Comparison of Bond Strength of Metal and Ceramic Brackets
Appropriate bond strength between bracket and tooth surface is one of the most important aspects of orthodontic treatments [1,2]. Bonding of MIM monoblock metal bracket to enamel started in the mid 1960s [3,4]. Only auto-polymerizing materials were available at the time. Bonding of orthodontic brackets with visible light-cure adhesives was first reported by Tavas and Watts . The light-cure adhesives were widely accepted due to their advantages in comparison with other chemical-cure adhesives. These advantages include high primary bond strength, better physical characteristics because of air inhibition phenomenon, user friendly application, extended working time for precise bracket placement and better removal of adhesive excess; but they have three major disadvantages namely being time-consuming, hindering light transmission and polymerization shrinkage [6,7]. Since then, several new methods using different composites and light-curing units have been introduced for this purpose. The halogen lamp, also known as quartz halogen and tungsten halogen lamp, has been used as light-curing unit for many years [8,9], and is the most common source of visible blue light for dental applications. This lamp contains a blue filter to produce light of 400–500 nm wavelength . The wide spectrum of action, easy use and low-cost maintenance are the most favorable characteristics of halogen light curing systems . Despite their popularity, halogen light curing units have several disadvantages. For example, their light power output is 1% of the total electric energy consumed [11,12]. Moreover, the lamp, reflector and filter wear out gradually . Halogen bulbs have a restricted useful lifetime of about 40–100 hours [13,14]. The power density of light curing unit decreases with increase in distance. The other drawback of application of halogen bulbs is prolonged curing time [15,16]. Over the past several years, other light sources such as xenon plasma arc, argon laser, and light-emitting diodes (LEDs) have been introduced in orthodontics . According to the results of previous studies [1,18–20], the shear bond strength (SBS) values of orthodontic brackets in curing with halogen lamps and plasma arc are the same but plasma light reduces curing time per tooth from 20–40 seconds to two seconds. Also, argon laser curing unit provides better SBS than halogen lights. But xenon plasma arc and argon laser are too expensive . Mills  introduced LED light curing units as a polymerizing light source in 1995. At present, LED sources are among the most reliable light source categories for bracket bonding [8,20]. Light cure resins set when irradiated with light at wavelengths of 460nm and 480nm in the blue end of visible spectrum with an intensity of 300mW/cm 2 . Also, LED is an effective transducer of electrical power into visible blue light and does not produce a lot of heat . The advantages of LED light curing units include lifetime of several thousand hours without significant degradation of light flux over time, resistant to shock and vibration and no need for filter to produce blue light [22–24]. Moreover, LED light curing units consume little power and can be run on rechargeable batteries, allowing them to have a lightweight ergonomic design . The new LED curing units were launched simultaneously with the advancement of technology. First, these curing units generated light with an intensity of approximately 800–1000YmW/cm 2 , reducing the required light exposure time to 10 seconds [26,27]. Currently, some high-power LED curing units are able to emit light radiation with intensity of 1600–2000YmW/cm 2 , allowing shorter exposure times of six seconds for metal brackets . In this study, the effect of conventional and high-power models of LED units on SBS of metal and ceramic brackets to tooth surfaces was evaluated.
Forty sound bovine maxillary central incisors were used in this study. After extraction, the teeth were cleaned and immersed in 0.5% chloramine solution at 4°C for one week. They were divided into four groups of 10 teeth in each group. Next, teeth surfaces were etched with 37% phosphoric acid (Reliance; Itasca, IL, USA) for 20 seconds. After etching, the teeth were washed with water spray for approximately 10 seconds. The sample size (n=8 minimum samples for each group) was calculated with a power analysis in order to provide a statistical significance of alpha=0.05 and a standard deviation of 4.2 MPa using Minitab software. Sampling method in the study was consecutive. Bracket model and the type of light curing unit used for teeth were determined randomly.
Group A: After checking correct conditioning of the enamel, metal brackets (American Orthodontics, Sheboygan, WI, USA) with a nominal base area of 11.3mm 2 were bonded with Transbond XT (3M ESPE, St. Paul, MN, USA), applying a uniform layer of adhesive primer on the etched enamel, and resin cement on the base of brackets. Brackets were placed in place and were pressed against the surface of the tooth. Excess cement was carefully removed with a dental probe, and the adhesive was high-power light-cured (2700mW/cm 2 ; Dentlight LLC, Plano, TX, USA) for four seconds (two seconds from mesial and two seconds from distal).
MIM bondable metal bracket with a nominal base area of 15.1mm 2 were bonded to the etched enamel and other steps were performed similar to group A. The adhesive was high-power light-cured for three seconds (1.5 seconds from mesial and 1.5 seconds from distal).