Introduction

INTRODUCTION
In the evolution of fixed orthodontic appliances, aesthetics is one of the prime
concern in the acceptance of any appliance by the patient. Patient walking into an
orthodontic office to better their smile used to land up with a metallic smile with the
multibanded appliance. But this time consuming and unaesthetic procedure has been
virtually discarded after the introduction of acid etch technique in 1!! by Buonocore.
"
#irst bonding in orthodontics was reported by $ewman in 1%!.
&
'e used epoxy resin
forattaching brackets. In 1%( )mith introduced *inc polyacrylate +carboxylate, cement
for bonding of orthodontics brackets. -irect bonding of attachments to teeth has several
advantages over banding like improved esthetics, faster attachments to multiple units,
decreased gingival irritation, less patient discomfort, overall arch length is not increased,
better oral hygiene, partially erupted teeth and with abnormal morphology can be bonded,
mesiodistal enamel reduction is possible during treatment, bonding can be done on
artificial tooth surface, caries risk under loose bands is eliminated, elimination of residual
band space at the end of the treatment and less decalcification due to leakage.
.ver the past two decades, the evolution of adhesive techniques has transformed
the scope of dental practice. In $orth /merica, the ma0ority of direct and indirect
restorations are bonded to natural tooth structure rather than cemented or mechanically
retained.
1xtensive research and product development have consistently improved the
adhesive armamentarium available to the dentist, broadening its applications and range.
Patient interests and demands have reflected a newfound interest in oral appearance and
health, most commonly associated with adhesive procedures. 2he widespread demand
1
Introduction
for, and use of, dental adhesives has fueled an intensive development of better and easier
dental adhesives in rapid succession3 dentists have literally been inundated with
successive 4generations5 of adhesive materials.
2he 4generational5 definitions help in the identification of the chemistries
involved, the strength of the bonding agent and the ease of use for the practitioner.
6ltimately, this type of classification benefits the dentist and the patient in terms of
simplifying the clinician7s chairside choices.
/round 189 several articles appeared on bonding attachments with different
adhesives. :iura et al described an acrylic resin +.rthomite,, using a modified trialkyl
borane catalyst, that proved to be particularly successful for bonding plastic brackets and
for enhanced adhesion in the presence of moisture. -iacrylate resins as sealants and
adhesives were introduced in orthodontics. 2he most widely used resin, commonly
referred to as bis;<:/ +bisphenol / glycidyl dimethacrylate, or Bowen7s resin, which is
a self;cure resin, was introduced in late 1%9s and these self;cure resins were the only
choice available to orthodontists for many years. 2hough it provided good bond strength,
it had a few inherent flaws like being extremely technique sensitive, having a short
setting time which affects bracket positioning accuracy and a low initial bond strength.
/n alternative to self;cure resin was introduced in the 189s called light cure
resin since it was activated by 6.= light. 2his provided operator with virtually unlimited
working time to position the brackets accurately since the material can be cured at will
which is known as the 4>ommand set5, easier removal of excess resin before setting is
initiated and also higher initial bond strength enabling immediate placement of archwires.
'owever, 6= light has been replaced by visible light nowadays. Both self;cure
2
Introduction
and light cure resins are equally used in current orthodontic practice. Bonding procedure
for both is somewhat similar. 2hese resins do not adhere to the enamel chemically3 they
are retained by micro mechanical interlocking. :icro porosities are created on the
enamels surface by acid etching with &8? to !9? phosphoric acid.
/cid etching causes selective dissolution of the enamel rods creating surface
irregularities into which the resin penetrates and creates micro mechanical interlocking.
2he continuing research @ developments in dental material science have led to
improvement in adhesive bonding formulations, resulting in current availability of a wide
range of products, including the single;step etchAprimer solutions.
2he self;etching primer system consists of etchant @ primer dispersed in a single
unit. /cid component of the system demineralises the enamel surface @ the etched
enamel gets simultaneously primed. 'ence, the etching @ priming are merged as a single
step leading to fewer stages in bonding procedure, resulting in time saving for the
clinician, which has cost implications. It also results in smaller extent of enamel
decalcification.
"%
)ince this system is a recent addition to orthodontic bonding adhesives, it has not
been studied extensively. Besearch on the ability of self etching primers to adequately
bond orthodontic brackets has provided mixed results. Bishara and <ordon
"%
+1,
concluded that the shear bond strength obtained with an acidic primer might not be
reliable.
'owever, in a more recent study, Bishare et al
"8
+"991, suggested that, although
the mean shear bond strength of a self etching primer was significantly lower than that of
the control group+&8? phosphoric acid and sealant,, it was clinically acceptable.
3
Introduction
/ variety of clinical conditions do not permit ideal isolation for commonly used
orthodontic bonding adhesive. / dry field is paramount for successful bonding.
>ontamination can occur at two critical timesC after the tooth surface has been etched and
after the primer has been applied. Bonding could be compromised at both these times.
:oisture contamination with gingival fluid, saliva or blood tends to reduce the
bond strength significantly and is the ma0or cause for bond failure which is an inherent
problem all orthodontist face on a daily basis while using these conventional bonding
agents.
(,,19,11
2o address this reality, some manufacturers have introduced hydrophilic bonding
materials like )1P +)elf;etching primer, and :IP +:oisture insensitive primer,, and
suggested that it may allow successful orthodontic bonding to a moisture contaminated
enamel surface.
1",1&,1D,1!,1%
2his study has been undertaken and designed to evaluate
efficacy of these new materials ,comparing them with conventional ones.
4
Aims and Objectives
AIMS AND OBJECTIVES
This study is undertaken with the foowin! Ai"s and O#$e%ti&es'
To "easure and %o"(are the shear #ond stren!th of orthodonti% #ra%kets usin!
different (ri"ers )
1 >onventional primer with self;cure composite resin.
2 >onventional primer with light cure composite resin.
3 )elf;etch primer +)1P, with light cure composite resin.
4 :oisture;insensitive primer +:IP, with light cure composite resin
+>ontaminated with artificial saliva,.
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Review of Literature
REVIE* O+ ,ITERATURE
-. REVIE* O+ ,ITERATURE O+ ON CONVENTIONA, /RIMERS'
Buono%ore 0. demonstrated that an increase in the adhesive properties could be
produced by pre;treatment of the enamel surface with (!? phosphoric acid for &9
seconds. It was found that increase in adhesion could be due to an increase in
surface area brought about by acid etching. 2his treatment could increase the
wettability of the adherent surface allowing for a more intimate contact with the
adhesive. It was considered to be an important landmark in the history of dentistry
which was also significant in orthodontics as it made possible the use of resin
system for orthodontic bonding.
New"an 0.V. studied the properties of epoxy resins in restorative materials and it
was found that epoxy resins exhibited very little polymeri*ation shrinkage. It was
also found that when the coefficient of thermal expansion of the teeth and that of the
resins were equali*ed, the adhesions increased. 2his was achieved by adding fused
quality to the resin. 2hese findings were applied in con0unction with an epoxy resin
diglyceryl ether of bisphenol;/ with a poly amide curing agent using D9?
phosphoric acid for etching for %9 seconds. It was concluded that treatment with
D9? phosphoric acid enhanced 0oint strength larger the 0oint area and larger the
force required to break the 0oint.
A##as 1or"ati2 Ja"es +uer et a. studied the effect of contamination and
mechanical disturbance on the quality of acid; etched enamel. 2he result showed
that shear bond strength was less after contamination. #urthermore, etched enamel
samples that were dried with air after saliva contamination showed significant low
shear bond strength than etched enamel samples that were re;etched for %9 seconds,
6
Review of Literature
washed and dried.
,eon Si&erstone2 John 1i%ks et a. carried out a study to determine the effect of
differing salivary contamination periods on the surface topography of acid;etched
human enamel. 2he effect of contamination on bond strength reduced to !9? when
it was compared with non;contaminated control group. It was also noted that even if
the contaminated surface was washed and re;etched, the bond strength was still less
than that for etched enamel. )alivary contamination of etched enamel for 1 second
or a longer period resulted in the formation of surface coating that could not be
removed by washing and if it was more than one second , it could be removed easily
by washing.
Mark Nei Corei2 / M%nnes3,edou4 et a. evaluated the shear bond strengths of
three new bonding systems3 +/, )aga sealant3 +B, :aximum >ure3 +>, )cotchbond;
"3 and compared these with a conventional orthodontic bonding system +-, >oncise
enamel bond. )hear bond strength was tested with an Instron testing machine at a
strain rate of 9.9" mmAmin. 2he mean shear bond strengths for groups /, B, and -
were significantly greater than that for group >.
Osen ME2 Bishara SE2 Da"on /2 et a. compared the traditional acid;etch
technique with an air;abrasion surface preparation technique. 2he first group of
teeth was etched with a &8? phosphoric acid gel for &9 seconds, rinsed for &9
seconds, and dried for "9 seconds.
2he second and third groups of teeth were air;abraded with +a, a !9 micron particle
and +b, a 9 micron particle of aluminium oxide, with the :icro;etcher
microabrasion machine. /ll three groups had molar stainless steel orthodontic
brackets.
In conclusion, findings indicated that enamel surface preparation using air;abrasion
results in significant lower bond strength and should not be advocated for routine
7
Review of Literature
clinical use as an enamel conditioner at this time.
Itoh T2 +ukushi"a T2 Inoue 5 et a. investigated the influence of contamination by
water, human saliva and blood on the bonding of metal brackets with a D;
:12/A::/A2BB adhesive resin in vitro.
2he surfaces of bovine enamel were prepared by etching with &8? phosphoric acid
solution for 19, &9 or %9 seconds and then dried with oil;free compressed air for 19
seconds. 2hen the surface was contaminated with water, human saliva and blood.
2he bonded samples were immersed in water for 1 day or thermo;cycled for !99
cycles.
Besults showed a short etching duration provided higher bond strengths than
extended etching of samples contaminated with saliva and blood. 2he samples
contaminated by saliva showed the lowest bond strength, and thermal stress did not
reduce the bond strengths.
Oestere ,J2 Shehart *C2 +isher A. determined the efficacy of precuring the
liquid resin primer phase of the systems to increase shear bond strength. In one
group, the primer was cured before placement of the bracket with filled adhesive
material and in the other group, the primer was not precured. $o statistically
significant difference in bond strength was found between the two groups. 2hey also
concluded that there was no advantage or disadvantage in bracket bond strength by
precuring the primer before placing the bracket and filled component of the
adhesive.
Eha" A#u Aha$a2 A3*ahadni investigated the shear bond strength between acid
etching +&8? phosphoric acid, and grit blasting and also between the two adhesive
systems. 2he result showed that enamel surface preparation using grit blasting
8
Review of Literature
reduces the bond strength and should not be advocated for clinical use.
9
Review of Literature
6. REVIE* O+ ,ITERATURE ON SE,+3ETC1 /RIMER 7SE/8
)elf;etching primers are often referred to as sixth generation bonding agents. 2hese
systems were first intended for use on dentin and enamel in restorative dentistry and
have been available for several years. Barkmeier et al. examined the effect of
>learfil Eiver Bond " +an acidic primer, on enamel through shear bond strength
testing and stated that the resin penetrated through enamel surface and adequate
conditioning was achieved.
)1P usually contains methacrylated phosphoric acid esters, formed when phosphoric
acid and a methacrylate group are combined into a molecule that etches and primes
the tooth surface simultaneously.
2hus, such adhesive systems reduce the number of procedural steps during bonding,
decrease the technique sensitivity and chair side time without compromising the
outcome. 2his is advantageous in both time and cost effectiveness to the clinician as
well as to the patient. 2he material is easy to use and about %!? of total working
time reduction has been reported. Becently, a new self;etch primer, one;up Bond #
+6)/ Inc, Irvine, >alif, that contains and releases fluoride ions has been also
introduced.
Sa"ir Bishara2 V. 0ordan2 Mar% E. Oson studied the effects on the shear bond
strength and the bracketA adhesive failure mode when an acidic primer and other
etchants were used to condition the enamel surface in vitro. 2he in vitro findings
indicated that the use of acidic primers to bond orthodontic brackets could provide
clinically acceptable bond strength. Fhen used with a highly +88?, filled adhesive
+Paravia"1, than with lightly +19?, filled adhesive.
Sa"ir E. Bishara2 Vaeria V. 0ordan et a. determined the shear bond strengths of
orthodontic brackets bonded with a glass ionomer adhesive, a composite resin
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Review of Literature
adhesive and an acidic primer that combines the etchant with the primer in one
application. 2he results indicated that the resinAphosphoric acid adhesive system
+control group, provided the strongest shear bond strength. 2he glass ionomer
adhesive system provided significantly lower bond strength. 2he least shear bond
strength was present when the acidic primer was used with an orthodontic adhesive.
Sa"ir E.Bishara2 ,ei!h VonVad et a. conducted a study to determine the effects
of the use of a self;etch primer on the shear bond strength of orthodontic stainless
steel brackets. )hear bond strength with self;etch primer was significantly lower, but
clinically acceptable as compared with conventional technique.
Rieko 5a"ada2 Tohru 1ayakawa2 9. 9asai evaluated the shear bond strength of
orthodontic stainless steel brackets bonded with D9? phosphoric acid, :ega bond
self etch primer, resin modified glass ionomer cement, resin modified glass ionomer
used with :ega bond self etch primer. 2he results under scanned electron
microscope +)1:, revealed that :egabond self;etching primer produced less
dissolution of enamel surface than did phosphoric acid and polyacrylic acid etching
and shear bond strength of about (; :Pa was obtained which was clinically
acceptable.
Bishara SE2 Oonso"#atC2 A$ouni R2 Denehy 0. studied the effects of saliva
contamination on the shear bond strength of orthodontic stainless steel brackets at
various stages of the bonding procedure using a new self;etch primer. +/ngel I
&:A1)P1 :inneapolis, :inn,
#indings indicated that contamination both before and after the application of the
acid;etch primer resulted in a significantly lower shear bond strength than the
control group. But still self;etch primer had achieved adequate shear bond strength.
Miya:aki M2 1inoura 9 et a. determined the effect of self;etching primer
application method on enamel bond strength.
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Review of Literature
#ive commercial self;etching primer systems, Imperva #luoro Bond, :ac Bond II,
>learfil Einer Bond II sigma, >learfil )1 Bond and 6nifil Bond were used.
2he self;etching primers were applied without agitation +inactive, or by brush
+active,. 2he findings indicated that the bond strengths with active application were
higher than with inactive application. /ctive application of self;etching primer helps
to ensure the creation of roughened enamel surface and enhances the penetration of
primer into subsurface demineralised enamel.
5.D. A$u#ouri2 D.T. Miett compared the mean bonding time, mean shear bond
strength and mean survival time of stainless steel brackets with a light cured
composite using self;etch primer +)1P, and conventional two stage etch and primer
system. 2he results have shown that the mean shear bond strength of the )1P group
was significantly less than that of two stage bonding system but the self; etch
primer +)1P, significantly reduced the bracket bonding time.
9or#"a%her 12 9o%ke A et a. evaluated an alternative method to the
conventional acid etch technique by using single step etchant 1$light ++B,,C .rmco,
.range, >/, 6)/ in vitro. Besult showed that single;step bonding agent seems to
provide acceptable bond strength between adhesive and enamel. $o enamel
fractures were detected.
Jason C. Dor"iney2 *iia" J. Dunn compared the shear bond strength of
orthodontic stainless steel brackets bonded to enamel with conventional, multistep
adhesive system and a self;etching primer adhesive system. In addition, another
group was included in which the air dispersion step in the self;etching primer was
omitted. 2he results showed no difference in mean shear bond strength between the
multistep adhesive system +11.&:Pa, and self;etching primer adhesive system
+11.:Pa, when primer was dispersed correctly. 2he mean shear bond strength of
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Review of Literature
the self;etching primer group in which air dispersion step was omitted was
significantly less +(.":Pa, than in other groups
Buyukyi"a: T2 Usu"e: S2 9ara"an A. determined the effects of using three
self;etching primers on the )hear Bond )trength +)B), of orthodontic metal
brackets and on the bracketAadhesive failure mode in vitro. 2he findings indicated
that conditioning with 2ransbond Plus +2BP, before bonding orthodontic brackets to
the enamel surface resulted in a significantly higher )B) than that found in >learfil
)1 bond +>)1,, 1tch and Prime + 1P),, and the control +acid;etched, groups. 2he
use of 1tch @ Prime +1P&, for enamel conditioning resulted in the lowest means
)B) value the adhesive remnant index scores indicated that there was more residual
adhesive. / comparison of remaining on the teeth that were treated with
conventional acid etching than in the >)1 and 1P& groups.
Oonso"#at C2 Bishara SE2 A$ouni R. assessed the effect of blood contamination
on the shear bond strength of orthodontic brackets with a new self;etch primer
/ngel I +&:A1)P1, )t. Paul, :inn,. #indings showed that blood contamination at
any stage of the bonding procedure results in a significant and drastic drop in the
shear bond strength of orthodontic brackets.
1een2 0ru#isa et a. evaluated and compared the bond strengths of orthodontic
bracket achieved with self;etch primer. 2he result showed that shear bond strength
achieved with 2ransbond Plus )elf;1tching primer +&: 6nitek, and &8? phosphoric
acid etching had no significant differences. )elf;etch primer also reduced number of
steps required to bond the brackets.
A$ouni2 Bishara SE et a. evaluated the shear bond strength of orthodontic metal
brackets when light cured both the self;etch primer and the adhesive in one step.
2hey concluded that light curing the acid;etch primer together with the adhesive
13
Review of Literature
after placing the orthodontic bracket did not significantly reduce the shear bond
strength as compared with light curing the acid;etch primer and the adhesive
separately.
Trites B2 +oey T+2 Bantin! D. evaluated the shear;peel bond strength of " self;
etching primer systems3 2ransbond Plus +&:A 6nitek, :onrovia, >alif, and #irst
)tep +Beliance .rthodontic Products, Itasca, 111, with their respective adhesives,
and compared them with control adhesive system +2ransbond G2, &:A 6nitek,
:etal orthodontic brackets were bonded to the enamel, and each adhesive group was
stored for "D hours +2l,, &9 days +2",, or & months +2&, in deionised water at &8
9
>.
2he shear;peel bond strengths of the & bonding systems were clinically acceptable
with the possible exception of #irst )tep at &9;day storage. Bepeated measures of
analysis of variance showed a statistically significant difference in mean bond
strengths between the & adhesive systems. 2he lowest mean shear;peel bond strength
values were noted at the &9;day storage.
Sirirun!ro$yin! S2 1ayakawa T et a. determined the bonding durability using a
:egabond self;etching primer with D;:12/A::/ 2BB resin )tainless steel
orthodontic brackets were bonded to the enamel of human premolar teeth. 2hree
conditions of enamel were preparedC :egabond self;etching primer without saliva
contamination, :egabond self;etching primer with saliva contamination, and repeat
:egabond self;etching priming after saliva contamination. 2here were no
significant differences in shear bond strength among all three groups. 2hey
concluded that, in human teeth, when using D;:12/A::/;2BB resin, :egabond
self;etching primer treatment produced tight bonding even when surface was
contaminated with saliva.
9ire"it%i A2 5a%in +2 0oka( S. investigated the effectiveness of three different
14
Review of Literature
dentin adhesive systems on the adhesion of resin composite to both dentin and
enamel. .ne total;etch self;priming adhesive system +Prime @ Bond $2,, one two;
step self etching primer adhesive system +>learfil )1 Bond,, and Hall;in;oneH self;
etching adhesive system +Prompt E;Pop, were evaluated. Prompt E;Pop exhibited
significantly higher bond strength values to enamel than dentin and all other
groups. 2here were no statistically significant differences between the enamel and
dentin bond strengths of >learfil )1 Bond and Prime @ Bond $2. 2hey concluded
that self;etching adhesive systems produced high bond strengths to human coronal
dentin and ground enamel surfaces and these materials seems to be very promising
for further clinical applications, and success.
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Review of Literature
;. REVIE* O+ ,ITERATURE O+ MOISTURE INSENSITIVE /RIMER
7MI/8
:IP is hydrophilic and contains mainly ";hydroxyethylmethacrylate, polyalkenoate
copolymers with carboxylate groups and ethanol.
2his primer is generally known to provide adequate bond strength in wet
environment when used with light activated resin.
Ra" 0randhi2 E C Co"#e evaluated the shear bond strength of stainless steel
orthodontic brackets bonded to dry and wet +with water and saliva, etched enamel
with the use of the moisture;insensitive primer +:IP3 2ransbond3 &: 6nitek,
:onrovia, >alif, and also compared the effectiveness of :IP with chemically and
light activated resin. :IP in combination with 2ransbond G2 produced comparable
bond strengths in both dry and wet environment. 2he results of this study suggested
that moisture;insensitive primer +:IP, can be used with light; activated composite
resins for better bond strength.
*e#ster MJ2 Nanda RS et a. compared the shear bond strengths of " light cured
hydrophilic bonding systems, 2ransbond G2 with :IP +&:A6nitek, :onrovia,
>alif, and /ssure +Beliance .rthodontics, Itasca, 111, with a hydrophobic bonding
system, and 2ransbond G2 with G2 primer +&:A6nitek,.
>omparison tests were conducted under D enamel surface conditionsC +1, etched and
dried3 +", etched and moistened with artificial saliva3 +&, etched, primed, and
moistened with artificial saliva3 and +D, etched, primed, moistened with artificial
saliva and reprimed.
Besults showed the highest mean bond strengths in groups 1 and D. In groups " and
& the lowest mean bond strengths and scores were seen.
1o#son RS2 ,ed&inka J2 Mee%han J0 evaluated the bond strength of 2ransbond
:IP under dry, moist and blood;contaminated conditions on human premolar teeth.
-ry bonding resulted in significantly higher bond strength than moist or blood;
16
Review of Literature
contaminated +11.1% :Pa, bonds. 2hus they suggested that 2ransbond :IP was a
suitable adhesive for bonding in conditions of poor moisture control or blood
contamination as clinically acceptable bond strength was achieved.
Shane S%hane&edt2 Ti"othy +oey evaluated the effectiveness of " moisture;
insensitive primers, /ssure +Beliance orthodontic Products, Itasca, and :IP +&:
6nitek, >alif, and compared them with a control of hydrophobic primer, 2ransbond
G2 +&: 6nitek, in vitro.
2he brackets were bonded according to different protocols. <roup 1 was taken as
control where brackets were bonded with 2ransbond G2. <roups " and & were
experimental. In group " contamination was done before application of primer
where in group & contamination was done after application of primer. 2he samples
were stored for &9 days and thermocycled for "D hours before debonding. 2hey
concluded that the mean shear;peel bond strength of the control was significantly
higher than other groups. <roup & also showed higher mean shear bond strength
than group ".
T.Eiodes2 E.9atsa&rias and 0 Eidas investigated the reactivity of moisture
insensitive primer +:IP, with water, in con0unction with a no mix orthodontic
adhesive and moisture insensitive adhesive +smart bond, and also assessed their
bond strength in a contaminated field relative to conventional bonding system.
#ourier transform infrared spectroscopy +#2IB, showed that only )martbond set in
the presence of water while :IP increased the extent of carboxyl ioni*ation without
inducing any setting reaction. 2ransbond :IP +moisture;insensitive primer, did not
improve bond strength values when combined with no mix adhesive.
<e((ieri I,2 Chun! C12 Mante +9. investigated the effect of saliva contamination
on the shear bond strength of an orthodontic adhesive used with 2ransbond
17
Review of Literature
:oisture; Insensitive Primer +:IP, &: 6nitek, :onrovia, >alif, and 2ransbond
Plus )elf; 1tching Primer +)1P, &: 6nitek,. 2he samples were divided into (
groups. 2he contaminated groups were bonded with different protocols as follows
etchAdryA :IPA wetA :IP, etchAwet A:IP, dryA)1PAwetA)1P, wetA)1P. 2hey concluded
that 2ransbond G2 adhesive with 2ransbond G2 conventional primer and 2ransbond
:IP in a dry field yielded similar bond strengths of "1.&IA;%.( :Pa and "9.8IA!.9
:Pa respectively. )aliva contamination significantly lowers the bond strength of
2ransbond :IP +1&.1IA;&.% :Pa,. 2hey also concluded that saliva had no effect on
the bond strength of 2ransbond )1P +dry;1&.8 :Pa and wet 1&.( :Pa,. 2ransbond
G2 adhesive with 2ransbond :IP and )1P might have clinically acceptable bond
strengths in either dry or wet fields.
Ca%%iafesta V2 Sfondrini M+2 et a. assessed the effect of water and saliva
contamination on the shear bond strength and bond failure site of & different
orthodontic primers +2ransbond G2, 2ransbond :oisture Insensitive Primer, and
2ransbond Plus )elf 1tching Primer3 &: 6nitek, :onrovia, >alif, used with a light;
cured composite resin +2ransbond G2,. 2he result showed that non contaminated
enamel surfaces had the highest bond strengths for conventional, moisture
insensitive primer and self;etching primers. In most contaminated conditions, the
self;etching primer had higher strength values than either the hydrophilic or
conventional primers. 2he self;etching primer was the least influenced by water and
saliva contamination, except when moistening occurred after the recommended &;
second air burst.
9ua 9S2 Nash TD2 /urk J1 determined whether a hydrophilic primer +2ransbond
:IP,, produces a significant difference in shearApeel bond strength compared with a
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Review of Literature
traditional hydrophobic primer +2ransbond G2, in wet +F, or dry +-, conditions in
vitro. 2he shear bond strengths obtained were significantly differentC >onventional
2ransbond G2 showed (.& J ".& :Pa3 :IP in dry field showed 8.! J 1.( and :IP
in wet field showed 8. J 1.8 :Pa. 2hey suggested that .rthodontists who suspect
moisture contamination should use a hydrophilic primer during bonding procedures
to maintain shear bond strength.
Ra$a!o(a R2 /ad"ana#han S2 0nana"ani J. compared the shear bond strength
among three materialsC conventional 2ransbond G2 primer +&: 6nitek,, moisture
insensitive primer +:IP, &: 6nitek,, and self;etch primer +2ransbond plus, &:
6nitek,. Bond strength was tested under laboratory conditions with brackets bonded
on both dry enamel and enamel contaminated with natural saliva. )elf;etch primer
showed maximum bond strength under both dry and wet conditions. >onventional
primer was comparable with the former under dry conditions but did not offer
clinically adequate bond strength in cases of moisture contamination. Both
moisture;insensitive primer +:IP, and self;etch primer +)1P, showed adequate
bond strengths superior to that of conventional primer in case of moisture
contamination.
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Review of Literature
=. REVIE* O+ ,ITERATURE O+ CURIN0 ,I01TS
Tun!sten 3 >uart: hao!en %urin! units 7T?18
It is a standard curing light that provides heat and stimulates the initiation of the
chemical reaction by activating the light sensitive chemical +i.e. camphorquinone, in
the adhesive. It consists of a halogen lamp that produces a broad spectral emission,
in which much of this is infrared energy +white light, that generates heat. But
subsequently it gets filtered to produce blue light with a wavelength of D99 to !99
nm. Because of the heat generation the lamp becomes extremely hot and the power
loss reaches 89? and less than 1? of the electrical energy is used for light emission.
2he bulb has a limited lifetime of around 199 hours. 2hese units deliver D99;
99mFAcm of energy. 2hus total time taken for curing each tooth is about D9;%9
seconds.
Ar!on aser 7-@ABs8
/ true laser light is delivered to the chemical agent. 2he action is to stimulate the
catalyst in the chemical. 2here is no thermal effect 3 therefore there will be less
dehydration of the enamel. 2he curing time for each tooth is about 19 seconds. 2he
purpose of these lamps is to increase the output light energy to an intensity that
/as"a ar% i!ht 7-@@Bs8
2his is a non laser, high;intensity light produces a great deal of heat 3 therefore it
can only be applied for & seconds per tooth. 2he action is thermal and stimulates the
catalyst in the chemical. /lthough it is very fast, there is a greater potential for
thermal trauma to the pulp and surrounding soft tissues than with other light
sources. 2his lamp generally has a tungsten anode and a cathode in a tube filled with
xenon gas. Fhen electric current is passed through xenon, the gas becomes ioni*ed
and forms plasma. 2he emitted white light is filtered to a D!9;!99nm and the power
density can reach more than "999mFAcm approaches (99mFAcm and wavelength to
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Review of Literature
approximately D89nm.
,i!ht 3 e"ittin! diodes 7,ED8
It is a true laser light produced from a solid ; state source. It consists of gallium
nitride blue light;emitting diodes. It produces high intensity light source +K
1999mFAcm , and it is concentrated over a much narrow bandwidth. -ue to high
power light source, more photons are available for absorption by the
photosensiti*ers. )o the E1- requires no filters to produce blue light. 2hey produce
wavelength between D19;!99nm.2he curing time for each tooth is about & to !
seconds. 2he advantage of E1- is minimal generation of heat, so it has longer
lifetime +19,999 hours,. It is resistant to shock and vibration. 2here are also cordless
and does not need a cooling fan.
*an! et a. 7-@@6, evaluated the effectiveness of a visible light source in curing the
resin under a solid metal bracket, compared the tensile bond strength at different
exposures and analy*ed the broken interface distribution between light cure resin
with various light exposure times and self cured resin. 2he bond strength of
2ransbond with %9 seconds and D9 seconds of light exposure was greater than both
the bond strength of 2ransbond with "9 seconds of light exposure and the strength
of the self cure resin +concise,. 2ransbond with D9 seconds of exposure was
suggested for clinical application.
21
Material and Method
MATERIA, AND MET1OD
2he study was conducted at 2he -epartment of .rthodontics /nd -entofacial
.rthopedics, Bural -ental >ollege, Eoni and Pra0 laboratory, Pune.
TEET1
1ighty extracted human premolar teeth is used in this study. /ll the teeth selected had
intact buccal enamel surfaces with no cracks, caries or developmental defects and were
stored in distilled water at room temperature.
/crylic blocks were prepared so that all the teeth could be mounted in it to be placed in
the 62:.
BONDIN0 S5STEM
#our bonding systems are used in this studyC Lfigure 1,",& @ DM
>onventional Primer I )elf >ure C 6nite +&: 6$I21N,
>onventional Primer I Eight >ureC 2ransbond G2 +&: 6nitek,
)elf 1tch Primer 2ransbond plus +&: 6nitek,
:oisture Insensitive Primer 2ransbond :IP +&: 6nitek,
/REMO,AR BRAC9ETS
:B2 +9."" slot, <emini series, (9;gauge mesh, &: 6nitek, is used.
Lfigure ! +a, and +b,M
22
Material and Method
ARTI+ICIA, SA,IVA
Fet mouth, salivary substitute. I>P/ health care ltd.
UNIVERSA, TESTIN0 MAC1INE 7UTM8
6niversal testing machine +62:,; )tar 2esting )ystems +)oft ware based, :odel )2)
"D(. Lfigure "9 +a, and +b,M
,I01T CURE UNIT.
>omposite curing unit +'ilux, 2urkey3 :odel $oC "99, "&9=, Lfigure 11M, the light
source does not have to be regularly replaced as is the case with halogen lights. 2he light
intensity of more than !99 mFAcm" covers all the important indications required for
proper bonding.
MET1OD
/crylic blocks were prepared so that all the teeth could be mounted in it to be placed in
the 62:. Before bonding the stainless steel brackets on the tooth, the buccal surface of
each tooth was cleaned and then polished using a brush dipped in pumice slurry. 2hen the
buccal surface was thoroughly rinsed with water and dried with oil free air spray.
Lfigure %M
/ll the blocks were colour coded @ divided into D groups with "9 teeth in each group.
Lfigure 1!,1%,18,1( @ 1M
23
Material and Method
1) >.$=1$2I.$/E PBI:1B I )1E# >6B1 >.:P.)I21 >.P.).>.,
+Oellow <roup,
2) >.$=1$2I.$/E PBI:1B I EI<'2 >6B1 >.:P.)I21 >.P.E.>.,
+<reen <roup,
3) )1E# 12>' PBI:1B I EI<'2 >6B1 >.:P.)I21 )1P.E.>.,
+Blue <roup,
4) :.I)26B1 I$)1$)I2I=1 PBI:1B I EI<'2 >6B1 >.:P.)I21
:IP.E.>., +Bed <roup, Lcontaminated with artificial salivaM

24
Material and Method

+I0URE -
+I0URE 6

+I0URE ; +I0URE =
25
Material and Method

+I0URE C 7a8 +I0URE C 7#8


+I0URE D +I0URE E

26
Material and Method
+I0URE A
+I0URE@
+I0URE -B
27
Material and Method

+I0URE --

+I0URE -6 +I0URE -;

+I0URE -=
28
Material and Method

+I0URE -C

+I0URE -D
+I0URE -E
29
Material and Method

+I0URE -A

+I0URE -@
30
Material and Method
+I0URE 6B 7#8
+I0URE 6B 7a8
31
Material and Method
+I0URE 6- 7a8
+I0URE 6- 7#8
0rou( I8 CONVENTIONA, /RIMER F SE,+ CURE COM/OSITE 7C./.S.C.82
32
Material and Method
G5eow 0rou(H in dry en&iron"ent
2he buccal surfaces of the teeth were etched with &8? phosphoric acid gel for &9
seconds, washed thoroughly with water and dried. >onventional primer +6$I21 &:
6nitek, was applied to the enamel surface. Lfigure 8M /dhesive paste +6$I21 &: 6nitek
self cure composite resin, was placed on the base of the brackets and brackets were
bonded on the enamel with gentle pressure. 2he excess material was removed with an
explorer.
0rou( II8 CONVENTIONA, /RIMERS F ,I01T CURE COM/OSITE
7C./.,.C.82 G0reen 0rou(H in dry en&iron"ent
2he buccal surfaces of the teeth were etched with &8? phosphoric acid gel for &9
seconds, washed thoroughly with water and dried. >onventional primer +2ransbond G2
&: 6nitek, was applied to the enamel surface. Lfigure (M /dhesive paste +2ransbond G2
&: 6nitek composite resin, was placed on the base of the brackets and brackets were
bonded on the enamel with gentle pressure. 2he excess material was removed with an
explorer. 2he adhesive was light cured on all D sides of the bracket for 19 seconds.
0rou( III8 SE,+3ETC1 /RIMER F ,I01T CURE COM/OSITE 7SE/.,C.82 GBue
0rou(H in dry en&iron"ent
2ransbond plus self etch primer was mixed in disposable dispensers as directed by the
manufacturer ,then it was gently rubbed on the enamel for D;! seconds with a disposable
applicator brush and gently evaporated with air for ";& seconds. Lfigure M 2his imparts a
glossy surface to the tooth surface, indicating that the tooth is ready to be bonded. 2he
33
Material and Method
brackets were bonded with 2ransbond G2 +&: 6nitek, adhesive paste and light cured on
all D sides for 19 seconds each.
0rou( IV8 MOISTURE INSENSITIVE /RIMER F ,I01T CURE COM/OSITE
7MI/.,.C.82 GRed 0rou(H under wet en&iron"ent
In this group, after etching procedure, a thin coat of artificial saliva Lwet mouthM was
applied on the enamel surface. /fter that one coat of :oisture insensitive primer L:IPM
was applied, gently evaporated Lfigure 19M and then the brackets were bonded in the
usual way with 2ransbond G2 +& : 6nitek, adhesive paste and cured on all D sides for 19
seconds each. Lfigure 1" @1&M
BOND STREN0T1 TESTIN0C
34
Material and Method
2he shear bond strength of the bonded samples were tested by securing the specimen to
the lower grip of the machine +#ixed 'ead, and a custom made bevel shaped tool was
fixed in the upper grip +:ovable 'ead, connected to the digital load level. Lfigure "9
+a,b, and "1+a,b,M
2he tool was positioned in such a way that it touched the bracket. Lfigure "1 +a,b,M. 2he
machine had been precalibrated before the testing was conducted. 2he crosshead speed
was ad0usted to ! mmAmin and the force at which the bracket debonded was recorded in
$ewton L$M. 2he surface area of the bracket base was calculated to be 19.&&Amm", with
the help of digital verniers7 calipers Lfigure 1DM. Fhile conducting the testing, none of the
enamel surface or the tooth fractured.
/ll the readings were taken from the digital load level.
2he bond strength was calculated in :ega Pascals by using the following formula.
+or%e in Newton
Bond stren!th in M/a P
Surfa%e Area of #ra%ket in ""
6
/fter obtaining all the values for each group, computeri*ed graphs were made showing
the )hear Bond )trength +)B), testing trends for each group. 2he graphs were made on
:icrosoft .ffice 1xcel "998.
2here after all the data is tabulated @ sub0ected to the statistician for the relevant
analysis.
35
Observations
OBSERVATIONS
TAB,E - ) VA,UES O+ A,, /ARAMETERS UNDER STUD5 CONVENTIONA,
/RIMER F SE,+ CURE COM/OSITE 7C./.S.C8 G5E,,O* 0ROU/H 7N I 6B8
Sa"(e No.
+or%e 7in Newton8
Shear Bond Stren!th 7in M/a8
1 119.1" 19.%%
" %.!( .&!
& 19D.(! 19.1!
D 1&9.1% 1".%
! 11%.11 11."D
% 11&.D" 19.(
8 1"D.8 1".9(
( !.9D ."9
19D.8! 19.1D
19 %.% .&%
11 1"".8" 11.((
1" 19!.D8 19."1
1& 11&.(D 11.9"
1D 191.% .(8
1! 11."1 11.!D
1% 19%." 19.&!
18 19&.&9 19.99
1( 11%.91 11."&
1 19D.!D 19.1"
"9 111."! 19.88
36
Observations
TAB,E 6 ) VA,UES O+ A,, /ARAMETERS UNDER STUD5
CONVENTIONA, /RIMER F ,I01T CURE COM/OSITE 7C./.,.C.8 G0REEN
0ROU/H 7N I 6B8
Sa"(e No.
+or%e 7in Newton8
Shear Bond Stren!th 7in M/a8
1 1"D.18 1".9"
" 1&!.!& 1&.1"
& 19%.!9 19.&1
D 1"8.D8 1".&D
! 1D1."1 1&.%8
% 1&!."" 1&.9
8 1D".!! 1&.(9
( 1"D.& 1".19
1"&.8! 11.(
19 11(."( 11.D!
11 11%.D" 11."8
1" 1&".(D( 1".(%
1& 1&D.89 1&.9D
1D 1"D.&8 1".9D
1! 11%.!" 11."(
1% 1".D& 1".!&
18 1"%.1& 1"."1
1( 1&9.%8 1".%!
1 1"1.D( 11.8%
"9 1&".9" 1".8(
37
Observations
TAB,E ; ) VA,UES O+ A,, /ARAMETERS UNDER STUD5 SE,+ ETC1
/RIMER F ,I01T CURE COM/OSITE 7SE/.,.C.8 GB,UE 0ROU/H 7N I 6B8
Sa"(e No.
+or%e 7in Newton8 Shear Bond Stren!th 7in M/a8
1 19!.(( 19."!
" 11D.9D 11.9D
& 19".8( .!
D 1".! 1".!(
! 1"%.%D 1"."%
% 191.8! .(!
8 1"&.1& 11."
( 1"D.9% 1".91
1.D (.9
19 1""."9 11.(&
11 1"!.8" 1".18
1" 1"%."& 1".""
1& 1"1.8 11.8
1D 1D!."D 1D.9%
1! 1"&.DD 11.!
1% 1"(.D9 1".D&
18 1DD.99 1&.D
1( 1"9.%! 11.%(
1 1"&.1& 11."
"9 1"".!1 11.(%
TAB,E = ) VA,UES O+ A,, /ARAMETERS UNDER STUD5 MOISTURE
INSENSITIVE /RIMER F ,I01T CURE COM/OSITE 7MI/.,.C.8 GRED
0ROU/H 7N I 6B8
Sa"(e No. +or%e 7in Newton8 Shear Bond Stren!th 7in M/a8
1 (D.81 (."9
" 191."& .(9
& (&.D8 (.9(
D 8."& 8.%8
38
Observations
! (1.81 8.1
% (D." (.1%
8 %."( .&"
( 8(.D9 8.!
(D.(1 (."1
19 .D( .%&
11 8!.%" 8.&"
1" &."( .9&
1& 8.DD 8.%
1D (D.81 (."9
1! %.% .&%
1% 8D.8 8."D
18 !.&! ."&
1( (!.! (.&"
1 8.8" .D%
"9 ((.&" (.!!
39
Results
RESU,TS
2he study was conducted at the -epartment .f .rthodontics /nd -entofacial
.rthopaedics, Bural -ental >ollege, Eoni and Pra0 laboratory, Pune.
/ll the blocks were colour coded @ divided into D groups with "9 teeth in each group.
1. >.$=1$2I.$/E PBI:1B I )1E# >6B1 >.:P.)I21 +>.P.).>., LOellow
<roupM
2. >.$=1$2I.$/E PBI:1B I EI<'2 >6B1 >.:P.)I21 +>.P.E.>., L<reen
<roupM
3. )1E# 12>' PBI:1B I EI<'2 >6B1 >.:P.)I21 +)1P.E.>.,
LBlue <roupM
4. :.I)26B1 I$)1$)I2I=1 PBI:1B I EI<'2 >6B1 >.:P.)I21 +:IP.E.>.,
LBed <roup3 contaminated with artificial salivaM
/ll the samples were tested for )hear bond strength +)B), on a 6niversal testing machine
+62:,, while conducting the testing, none of the enamel surface or the tooth fractured.
<raphs I, II, III, @ I= show the )B) testing trends for each group while testing.
0RA/1 I' >.$=1$2I.$/E PBI:1B I )1E# >6B1 >.:P.)I21 +>.P.).>,
LOellow <roupM
40
Results
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
0
2
4
6
8
10
12
14
12.6
9.2
C.P.S.C
SAMPles
SBS In MPa
>.P.).> +Oellow <roup, which comprised of
>onventional primer I self cure composite L6$I21 , &: 6nitekM
:1/$ )B) P 19.%D :Pa +).-.P 9.D,
B/$<1 P L."9 ; 1".%9 :PaM
0RA/1 II' >.$=1$2I.$/E PBI:1B I EI<'2 >6B1 >.:P.)I21 +>.P.E.>.,
L<reen <roupM
41
Results
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
0
2
4
6
8
10
12
14
16
10.31
13.8
C.P.L.C
SAMPles
SBS In MPa
>.P.E.>. +<reen <roup, which comprised of
>onventional primer I light cure composite L2ransbond G2 +&: 6nitek,M
:1/$ )B) P 1".&":Pa +).-.P 9.(%,
B/$<1 P L19.&1; 1&.(9 :PaM
42
Results
0RA/1 III' )1E#;12>' PBI:1B I EI<'2 >6B1 >.:P.)I21 +)1P.E.>.,
LBlue <roupM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
0
2
4
6
8
10
12
14
16
8.9
14.06
S.E.P.L.C
SAMPles
SBS In MPa
)1P.E.>. +Blue <roup, which comprised of
)elf;1tch primer L2ransbond Plus, &: 6nitekM I light cure composite L2ransbond G2,
&: 6nitekM
:1/$ )B) P 11.8&:Pa +).-.P1."!,
B/$<1 P L(.; 1D.9%:PaM
43
Results
0RA/1 IV' :.I)26B1 ;I$)1$)I2I=1 PBI:1B I EI<'2 >6B1 >.:P.)I21
+:IP.E.>., LBed <roupM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
0
2
4
6
8
10
12
9.8
7.24
M.I.P.L.C
SAMPles
SBS In MPa



:IP.E.>. +Bed <roup, which comprised of
:oisture Insensitive Primer L2ransbond :IP, &: 6nitekM I light cure composite
44
Results
L2ransbond G2, &: 6nitekM
:1/$ )B) P (.D!:Pa +).-.P9.(,
B/$<1 P L8."D to .(:PaM
0RA/1 V' )hear Bond )trength testing trends among four groups
45
Results
1 2 3 4 5 6 7 8 9 1011121314151617181920
0
2
4
6
8
10
12
14
16
SBS TESTING TRENDS
CPSC
CPLC
SEP LC
MIP LC
SBS In MPa
C.P.S.C C.P.L.C SEP.LC MIP.LC
0
2
4
6
8
10
12
14
10.64
12.32
11.73
8.45
COMPARITIVE MEAN SBS

SBS In MPa
0RA/1 VI' >omparison between the mean values of )hear Bond )trength among four
groups
STATISTICA, ANA,5SIS O+ T1E RESU,T +INDIN0S
46
Results
2he data was analysed using descriptive statistics including means and standard
deviations. One way anaysis of &arian%e 7ANOVA8 was used to determine differences
between four experimental groups +<reen, Blue, Oellow@ Bed ,.
Criti%a Differen%e Test was used to determine whether significant differences existed
between groups.
Des%ri(ti&e statisti%s, including Means2 Standard De&iation and Ran!e, was calculated
for )B) of each group.
/s there more than two treatments to be compared we have to follow ANOVA Test to
test the null hypothesis.
'oC m< P mB P mO P mB against the alternative that at least two of them are different,
where m<,mB,mO and mB represent the effect of treatments applied to <reen, Blue, Oellow
and Bed group respectively.
'ere tPD, nP"9 for all I total number of observations are eighty, so we set up the
following /$.=/ 2able.
ANOVA for S1EAR BOND STREN0T1 7SBS8
)um of
)quares
df :ean )quare # )ig.
Between <roups 18D.&18 & !(.19% %9.8"8 .999
Fithin <roups 8".81 8% .!8
2otal "D8.9&% 8
df = Degree of Freedom, F= F test value, Sig.= Significance.
2reatments are significantly different even at 1? level of significance.
Criti%a Differen%e Test2 this test was done to find whether any significant differences is
present in between the groups, as we already know from /$.=/ test that the samples are
significantly different, even at 1? level of significance.
47
Results
$ow >ritical -ifference +>.-., P t!?Q
2MSE
n
Fhere, MSE= Mean Square Error from /$.=/ table.
/t !? +>.-., P 1.% Q
20.957
20
P 9.%9
/t 1 ? +>-, P ".!%Q
20.957
20
P 9.8
2his signifies that if ,
>.-. R 9.%9 that means that samples are not significantly different
>.-. R 9.8 but K 9.%9 that means that samples are significantly different at !? level of
significance, but not at 1? of significance.
>.-. K 9.8 that means the samples are significantly different even at 1? of significance.

48
Results
(i) Sxx <;xx BS I 9.! which is less than >.-. at !? @ 1?. 2herefore, the effects of
>.P.E.>. +<reen group, and )1P.E> +Blue group, are not significantly different even
at 1? level of significance
.
C.P.L.C SEP.LC
0
2
4
6
8
10
12
14
12.32
11.73

MPa
0RA/1 VII' >omparison between the mean values of )hear Bond )trength in >.P.E.>.
+<reen <roup, @ )1P.E.>. +Blue <roup,
49
Results
(ii) Sxx <;xx yS I 1.%( which is greater than >.-. at !? and 1?. 2herefore, there effects
are significantly different even at 1? level of significance.
C.P.S.C C.P.L.C
0
2
4
6
8
10
12
14
10.64
12.32

MPa
0RA/1 VIII ' >omparison between the mean values of )hear Bond )trength in
>.P.).>. +Oellow <roup, @ >.P.E.>. +<reen <roup,
50
Results
(iii) Sxx <;xx BS I &.(8 which is again greater than >.-. at !? and 1? level. 'ence,
they are significantly different even at 1? level of significance.
C.P.L.C MIP.LC
0
2
4
6
8
10
12
14
12.32
8.45

MPa
0RA/1 IJ' >omparison between the mean values of )hear Bond )trength in >.P.E.>.
+<reen <roup, @ :IP.E.>. +Bed <roup,
51
Results
(iv) Sxx O;xx BS I 1.9 which is greater than >.-. at !? and l? level of significance.
'ence, these effects are significantly different even at 1? level of significance.
C.P.S.C SEP.LC
0
2
4
6
8
10
12
14
10.64
11.73

MPa
0RA/1 J' >omparison between the mean values of )hear Bond )trength in >.P.).>
+Oellow <roup, @ )1P.E> +Blue <roup,
52
Results
(v) Sxx B;xx BS I&."( which is greater than >.-. at !? and l? level of significance.
'ence, these effects are significantly different even at 1? level of significance.
SEP.LC MIP.LC
0
2
4
6
8
10
12
14
11.73
8.45

MPa
0RA/1 JI' >omparison between the mean values of )hear Bond )trength in )1P.E>
+Blue <roup, @ :IP.E> +Bed <roup,
53
Results
(vi) Sxx O;xx BS I".1 which is higher than >.-., both at !? and 1? level of significance.
2herefore it can be concluded that these two are significantly different even at 1?
level of significance.
C.P.S.C MIP.LC
0
2
4
6
8
10
12
10.64
8.45

MPa
0RA/1 JII' >omparison between the mean values of )hear Bond )trength in >.P.).>
+Oellow <roup, @ :IP.E> +Bed <roup,
54
Results
(i) 2he >onventional Primer I Eight >ure >omposite +<reen group, and )elf 1tch
Primer I Eight >ure >omposite +Blue group, are $.2 significantly different at both
!? @ 1 ? level of significance.
(ii) 2he >onventional Primer I Eight >ure >omposite +<reen group, is far )uperior than
the >onventional Primer I )elf >ure >omposite +Oellow group, at both !? @ 1?
level of significance.
(iii) 2he >onventional Primer I Eight >ure >omposite +<reen group, is far )uperior
than the :oisture Insensitive Primer I Eight >ure >omposite +Bed <roup, at both
!? @ 1? level of significance.
(iv) 2he )elf 1tch Primer I Eight >ure >omposite +Blue group, is far )uperior than the
>onventional Primer I )elf >ure >omposite +Oellow group, at both !? @ 1? level
of significance.
(v) 2he )elf 1tch Primer I Eight >ure >omposite +Blue group, is far )uperior than the
:oisture Insensitive Primer I Eight >ure >omposite +Bed group, at both !? @ 1?
level of significance.
(vi) 2he >onventional Primer I )elf >ure >omposite +Oellow group, is far )uperior than
the :oisture Insensitive Primer I Eight >ure >omposite +Bed group, at both !? @
1? level of significance.

1en%e we %on%ude2
'ighest bond strength was elicited by Conventional Primer + Light Cure
Composite +<reen group, followed by Self Etch Primer + Light Cure Composite +Blue
group,, then Conventional Primer + Self Cure Composite +Oellow group, and lowest,
55
Results
but still above the minimum required bond strength +(.&1:Pa,, was exhibited by
Moisture Insensitive Primer + Light Cure Composite +Bed group,.
56
Discussion
DISCUSSION
2he development of acid etching technique by Buono%ore
"
led to the direct
bonding of orthodontic brackets with composite resin. 2he advantages of direct bonding
include benefit for both the patient and the practitioner. #or patients, there is less risk of
enamel decalcification, better oral hygiene maintenance, decreased irritation of the
gingival tissue, and improved esthetics. #or practitioners, direct bonding eliminates
pretreatment separation of the teeth, and decreases the chair;side time. .ne of the
disadvantages of direct bonding however is bond failure due to moisture
contamination.
11,D&

>onventional BI);<:/ orthodontic adhesive and primer contains 2riethylene
glycol;dimethacrylateTbisphenol/Tdiglycidol;ether;dimethacrylate. -espite their
hydroxyl groups, they require dry etched enamel for mechanical adhesion which is
largely due to their hydrophobic properties of functional monomer and absence of
chemical adhesion. BI);<:/ related monomer is known to have hemolytic properties
but the blood contamination still does not allow the adhesive resin to achieve its full bond
strength potential.
19
:oisture contamination is considered the most common reason for bond
failure.
11,!9
1namel contamination can occur at two critical timesC after the tooth surface
has been etched and after primer has been applied. Bonding could be compromised at
both times.
!,D&
2herefore, a bonding system that provides adequate bond strengths while
tolerating moisture would be ideal.
!,D%,!9,!1
Becently, to overcome such problems, two new primers have been introduced
57
Discussion
Lsixth generation bonding agentsM, namely Sef3et%h (ri"er and Moisture3insensiti&e
(ri"er. :anufacturers claim that these new primers have the potential to produce
clinically sufficient bond strength of orthodontic stainless steel brackets in dry as well as
wet mediums.
.ur study basically aims to measure the )hear Bond )trength +)B), of
orthodontic brackets, using these newer primers @ to compare them with the
conventional primers Llight cureI self cureM so that we get a better idea about the clinical
performance of these newer materials when compared simultaneously with the
conventional ones.
2his study was done with the ob0ective of comparing the )B) of these routinely
used materials so as to get an insight on their )B) so as to apply this knowledge in
clinical conditions.
1ighty extracted human premolar teeth were used in this study. /ll the teeth selected had
intact buccal enamel surfaces with no cracks, caries or developmental defects and were
stored in distilled water at room temperature. /crylic blocks were prepared so that all the
teeth could be mounted in it to be placed in the 6niversal 2esting :achine +62:,.
/ll the blocks were colour coded @ divided into D groups with "9 teeth in each group.
1) >onventional Primer I )elf >ure >omposite +>.P.).>., LOellow groupM
2) >onventional Primer I Eight >ure >omposite +>.P.E.>., L<reen groupM
3) )elf 1tch Primer I Eight >ure >omposite +)1P E.>., LBlue groupM
4) :oisture Insensitive Primer I Eight >ure >omposite +:IP E.>., LBed groupM
Ucontaminated with artificial salivaV
.ne of the advantages of the present study was that human premolar teeth were
58
Discussion
used. 'ence the findings may be more appreciable and authentic. /ll the samples were
bonded together, @ after ! days, debonded on the same day to maintain the accuracy of
the results. 2he samples were tested on the 62: +)tar 2esting )ystems, )oftware based,
:odel )2) "D(,, to measure the shear bond strength. 2he crosshead speed of the 62:
was set at ! mmA min, for all the samples so that there are no false readings. /ll the
materials used were of &: 6nitek. /ll the readings were taken through a computeri*ed
processor. In all, utmost care was taken for standardi*ation, to avoid any errors.
2he same results can be obtained with a tensile testing machine, but 62: is
considered to be the gold standard machine in )B) testing, hence we used it.
2he results were taken @ the statistical analysis was done. #ollowing conclusions
can be drawn from the present studyC
2he results showed that the mean )B) of G-6.;6K B.AD M/aH was achieved with
2ransbond G2 adhesive when it was used with conventional hydrophobic primer
2ransbond G2. >.P.E.>. +<reen group,, which is well above the clinically acceptable
limit for orthodontic purpose.
!"
2hese findings indicate that 2ransbond G2 adhesive provides stronger )B) with
2ransbond G2 Primer than self;etch primer +)1P,.
2his result is similar to ,ittewood
!&
findings where hydrophilic primer showed
lower bond strength than conventional hydrophobic primer which showed the maximum
)B).
2he results also showed that )1P had an adequate shear bond strength in dry field,
59
Discussion
G"ean SBS of --.E;K -.6C M/aH with reduction of steps of bonding procedure which are
similar to the results of A$u#ouri, Miett
&"
, 9or#"a%her 1. 9o%ke.
&9
/lthough the >.P.E.>. +<reen group, showed maximum )B), when compared
statistically with the )1P.E.>. +Blue group, showed that the two groups were not
significantly different. 2his shows that in a dry field the )B) of both )1P @ conventional
primer are comparable and clinically acceptable. 2his result of our study is in accordance
with <e((ieri2 Chun! et a.
D
and Bishara et a.
&!,&%
, /erdia!ao and ,o(es
!D
and 1een2
Don Ra#oud
&8
whose studies also showed that self;etch primer had clinically acceptable
bond strength when compared with conventional primer in dry field.
Rayn Arnod2 Edward Co"#e
"(
found no significant difference in mean bond
strength of orthodontic metal brackets when bonded with )1P and conventional primer in
dry field.
2he present findings are also similar to /eut:fedt A2 Niesen,A
D"
where there
was little difference in the bond strength between phosphoric acid etch and self;etch
adhesive group in dry field.
Sa"ir Bishara2 0ordan
"!
stated that use of acidic primers to bond orthodontic
stainless steel brackets could provide clinically acceptable bond strength +19.DJD.D :Pa,.
'owever this finding of our study doesn7t coincide with Ra$a!o(a R2
/ad"ana#han S2 0nana"ani J.
1
who in their study stated that )1P in dry field yields
maximum )B) even more than the conventional primer I light cure.
The other si!nifi%ant findin! was %o"(arison of SBS of ,i!ht Cure L Sef Cure
60
Discussion
!rou(s.
Present study showed that the )B) of the >.P.E.>. +<reen group, L-6.;6 K B.AD
M/aM 2ransbond G2 was superior than the >.P.).>.+Oellow <roup, G-B.D= K B.@= M/aH
6nite, which shows that in dry conditions light cure adhesives perform better than the
self cure adhesives, although both provide a )B) which is clinically acceptable.
2his finding is in accordance with Sunna L Ro%k
!!
, *an! L Men!
D
who stated
that in dry conditions the )B) of the light cure resin was superior than the self cured
resins.
'owever this is not in accordance with a study by Toedane L Osorio et a.
!%
who found out that the self cure )B) was superior than the light cure, however this may
be attributed to the, incomplete polymeri*ation. In this study the samples were also
thermocycled prior debonding. 2he possibility that leakage of uncured bis; <:/ from
E> resin cements could occur, should be taken into account.
In recent years the light cure technology has advanced tremendously, @ with the
advent of E1- lights @ proper curing techniques the mean )B) of light cure material is
definitely superior than the self cure.
In a study Cha"ada L Stein
!8
, stated that although the initial )B) of light cure is
more , the strength of self cure composite increases with time, and after a %9 minute gap
both of them show comparable )B).
Ne4t findin! was %ini%ay a%%e(ta#e SBS dis(ayed #y the MI/.,.C. 7Red !rou(8
G%onta"inated with artifi%ia sai&aH.
61
Discussion
2his group showed a mean )B) of GA.=C K B.AB M/aH which is clinically
acceptable according to Reynods.
!
S%hane&edt and +oey
DD
and *e#ster MJ, Nanda RS
D&
measured the shear bond
strength of orthodontic stainless steel brackets in which moisture contamination occurs
after :IP application and when enamel surface was reprimed. /ll of them showed shear
bond strength which was adequate and clinically acceptable.
Ra$a!o(a R2 /ad"ana#han S
1
2 1o#son RS2 ,ed&inka J et a.

also showed
comparable mean bond strength when :IP was used in wet field. 2hus, our results
indicate that :IP performs significantly well in moisture contaminated fields.
The 1i!her SBS of the SE/ ,.C. 7Bue !rou(8 in %o"(arison to C./.S.C.
75eow 0rou(8 can be attributed to the use of light cure composite which showed a
higher bond strength in comparison to the self cure group. /s stated by Sunna L Ro%k
&!
2
*an! L Men!.
D
The su(erior SBS of a the ; !rou(s o&er the MI/ ,.C. 7Red 0rou(8 is
because of the saliva contamination in the red group, past studies by Ra" 0randhi2 EC
Co"#e
11
2 <e((ieri I,2 Chun! C1 et a
D
showed that no significant difference between
)B) of conventional primer and :IP in dry field .
Eiterature also supports the comparable @ acceptable mean )B) of )1P @ :IP in
a contaminated field. /s shown by <e((ieri I,2 Chun! C1 et a.
D
where they stated that
saliva contamination did not affect the bond strength of )1P when )1P was reapplied.
Ca%%iafesta V2 Sfondrini M+ et a
!
in their study showed that )1P had higher
62
Discussion
mean shear bond strength than >onventional primer and :IP in a contaminated
environment.
/ lot of studies have been done regarding the moisture contamination @ its effect
on the )B) of brackets using >onventional PrimerI Eight >ure Besins @ all of them
unanimously agree that moisture contamination does corrupt the bonding procedure
resulting in weaker )B). >onventional primer shows significantly low mean bond
strength in wet field which is similar to that observed by Ca%%iafesta V2 Sfondrini M+ et
a.
!
2,eon S2 John 1 et a.
1(
and A##as 12 Ja"es + et a.
18
Itoh T2 Inoue 5 et a
"1
also concluded that contamination causes low shear bond
strengths when >onventional primers are used.
2hus we can safely say that the >onventional primers do under perform in
moisture contamination as reviewed in literature.
'owever )1P performs well in contaminated situations @ can give )B)
equivalent to :IP.
>omparisons with previously reported results are difficult because there is a lack
of consensus on the materials and methods +storage time before debonding,
thermocycling, debonding device, bonding area, differences in the bracket mesh., for
orthodontic bond strength testing. )o, studies determining the bond strength are important
mainly for their relative values and numerical comparisons are not always feasible.
!%
2he present study shows that the conventional primers are still very efficient @
reliable material for the orthodontic bonding (ro&ided that we (ro(ery "aintain
63
Discussion
isoation.
19,1!
)1P and :IP also show clinically acceptable bond strengths when enamel is
contaminated and these primers are reapplied.
2aking into consideration the above results and discussion, the use of )1P seems
to be less technique sensitive. )1P definitely reduces chair side time as it etches and
primes simultaneously and thus may offer a better alternative to bonding with
conventional primer as it would reduce the bonding steps and be more comfortable to the
patient.
'owever, the use of )1P is limited to a single patient and thus would offer more
expense @ lesser flexibility to be used.
:IP would be a better alternative when isolation is difficult, as may occur in
conditions of excessive salivation, impacted canines and mandibular second molars. 2his
is because :IP is more cost effective in comparison to )1P and shows a comparable
bond strength in wet environment.
2his was an in vitro study3 hence it is necessary to compare the results with those
that might be obtained in the oral environment.
2ill date there is no standard machine to measure, the shear bond strength
intraorally, like the 62:.
/lso scanning electron microscope study would give us a clearer picture of the
structure of enamel surface when self etch and moisture insensitive primers are used for
bonding purposes.
64
Discussion
Reiko 52 9asai k
6A
has stated in their scanning electron microscope study that self
etch primer causes less dissolution of enamel surface, however more research is needed
in this particular matter.
=ery few studies in the past have used all the four materials as used in the present
study, hence via this study a clearer picture about the shear bond strength of the newer @
the older materials is obtained. /s all the groups were compared together, this study
accurately tells us about the clinical performances of these materials @ also gives us an
insight on how they can be utili*ed in different clinical situations.
65
Summary and Conclusion
SUMMAR5 AND CONC,USION
/chieving effective and lasting shear bond strength between enamel, adhesive and
orthodontic brackets is essential in day to day orthodontic practice. 2he effectiveness of
direct bonding in achieving a mechanical bond requires a dry environment. /ny
contamination during bonding procedure reduces the bond strength completely and is
considered the most common reason for bond failure. 2o overcome this problem, new
materials like )elf etch primers and :oisture insensitive primers are introduced.
2he basic aim of this study was to measure and compare the )hear Bond )trength
+)B), of these newer materials with the conventional primer using Eight cure @ )elf cure
composite, so that it can be known how these new materials perform in comparison to the
conventional approach.
2he study was conducted at 2he -epartment of .rthodontics @ -entofacial
.rthopedics, Bural -ental >ollege, Eoni and Pra0 Eaboratory, Pune.
1ighty extracted human premolar teeth were used in this study. /crylic blocks
were prepared so that all the teeth could be mounted in it to be placed in the 6niversal
2esting :achine.
#our bonding systems were used @ accordingly all the blocks were colour coded
@ divided into D groups with "9 teeth in each group.
2hen the samples were tested on the 6niversal 2esting :achine to measure the
shear bond strength, the results were taken @ the statistical analysis was done.
66
Summary and Conclusion
#ollowing conclusions can be drawn from the present studyC
The shear #ond stren!th of'
I. ,i!ht %ure !rou( is su(erior than Sef %ure !rou( in dry fied.
II. ,i!ht %ure !rou( L Sef et%h (ri"er are not si!nifi%anty different in dry
fied.
III. ,i!ht %ure !rou( in dry fied is su(erior than Moisture insensiti&e (ri"er in
%onta"inated fied.
IV. Sef et%h (ri"er is su(erior than Sef %ure !rou( in dry fied.
V. Sef %ure !rou( in dry fied is su(erior than Moisture insensiti&e (ri"er in
%onta"inated fied.
VI. Sef et%h (ri"er in dry fied is su(erior than Moisture insensiti&e (ri"er in
%onta"inated fied.
2he present study shows that the conventional primers are still very efficient @ reliable
material for the orthodontic bonding, provided, isoation is (ro(ery "aintained.
/ll the groups in the present study showed different shear bond strength but more
importantly,
Mean shear bond strength of each & every group as above the clinically acceptable
limit for the orthodontic purpose!"
2his shows that all these materials +new @ old, are efficient enough for reliable bonding,
these newer materials add up to the armamentarium of the orthodontist @ can be used
0udiciously in different clinical situations.
67
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73