INTRODUCTION:

Orthodontic is a part of dental medicine and the aim is to restore dental condition or jaw disorder into normal condition¹. Aim of orthodontic treatment is to restore aesthetic and function of orofacial region. Some aspects in orthodontic treatment objective includes facial aesthetic improvement, oral composition, a good relationship between occlusion and function, psychological aspect, and maintaining medical tissue that support the tooth that create a stabilize tooth position after the treatment. That mission would be achieve by a good treatment plan¹.

Orthodontic treatment with fixed appliance has a massive development. In early of 1900, fixed appliance must adhere with band in each teeth². Newman introduce acid etch technique in 1965 for direct installation of bracket into enamel. A direct bracket installation into tooth with adhesive resin is known as bonding³. A direct bracket bonding into tooth enamel surface has reduce a requirement of band application and become a general clinical procedure in orthodontists². Orthodontic bracket bond failure is commonly found among orthodontic patients. A cohort study found that the bracket failure rate was 6,4%, with most bracket failure occurring in the first 6 months after bonding with individual differences ⁴.

Clinician practices acid etching bonding technique when bonding the bracket into enamel surface. Etch with phosphoric acid used in bracket bonding step into enamel that applied composite resin. Acid etch technique is consist of: (1) enamel hydroxyapatite solution with phosphoric acid to create microporous and increase the bonding surface area, (2) application primary resin material, and (3) composite resin application in orthodontic bracket⁵. This technique require washing and drying activity after application of etchant material⁶. This technique is also called as total etch method. Microporous will form in enamel surface email surface and increase surface area of bond that create possibility for resin to easily enter enamel prism microporous. Resin that enter into microporous will create mechanic bonding with enamel or called as resin tag⁷.

The total etches method with phosphoric acid etch is a useful procedure in the orthodontic field. However, this method should be simplified. This simplification effort will decrease a number of procedure, reducing the working time of bonding process, and decreasing the risk of enamel damage⁶. This effort should be done because bonding procedure frequently occur a problem in clinical application that related on saliva contamination occurrence in enamel surface. This problem raise a risk of bonding formation failure⁸.

One of bonding system development in dental conservation science is combining etch and primer material into one solution that applicable either in dentin or enamel⁹. A combination of etching and primer material in one solution is called self-etching primer¹⁰. Most of self-etching primer material contains Hydroxyethyl Metacrylate molecule (HEMA) with hydrophilic characteristic¹¹. This molecule will properly function in humid condition that are helpful during the application of bracket in difficult location such as in gingival area, second molar, and tooth impaction. In that case, bonding failure frequently occurs that would involve bracket reposition action and cause an extra working time for the orthodontist and patient^12,13.

Self-etching primer has proper function as etchant or primer material. Enamel wash is not required after the application of this material⁶. Bonding method with self-etching primer is also called as self-etch¹⁴. Combination of etch and primer in one solution produce one step procedure that create a shortcut on working time, saving the cost, and reducing the contamination risk during bonding process that clinically useful, directly and indirectly to the patient¹². Previous studies show shear strength in self-etch method is equal to shear strength in total etch method^15–17. Meanwhile, another study shows self-etch method has lower shear strength but bracket bonding strength is still accepted clinically^6,18.

Bonding strength may define as a two power that applied each other but does not occur in one similar line. During the orthodontic treatment, this power will accepted by bracket in vertical direction that occur when the patient chewing and receiving power to the bracket will shift the tooth in distal or mesial direction¹.

Adhesive remnant number in tooth surface or bracket base is an important factor for orthodontist in selection of adhesive material. Artun and Bergland applied an Adhesive Remnant Index (ARI) to evaluate adhesive remnants in tooth enamel surfaces after bonding process. For years, Adhesive Remnant Index (ARI) has become one of the most aspects that evaluated in the study of orthodontic adhesive material.

In this study, we determined the shear bond strengths of orthodontic brackets bonded with one of four procedures: (1) a composite resin adhesive used with 40% phosphoric acid etchant, (2) the same composite resin used with Transbond Plus Self-etching Primer. The surface appearances of teeth after etching or self-etch priming were observed with a field-emission scanning electron microscope (FE-SEM). Hence, the hypothesis of this study are: (1) There is a difference in shear strength between the self-etch adhesive and the total-etch adhesive in the attachment of the bracket. (2) There is a difference in Adhesive Remnant Index between self-etch adhesives and total-etch adhesives on bracket attachment. (3) There is a difference in the length of the enamel crack between the self-etch adhesive and the total-etch adhesive in the bracket attachment.

MATERIALS AND METHODS:

The minimum n value (sample quantity) is defined by lemeshow formula which is 6 samples for each group.

Sample in this research is premolar tooth that has extracted with these criteria:

a. First premolar tooth of upper jaw

b. Obtain from the patient that will receive orthodontic treatment

c. Premolar tooth has a complete buccal enamel surface without caries, restoration, and never receive bonding with adhesive material.

This research conducted in Laboratory of Microbiology, Faculty Dental Medicine, Universitas Airlangga for storing the sample in incubator for 28 days, Joint Laboratory of Pharmacy Faculty of Universitas Airlangga for shear strength test, and continued in Robotics Laboratory of Teknologi Sepuluh November Institute of Surabaya (ITS) for SEM test.

Research Tools

1. Ruler and pencil

2. Air syringe

3. Plastic cup, pipette, and spatula

4. Bracket holder and bracket gauge

5. Rubber cup and disposable brush

6. Dental explorer, sickle

7. Brass cylinder bar as assist tool in removing the bracket

8. Ligature Cutter Plier (RMO, United States)

9. Dental Curing Light (Monitex)

10. Tungsten Carbide Burs (Ortho Technology, United States)

11. Shear Strength Test Tool (Shimadzu Autograph AG-10TE)

12. Scanning Electron Microscope (Carl Zeiss, United Kingdom)

Research Material

1. 18 human premolar teeth

2. 18 premolar bracket Roth RMO 0.22 (RMO, United States)

3. Scotchbond etch material (3M Dental Product, Monrovia, Calif)

4. Transbond XT Primer adhesive material (3M Unitek, Monrovia, Calif)

5. Transbond Plus Self-Etching Primer adhesive material (3M Unitek, Monrovia, Calif)

6. Transbond XT Light Cure Adhesive Paste composite resin material (3M Unitek, Monrovia, Calif)

7. Pumice (Kemdent, Partson Swindo Witshire,Germany)

8. Self curing acrylic (Pigeon Dental Resin Powder, Shanghai, China)

9. Ligatur wire 0,009 inch (RMO, United states)

10. Saline solution

11. Artificial saliva solution (Fukuyama)

12. Distillated water

Sample Preparation

There are 18 premolar teeth in this research. The tooth is planted in acrylic before treated as a holder for the application in universal testing as shear strength test tool.

Figure 1. Planted tooth in acrylic

Application method for adhesive material

1. Group 1 (Control)

Dental buccal surface cleaned and polished by pumice with rubber cup and water for 10 seconds, then rinsed by a water and dried with air syringe. Transbond XT Primer was applied in the enamel surface. Transbond XT Adhesive Paste applied in premolar bracket base. After that, the bracket was put in the tooth enamel surface with light pressure and enlighten by Dental Light Curing for 20 seconds with 1-5 mm illumination length.

2. Group 2 (Self-etch)

The tooth buccal surface was cleaned and polished by pumice with rubber cup and water for 10 seconds and rinsed with water and dried with air syringe. Activation of Transbond Plus Self-etching Primer practiced in according to manufacture guideline. Transbond Plus Self-etching Primer content mix is completed with holding the applicator part in one hand and the thumb and another index finger press all liquid from the inside of black reservoir into white reservoir. Black and white reservoir connection is folded to prevent the liquid flows back into black reservoir. After that, liquid from white reservoir is pressed into purple reservoir and activated with spinning movement by existing applicator inside the reservoir until the color become light yellow and ready to use. Transbond Plus Self-etching Primer applied in tooth enamel surface with spinning movement for 3-5 seconds by applicator and dried with low wind blowing for 1-2 seconds. Transbond XT Adhesive paste applied in premolar bracket base. After that, bracket put in tooth enamel surface with low pressure and enlighten with Dental Light Curing for 20 seconds with 1-5 mm illumination length.

Figure 2. Self-etch material application in tooth surface

3. Group 3 (Total etch)

Tooth buccal surface cleaned and polished with pumice by rubber cup and water for 10 seconds, then rinsed with water and dried with an air syringe. Tooth enamel surface etched with 35% phosphoric acid (Scotchbond acid gel) for 15 seconds, rinsed with water, and dried with air syringe in according to manufacture guideline. Transbond XT Primer was applied to the etched enamel surface. Transbond XT Adhesive paste applied in premolar bracket base. Afterward, the bracket put in tooth enamel surface with low pressure and cure with dental light curing for 20 seconds with 1-5 mm illumination length.

Shear Strength Test

The sample put in shear strength test tool. Experiment performed with Shimadzu autograph tool with teeth mesio-distal direction and in line with tooth enamel surface that cause the bracket sliding in line with tooth enamel surface until the bracket is removed. Shear strength value is in Kgf unit and converted into Newton unit and then into Megapascals (Mpa) unit by dividing the bracket surface area.

Measurement of Adhesive Remnant Index (ARI)

This measurement is to observe the adhesive remnant on tooth enamel surface after the bracket is removed. This measurement is in a visualization way and the result evaluate with scales:

0 = No adhesive remnant in tooth enamel surface

1 = Less than 50% adhesive remnant in tooth enamel surface

2 = More than 50% adhesive remnant in tooth enamel surface

3 = All adhesive remnant is remained in tooth enamel surface

Figure 4. Adhesive Remnant Index (ARI) Measurement

Enamel Surface Crack Test

Enamel surface crack test performed after completion of adhesive remnant measurement that remain in toot surface. Adhesive remnant is cleaned first before enamel surface crack test with tungsten carbide burs. After the adhesive remnant is clean then enamel crack length calculates with SEM.

Figure 5: Enamel Crack Test

Data analysis

Six specimens were tested for each protocol. Significant differences in measurement were determined by following analysis which was conducted using SPSS Statistics 1.0. 0.1275

a. Kolmogorov Smirnov test is performed to know the research result in form of shear strength test data value, ARI, and enamel crack length in all treatment are normal distribution.

b. One-Way Anova and post hoc Duncan test with LSD method, multivariate test, kruskal walls test and mann whitney test will observe a significant difference between treatment group in shear strength test, ARI, and enamel crack length.

RESULT:

Result and Statistic Test for Comparison of Shear Strength Test

All data was collected, tabulated, and tested with Kolmogorov Smirnov test after measurement of shear strength test in Pharmacy Laboratory of Universitas Airlangga to observe either the data is normal distribution or not. The result as follows:

Table 1. Shear Strength Test Result

Group	N	Average	SD	P value
K-1	6	5.363	0.779	0.941
K-2	6	8.815	0.485	0.734
K-3	6	10.963	0.837	0.595
Total	18	8.380	0.4855	0.783

Remarks:

K–1: Control group, sample without etchant polished

K–2: Sample group with self-etch material

K–3: Sample group with total etch material

Kolmogorov Smirnov generates p value (0.783) > α (0.05). As a conclusion, the data is normal distribution. The test is continued with homogeneity test with Levene test and significant degree 0.05 is applied to know homogeneity of various variances of research result data.

Levene test shows the result has homogenous variance (0.459 > 0.05). Shear strength data in all samples shows normal distribution data and homogenous. Therefore, to know significance difference occurrence, One Way Anova performed, and the result is in Table 2 below:

Table 2. One Way Anova Test for Shear Strength

Group	K-1	K-2	K-3
Control (K-1)	-	0.000	0.000
Self-etch (K-2)	-	-	0.000
Total etch (K-3)	-	-	-

One Way Anova statistic test result shows a significant different in shear strength along groups treatment (0.000 < 0.05).

Result and ARI Statistic Test (Adhesive Remnant Index)

Because of the ARI data is ordinal scale then Kruskal Wallis test performed to observe ARI differences. The result is below:

Table 3. Kruskal Walls Test Result

Group	N	Average	Sig.
K -1	6	4.25	0.002
K- 2	6	9.75
K-3	6	14.50

Table 3 shows a difference of Adhesive Remnant Index (ARI) value in each group (0.002 < 0.05).

Adhesive Remnant Index (ARI) scores result data is ordinal scale. Non-parametric statistic or Wilcoxon Mann Whitney performed to know ARI score difference for each treatment group. The significant degree is 0.05.

Table 4. Wilcoxon Mann Whitney ARI Test Result

Group	K-1	K-2	K-3
Control (K-1)	-	0.002	0.002
Self-etch (K-2)	-	-	0.002
Total etch (K-3)	-	-	-

According to Table 4, Wilcoxon Mann Whitney test results are:

· There is a significant difference for Adhesive Remnant Index (ARI) score between K-1 and K-2 group (0.002<0.05).

· There is a significant difference for Adhesive Remnant Index (ARI) score between K-1 and K-3 group (0.002<0.05).

· There is a significant difference for Adhesive Remnant Index (ARI) score between K-2 and K-3 group (0.002< 0.05)

Illustration from ARI measurement is below:

Figure 6. (A) ARI Control Group (K-1), (B) ARI Self-Etch Group (K-2), (C) ARI Total Etch Group (K-3)

Result and Statistic Test for Enamel Crack Length:

After measurement of enamel crack length in Robotics Laboratory of ITS, all data was collected, tabulated, and tested with Kolmogorov Smirnov test to observe either data is normal distribution or not and the result is in Table 5 below:

Table 5. Enamel Crack Length Test Result

Group	N	Average	SD	p Value
K-1	6	94.171	11.652	0.518
K-2	6	272.956	30.107	0.833
K-3	6	512.546	46.136	0.573
Total	18	293.225	178.994	0.576

Kolmogorov Smirnov test shows a significant value (0.576) > α (5%), as conclusion the data is normal distribution. The test is continued by homogeneity test with Levene test, and the significant degree is 0.05 to know homogeneity of various variance of research result data. Levene test shows the research result has heterogonous variance (0.009 < 0.05). Research result data for enamel crack length for all samples shows the data is normal distribution and heterogonous. Consequently, One Way Anova test is not performed and applied Kruskal Wallis and Wilcoxon Mann Whitney test and the result is below:

Table 64. Wilcoxon Mann Whitney Test for Enamel Crack Length

Group	K-1	K-2	K-3
Control (K-1)	-	0.000	0.000
Self-etch (K-2)	-	-	0.000
Total etch (K-3)	-	-	-

Statistic test result from Kruskal Wallis shows significant difference occurrence on enamel crack length in treatment groups (0.000 < 0.05).

Figure 7: (A) Control Group SEM (K-1), (B) Self-Etch Group SEM (K-2), (C) Total Etch Group SEM (K-3)

An illustration for enamel crack test from SEM is below:

Morphology result for tooth enamel surface in K-1 group (pumiced, primer, and adhesive tooth enamel) shows in Figure 7 (a) where enamel crack direction is vertical, long, and small quantity. K-2 group (pumiced, self-etch, and adhesive tooth enamel) are short enamel crack and small number (Figure 7.B). Meanwhile, K-3 group (pumiced, etchant, primer, and adhesive tooth surface) shows enamel crack illustration is in multiple vertical direction, oblique, and horizontal, short, and high quantity (Figure 7.C)

DISCUSSION:

This research applied first premolar tooth based on previous research sample criteria¹⁹. There are 18 upper premolar teeth that qualified as research samples. The criteria are comprehensive root, no caries, fracture, abrasion, or enamel damage that caused by extraction tool during extractaion²⁰, no enamel disorder (hypoplasia/hyper classification), no restoration in dental crown, never soaked or treated with chemical solution²¹, never performed endodontic treatment, and never performed orthodontic. Research sample selection is not considered to age of tooth sample and enamel thickness where enamel thickness is assumed as equal.

This research creates three treatment groups, which are control group (K-1) where pumiced tooth enamel, primer, and adhesive; treatment group 2 (K-2) where pumiced, self-etch, and adhesive tooth enamel; and treatment group 3 (K-3) where pumiced, etchant, primer, and adhesive tooth enamel.

The shear strength test tool is a universal testing machine (autograph) and the crosshead speed is 1 mm/minute²². Before testing, tooth is planted in acrylic as a holder for application in universal testing as shear strength test tool²³. After the bracket attached in tooth, each sample group soaked in artificial saliva with Fusayama composition that consists of NaCl (400mg/L), KCl (400mg/L), CaCl₂H₂O (795mg/L), NaH₂PO₄H₂O (690mg/L), KSCN (300mg/L), Na₂S.9H₂O (5mg/L), and urea (1000mg/L) pH 7 and stored inside in incubator in 37^oC for 28 days. The considerations are creating a condition as same as inside oral cavity and average of patient control time. Artificial saliva soaking for 28 days does not influence enamel crack because the saliva function itself is to create humidity of tooth surface.

After 28 days soaking then continued by shear strength test in accordance with research that practice with universal testing machine (autograph), comparing shear strength test in each bracket that attach with self-etch and total etch material, and observing the crack in enamel surface. Result from shear strength test is to know generated force power until the bracket is detach from the tooth. If generated force power is bigger, then generated shear power from adhesive material is better and more retentive.

Etched enamel with phosphate acid will form etch pattern in form of depth demineralization area, asymmetrical surface, and micro porosity. This demineralization area will be infiltrated by resin from primer liquid material and creates a resin tag that enter into the surface of demineralization area. Application of phosphate acid in enamel is related in increasing on surface roughness and increasing shear strength power. As requirement on time saving for bonding procedure and minimizing enamel damage without decreasing the ability to sustain shear strength during the application of orthodontic tool makes the researchers combine the etchant procedure and bonding in one application, which is self-etch primer⁷. If we compare with conventional technique that applied etch and bonding separately, self-etch primer produces an identical etchant pattern with systemic adhesive penetration and less demineralization result. Benefit on self-etch material is simultaneous penetration for etchant and primer, provides a perfect interlocking mechanical²⁴.

The research result shows average of shear strength test value from three treatment groups and the highest force in those treatment group is group 3(K-3) which is 10.9633N/mm²(MPa), followed by K-2 treatment group (8.8150MPa), and K-1 (5.3633MPa). This result is similar with previous resaerch⁶ where etched, primer, and adhesive tooth (total etch) has higher shear strength compare with tooth surface that applied the self-etch primer.

Previous study explains on minimum orthodontic shear strength is 6-8 MPa¹². This is in line with research¹² that state the self-etch material has lower shear strength than total etch material but has optimal shear strength and could become an alternative during the selection orthodontic bonding material. This alternative will decrease procedure step, saving the time when handling the patient in dental chair, increasing patient comfort, and decreasing saliva contamination risk. Moreover, self-etch material advantage is properly attach in drying enamel or humid and protecting enamel because enamel damage will be lower compared to total etch material.

The adhesive remnant in the surface of tooth enamel after removing the bracket is checked to calculate with Adhesive Remnant Index (ARI). The result shows the higher ARI value is in tooth surface that applied total etch material. This is related to research⁶ that explain the self-etch material has lower ARI value than total etch that create lower damage and time saving in cleaning the resin remnant that left in tooth surface.

Sample treatment was continued by cleaning adhesive remnant with tungsten carbide burs because the cleaning process will produce the most smooth enamel surface when observing with SEM compare to diamond burs, ultrasonic scaler, and adhesive remover plier ²⁵. Enamel crack in this research is observed by Scanning Electron Microscope. The measurement result on enamel crack length shows average enamel crack length in total etch material on toot surface group is higher than tooth surface group with self-etch material application and control. A less enamel crack length with self-etch material is cause by a simultaneous etchant and bonding application, no cleaning and drying solution separately that eliminating collagen collapse risk.

This research shows self-etch material application is better and become a recommendation compare with phosphoric acid etchant material and conventional bonding (total etch). This result is similar with research²⁶ that recommend one step self-etch material application, even this material has lower shear strength compare with total etch material but the scales is still optimum in term of shear strength. Phosphate acid etchant material in total etch is also cause deeper porosity in enamel surface and higher demineralization than self-etch compare to self-etch.

CONCLUSION:

According to the laboratory experiment result of this research, total-etch material has higher shear strength, higher ARI value and higher enamel crack length compared to self-etch material. We suggest self-etch material is used as a bonding alternative other than total-etch. Since this present study is limited by observing only one kind of adhesive, Transbond XT adhesive, future study will need to use more varieties of adhesives.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

The authors express the sincerest gratitude to the authorities of the Faculty of Dental Medicine, Universitas Airlangga, Indonesia.

REFERENCES:

1. Graber LW, Vanarsdall RL, Vig KWL, Huang GJ. Orthodontics: Current Principles And Techniques. 6th ed. Elsevier; 2017.

2. Proffit WR, Fields HW, Larson BE, Sarver DM. Contemporary Orthodontics. 6th ed. Elsevier; 2019.

3. Bhalajhi SI. Orthodontics: The Art and Science. Arya (Medi) Publishing House; 2004. https://books.google.co.id/books?id=LRTbNwAACAAJ

4. Khan H, Mheissen S, Iqbal A, Jafri AR, Alam MK. Bracket Failure in Orthodontic Patients: The Incidence and the Influence of Different Factors. Biomed Res Int. 2022;2022:5128870. doi:10.1155/2022/5128870

5. Van Meerbeek B, Vargas M, Inoue S, et al. Adhesives and cements to promote preservation dentistry. Oper Dent. Published online 2001:119-144. Meerbeek_2001_Operative

6. Yamada R, Hayakawa T, Kasai K. Effect of using self-etching primer for bonding orthodontic brackets. Angle Orthod. 2002;72(6):558-564. doi:10.1043/0003-3219(2002)072<0558:EOUSEP>2.0.CO;2

7. Kenneth J. Anusavice DMD, Shen C, Rawls HR. Phillips’ Science of Dental Materials. Elsevier Health Sciences; 2012. https://books.google.co.id/books?id=gzUeKDhP-KQC

8. Paschos E, Westphal J-O, Ilie N, Huth KC, Hickel R, Rudzki-Janson I. Artificial saliva contamination effects on bond strength of self-etching primers. Angle Orthod. 2008;78(4):716-721. doi:10.2319/0003-3219(2008)078[0716:ASCEOB]2.0.CO;2

9. Chigira H, Koike T, Hasegawa T, Itoh K, Wakumoto S, Hayakawa T. Effect of the self etching dentin primers on the bonding efficacy of a dentin adhesive. Dent Mater J. 1989;8(1):86-92124. doi:10.4012/DMJ.8.86

10. Singh G. Textbook of Orthodontics. Jaypee Brothers Medical Publishers Pvt. Limited; 2015. https://books.google.co.id/books?id=MsIHCgAAQBAJ

11. Vicente A, Molina S, Ortiz AJ, Bravo LA. Influence of food-simulating liquids on bond strength of brackets bonded with a HEMA-free and HEMA-containing self-etching primer. Angle Orthod. 2012;82(2):346-350. doi:10.2319/032711-216.1

13. Rajagopal R, Padmanabhan S, Gnanamani J. A comparison of shear bond strength and debonding characteristics of conventional, moisture-insensitive, and self-etching primers in vitro. Angle Orthod. 2004;74(2):264-268. doi:10.1043/0003-3219(2004)074<0264:ACOSBS>2.0.CO;2

14. Santos BM, Pithon MM, De Oliveira Ruellas AC, Sant’Anna EF. Shear bond strength of brackets bonded with hydrophilic and hydrophobic bond systems under contamination. Angle Orthod. 2010;80(5):963-967. doi:10.2319/022310-113.1

15. Breschi L, Mazzoni A, De Stefano Dorigo E, Ferrari M. Adhesion to Intraradicular Dentin: A Review. J Adhes Sci Technol. 2009;23(7-8):1053-1083. doi:10.1163/156856109X440957

16. Arnold RW, Combe EC, Warford JHJ. Bonding of stainless steel brackets to enamel with a new self-etching primer. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2002;122(3):274-276. doi:10.1067/mod.2002.125712

17. Cacciafesta V, Sfondrini MF, De Angelis M, Scribante A, Klersy C. Effect of water and saliva contamination on shear bond strength of brackets bonded with conventional, hydrophilic, and self-etching primers. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2003;123(6):633-640. doi:10.1016/s0889-5406(03)00198-7

18. Dorminey JC, Dunn WJ, Taloumis LJ. Shear bond strength of orthodontic brackets bonded with a modified 1-step etchant-and-primer technique. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2003;124(4):410-413. doi:10.1016/s0889-5406(03)00404-9

19. Zeppieri IL, Chung C-H, Mante FK. Effect of saliva on shear bond strength of an orthodontic adhesive used with moisture-insensitive and self-etching primers. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2003;124(4):414-419. doi:10.1016/s0889-5406(03)00405-0

20. Robles-Ruíz JJ, Arana-Chavez VE, Ciamponi AL, Abrão J, Kanashiro LK. Effects of sandblasting before orthophosphoric acid etching on lingual enamel: in-vitro roughness assessment. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2015;147(4 Suppl):S76-81. doi:10.1016/j.ajodo.2014.11.023

21. Mhatre AC, Tandur AP, Reddy SS, Karunakara BC, Baswaraj H. Enamel Surface Evaluation after Removal of Orthodontic Composite Remnants by Intraoral Sandblasting Technique and Carbide Bur Technique: A Three-Dimensional Surface Profilometry and Scanning Electron Microscopic Study. J Int oral Heal JIOH. 2015;7(Suppl 2):34-39.

22. Shetty V, Shekatkar Y, Kumbhat N, Gautam G, Karbelkar S, Vandekar M. Bond efficacy of recycled orthodontic brackets: A comparative in vitro evaluation of two methods. Indian J Dent Res Off Publ Indian Soc Dent Res. 2015;26(4):411-415. doi:10.4103/0970-9290.167635

23. van Waveren Hogervorst WL, Feilzer AJ, Prahl-Andersen B. The air-abrasion technique versus the conventional acid-etching technique: A quantification of surface enamel loss and a comparison of shear bond strength. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2000;117(1):20-26. doi:10.1016/s0889-5406(00)70244-7

24. Toroglu MS, Yaylali S. Effects of sandblasting and silica coating on the bond strength of rebonded mechanically retentive ceramic brackets. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 2008;134(2):181e1-7. doi:10.1016/j.ajodo.2008.05.012

25. Buyukyilmaz T, Usumez S, Karaman AI. Effect of self-etching primers on bond strength--are they reliable? Angle Orthod. 2003;73(1):64-70. doi:10.1043/0003-3219(2003)073<0064:EOSEPO>2.0.CO;2

26. Karan S, Kircelli BH, Tasdelen B. Enamel surface roughness after debonding. Angle Orthod. 2010;80(6):1081-1088. doi:10.2319/012610-55.1

27. Naini FB, Gill DS. Tooth fracture associated with debonding a metal orthodontic bracket: a case report. World J Orthod. 2008;9(3):e32-6.

Received on 13.06.2022 Modified on 19.07.2022

Research J. Pharm. and Tech 2023; 16(6):2991-2998.

DOI: 10.52711/0974-360X.2023.00494