Journal of Orthodontic Science

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 11  |  Issue : 1  |  Page : 43-

Comparative evaluation and influence of new Optibond eXTRa self-etch Universal adhesive and conventional Transbond XT on shear bond strength of orthodontic brackets—An in vitro study


Bhogi Siddarth, Kaladhar Reddy Aileni, Madhukar Reddy Rachala, Arun Kumar Dasari, Jaya Priyanka Mallepally, Pooja Reddy Thadisina, Shaik Navab 
 Department of Orthodontics, SVS Institute of Dental Sciences, Mahabubnagar, Telangana, India

Correspondence Address:
Arun Kumar Dasari
Department of Orthodontics, SVS Institute of Dental Sciences, Mahabubnagar - 509 002, Telangana
India

Abstract

INTRODUCTION: The demand by dental practitioners for adhesives led to the innovation of newer self-etched universal adhesive systems. The objectives were to evaluate the shear bond strength (SBS) of metal brackets bonded with Optibond eXTRa Universal self-etch adhesive and Transbond XT primer and also to assess the adhesive remnant index (ARI). MATERIALS AND METHODS: A total of 100 extracted human premolar tooth samples were divided into 2 groups (n = 50) according to the adhesive system employed: Transbond XT (3M Unitek) and Optibond eXTRa Universal (KaVo Kerr). In group A, Transbond XT primer was applied, and in group B, Optibond eXTRa was applied, and metal brackets (American Orthodontics) were bonded with the Transbond XT adhesive, followed by photopolymerization with LEDition. The samples were preserved in artificial saliva for 30 days. SBS was tested using a universal testing machine (DAK Series7200, India). The ARI was assessed at 10× magnification under a stereomicroscope (Meiji Techno, Japan). The SBS scores were subjected to independent sample t-test and ARI scores to Pearson's Chi-square test. RESULTS: The mean SBS and standard deviation of Transbond XT is 12.11 ± 2.6 MPa and that of Optibond eXTRa Universal is 11.36 ± 2.8 MPa, revealing a statistically nonsignificant difference. Transbond XT displayed higher ARI scores and was statistically significant (P = 0.001). CONCLUSION: The Optibond eXTRa Universal adhesive appears to be preferable for orthodontic bonding as it exhibited clinically acceptable SBS and performed better in terms of the ARI.



How to cite this article:
Siddarth B, Aileni KR, Rachala MR, Dasari AK, Mallepally JP, Thadisina PR, Navab S. Comparative evaluation and influence of new Optibond eXTRa self-etch Universal adhesive and conventional Transbond XT on shear bond strength of orthodontic brackets—An in vitro study.J Orthodont Sci 2022;11:43-43


How to cite this URL:
Siddarth B, Aileni KR, Rachala MR, Dasari AK, Mallepally JP, Thadisina PR, Navab S. Comparative evaluation and influence of new Optibond eXTRa self-etch Universal adhesive and conventional Transbond XT on shear bond strength of orthodontic brackets—An in vitro study. J Orthodont Sci [serial online] 2022 [cited 2022 Sep 29 ];11:43-43
Available from: https://www.jorthodsci.org/text.asp?2022/11/1/43/354502


Full Text



 Introduction



Orthodontics, as a specialty in dentistry, has seen its share of growth and development. In due course of time, much attention has been paid to enhance bonding techniques which include acid etchants, primers, and adhesives. Since the advent of acid etching techniques by Buonocore[1] in the 1960s, the total etching technique by Kanca, and also the developments in adhesives by Saddler,[2] Newman,[3] Bowen,[4] Retief,[5] and Miura[6] further paved a way for it. However, bond failures still exist due to several reasons.

Nowadays, in orthodontics, total-etch multi-step adhesive systems are most often employed to bond brackets to the enamel surface. Orthophosphoric acid etching causes dissolution of the interprismatic enamel, which forms a rough pervious layer that ranges from 5 to 50 μm in depth for the formation of resin tags. This might harm the dental substrate, resulting in cracks and microfractures, discoloration, decreased modulus of elasticity, and enamel hardness.

The demand for usage of various adhesives by dental practitioners has led to the emergence of newer universal self-etch adhesive systems (USEASs).[7],[8] It has a less invasive pH (1.5<pH<3) and bonding employed with acidic functional monomers glycerol dimethacrylate dihydrogen phosphate (GPDM) and 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP), available in both self-etch and total-etch modes. When employed in a self-etch mode, USEASs may remarkably simplify the bonding procedure by decreasing the steps in bonding, number of eroded enamel rods, and eliminating the necessity for total acid etching.[9] USEASs may be applied to the substrate either after pre-etching or without etching, thanks to the presence of acidic functional monomers that have huge propinquity for the calcium ions of hydroxyapatite. The advantages of few bonding steps and reduced chair time should be weighed against the increasing cost of the self-etching universal adhesive system.

Optibond eXTRa Universal, a two-component universal new bonding agent from KaVo Kerr promoted unique smart pH technology, that is, acidity drop after photopolymerization, a patented formula enriched with the gold standard GPDM monomer and ternary solvent system for overall combined action, which includes enhanced etching, re-wetting ability, deep penetration, and a homogeneous adhesive layer.

Earlier, several universal adhesives were employed in orthodontic bonding to evaluate their performance, which include Scotchbond Universal,[10] Clearfil Universal Bond,[10] All-Bond Universal,[11] Ambar Universal,[11] etc. The current study was undertaken because there were no studies in the past to evaluate the shear bond strength (SBS) of the two-component self-etching universal adhesive (Optibond eXTRa Universal).

 Materials and Methods



Inclusion and randomization

A total of 100 maxillary and mandibular premolar teeth were collected from patients undergoing therapeutic extractions for orthodontic purposes and were preserved in a 0.1% thymol solution. All premolars were selected on the basis of teeth that were non-carious and freshly extracted with an intact buccal surface. Teeth that were fluorosed, carious, restored, with anomalous morphology, and those having cracks were excluded from the study.

The extracted teeth were mounted vertically on acrylic resin blocks with only the crown portion exposed. Before bonding, the tooth surface was cleaned and polished with pumice and paste application using a rubber cup on a slow-speed handpiece, then rinsed with a splash of water, and dried with moisture-free airstream. MBT 0.022” stainless-steel brackets (American Orthodontics, Sheboygan, USA) with a bracket base surface area of 9.806 mm2 were used. All of the 100 samples were randomly assigned into two groups of 50 each: group A Transbond XT and group B Optibond eXTRa Universal.

Bonding procedure

In group A, all of the 50 samples were etched with 37% orthophosphoric acid gel (Neoetch gel, Orikam, India) for 15 seconds, rinsed with water, and air-dried. Transbond XT primer (3M Unitek, Monrovia, California, USA) was applied on the tooth surface and cured for 15 seconds. In group B, all of the 50 samples were etched with Optibond eXTRa Universal self-etching primer (KaVo Kerr, Brea, California, USA) for 20 seconds and air-dried for 5 seconds. Optibond eXTRa Universal self-etch adhesive (KaVo Kerr, Brea, California, USA) was applied on the tooth surface and cured for 15 seconds. In both the groups, brackets were bonded using the Transbond XT adhesive (3M Unitek, Monrovia, California, USA) [Table 1] and [Figure 1]. All of the teeth were photo-polymerized on mesial and distal surfaces using a LEDition (Ivoclar Vivadent, 600 mW/cm2) for 30 seconds. The samples were then stored in artificial saliva for 30 days.{Table 1}{Figure 1}

Shear bond strength: The long axis of each specimen was mounted perpendicular to the applied force onto a universal testing machine (DAK System Inc Series 7200, India) with a crosshead speed of 1 mm/min that was generated until the bracket debonded [Figure 2]. A looped wire made of 0.8 mm stainless steel was employed for shear-load testing directed from gingival to incisal as described by Oesterle et al.[12] The force values were noted initially in Newton (N) and then converted to megapascal (MPa = N/mm2).{Figure 2}

Adhesive remnant index: The enamel surface of each tooth was visually examined following debonding by applying articulating paper to contrast as described by Rachala et al.[13] Later, each tooth was observed under a stereomicroscope (Meiji Techno, Japan) at 10× magnification [Figure 3] for assessing the adhesive remnant index (ARI), as suggested by Artun and Bergland.[14]{Figure 3}

Statistical analysis

All data were analyzed using IBM SPSS software (version 21). The P value at 5% was considered significant (P < 0.05). Levene's test was used to evaluate the normality of data. SBS values were subjected to the independent sample t-test for evaluating the statistically significant difference among the groups. The ARI scores were analyzed using Pearson's Chi-square test to evaluate the association between the kind of bond failure and bonding agents.

 Results



The comparison of SBS between the groups revealed a slightly higher (4%) bond strength of Transbond XT than Optibond eXTRa Universal [Figure 4]. The mean and standard deviation value of group A was 12.11 ± 2.6 MPa and that of group B was 11.36 ± 2.8 MPa [Table 2], [Figure 5]. The independent sample test showed that the variances between the two groups were homogeneous in nature (P = 0.928), and both groups were statistically insignificant with a P value of 0.170 (>0.05) [Table 3].{Figure 4}{Figure 5}{Table 2}{Table 3}

The comparison of ARI scores between the two groups showed a statistically significant difference (P < 0.005) [Figure 6] and [Table 4]. Group A (Transbond XT) showed a higher distribution of ARI scores 1 and 2, suggesting failure mostly at the bracket–adhesive interface, whereas group B (universal self-etch adhesives) had a higher frequency of ARI scores 0 and 1, suggesting failure mostly at the enamel–adhesive interface [Figure 7].{Figure 6}{Table 4}{Figure 7}

 Discussion



The adhesives utilized in orthodontics and clinical dentistry are improving day by day. However, there is still a need to enhance the current bonding techniques pertaining to orthodontics. The current study evaluated the SBS of the self-etching universal adhesive system and compared it with the conventional adhesive system for bracket bonding. The Transbond XT (conventional) adhesive system is most widely used and is well accepted as a standard control in several studies.

Universal adhesives contain the acidic functional phosphate ester monomer such as 10-MDP and GPDM that exhibit strong binding to hydroxyapatite.[15] The adhesion/decalcification concept (”AD concept”) was put forward to elucidate the chemistry of acidic functional phosphate monomers with hydroxyapatite.[16] This AD concept indicates the interaction where all acidic monomers bond to the Ca ions of hydroxyapatite initially (phase 1), that is, within the midst of the release of phosphate (PO43−) and hydroxide (OH−) ions from hydroxyapatite to reach electron neutrality into its solution. Either the functional monomer will adhere (phase 2, adhesion route) or dissociate together with an abundant decalcification (phase 2, decalcification route) depending on the steadiness of the monomer–Ca salt formed. 10-MDP–calcium salt is slightly more stable than the GPDM–calcium salt; GPDM undergoes decalcification, and 10-MDP sticks to the adhesion route.[17]

Reynolds et al.[18] suggested that the optimal SBS to withstand masticatory and orthodontic forces ranges from 5.9 to 7.8 MPa. The mean SBS of group A (Transbond XT) is 12.11 ± 2.6 MPa and that of group B (Optibond eXTRa universal system) is 11.36 ± 2.8 MPa. According to Bishara et al.,[19] a clinically acceptable SBS of 7.1 MPa was needed when a self-etched primer was employed. Therefore, SBS using the self-etched universal adhesive system was marginally lesser when compared to Transbond XT; however, it was within the range of ideal bond strength to hold brackets during orthodontic treatment.

The results were in agreement with previous studies conducted by Cal-Neto et al.,[20] Larmour et al.,[21] Arnold et al.,[22] Hellak et al.,[23] Zeynep et al.,[24] and Proenca et al.[11] who reported the SBS of self-etched primers and the universal bonding system that displayed similar SBS values to that of Transbond XT. The universal bonding system can be employed safely either in the etch or self-etch mode for orthodontic bracket bonding.[11] However, the results of studies related to self-etch adhesive systems are contradictory. Buyukyilmaz et al.[25] reported that self-etch adhesive systems had higher SBS than the conventional system—Transbond XT. Prakki et al.[10] in their study concluded that neither of the universal adhesives employed in the self-etch mode achieved SBS that was satisfactory for orthodontic therapy.

The ARI is most commonly used to assess the quantum of adhesion between the tooth, bonding agents, and bracket bases.[14] Lesser ARI scores are clinically advantageous because of the least adhesive remnant found on the substrate base, cleaning the tooth surfaces easier and quicker.[26] In our study, both groups showed significant differences in ARI scores. The group A conventional adhesive system showed a higher distribution of ARI scores 1 and 2, whereas the group B self-etched universal adhesive system had a higher frequency of ARI scores 0 and 1. A relatively USEAS performed best in terms of the ARI.

Al-Salehi et al.[27] claimed that there is a relationship between SBS and the failure mode as higher bond strengths correlate with greater mixed fractures. This relationship is seen during the present study when comparing the ARI scores of Transbond XT and Optibond eXTRa Universal; thus, we can reject our null hypothesis. Group A showed the highest SBS and also had a higher ARI score. The results are in accordance with the study conducted by Sharma et al.,[28] who concluded that the highest ARI scores were observed for the total-etch system.

Furthermore, variances in the mode of fracture between universal self-etch and total-etch adhesives are in accordance with the study of Schnebel et al.[29], which revealed that failure occurs mostly at the bracket–adhesive interface for total-etch adhesives, leaving the enamel surface intact, but more chair time is needed to eliminate the residual adhesive. Self-etched universal adhesives resulted in more failures at the enamel–adhesive interface. However, bracket failure occurs at the weakest link, indicating a weak bond with the enamel surface, leading to lower SBS values.

 Conclusion



Both the bonding systems evaluated in the present study provide an adequate SBS for orthodontic purposes, and the self-etched universal adhesive system performed better in terms of the ARI. The self-etched universal adhesive system is advantageous over the conventional bonding system in terms of decreasing clinical chair-side time without compromising the bond strength and it reduces the amount of adhesive left, thus reducing the loss of enamel. Hence, a self-etched universal adhesive system is preferable for bonding brackets on the enamel surface.

Abbreviations

SBS = Shear bond strength

ARI = Adhesive remnant index.

Acknowledgement

We would like to thank Dr. Shailaja, Professor and Head, for providing us the Meiji Techno stereomicroscope for the present study. We are also grateful to Dr. N. Jitender for carrying out all necessary statistical analyses.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Buonocore MG. Simple method of increasing the adhesion of acrylic filling materials to enamel surface. J Dent Res 1955;34:849-53.
2Saddler JF. A survey of some conventional adhesives: Their possible applications in clinical orthodontics. Am J Orthod Dentofacial Orthop 1958;44:65-9.
3Newman GV. Adhesion and orthodontic plastic attachments. Am J Orthod 1969;56:573-88.
4Bowen RL. Adhesion bonding of various materials to hard tooth surface. IV. Bonding to dentin, enamel, and fluoroapatite improved by the use of surface-active co-monomer. J Dent Res 1965;44:906-11.
5Retief DH, Dreyer CJ, Gavron G. The direct bonding of orthodontic attachment to teeth by means of an epoxy resin adhesive. Am J Orthod 1970;58:21-40.
6Miura F, Nakagawa K, Masuhara E. New bonding system for plastic brackets. Am J Orthod 1971;59:350-61.
7Shaik JA, Reddy RK, Bhagyalakshmi K, Shah MJ, Madhavi O, Ramesh SV. In vitro evaluation of shear bond strength of orthodontic brackets bonded with different adhesives. Contemp Clin Dent 2018;9:289-92.
8Christensen GJ. Self-etching primers are here. J Am Dent Assoc 2001;132:1041-3.
9Stape THS, Tjäderhane L, Abuna G, Sinhoreti MAC, Martins LRM, Tezvergil-Mutluay A. Optimization of the etch-and-rinse technique: New perspectives to improve resin–dentin bonding and hybrid layer integrity by reducing residual water using dimethyl sulfoxide pretreatments. Dent Mater 2018;34:967-77.
10Prakki A. Bond strength of universal self-etch 1-step adhesive systems for orthodontic brackets. J Can Dent Assoc 2019;85:1488-2159.
11Proença MA, Silva KT, Costa e Silva A, Carvalho EM, Bauer J, Carvalho CN. Shear strength of brackets bonded with universal adhesive containing 10-MDP after 20,000 thermal cycles. Int J Dent 2020;2020: 4265601.
12Oesterle LJ, Shellhart WC, Belanger GK. The use of bovine enamel in bonding studies. Am J Orthod Dentofacial Orthop 1998;114:514-9.
13Rachala MR, Kishore MSV, Vamshilatha K. Clinical pearl: Staining adhesive remnants for easy removal. J Clin Orthod 2013;47:67.
14Artun J, Bergland S. Clinical trials with crystal growth conditioning as an alternative to acid-etch enamel pretreatment. Am J Orthod 1984;85:333-40.
15Yoshihara K, Nagaoka N, Hayakawa S, Okihara T, Yoshida Y, Van Meerbeek B. Chemical interaction of glycero-phosphate dimethacrylate (GPDM) with hydroxyapatite and dentin. Dent Mater 2018;34:1072-81.
16Tian FC, Wang XY, Huang Q, Niu LN, Mitchell J, Zhang ZY, et al. Effect of nanolayering of calcium salts of phosphoric acid ester monomers on the durability of resin-dentin bonds. Acta Biomater 2016;38:190-200.
17Hoshika S, Kameyama A, Suyama Y, De Munck J, Sano H, Van Meerbeek B. GPDM- and 10-MDP-based self-etch adhesives bonded to bur-cut and uncut enamel – “Immediate” and “Aged” μTBS. J Adhes Dent 2018;20:113-20.
18Reynolds I. A review of direct orthodontic bonding. Br J Orthod 1975;2:171-8.
19Bishara SE, Oonsombat C, Ajlouni R, Laffoon JF. Comparison of the shear bond strength of 2 self-etch primer/adhesive systems. Am J Orthod Dentofacial Orthop 2004;125:348-50.
20Cal-Neto JP, Miguel JA. Scanning electron microscopy evaluation of the bonding mechanism of a self-etching primer on enamel. Angle Orthod 2006;76:132-6.
21Larmour CJ, Stirrups DR. An ex vivo assessment of a bonding technique using a self-etching primer. J Orthod 2003;30:225-8.
22Arnold RW, Combe EC, Warford JH, Jr. Bonding of stainless steel brackets to enamel with a new self-etching primer. Am J Orthod Dentofacial Orthop 2002;122:274-6.
23Hellak A, Ebeling J, Schauseil M, Stein S, Roggendorf M, Korbmacher-Steiner H. Shear bond strength of three orthodontic bonding systems on enamel and restorative materials. Biomed Res Int 2016;2016:6307107.
24Zeynep A, Kolcuoğlu K, Alper A, Karaman E. Effect of a universal adhesive on shear bond strengths of metal orthodontic brackets. Yeditepe J Dent 2019;15:24-7.
25Buyukyilmaz T, Usumez S, Karaman AI. Effect of self-etching primers on bond strength—are they reliable? Angle Orthod 2003;73:64-70.
26Bishara 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.
27Al-Salehi SK, Burke FJ. Methods used in dentin bonding tests: An analysis of 50 investigations on bond strength. Quintessence Int 1997;28:717-23.
28Sharma S, Tandon P, Nagar A, Singh GP, Singh A, Chugh VK. A comparison of shear bond strength of orthodontic brackets bonded with four different orthodontic adhesives. J Orthod Sci 2014;3:29-33.
29Schnebel B, Mateer S, Maganzini AL, Freeman K. Clinical acceptability of two self-etch adhesive resins for the bonding of orthodontic brackets to enamel. J Orthod 2012;39:256-61.