Introduction: Various surface pre-treatment methods have been adapted to optimize the bonding between the zirconia ceramics and the orthodontic brackets. Objective: This review is aimed at systematically analyzing the relevant data available in the literature, to find out the most effective and durable bonding protocol. Methods: Database search was conducted in PubMed, Scopus, and ScienceDirect, during September 2020. The review was conducted according to the PRISMA guidelines. Results: Based on the inclusion criteria, 19 articles were selected for qualitative analysis. Meta-analysis could not be performed due to the heterogeneity of the methodology among the studies. Most of the studies scored medium risk of bias. Compared to the untreated surface, surface pretreatments like sandblasting and lasers were advantageous. Primers and universal adhesive were mostly used as an adjunct to the mechanical pretreatment of the zirconia surface. In most studies, thermocycling seemed to lower the shear bond strength (SBS) of the orthodontic brackets. Conclusion: Based on this qualitative review, surface pretreatments with lasers and sandblasting can be suggested to optimize the bracket bond strength. To clarify this finding, meta-analysis is anticipated. Hence, high heterogeneity of the included studies demands standardization of the methodology.

The aim of this study was to systematically review the available studies measuring the bond strength of orthodontic bracket-adhesive system under different experimental conditions in vivo. Literature search was performed in four different databases: PubMed, Web of Science, Cochrane, and Scopus using the keywords – bond strength, orthodontic brackets, bracket-adhesive, and in vivo. A total of six full-text articles were selected based on the inclusion and exclusion criteria of our study after a careful assessment by the two independent reviewers. Data selection was performed by following PRISMA 2009 guidelines. Five of the selected studies were clinical trials; one study was a randomized clinical trial. From each of the selected articles, the following data were extracted – number of samples, with the type of tooth involved materials under experiment methods of measurement, the time interval between bonding and debonding orthodontic brackets, mode of force application, and the bond strength results with the overall outcome. The methodological quality assessment of each article was done by the modified Downs and Black checklist method. The qualitative analyses were done by two independent reviewers. Conflicting issues were resolved in a consensus meeting by consulting the third reviewer (MKA). Meta-analysis could not be performed due to the lack of homogenous study results. The review reached no real conclusion apart from the lack of efforts to clinically evaluate the bonding efficiency of a wide range of orthodontic bracket-adhesive systems in terms of debonding force compared to laboratory-based in vitro and ex vivo studies.

Background To introduce an orthodontic bracket debonding device capable of measuring debonding force clinically by a novel sensor mechanism Materials and method A prototype orthodontic debonding device was constructed utilizing a lift-off debonding instrument (LODI) and force-sensitive resistor (FSR). For data interpretation, the force sensor was equipped with a microcontroller and C++ programming software running on a computer. Ninety-nine (99) 0.022-in. conventional metallic brackets were bonded to premolar teeth in vitro by a single clinician applying the same adhesive and bonding technique. For validation, the mean debonding force measured by the prototype debonding device ( n = 30) and the universal testing machine ( n = 30) was compared. Both intra- and inter-examiner reliability tests were done by holding and operating the device in a standardized manner. Following debonding by the prototype device, the bracket failure pattern was evaluated ( n = 30) by adhesive remnant index (ARI) under the stereomicroscope at × 30 magnification. Statistical analysis included independent samples t test for validation and intraclass correlation coefficient (ICC) with a 95% confidence interval for both intra- and inter-examiner reliability. Results Mean orthodontic bracket debonding force measured by the prototype device (9.36 ± 1.65 N) and the universal testing machine (10.43 ± 2.71 N) was not significantly different ( p < 0.05). The prototype device exhibited excellent intra- [ICC (3, 1) = 0.942] and inter-examiner reliability [ICC (2, 1) = 0.921] and was able to debond brackets mostly at the bracket-adhesive interface. Limitation Due to adjusting the position and mechanism of the force sensor, the device had to be held in a modified standardized position. Conclusion A novel method of measuring in vivo orthodontic bracket debonding force has been introduced which proved to be validated, reliable, and safe in terms of enamel damage.

Objective. To compare the orthodontic bracket debonding force and assess the bracket failure pattern clinically between different teeth by a validated prototype debonding device. Materials and Method. Thirteen (13) patients at the end of comprehensive fixed orthodontic treatment, awaiting for bracket removal, were selected from the list. A total of 260 brackets from the central incisor to the second premolar in both jaws were debonded by a single clinician using a validated prototype debonding device equipped with a force sensitive resistor (FSR). Mean bracket debonding forces were specified to ten (10) groups of teeth. Following debonding, Intraoral microphotographs of the teeth were taken by the same clinician to assess the bracket failure pattern using a 4-point scale of adhesive remnant index (ARI). Statistical analysis included one-way ANOVA with post hoc Tukey HSD and independent sample t -test to compare in vivo bracket debonding force, Cohen’s kappa ( κ ), and a nonparametric Kruskal-Wallis test for the reliability and the assessment of ARI scoring. Results. A significant difference ( p < 0.001 ) of mean debonding force was found between different types of teeth in vivo. Clinically, ARI scores were not significantly different ( p = 0.921 ) between different groups, but overall higher scores were predominant. Conclusion. Bracket debonding force should be measured on the same tooth from the same arch as the significant difference of mean debonding force exists between similar teeth of the upper and lower arches. The insignificant bracket failure pattern with higher ARI scores confirms less enamel damage irrespective of tooth types.