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Orthodontic bonding techniques continue to evolve with the ever-changing population. With the demand for orthodontic treatment increasing, the specialty is regularly presented with restored dentitions, anterior crowns, bleached teeth, as well as those presenting with developmental conditions, such as fluorosis and amelogenesis imperfecta. Reduced orthodontic bond strength can lead to failure of the appliance and in turn lead to prolonged treatment times and patient dissatisfaction. This article aims to summarize the recommended methods for bonding and give an updated review of optimizing techniques.
CPD/Clinical Relevance: Adequate bracket bond strength is an essential part of orthodontic treatment, to prevent breakages and reduce treatment time and risk factors.
Article
The invention of direct bonding of brackets to enamel surfaces of teeth has dramatically changed orthodontic treatment. The acid-etch bonding technique was introduced by Buonocore in 19551 and later adopted by Newman for the attachment of orthodontic brackets.2 This led to the progression from the traditional banding of individual teeth, to the direct bonding technique that is now ubiquitous.
This ability to bond orthodontic brackets directly has offered numerous clinical advantages including: reduced patient chair-time; increased patient comfort; improved aesthetics; reduced plaque retention; and the possibility of placing attachments on partially erupted teeth.
Although a number of bonding materials have been trialled, composite has been found to be the most effective for orthodontic bonding, exhibiting adequate bond strength to withstand intra-oral and orthodontic forces (6−8 MPa at 24 hours,3 with acceptable bond failure rate of 1−5%4). With the demand for orthodontic treatment increasing, particularly amongst the adult population, the specialty is facing new challenges. Many patients now present with teeth restored with a variety of materials, such as composite or amalgam fillings, porcelain veneers and ceramic or metal crowns. In an unrestored dentition, patients may also present with previously bleached teeth and both adult and adolescent patients may present with other atypical tooth surfaces, including developmental conditions such as fluorosis and amelogenesis imperfecta.
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