; 3M ESPE) for a total of 40 s, with 10 s for each of the mesial, distal, occlusal, and gingival surfaces.

The discs were embedded into 20 mmx10 mmx10 mm poly-methyl methacrylate blocks (Meliodent; Heraeus Kulzer, Hanau, Germany), with the bracket bases placed parallel to the ground. All specimens were stored in 37[+ or -]2 [degrees]C distilled water for 24 h.

Bracket Debonding Procedures

The SBS was measured using a universal testing device (Autograph AGS-X, Shimadzu, Japan), where the value of the applied force is recorded to the electronic display of the device in Newtons (N). The crosshead speed of the device was set to 1 mm/min (14). The direction of the debonding force was applied to the ligature groove parallel to the bracket base (Figure 1). The force required to dislodge the bracket was recorded in N and converted to megapascals (MPa) using the following equation: Shear force (MPa)=Debonding force (N)/(WxH) ([mm.sup.2]), where W is the width of the bracket base, and H is the height of the bracket base (1 Mpa=1 N/[m.sup.2]). A digital caliper was used to determine the bracket base area, which was found to be 10 [mm.sup.2].

Determination of Fracture Sites

After debonding, all disc surfaces were examined under a stereomicroscope at 10x magnification. The remaining residual adhesives on the disc surfaces were evaluated by the adhesive remnant index (ARI) defined by Artun and Bergland in 1984 (15). ARI scores range between 0 and 3, with 0 indicating no adhesive remains on the disc surfaces; 1 indicating <50% of adhesive remains on the disc surfaces; 2 indicating >50% of adhesive remains on the disc surfaces; and 3 indicating that the entire adhesive remains on the disc surfaces.

Statistical Analysis

Descriptive statistics for studied variables (characteristics) were presented as mean, standard deviation, median, minimum, and maximum values. Normality test was performed, and violation of the normality assumption was detected. Kruskal-Wallis test was used to compare the aged and fresh groups with regard to SBS. Dunn's multiple comparison test was used to determine different groups. Chi-square or Fisher's exact tests were used to compare the aged and fresh groups with regard to ARI scores. The significance level was set to 5%. Statistical Package for Social Sciences program version 13 (SPSS Inc.; Chicago, IL, USA) was used for all statistical computations.

RESULTS

Comparisons of SBSs in porcelain discs: The mean SBS values of metal orthodontic brackets in the aged and fresh VA porcelain groups were 6.37[+ or -]2.84 and 8.06[+ or -]4.72 MPa, respectively. The difference between the aged and fresh groups was not statistically significant (Table 2).

Comparisons of SBSs in composite discs: The mean SBS values of metal orthodontic brackets in the aged and fresh groups were 9.18[+ or -]2.46 and 10.35[+ or -]3.11 MPa for FU composite, 13.63[+ or -]5.55 and 17.02[+ or -]4.15 MPa for TEC composite, and 15.01[+ or -]3.67 and 19.09[+ or -]5.33 MPa for GDA composite, respectively. Although the difference between the mean SBS of metal orthodontic brackets in the aged and fresh groups with FU and TEC composites was not statistically significant, the mean SBS of the fresh group with GDA composite was significantly higher. However, the differences between the mean SBS of metal orthodontic brackets with fresh GDA composite and fresh TEC composite and between the mean SBS of metal orthodontic brackets with aged GDA composite and aged and fresh TEC composites were not statistically significant (Table 2).

The results also show that the mean SBS of metal orthodontic brackets bonded to composite discs was higher than that of the porcelain discs.

ARI scores of porcelain discs: The ARI scores of VA porcelain were significantly higher in the aged group. Intergroup comparison showed that for VA porcelain, in the aged group, four samples had an ARI score of 0, and six samples had an ARI score of 1, and all samples in the fresh group had 0 (Table 3).

ARI scores of composite discs: No significant difference was found between the ARI scores of the aged and fresh groups with FU and GDA composites, whereas the ARI score of the aged group with Tetric EvoCeram composite was higher. Intergroup comparison showed that for FU composite, six samples in the aged group had an ARI score of 0, and four samples in the fresh group had an ARI score of 1. For Tetric EvoCeram composite, one sample had 1 and nine samples had 2 in the aged group, whereas seven samples had 0 and three samples had 1 in the fresh group. For GDA composite, five samples had 0 and five samples had 1 in the aged group, whereas seven samples had 0 and three samples had 1 in the fresh group (Table 3).

DISCUSSION

Dental restorations age in the long term due to the humid environment inside the mouth, since they become water-saturated and their free radical activity gradually dies off (1). The bond strengths of the aged materials decrease due to the hydrolytic degradation of the interface components and significant reduction in mechanical properties (16). In addition, the duration of aging and the material itself have a decisive effect on the decrease in bond strength (10, 11, 17). In this context, the aim of the present study was to compare the SBS of metal orthodontic brackets bonded to aged and fresh porcelain (feldspathic ceramic) and composite (nano-filled, nanohybrid, and microhybrid) surfaces.

In the present study, storage in distilled water, a commonly used aging technique, was used as water behaves similar to the liquids that usually exist in the mouth and constantly interact with the teeth and restorations (11, 16, 18). Furthermore, since the follow-up periods in prosthetic and restorative studies were between 3 and 22 years for composite restorations (19) and a minimum of 5 years for porcelain restorations (20), the duration of aging in our study was determined as the minimum follow-up period of 5 years.

To provide good adhesion and sustain the forces arising from mastication and orthodontic mechanotherapy, a minimum bond strength of 5-10 Mpa is recommended (21). In addition, extremely high bond strengths (40-50 MPa) should be avoided as they may harm the enamel due to the application of high debonding forces during or at the end of the treatment (22). It is assumed that the acceptable SBSs should be between 5 MPa and 50 MPa, even if the limits are within theoretical parameters. The results of the present study reveal that the mean SBS values of metal orthodontic brackets in the aged and fresh groups were between 6.37[+ or -]2.84 and 19.09[+ or -]5.33 MPa for porcelain and composite discs, respectively, and these values were within the acceptable limits. The results also show that the SBS of metal orthodontic brackets bonded to composite discs was higher than those of porcelain discs.

Owing to their high translucency, feldspathic porcelains are relatively aesthetic and are frequently used (23, 24). A number of studies have been published to evaluate the SBS of metal orthodontic brackets bonded to fresh feldspathic porcelain discs (Vitadur Alpha; Vita Zahnfabrik, Bad Sackingen, Germany) that were subjected to different surface treatments using Transbond XT primer and adhesive (Transbond XT). Of these studies, Turk et al. (24) reported that the mean SBS of metal orthodontic brackets bonded to 12 feldspathic porcelain discs that underwent surface treatment with 9.6% hydrofluoric acid (Porcelain Etch Gel; Pulpdent, Watertown, MA, USA) and silane agent (Bond Enhancer; Pulpdent) is 5.39[+ or -]2.59 MPa. Yadav et al. (25) stated that the mean SBS of metal orthodontic brackets bonded to 20 feldspathic porcelain discs that underwent surface treatment with 9.5% hydrofluoric acid (Ultradent) and silane agent (Kuraray Co., Osaka, Japan) is 9.9[+ or -]2.7 MPa. Abdelnaby (26) determined that the mean SBS of metal orthodontic brackets bonded to 25 feldspathic porcelain discs that were subjected to surface treatment with 9.6% hydrofluoric acid (Pulpdent) and resin-based primer (Embrace First-Coat) is 5.48[+ or -]1.03 MPa. In addition, Buyuk et al. (5) indicated that the mean SBS of metal orthodontic brackets bonded to 10 feldspathic porcelain discs that were subjected to surface treatment with only 9.6% hydrofluoric acid (Ultradent) is 6.36[+ or -]2.19 MPa. Consistent with these results, in our study, the mean SBS values of metal orthodontic brackets bonded to aged and fresh feldspathic porcelain discs were 6.37[+ or -]2.84 and 8.06[+ or -]4.72 MPa, respectively.

To our knowledge, no study in the literature has evaluated the SBS of metal orthodontic brackets bonded to aged feldspathic porcelain discs and compared the SBS of metal orthodontic brackets bonded to the aged and fresh groups. In the present study, no significant difference was found between the aged and fresh groups; therefore, the null hypothesis for porcelain surfaces was accepted.

Nanofilled composites have been produced as universal restorative materials, and their strength and aesthetic properties allow the clinicians to use it for both anterior and posterior restorations (17, 27). A limited number of studies evaluated the SBS of metal orthodontic brackets bonded to aged and fresh nanofilled composite discs (Filtek[TM] Supreme XT; 3M ESPE) on which Transbond XT primer and adhesive (Transbond XT) were applied. Among these, Bayram et al. (1) stated that the mean SBS of metal orthodontic brackets bonded to 15 nanofilled composite discs that were aged with an accelerated process involving surface treatment with 38% phosphoric acid (Pulpdent) is 3.71[+ or -]1.22 MPa. Viwattanatipa et al. (27) reported that the mean SBS of metal orthodontic brackets bonded to 32 fresh composite discs that were subjected to surface treatment with 37% phosphoric acid (3M ESPE Dental Products) and plastic conditioner agent (Reliance Orthodontic Product Inc.) is 4.03[+ or -]1.6 MPa. In another study, it was found that the mean SBS of upper molar tubes bonded to 31 composite discs stored in deionized water for 1 month and were subjected to surface treatment with 9.6% hydrofluoric acid, plastic conditioner agent (Reliance Orthodontic Product Inc.), and unite adhesive (3M Unitek) was 6.87[+ or -]4.58 MPa (28). To the best of our knowledge, there are no studies in the literature that have compared the SBS of metal orthodontic brackets bonded to aged and fresh nanofilled composite discs. In the present study, the mean SBS of metal orthodontic brackets bonded to aged and fresh nanofilled composite discs were 9.18[+ or -]2.46 and 10.35[+ or -]3.11 MPa, respectively, and these values were higher than the results reported in the current studies on this subject. Furthermore, no significant difference was found between the aged and fresh groups.

Nanohybrid composites contain a range of macrofillers and microfillers in different sizes, which occupy the spaces between the larger particles and shorten the particle space (10). In studies evaluating the SBS of metal orthodontic brackets bonded to different nanohybrid composites, different results and different aging procedures were reported. Among these, Demirtas et al. (12) used thermocycling for aging and stated that the mean SBS of metal orthodontic brackets bonded to 40 nanohybrid composite discs (Filtek Z550; 3M ESPE) with a surface treatment of 37% phosphoric acid (Pulpdent) and Transbond XT primer and adhesive (Transbond XT) is 4.58[+ or -]1.42 MPa. Hammad et al. (17) treated the labial surfaces of 20 incisor teeth with composite veneer restorations (Tetric EvoCeram; Ivoclar Vivadent AG, Schaan, Liechtenstein) and aged them in deionized water. Then, the mean SBS of metal orthodontic brackets bonded to these surfaces that were subjected to 38% phosphoric acid (3M ESPE) and no-mixed adhesive resin (Granitec[R]; Confi-Dental Products Co., Louisville, CO, USA) surface treatments was calculated as 5.14[+ or -]0.03 MPa. Moreover, Eslamian et al. (29) calculated the mean SBS of metal orthodontic brackets bonded to labial surfaces of 15 premolar teeth restored with TEC composite and aged artificially and found that the mean SBS of metal orthodontic brackets is 12.85[+ or -]5.20 MPa when 5% hydrofluoric acid (Ivoclar Vivadent AG) and no-mixed adhesive resin (Granitec[R]) were applied as surface treatments. To our knowledge, no study in the literature has evaluated the SBS of metal orthodontic brackets bonded to fresh nanohybrid composite discs and compared the aged and fresh groups. In our study, the mean SBS values of metal orthodontic brackets were 13.63[+ or -]5.55 and 17.02[+ or -]4.15 MPa in the aged and fresh groups, respectively, with no significant difference between the groups. Therefore, the null hypothesis for composite surfaces was rejected for nanofilled FU and nanohybrid TEC composites.

In our study, it was also observed that the mean SBS values of metal orthodontic brackets bonded to aged and fresh microhybrid GDA composite discs were 15.01[+ or -]3.67 and 19.09[+ or -]5.33, respectively, and the mean SBS of the fresh group was significantly higher. Therefore, the null hypothesis for composite surfaces was accepted for microhybrid GDA composite. Although a number of studies have been published to evaluate the SBS of metal orthodontic brackets bonded to different aged and fresh microhybrid composites with Transbond XT primer and adhesive surface treatments, to our knowledge, no study in the literature has evaluated the microhybrid GDA composite. Tayebi et al. (4) evaluated the cyclic aged microhybrid Filtek Z250 composite discs (3M ESPE) and concluded that the mean SBS values of metal orthodontic brackets bonded to these composite discs are 9.94[+ or -]2.5 and 7.57[+ or -]4.0 Mpa in the groups that underwent sandblasting and burring as surface treatments, respectively. In his study, Tse (6) used Filtek Z250 microhybrid composite in the restoration of Class V buccal cavities of 24 upper incisor teeth and aged these restorations in distilled water. Then, the mean SBS of metal orthodontic brackets bonded to these aged composites was calculated and found as 12.1[+ or -]3.4 MPa. Moreover, Brunharo et al. (30) stated that the mean SBS of metal orthodontic brackets bonded to 10 fresh Charisma microhybrid composite discs (Heraeus Kulzer) that were subjected to 37% phosphoric acid surface treatment is 5.82[+ or -]1.90 MPa.

In the present study, the ARI scores showed that bond failure predominantly occurred between the restoration and the adhesive as the majority of the adhesive remained on the bracket bases in all groups except for aged Tetric EvoCeram composite. These results were consistent with previous studies (1,6,24,26). However, in the aged TEC composite, most of the adhesive remained on the restoration surface, which was consistent with the results by Demirtas et al. (12) evaluating the aged nanohybrid composite discs (Filtek Z550; 3M ESPE).

Finally, we compared the SBS of metal orthodontic brackets in one porcelain material and three different composite materials that were subjected to a single surface treatment. Therefore, further studies using a greater number of porcelain and composite materials with different surface treatments are recommended.

CONCLUSION

* No significant difference was found between the aged and fresh groups with VA porcelain and FU and TEC composites with regard to the SBS of metal orthodontic brackets.

* The SBS of metal orthodontic brackets was significantly higher in the fresh group with GDA composite.

* No significant difference was found between the aged and fresh groups with FU and GDA composites with regard to ARI scores.

* ARI scores were significantly higher in the aged group with VA porcelain and TEC composite.

Ethics Committee Approval: N/A.

Informed Consent: N/A.

Peer-review: Externally peer-reviewed.

Author Contributions: Concept - Y.K., B.O.D.; Design - Y.K., B.O.D.; Data Collection and/or Processing - Y.K., B.O.D., A.D.; Analysis and/or Interpretation - Y.K.; Literature Search - Y.K.; Writing Manuscript - Y.K.; Critical Review - Y.K.

Conflict of Interest: The authors have no conflict of interest to declare.

Financial Disclosure: The authors declared that this study has received no financial support.

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Yesim Kaya (1) [iD], Beyza Unalan Degirmenci (2) [iD], Alperen Degirmenci (3) [iD]

(1) Department of Orthodontics, Yuzuncu Yil University School of Dentistry, Van, Turkey

(2) Department of Prosthodontics, Yuzuncu Yil University School of Dentistry, Van, Turkey

(3) Department of Restorative Dentistry, Yuzuncu Yil University School of Dentistry, Van, Turkey

Cite this article as: Kaya Y, Unalan Degirmenci B, Degirmenci A. Comparison of the Shear Bond Strength of Metal Orthodontic Brackets Bonded to Long-term Water-aged and Fresh Porcelain and Composite Surfaces. Turk J Orthod 2019; 32(1): 28-33.

Address for Correspondence: Yesim Kaya, Department of Orthodontics, Yuzuncu Yil University School of Dentistry, Van, Turkey

E-mail: yesimkaya82@hotmail.com

Received: April 27, 2018

Accepted: September 26, 2018

DOI: 10.5152/TurkJOrthod.2019.18034
Table 1. Materials used in the present study

Materials               Manufacturer        Material group code

Vitadur Alpha           Vita Zahnfabric,    Feldispatic ceramic
                        Bad Sackingen,
                        Germany
Filtek Ultimate         3M ESPE, St. Paul,  Nanofilled composite
                        MN, USA

Tetric EvoCeram         Ivoclar Vivadent    Nanohybrid composite
                        AG, Schaan,
                        Liechtenstein
Gradia Direct Anterior  GC Co., Tokyo,      Microhybrid composite
                        Japan

Materials               Organic matrix       Fillers

Vitadur Alpha           -                    -

Filtek Ultimate         Bis-GMA, UDMA,       20 nm silica filler, 4-11
                        Bis-EMA, TEGDMA      nm zirconia filler,
                                             zirconia/silica cluster
                                             filler 78.5% weight or
                                             63.3% volume
Tetric EvoCeram         Bis-GMA, UDMA,       Barium glass,
                        Bis-EMA              ytterbium-trifluoride,
                                             mixed oxide, and copolymers
                                             75%-76% weight or 53%-55%
                                             volume
Gradia Direct Anterior  UDMA, dimethacryate  Fumed silica,
                        comonomers           prepolymerized filler,
                                             silica and/or
                                             fluoroaluminosilicate
                                             glass, 73% weight

Table 2. Shear bond strength of metal orthodontic brackets bonded to
aged and fresh porcelain and composite disc surfaces

                                Sample   Median     Mean[+ or -]SD
                               size (n)

Vitadur Alpha           Aging     10      5.18    6.37[+ or -]2.84d (*)
                        Fresh     10      6.04    8.06[+ or -]4.72d
Filtek Ultimate         Aging     10     10.06    9.88[+ or -]2.46c
                        Fresh     10      8.89   10.85[+ or -]3.11c
Tetric EvoCeram         Aging     10     15.11   13.63[+ or -]5.55bc
                        Fresh     10     17.70   17.02[+ or -]4.15ab
Gradia Direct Anterior  Aging     10     14.95   15.01[+ or -]3.67b
                        Fresh     10     18.50   19.09[+ or -]5.33a
Total                             80     12.05   12.34[+ or -]5.81

                         Minimum  Maximum

Vitadur Alpha              4.00    12.05
                           3.67    16.79
Filtek Ultimate            5.55    13.34
                           6.24    14.55
Tetric EvoCeram            4.14    21.66
                          10.31    24.46
Gradia Direct Anterior     9.08    20.55
                          10.38    26.92
Total                      3.67    26.92

(*) Different letters in lower cases represent statistically
significant differences among the groups (p<0.05)

Table 3. Distribution of adhesive remnant index (ARI) scores among the
aged and fresh groups

                                   ARI scores
                                0  1  2  3    p

Vitadur Alpha           Aged    4  6  0  0  0.001
                        Fresh  10  0  0  0
Filtek Ultimate         Aged    6  4  0  0  0.999
                        Fresh   6  4  0  0
Tetric EvoCeram         Aged    0  1  9  0  0.001
                        Fresh   7  3  0  0
Gradia Direct Anterior  Aged    5  5  0  0  0.361
                        Fresh   7  3  0  0

Chi-square or Fisher's exact tests (p<0.05)
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Title Annotation:Original Article
Author:Kaya, Yesim; Degirmenci, Beyza Unalan; Degirmenci, Alperen
Publication:Turkish Journal of Orthodontics
Date:Mar 1, 2019
Words:5013
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