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UPDATE OF ORTHODONTIC ADHESIVES

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UPDATE OF ORTHODONTIC ADHESIVES

  1. 1. UPDATE OF ORTHODONTICUPDATE OF ORTHODONTIC ADHESIVESADHESIVES www.indiandentalacademy.com
  2. 2. EVOLVEEVOLVE starts with blue color and changes to natural shade after light cure HELPS TO REMOVE EXCESS FLASH. Color change compleats complete light cure and bond strength. Adhesive contain fluoride Available in push syrenge and pre loaded syrenge tips. www.indiandentalacademy.com
  3. 3. ENAMEL BONDING AGENTSENAMEL BONDING AGENTS  Consists of unfilled liquid acrylic monomer placed on acid etched enamel.  micromechanical retention by resin tag formation on resin enamel interface.  Micro tags and macro tags are basis for micro mechanical retention.  Micro tags are more important because of their large number and great surface of contact.  On other side bonding agent co-polymerises with matrix phase of dental composite www.indiandentalacademy.com
  4. 4. DENTIN BONDING AGENTSDENTIN BONDING AGENTS  Unless we understand dentin bonding and certain terminologies related to it we will not be able to follow the update of adhesives.  Disadvantages of Dentine Bonding: Smear Layer . Moist dentine. www.indiandentalacademy.com
  5. 5. DENTIN BONDING AGENTSDENTIN BONDING AGENTS Un filled ,liquid acrylic monomer mixture placed onto acid conditioned and primed dentin surface www.indiandentalacademy.com
  6. 6. GENERATIONS OF BONDINGGENERATIONS OF BONDING AGENTSAGENTS  Generations are nothing but evolution of bonding agents from 1955 to 2003.  There are 7 generations.  I - GENERATION Buonocore(1956) introduced.  Resin containing glycerophosphoric acid dimethacrylate.  Bowen introduced N­Phenyl Glycine & GlycidylMethacrylate (NPG-GMA)  Bonding-is by chelation of bonding agent to calcium of dentine www.indiandentalacademy.com
  7. 7. Drawback:  Poor dentine bonding . Enamel bonding is good  Examples-The first commercial system of this type (Cervident, SS White). www.indiandentalacademy.com
  8. 8. II - GENERATION (1978) Bis-GMA (or) HEMA were introduced which are unfilled resins which causes ionic bonding to the calcium in dentine. 1. Bonding to smear layerDraw Backs 2.require mechanical preparation www.indiandentalacademy.com
  9. 9.  III - GENERATION  Principle: Partially removed (or) modified the smear layer  Etching opens dentinal tubules and primer META or BPDM modifies smear layer and attaches to composites.  Drawbacks:  Primer, does not penetrate the smear layer  Adhesive retention decreases after some time  Examples  Mirage bond, Scotch bond 2  Prisma Universal bond 2 and 3 www.indiandentalacademy.com
  10. 10. IV - GENERATION  Complete removal of smear layer was attempted .  Total - etch technique. In the total etch - technique Orthophosphoric acid was used to etch enamel and dentin, simultaneously for 15 - 20 seconds  Moist - Dentine Concept. However, in order to avoid collagen collapse, primer solution is applied which can infiltrate the exposed collagen network forming hybrid layer. This is called moist dentin concept www.indiandentalacademy.com
  11. 11. Hybridization: Replacement of hydroxy- apatite and water in the surface dentin with resin Hybrid: resin in combination with remaining collagen fibre www.indiandentalacademy.com
  12. 12.  4th generation dentin bonding agents may be again described as  Etch (phosphoric acid) + Primer (NTG-GMA, N­ tolyglycine -glycidyl methacrylate) + Bond (Bis- GMAj TEGDMA  Examples  All bound-2 (BISCO), Scotch bond  Multipurpose (3M), Prime and bond www.indiandentalacademy.com
  13. 13. v - GENERATION 1. One -Bottle System Primer and adhesives are combined into one solution. Show high bond strength values both to the etched enamel and dentin due to adhesive lateral branches and hybrid layer formation 2. Self etching primers www.indiandentalacademy.com
  14. 14. Contents This system may be described as, E (phosphoric acid) + PB (PENTA, methacrylated phosphonates Examples One step (BiSCO), Single bond (3M), Clearfil SE bond (J MORITA). Opti bond solo (KERR www.indiandentalacademy.com
  15. 15.  VI- GENERATION VIEtchng was not required at least at the dentinal interface. They contained dentin conditioning agent as one of their components. Described as EPB(METHACRYLAED PHOSPHATES) Drawbacks: Multiple components and multiple steps www.indiandentalacademy.com
  16. 16. VII - GENERATION I-bond. Etching, priming, bonding all were combined into one step.  Shear bond strength not affected-any type of curing light .  Similar adhesion to prepared and unprepared enamel.  Desensitizers were added. www.indiandentalacademy.com
  17. 17. CEMENTSCEMENTS  GLASS IONOMER CEMENTS  Invented -1969 reported in 1971 by WILSON AND KENT POWDER ; Flouroalumino silicate glass Liquid: Poly alkenoic acid (Carboxyl containing acid ) www.indiandentalacademy.com
  18. 18.  Setting Reaction: The hydrogen ions of the acid attack the glass particles in the presence of water releasing calcium, strontium, and aluminium ions .  The metal ions combine with the carboxylic group of the polyacid to form the polyacid salts matrix and the glass surface is changed to a silica hydrogel.  Advantages  Fluoride release  Hydrogel phases  Moisture tolerance www.indiandentalacademy.com
  19. 19.  Advantages  Fluoride release  Hydrogel phases  Moisture tolerance  Disadvantages  Bond strength less than that of composite Hydrogel phase: Responsible for the uptake and release of added environmental fluoride from topical gels, rinses & dentifrices www.indiandentalacademy.com
  20. 20. Gic's used for bonding toGic's used for bonding to ceramic bracketsceramic brackets Cacciafesta et al (1998) (European journal of orthodontics) The lower bond strength of glass ionomer cements might be advantageous with ceramic brackets where high bond strengths have been associated with enamel damage www.indiandentalacademy.com
  21. 21. RMGIC'SRMGIC'S Orthodontic use of GIC increased with development of resin modified GIC. + +10-20% resin monomers GIC RMGIC'SRMGIC'S LIGHT OR CHEMICAL www.indiandentalacademy.com
  22. 22. RMGIC'SRMGIC'S Composition: Polyacid +fluroalumino silicate Glass particles Monomer+photoinitiator +light . Monomer+initiator+ catalyst. www.indiandentalacademy.com
  23. 23. Reaction TypeReaction Type  Reaction Type - acid –base reaction  polymerization (light –initiated)  polymerization (chemical initiator ) www.indiandentalacademy.com
  24. 24. ADVANTAGESADVANTAGES  Improved physical properties especially fracture resistance.  Stable hydrogels when compared with GIC.  Capsulation helps in mixing with a trichurator.  Polymerization proceeds faster than acid-base reaction  RMGIC-tolerates moisture similar to GIC's  Maturation hardeming.  Sustained fluoride release and caries inhibition www.indiandentalacademy.com
  25. 25. Effect of brushing on fluoride release from 3 bracket adhesives- AJO DO Staley e tal. Resin modified GIC bracketed groups released morefluoride han the other groups over the 93 days of study. www.indiandentalacademy.com
  26. 26. Silver et al AJO (1995) Found excellent long term adhesion with such materials in the absence of enamel etching . Bishata et al: AJO (1999) Advised etching of enamel for sufficient bond strength. www.indiandentalacademy.com
  27. 27. Multicure GICMulticure GIC Ortholux XT GIC www.indiandentalacademy.com
  28. 28. Multicure GICMulticure GIC Manufactured by –3M- UNITEK Features-slight blue tint of the cement for easy clean up Cherry flavour for pt acceptance Adequate strength with in 40 sec of curing with ortholux -XT . Advantages-adhers to regular etched or enhanced bands Minimizing wash out by filling voids. Sustained fluoride release.www.indiandentalacademy.com
  29. 29. CURRENT CATEGORIES OF ADHESIVECURRENT CATEGORIES OF ADHESIVE BONDINGBONDING 1. Total etch adhesive bonding 2. Self - etch adhesive bonding www.indiandentalacademy.com
  30. 30. Total- etch Adhesive bondingTotal- etch Adhesive bonding Bonding or adhesion to the enamel is done in the following procedure:  1) Cleansing 2) Enamel conditioning or acid etching  3) Priming 4) Bonding www.indiandentalacademy.com
  31. 31. cleansingcleansing To remove saliva,acquired pellicle, different organic and inorganic components of enamel and dentin. Also improves wetting. Pumice used www.indiandentalacademy.com
  32. 32. Acid etchingAcid etching Types of etchants : Strong acids–37% phosphoric acid fpr 15sec Weak acids -2.5% nitric acid (or) 7% maleic acid for 30­ www.indiandentalacademy.com
  33. 33. Etching in fluoridated teeth Fluoride ion is incorporated into hydroxy- apatite crystals and is resistant to acid- dissolution which aids in prevention of caries Hence fluoridated teeth requires longer etching time www.indiandentalacademy.com
  34. 34. Primers: Primers were invented to deal with moist dentine problem. They are difunctional .  one end has affinity for hydrophilic dentine and the other for hydrophobic resin. e. g HEM A (Hydroxy ethyl methacrylate) www.indiandentalacademy.com
  35. 35. A Self etching primerA Self etching primer A Self etching primer combines etchant and primer in one chemical compound  Contains bifunctional methacrylate base .  Primers - penetrates into the exposed rods . Less evoparation,more stable viscosity,and wetting capability due o unit dose package. www.indiandentalacademy.com
  36. 36. Trans plus SEPTrans plus SEP www.indiandentalacademy.com
  37. 37. Composition.Composition.  Trans bond plus SEP CONSISTS OF 3 COMPARTMENTS.  First compartment:methacrylated phosphoric acid esters,photosensitizers,stabilizers  Second compartment:water & soluble fluoride  Third compart ment:Applicator microbrush. www.indiandentalacademy.com
  38. 38. Chemical comparison of phosphoric acidChemical comparison of phosphoric acid to self-etching primerto self-etching primer www.indiandentalacademy.com
  39. 39. www.indiandentalacademy.com
  40. 40. Trans bond plus & APCTrans bond plus & APC www.indiandentalacademy.com
  41. 41. ArmamentariumArmamentarium www.indiandentalacademy.com
  42. 42. PROCEDUREPROCEDURE www.indiandentalacademy.com
  43. 43. procedureprocedure www.indiandentalacademy.com
  44. 44. Scanning electron microscopeScanning electron microscope observationobservation Irregular but smooth hybrid layer,3- 4 mm thick irregular tag formation with no apparent in dentations of enamel prisms. Minimal etching with SEP indicates majority of bond may be more of a chemical bond with calcium in the enamel than mechanical bond. www.indiandentalacademy.com
  45. 45. Scanning electron microscopeScanning electron microscope observationobservation Phosphoric acid etch Transbond plus www.indiandentalacademy.com
  46. 46. Effects of blood contamination on the shear bond strenghs of conventional and hydro philic primers-AJO DO-2004 Vittorioo cacaiafesta e tal Blood contamination of enamel during he bonding procedure of conventional and hydrophilic primers significantly lowers their bond strength values and mig produce a bond strength that not clinically adequate www.indiandentalacademy.com
  47. 47. MIP,s - MOISTUREMIP,s - MOISTURE INSENSITIVE PRIMERINSENSITIVE PRIMER Arndt kloche et. al. Angle orthodontist 2003 August.) Hydrophilic primer - from 3rd generation Bonding can be  Requires moisture for the initiation of polymerization www.indiandentalacademy.com
  48. 48. Commercially used MIPs transbond 2. Assure Ethyl alcohol 30-40% (Solvent) , Bis-GMA , - HEMA - Hydroxy ethyl methacrylate (main Hydrophilic component) - CDMA - Citric acid (allows greater cross linking) - GDMA - Diluent + hydrophilic monomer Same function as CDMA  / The Hydrophilic monomer takes Oral fluid & so fluoride uptake - Acidic Co-polymer Greater cross linking CPQ / Amine H2O - Solventwww.indiandentalacademy.com
  49. 49. Transbond™ MIP Moisture Insensitive Primer Transbond MIP primer offers bond strength in a moist environment comparable to a conventional primer in a dry environment www.indiandentalacademy.com
  50. 50. www.indiandentalacademy.com
  51. 51. Adhesion promoters forAdhesion promoters for orthodontic bondinqorthodontic bondinq Adhesion promoters-are chemical substances introduced to enhance the bond with resin. Used for increasing bond streangths. Adhesion promotors used in case of porcelain or gold resoratins. Adhesion promoors are teremed as MEGABOND 1,2,and 3(M-1,M-2,M-3) www.indiandentalacademy.com
  52. 52. Adhesion promotorsAdhesion promotors M-1:NTG – GMA -Magnesium Salt of N - Tolylglycineglycidyl Methacrylate in acetone and inhibitors. M-2:PMGDM -Adiadduct of Glyercol Dimethacrylate ­and pyrromellitic anhydride In acetone. M-3:Dimethyl paratoluidine in acetone. M-1 & M-2 are used primarily for tooth enamel surface where as M-3 & M-4 are used for coaing mesh meal brackets www.indiandentalacademy.com
  53. 53. The shear bond streangth was increased from 9.0Mpa for the control to 13.3Mpa(an increase of 48%) when adhesion promotors used. Adhesion promoters ,their effect on the bond strength of metal brackets-AJO 1995 www.indiandentalacademy.com
  54. 54. BONDING TO GOLDBONDING TO GOLD Until recently, bonding to gold and other metals was considered difficult. In the 1980's some adhesives - (Enamelite 500, Goldlink) etc and primers (fusion) - were designed to allow such bonding.  However, published reports and clinical experience do not support their effectiveness. www.indiandentalacademy.com
  55. 55. There are 2 types of AdhesionThere are 2 types of Adhesion promoters for goldpromoters for gold  Resins with adhesive promotors . eg-super bond c and b -  Geristore Super bond C & B is a metal bonding adhesive and contains 4 – META 10- MDP www.indiandentalacademy.com
  56. 56. Intermediate primers: eg. All bond 2 (Primers A & B) and scotch bond multipurpose adhesive system. All bond 2 contains an organosilane agent - BPDBM - Biphenyl dimethacrylate and NTC - GMA bond accelerator www.indiandentalacademy.com
  57. 57. Bonding to porcelainBonding to porcelain Bonding to porcelain is also enhanced by the use of adhesion promotors, principally organo silanes.  One difference from Gold is that an etching process is used similar to conventional etching.  The etchant used is 2.5% Hydrofluoric acid etch (porcelock). The etching time in 90 secs.  Hf acid dissolves the crystalline and glassy phases of porcelain thus enhancing the surface area and energy.www.indiandentalacademy.com
  58. 58. Chemistry of silane couplinqChemistry of silane couplinq www.indiandentalacademy.com
  59. 59. Chemistry of silane couplinqChemistry of silane couplinq Stage 1 Stage 2 Stage 3 www.indiandentalacademy.com
  60. 60. COMERCIALLY AVAILABLE ORGANOCOMERCIALLY AVAILABLE ORGANO SILANESSILANES Supplied in prehydrolysed form& hydrolysed form Pre hydrolysed form:eg scotch prime hydrolysed form:eg ormo porcelain primer. The pre hydrolysed form is unstable and has a very short shelf life www.indiandentalacademy.com
  61. 61. Bonding to amalgam restorationsBonding to amalgam restorations  Micro-etching is essential for bonding to amalgam and other non­precious metals.  Small amalgam restorations no sand blasting to be done  Large amalgams should be sandblasted for about 3 sec to provide an improved surface for bonding. www.indiandentalacademy.com
  62. 62. Bonding to acrylic and compositeBonding to acrylic and composite restorationsrestorations  An acrylic adhesive resin is preferred for bonding Metal, plastic or ceramic brackets to acrylic crowns. The bond strength obtained, with the addition of new composite to Mature composite, is substantially less than the cohesive strength of the Material. www.indiandentalacademy.com
  63. 63. Fluoride releasing adhesivesFluoride releasing adhesives Fluoride releasing adhesives is a relatively recent advancement.Fluoride release: Wiltshire et al have reported on the fluoride release characteristics of various resins. Most resins show an immediate release of fluoride following bonding and thereafter the levels of release decreases sharply and levels of off www.indiandentalacademy.com
  64. 64. Clinical comparision of the bond failure rates between the fluoride releasing and non- fluoride releasing composite resins- JCO 2000 CHUN-HIS CHUNG,DMD,MS This study demonstrates that a fluoride –exchanging composite resin such as phase II is clinically enough for use as an orthodontic bonding. www.indiandentalacademy.com
  65. 65. APC PLUS ADHESIVE SYSTEMAPC PLUS ADHESIVE SYSTEM www.indiandentalacademy.com
  66. 66. APC plus adhesive systemAPC plus adhesive system REDUCE BONDING STEPS. COLOR CODED TO REMOVE EXCESS FLASH. MOISTURE TOLERENCE AND FLUORIDE RELEASE MORE STABILITY AND SHELF LIFE CUTING BY ORTHOLUX. www.indiandentalacademy.com
  67. 67. ConclusionConclusion The future of adhesive dentistry is bright.The scope for deepening in this pool is still tremendous.This will require for more collabaration between molecular biologists and polymer chemists that has previously occurred Commercialization of such technology can only be done by large corporations that have both type of scientists in their research and development divisions. www.indiandentalacademy.com
  68. 68. DR.TRIVENI MADAM www.indiandentalacademy.com
  69. 69. www.indiandentalacademy.com
  70. 70. www.indiandentalacademy.com
  71. 71. www.indiandentalacademy.com
  72. 72. www.indiandentalacademy.com
  73. 73. www.indiandentalacademy.com
  74. 74. www.indiandentalacademy.com
  75. 75. Transbond XTTransbond XT AdhesivKit in Syringes AdhesivKit in capsules www.indiandentalacademy.com
  76. 76. Transbond™ XT Light CureTransbond™ XT Light Cure AdhesiveAdhesive  Bonds metal and ceramic brackets to tooth surfaces.  Available in both syringes and capsules,  uses light cure adhesive technology.  The viscosity of adhesive prevent adhesive run-on and bracket skating that saves you money .  reduces adhesive waste.  easy application, increased control and convenience.  A syringe delivery system is available too.  Immediate archwire tie-inwww.indiandentalacademy.com
  77. 77. Transbond LR AdhesiveAdhesive www.indiandentalacademy.com
  78. 78. Transbond™ LR AdhesiveTransbond™ LR Adhesive Developed specifically for bonding lingual retainers.  Easy to apply,  optimal handling characteristics . working time is extended so accurate placement is enhanced  product waste is minimized www.indiandentalacademy.com
  79. 79. Indirect Bonding AdhesiveIndirect Bonding Adhesive The Sondhi™ Rapid-Set Indirect Bonding Adhesive is revolutionary from every angle. This lightly filled resin cures in half the time (2 minutes vs. 4 minutes) of other indirect adhesives, while achieving two thirds of its bond strength within the first five minutes www.indiandentalacademy.com
  80. 80.  Designed to complement our APC™ Adhesive Coated Appliances, the Sondhi Rapid-Set Indirect Bonding Adhesive allows you to take full advantage of the benefits of indirect bonding. More accurate bracket placement; less bracket repositioning; maximization of doctor time; and compared to direct bonding, decreased chair time and patient discomfort from simultaneous bonding of all brackets www.indiandentalacademy.com
  81. 81. From the doctor's angle, it means less wasted time per patient and less stress. It also means more control over bracket placement second molar to second molar, and a higher level of precision, accuracy and strength. This instills added confidence that the doctor's goal, straight teeth, will be accomplished. www.indiandentalacademy.com
  82. 82.  From the patient's angle, it means a faster, more comfortable, more confident bonding experience. From the business angle, it means more cost effective use of doctor time. Any way you look at it, indirect bonding is superior with the Sondhi Rapid-Set Indirect Bonding Adhesive www.indiandentalacademy.com
  83. 83.  For fast orthodontic curing times andthe convenience of untethered portability, your best choice today is the Ortholux™ LED Curing Light from 3M Unitek. With the Ortholux LED light, there’s no cord connecting the handpiece to a light source. There’s no bulky equipment to get in the way or impede chairside mobility. And yet, with a small handheld unit, you have curing times for orthodontic bonds that are typically twice as fast aswww.indiandentalacademy.com
  84. 84.  Advanced LED Technology is the Key The Ortholux LED curing light uses one blue LED (Light Emitting Diode) that emits light in the 430-480 nm range at an intensity of 1000 mW/cm2 . The light is optimized specifically for the polymerization of materials used in orthodontic bonding. With LED technology, there is no bulb to lose intensity or wear out. Heat build-up is minimal, so there is no need for a fan which uses battery power and adds weight. Microprocessor-basedwww.indiandentalacademy.com
  85. 85.  Convenience for You and the Patient The Ortholux LED light is remarkably easy to handle and use. The handpiece is compact, sleek and weighs less than eight ounces. The light guide rotates 360 degrees, making positioning easy for you, and quick curing times enhance patient comfort and shorten chair time. www.indiandentalacademy.com

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