UPDATE OF ORTHODONTIC ADHESIVES

UPDATE OF ORTHODONTICUPDATE OF ORTHODONTIC
ADHESIVESADHESIVES
www.indiandentalacademy.com

EVOLVEEVOLVE
starts with blue color and changes to
natural shade after light cure
HELPS TO REMOVE EXCESS FLASH.
Color change compleats complete light
cure and bond strength.
Adhesive contain fluoride
Available in push syrenge and pre
loaded syrenge tips.

ENAMEL BONDING AGENTSENAMEL BONDING AGENTS
 Consists of unfilled liquid acrylic monomer
placed on acid etched enamel.
 micromechanical retention by resin tag formation
on resin enamel interface.
 Micro tags and macro tags are basis for micro
mechanical retention.
 Micro tags are more important because of their
large number and great surface of contact.
 On other side bonding agent co-polymerises with
matrix phase of dental composite

DENTIN BONDING AGENTSDENTIN BONDING AGENTS
 Unless we understand dentin bonding and certain
terminologies related to it we will not be able to
follow the update of adhesives.
 Disadvantages of Dentine Bonding:
Smear Layer .
Moist dentine.

DENTIN BONDING AGENTSDENTIN BONDING AGENTS
Un filled ,liquid acrylic monomer mixture
placed onto acid conditioned and primed
dentin surface

GENERATIONS OF BONDINGGENERATIONS OF BONDING
AGENTSAGENTS
 Generations are nothing but evolution of bonding
agents from 1955 to 2003.
 There are 7 generations.
 I - GENERATION Buonocore(1956) introduced.
 Resin containing glycerophosphoric acid
dimethacrylate.
 Bowen introduced NPhenyl Glycine &
GlycidylMethacrylate (NPG-GMA)
 Bonding-is by chelation of bonding agent to calcium
of dentine

Drawback:
 Poor dentine bonding .
Enamel bonding is good
 Examples-The first commercial system of
this type (Cervident, SS White).

II - GENERATION (1978)
Bis-GMA (or) HEMA were introduced which are
unfilled resins which causes ionic bonding to the
calcium in dentine.
1. Bonding to smear layerDraw Backs
2.require mechanical preparation

 III - GENERATION
 Principle: Partially removed (or) modified the
smear layer
 Etching opens dentinal tubules and primer META or
BPDM modifies smear layer and attaches to
composites.
 Drawbacks:
 Primer, does not penetrate the smear layer
 Adhesive retention decreases after some time
 Examples
 Mirage bond, Scotch bond 2
 Prisma Universal bond 2 and 3

IV - GENERATION
 Complete removal of smear layer was attempted .
 Total - etch technique. In the total etch -
technique Orthophosphoric acid was used to etch
enamel and dentin, simultaneously for 15 - 20
seconds
 Moist - Dentine Concept. However, in order to
avoid collagen collapse, primer solution is applied
which can infiltrate the exposed collagen network
forming hybrid layer. This is called moist dentin
concept

Hybridization: Replacement of hydroxy-
apatite and water in the surface dentin
with resin
Hybrid: resin in combination with
remaining collagen fibre

 4th generation dentin bonding agents may be again
described as
 Etch (phosphoric acid) + Primer (NTG-GMA, N
tolyglycine -glycidyl methacrylate) + Bond (Bis-
GMAj TEGDMA
 Examples
 All bound-2 (BISCO), Scotch bond
 Multipurpose (3M), Prime and bond

v - GENERATION
1. One -Bottle System
Primer and adhesives are combined into one
solution.
Show high bond strength values both to the etched
enamel and dentin due to adhesive lateral branches
and hybrid layer formation
2. Self etching primers

Contents
This system may be described as, E
(phosphoric acid) + PB (PENTA,
methacrylated phosphonates
Examples
One step (BiSCO), Single bond (3M),
Clearfil SE bond (J MORITA).
Opti bond solo (KERR

 VI- GENERATION
VIEtchng was not required at least at the dentinal
interface.
They contained dentin conditioning agent as one of
their components.
Described as EPB(METHACRYLAED PHOSPHATES)
Drawbacks: Multiple components and multiple steps

VII - GENERATION
I-bond.
Etching, priming, bonding all were
combined into one step.
 Shear bond strength not affected-any
type of curing light .
 Similar adhesion to prepared and
unprepared enamel.
 Desensitizers were added.

CEMENTSCEMENTS
 GLASS IONOMER CEMENTS
 Invented -1969 reported in 1971 by WILSON AND
KENT
POWDER ; Flouroalumino silicate glass
Liquid: Poly alkenoic acid (Carboxyl containing acid )

 Setting Reaction: The hydrogen ions of the acid
attack the glass particles in the presence of
water releasing calcium, strontium, and aluminium
ions .
 The metal ions combine with the carboxylic group
of the polyacid to form the polyacid salts matrix
and the glass surface is changed to a silica
hydrogel.
 Advantages
 Fluoride release
 Hydrogel phases
 Moisture tolerance

 Advantages
 Fluoride release
 Hydrogel phases
 Moisture tolerance
 Disadvantages
 Bond strength less than that of composite
Hydrogel phase: Responsible for the uptake and
release of added environmental fluoride from topical
gels, rinses & dentifrices

Gic's used for bonding toGic's used for bonding to
ceramic bracketsceramic brackets
Cacciafesta et al (1998) (European journal of
orthodontics)
The lower bond strength of glass ionomer
cements might be advantageous with ceramic
brackets where high bond strengths have
been associated with enamel damage

RMGIC'SRMGIC'S
Orthodontic use of GIC increased
with development of resin modified
GIC.
+
+10-20% resin monomers
GIC
RMGIC'SRMGIC'S
LIGHT OR CHEMICAL

RMGIC'SRMGIC'S
Composition:
Polyacid +fluroalumino silicate Glass particles
Monomer+photoinitiator +light .
Monomer+initiator+ catalyst.

Reaction TypeReaction Type
 Reaction Type - acid –base reaction
 polymerization (light –initiated)
 polymerization (chemical initiator )

ADVANTAGESADVANTAGES
 Improved physical properties especially fracture
resistance.
 Stable hydrogels when compared with GIC.
 Capsulation helps in mixing with a trichurator.
 Polymerization proceeds faster than acid-base
reaction
 RMGIC-tolerates moisture similar to GIC's
 Maturation hardeming.
 Sustained fluoride release and caries inhibition

Effect of brushing on fluoride
release from 3 bracket adhesives-
AJO DO Staley e tal.
Resin modified GIC bracketed
groups released morefluoride han the
other groups over the 93 days of
study.

Silver et al AJO (1995) Found excellent long
term adhesion with such materials in the
absence of enamel etching .
Bishata et al: AJO (1999) Advised etching of
enamel for sufficient bond strength.

Multicure GICMulticure GIC
Ortholux XT
GIC

Multicure GICMulticure GIC
Manufactured by –3M- UNITEK
Features-slight blue tint of the cement for
easy clean up
Cherry flavour for pt acceptance
Adequate strength with in 40 sec of curing
with ortholux -XT .
Advantages-adhers to regular etched or
enhanced bands
Minimizing wash out by filling voids.
Sustained fluoride release.www.indiandentalacademy.com

CURRENT CATEGORIES OF ADHESIVECURRENT CATEGORIES OF ADHESIVE
BONDINGBONDING
1. Total etch adhesive bonding
2. Self - etch adhesive bonding

Total- etch Adhesive bondingTotal- etch Adhesive bonding
Bonding or adhesion to the enamel is
done in the following procedure:
 1) Cleansing
2) Enamel conditioning or acid etching
 3) Priming
4) Bonding

cleansingcleansing
To remove saliva,acquired pellicle,
different organic and inorganic
components of enamel and dentin.
Also improves wetting.
Pumice used

Acid etchingAcid etching
Types of etchants :
Strong acids–37% phosphoric acid fpr 15sec
Weak acids -2.5% nitric acid (or) 7% maleic acid for
30

Etching in fluoridated teeth
Fluoride ion is incorporated into hydroxy-
apatite crystals and is resistant to acid-
dissolution which aids in prevention of
caries
Hence fluoridated teeth requires longer etching time

Primers: Primers were invented to deal
with moist dentine problem.
They are difunctional .
 one end has affinity for hydrophilic
dentine and the other for hydrophobic
resin.
e. g HEM A (Hydroxy ethyl methacrylate)

A Self etching primerA Self etching primer
A Self etching primer combines etchant
and primer in one chemical compound
 Contains bifunctional methacrylate base .
 Primers - penetrates into the exposed
rods .
Less evoparation,more stable viscosity,and
wetting capability due o unit dose package.

Trans plus SEPTrans plus SEP

Composition.Composition.
 Trans bond plus SEP CONSISTS OF 3
COMPARTMENTS.
 First compartment:methacrylated
phosphoric acid
esters,photosensitizers,stabilizers
 Second compartment:water & soluble
fluoride
 Third compart ment:Applicator microbrush.

Chemical comparison of phosphoric acidChemical comparison of phosphoric acid
to self-etching primerto self-etching primer

Trans bond plus & APCTrans bond plus & APC

ArmamentariumArmamentarium

PROCEDUREPROCEDURE

procedureprocedure

Scanning electron microscopeScanning electron microscope
observationobservation
Irregular but smooth hybrid layer,3-
4 mm thick irregular tag formation
with no apparent in dentations of
enamel prisms.
Minimal etching with SEP indicates
majority of bond may be more of a
chemical bond with calcium in the
enamel than mechanical bond.

Scanning electron microscopeScanning electron microscope
observationobservation
Phosphoric acid etch Transbond plus

Effects of blood contamination on the
shear bond strenghs of conventional and
hydro philic primers-AJO DO-2004
Vittorioo cacaiafesta e tal
Blood contamination of enamel during he
bonding procedure of conventional and
hydrophilic primers significantly lowers
their bond strength values and mig produce
a bond strength that not clinically adequate

MIP,s - MOISTUREMIP,s - MOISTURE
INSENSITIVE PRIMERINSENSITIVE PRIMER
Arndt kloche et. al. Angle
orthodontist 2003 August.)
Hydrophilic primer - from 3rd
generation
Bonding can be
 Requires moisture for the initiation
of polymerization

Commercially used MIPs
transbond
2. Assure
Ethyl alcohol 30-40% (Solvent) , Bis-GMA ,
- HEMA - Hydroxy ethyl methacrylate
(main Hydrophilic component) - CDMA -
Citric acid (allows greater cross linking) -
GDMA - Diluent + hydrophilic monomer
Same function as CDMA
 / The Hydrophilic monomer takes Oral
fluid & so fluoride uptake
- Acidic Co-polymer Greater cross linking
CPQ / Amine H2O - Solventwww.indiandentalacademy.com

Transbond™ MIP
Moisture Insensitive Primer
Transbond MIP primer offers bond strength in a
moist environment comparable to a conventional
primer in a dry environment

Adhesion promoters forAdhesion promoters for
orthodontic bondinqorthodontic bondinq
Adhesion promoters-are chemical
substances introduced to enhance the
bond with resin.
Used for increasing bond streangths.
Adhesion promotors used in case of
porcelain or gold resoratins.
Adhesion promoors are teremed as
MEGABOND 1,2,and 3(M-1,M-2,M-3)

Adhesion promotorsAdhesion promotors
M-1:NTG – GMA -Magnesium Salt of N -
Tolylglycineglycidyl Methacrylate in acetone
and inhibitors.
M-2:PMGDM -Adiadduct of Glyercol
Dimethacrylate and pyrromellitic anhydride
In acetone.
M-3:Dimethyl paratoluidine in acetone.
M-1 & M-2 are used primarily for tooth
enamel surface where as M-3 & M-4 are used
for coaing mesh meal brackets

The shear bond streangth was
increased from 9.0Mpa for the
control to 13.3Mpa(an increase of
48%) when adhesion promotors used.
Adhesion promoters ,their
effect on the bond strength of metal
brackets-AJO 1995

BONDING TO GOLDBONDING TO GOLD
Until recently, bonding to gold and other
metals was considered difficult.
In the 1980's some adhesives - (Enamelite
500, Goldlink) etc and primers (fusion) -
were designed to allow such bonding.
 However, published reports and clinical
experience do not support their
effectiveness.

There are 2 types of AdhesionThere are 2 types of Adhesion
promoters for goldpromoters for gold
 Resins with adhesive promotors .
eg-super bond c and b
-

Geristore
Super bond C & B is a metal bonding
adhesive and contains 4 – META 10-
MDP

Intermediate primers:
eg. All bond 2 (Primers A & B)
and scotch bond multipurpose adhesive
system.
All bond 2 contains an organosilane agent -
BPDBM - Biphenyl dimethacrylate and NTC -
GMA bond accelerator

Bonding to porcelainBonding to porcelain
Bonding to porcelain is also enhanced by the
use of adhesion promotors, principally organo
silanes.
 One difference from Gold is that an etching
process is used similar to conventional
etching.
 The etchant used is 2.5% Hydrofluoric acid
etch (porcelock).
The etching time in 90 secs.
 Hf acid dissolves the crystalline and glassy
phases of porcelain thus enhancing the
surface area and energy.www.indiandentalacademy.com

Chemistry of silane couplinqChemistry of silane couplinq

Chemistry of silane couplinqChemistry of silane couplinq
Stage 1 Stage 2
Stage 3 www.indiandentalacademy.com

COMERCIALLY AVAILABLE ORGANOCOMERCIALLY AVAILABLE ORGANO
SILANESSILANES
Supplied in prehydrolysed form& hydrolysed
form
Pre hydrolysed form:eg scotch prime
hydrolysed form:eg ormo porcelain primer.
The pre hydrolysed form is unstable and has
a very short shelf life

Bonding to amalgam restorationsBonding to amalgam restorations
 Micro-etching is essential for bonding to
amalgam and other nonprecious metals.
 Small amalgam restorations no sand
blasting to be done
 Large amalgams should be sandblasted for
about 3 sec to provide an improved surface
for bonding.

Bonding to acrylic and compositeBonding to acrylic and composite
restorationsrestorations
 An acrylic adhesive resin is preferred for
bonding Metal, plastic or ceramic brackets to
acrylic crowns.
The bond strength obtained, with the
addition of new composite to Mature
composite, is substantially less than the
cohesive strength of the Material.

Fluoride releasing adhesivesFluoride releasing adhesives
Fluoride releasing adhesives is a relatively
recent advancement.Fluoride release:
Wiltshire et al have reported on the fluoride
release characteristics of various resins.
Most resins show an immediate release of
fluoride following bonding and thereafter
the levels of release decreases sharply and
levels of off

Clinical comparision of the bond failure
rates between the fluoride releasing and
non- fluoride releasing composite resins-
JCO 2000 CHUN-HIS CHUNG,DMD,MS
This study demonstrates that a
fluoride –exchanging composite resin
such as phase II is clinically enough for
use as an orthodontic bonding.

APC PLUS ADHESIVE SYSTEMAPC PLUS ADHESIVE SYSTEM

APC plus adhesive systemAPC plus adhesive system
REDUCE BONDING STEPS.
COLOR CODED TO REMOVE EXCESS
FLASH.
MOISTURE TOLERENCE AND
FLUORIDE RELEASE
MORE STABILITY AND SHELF LIFE
CUTING BY ORTHOLUX.

ConclusionConclusion
The future of adhesive dentistry is bright.The
scope for deepening in this pool is still
tremendous.This will require for more collabaration
between molecular biologists and polymer chemists
that has previously occurred
Commercialization of such technology can only
be done by large corporations that have both type
of scientists in their research and development
divisions.

DR.TRIVENI MADAM

Transbond XTTransbond XT
AdhesivKit in Syringes AdhesivKit in capsules

Transbond™ XT Light CureTransbond™ XT Light Cure
AdhesiveAdhesive
 Bonds metal and ceramic brackets to tooth
surfaces.
 Available in both syringes and capsules,
 uses light cure adhesive technology.
 The viscosity of adhesive prevent adhesive run-on
and bracket skating that saves you money .
 reduces adhesive waste.
 easy application, increased control and convenience.
 A syringe delivery system is available too.
 Immediate archwire tie-inwww.indiandentalacademy.com

Transbond LR AdhesiveAdhesive

Transbond™ LR AdhesiveTransbond™ LR Adhesive
Developed specifically for bonding lingual
retainers.
 Easy to apply,
 optimal handling characteristics .
working time is extended so accurate
placement is enhanced
 product waste is minimized

Indirect Bonding AdhesiveIndirect Bonding Adhesive
The Sondhi™ Rapid-Set Indirect
Bonding Adhesive is revolutionary
from every angle. This lightly filled
resin cures in half the time (2
minutes vs. 4 minutes) of other
indirect adhesives, while achieving
two thirds of its bond strength within
the first five minutes

 Designed to complement our APC™
Adhesive Coated Appliances, the Sondhi
Rapid-Set Indirect Bonding Adhesive
allows you to take full advantage of the
benefits of indirect bonding. More
accurate bracket placement; less bracket
repositioning; maximization of doctor time;
and compared to direct bonding, decreased
chair time and patient discomfort from
simultaneous bonding of all brackets

From the doctor's angle, it means
less wasted time per patient and less
stress. It also means more control
over bracket placement second molar
to second molar, and a higher level of
precision, accuracy and strength. This
instills added confidence that the
doctor's goal, straight teeth, will be
accomplished.

 From the patient's angle, it means a
faster, more comfortable, more
confident bonding experience. From the
business angle, it means more cost
effective use of doctor time.
Any way you look at it, indirect bonding
is superior with the Sondhi Rapid-Set
Indirect Bonding Adhesive

 For fast orthodontic curing times andthe
convenience of untethered portability, your
best choice today is the Ortholux™ LED
Curing Light from 3M Unitek.
With the Ortholux LED light, there’s no
cord connecting the handpiece to a light
source. There’s no bulky equipment to get
in the way or impede chairside mobility.
And yet, with a small handheld unit, you
have curing times for orthodontic bonds
that are typically twice as fast aswww.indiandentalacademy.com

 Advanced LED Technology is the Key
The Ortholux LED curing light uses one
blue LED (Light Emitting Diode) that emits
light in the 430-480 nm range at an
intensity of 1000 mW/cm2
. The light is
optimized specifically for the
polymerization of materials used in
orthodontic bonding. With LED technology,
there is no bulb to lose intensity or wear
out. Heat build-up is minimal, so there is no
need for a fan which uses battery power
and adds weight. Microprocessor-basedwww.indiandentalacademy.com

 Convenience for You and the Patient
The Ortholux LED light is remarkably easy
to handle and use. The handpiece is
compact, sleek and weighs less than eight
ounces. The light guide rotates 360
degrees, making positioning easy for you,
and quick curing times enhance patient
comfort and shorten chair time.

UPDATE OF ORTHODONTIC ADHESIVES

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UPDATE OF ORTHODONTIC ADHESIVES