Comparing two orthodontic brackets’ bond to fluorosed and non-fluorosed enamel - an in vitro study

Abstract

Orthodontic attachments must be able to bond to a wide range of tooth and prosthetic surfaces. Despite the high prevalence of fluorosis in many parts of South Africa (Louw A, Chikte U 1997), only limited information is available on the integrity of the bond between orthodontic brackets and fluorosed teeth. The objective of this study was to measure and compare Shear Bond Strengths (SBSs) of metal and ceramic orthodontic brackets on fluorosed and non-fluorosed teeth. One hundred and twenty (60 fluorosed and 60 non-fluorosed) extracted premolar teeth were divided into four groups A to D, consisting of 30 teeth in each group. BluGloo® was used as an orthodontic adhesive to bond brackets on the buccal surface of each tooth. The experimental groups consisted of Group A, in which Nu-Edge® metal brackets were used and Group B, in which InspireIce® ceramic brackets were bonded to fluorosed teeth. Group C and D consisted of Nu-Edge® metal brackets and InspireIce® ceramic respectively, bonded to non-fluorosed teeth. Bonding techniques were kept the same and standardised for all four groups. An Instron testing device was used to debond and measure the SBSs. SBSs were compared using ANOVA with posthoc analysis done using Dunnett’s C test for pairwise comparisons. Significance was set at P<0.05. The results showed that SBS of Group B>Group C>Group D>Group A. Ceramic brackets bonded to fluorosed teeth had the highest SBS with a mean of 15.78 (SD=9.07) Megapascals (MPa), while metal brackets bonded to fluorosed teeth produced the lowest SBS of 8.41 (SD=4.68) MPa. The SBSs of ceramic brackets bonded to fluorosed teeth was significantly higher than that of SBS of metal brackets bonded to fluorosed teeth, but not significantly different from SBSs obtained from either brackets bonded to non-flurosed teeth. The BluGloo adhesive if used to bond ceramic brackets to fluorosed teeth can produce adequate SBS for clinical use. The recommendation from this study is that ceramic brackets can be used efficiently to bond to fluorosed teeth. A follow up study should be carried out to assess the nature of enamel damage caused during debonding of flourosed teeth. This is a laboratory study and thus the clinical application should be interpreted with caution.