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RETENTION OF THE ORTHODONTIC

BANDS FOLLOWING SANDBLASTING


USING THREE DIFFERENT LUTING
CEMENTS
A COMPARATIVE IN-VITRO STUDY

DR. PRIYA. K, MDS

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

RETENTION OF THE ORTHODONTIC BANDS


FOLLOWING SANDBLASTING USING THREE
DIFFERENT LUTING CEMENTS
A COMPARATIVE IN-VITRO STUDY

DR. PRIYA. K, MDS

2006.
Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.

ACKNOWLEDGEMENTS

I am extremely t hankful to my renowned teachers D r . G a n es h P , M DS ,


Dr. Silju Matthew, MDS, and Dr. Anil Kumar Rai, MDS, professors, department
of orthodont ics and dentofacial orthop edics, for their keen interest and
their valuable suggest ions whenever sought for and their coop eration in
the completion of t his stu dy.
I sincerely thank Dr. Shaik Hyder Ali. H.K MDS, Principal, for allowing me to
avail the facilit ies and his invaluable guida nce and encouragement during the
course of my study.
My sincer e thanks to Mr. Suresh, chief manager, HAL Fou ndr y
and Forge Department for providing me the testing facilities and
excellent gu idance wit hout which t his study would not have been possible. I
am also grateful to Mr. Dutta, Mr. Padmanabiah, and Mr. Madhavan who
helped me conduct the study. I am also grateful to Mr. Ravi for helping me with
the SEM facilities.
I am extremely obliged to Mr. Paul Gange, President, Reliance Orthodontic
Products for being kind enough to send the material required for my stud y.
I am thankful to Dr. Ramesh Hegde, MDS, Dept. of Oral Pathology and Dr.
Sreenivasa Murthy, MDS, Dept. of Conservative Dentistry for providing their
department facilit ies.
I also thank Dr. Kyshap and Mr. Reji George Professors, Department of M
echanical engineering M. S. Ramaiah Engineering College who helped me wit h
the surface area of the bands.
My heartfelt thanks to Mr. Jaganath, statisticia n for his immense help in statist
ica l analysis for this study.
I revere the suggestions and help offered to me b y my collea gu es Dr. Rajesh.
R.N.G, Dr. Dinesh Samuel Reddy. I am also thankful to my postgraduate juniors
Dr. Sukhpreet Mangat, Dr. Maheen Ali Fathima, Dr. Chetan Kumar, Dr. Sumit
Bansal, Dr. Rishi Seth, Dr. Kiran. H, Dr. Shrish, Dr Mahendra. S and Dr.
Gunasheela.B for their ever-read y help and assistance during my study. I am
also thankful to Dr. Deepa, my dear friends and postgraduate colleagues. I
thank them all sincer ely.
I sincerely thank Mr. Trimurthy and Mr. Reddy, of my department for their

sincer e co- operation during my course. I also thank Mr. Shashidhara, Librarian
and Mr. Yeshwantraj Urs, Assista nt lbrarian and other staff memb ers for their
support during my entire course.
My sincere and heartfelt thanks to my beloved parents, without whose endless
love, trust, advice, constant inspiration, patience and sacrifice I wou ld not
have reached this far. I am thankful to my brothers and all my family members
for their support and encouragement during all these years of my life.
Above all, it is the blessings of the Almighty and to him, I offer my sincere
prayers.
Dr. Priya. K

CONTENTS
LIST OF ABBREVIATIONS USED..1
PLAN OF STUDY..2 -3
PLAN..4 7

Sections
Tables
Figures

4
5
6 -7

INTRODUCTION..8 11
OBJECTIVES..12
DEFINITIONS..13 30

Dental Cements
Orthodontic bands
Sand Blasting

13 23
24 -26
27 30

SELECTION AND GROUPING OF TEETH..31


INSTRUMENTS AND MATERIALS USED..31
SPECIMEN PREPARATION..32 - 34
METHOD OF STATISIICAL ANALYSIS..34 35
FIGURES.36 - 48
TABLES..49 53
GRAPHS..54 - 57
COMPOSITION AND SETTING REACTION OF GIC..58 - 60
HYBRID CEMENTS..60 - 61
SETTING REACTION OF RMGIC..62 - 63
SETTING REACTION OF PMCR..63 - 67
EFFECT OF OTHER EXPLANATORY VARIABLES..67 - 70
BIBLIOGRAPHY..71 - 81

DR. PRIYA K, MDS

LIST OF ABBREVIATIONS USED


ANOVA

Analys is Of Var iance

ARI

Adhesive Remna nt Index

EBA

Ethoxy Benzoic Acid

GIC

Glass Ionomer C ement

MP a

Mega Pascal

PMCR

Polyacid Modified Composite R es in

RMGIC

Resin-M odified Glass Ionomer C ement

SEM

Scanning Electron Microscope

SS

Stainless Steel

ORTHODONTIC BANDS........1

DR. PRIYA K, MDS

PLAN OF THE STUDY


Background and Objectives: T he purpose of this in vitro study was to explore and
emp hasize the possibilities of increasing bond strength wit h newer hybrid cements and
subsequently sandblasting the inner surface of the bands to deter mine if this procedure
of increasing the surface area helps in enhancing bond strengt h.

Methods: Forty-five non-carious, unrestored human mandibular molars, which were


freshly extracted b ecause of severe periodontal disease, were used for this
investigation. T he teet h wer e mount ed in P VC sleeves and prefor med stainless steel
orthodontic bands wer e selected for each sp ecimen. The teet h were randomly divided
into 3 groups. The teeth specimens were cemented with one RMGIC and one PMCR
and the conventional GIC as t he control. The bond strengt h was tested after 24 hours
using T IRA.

The second part of the study involved measuring the force required to deband after the
luting surface was sandblasted. T he bands wer e treated with aluminum oxide (50 m)
particles dir ected from the sandblaster under 60 psi of air pressure. The force recorded
during debanding was chosen from the stress-strain curve for each specimen and were
measured in Newtons and fina l readings were tabulated in MPa.

Results: The sandblasted bands showed statistically higher results than non sandb lasted
bands. Among the groups, Group B exhib ited higher retentive valu es. Statistically,
ANOVA test indicated that non-sandblasted bands had significantly less retent ion than
sandblasted bands. (P<0.05), with a mean of 1.117 for non sandblasted bands and 1.860
for sandblasted bands. Among groups RMGIC had the highest mean value.

ORTHODONTIC BANDS........2

DR. PRIYA K, MDS

Interpretation and co nclusio n: The RMGIC luting cement gives ever y indication of
becoming t he material of choice for cementation of crowns, space maintainers and
orthodontic bands. In-office Sandblasting appears to be a convenient method to increase
the retention of loose bands.

Key words: (In-office Sandb lasting, RMGIC, PMCR, Prefor med Bands)

ORTHODONTIC BANDS........3

DR. PRIYA K, MDS

PLAN
sections
Page No.
1.

INTRODUCTION

1-3

2.

AIMS & OBJECTIVES

4-12

3.

REVIEW OF LITERATURE

13-30

4.

METHODOLOGY

31-48

5.

RESULTS

49-57

DISCUSSION

58-67

7.

SUMMARY & CONCLUSION

68-70

8.

BIBLIOGRAPHY

71-81

ORTHODONTIC BANDS........4

DR. PRIYA K, MDS

tables
Table No.

Title

Page no

Retentive bond strengt h valu es obtained from the study in

49

MPa

II

Comparison of mean values of bond strengt h b etween

50

non-sandb lasted and sandb lasted bands, also among


differ ent luting cements.

III

Comparison of the mea n valu es of bond strengt h between

52

non-sandb lasted bands and sandblasted bands.

IV

Comparison of the mea n valu es of bond strengt h a mong

52

different luting cements in the Non Sandblasted met ho d.

Comparison of the mea n valu es of bond strengt h a mong


different luting cements in the Sandb lasted method.

ORTHODONTIC BANDS........5

53

DR. PRIYA K, MDS

figures
Figure No.

Title

Page no

1.

Armamentarium

36

2.

Ultrasonic Cleaner

36

3.

Incubator

37

4.

TIR A

38

5.

Scanning Electron Microscope

38

6.

Mounting of the tooth specimen

39

7.

Enlarged view of the lingual surface of the

39

tooth, being parallel to the analyzing rod of the


surveyor
8.

Tooth held in the same position with PVC in

40

place.
9.

Group A Conventional GIC

40

10.

Group B Resin Modified GIC

41

11.

Group C Compomer

41

12.

Mounted Specimens Group A

42

13.

Mounted Specimens Group B

42

14.

Mounted Specimens Group C

43

15.

Specimen before debanding

44

16.

Specimen after debanding

44

17.

Bands placed in bottles after debanding

45

18.

Teeth specimens after debanding

45

19.

Procedure of sandblasting

46

20.

Non sandblasted band

47

21.

Sandblasted band

47

22.

Non sandblasted band under SEM

48

ORTHODONTIC BANDS........6

DR. PRIYA K, MDS

ORTHODONTIC BANDS INVITRO STUDY

23.

Sandblasted band under SEM

48

24.

Distribution of values of bond strength among

54

Group A
25.

Minimum and maximum bond strength values

54

between groups using group A bonding agent


26.

Distribution of values of bond strength among

55

Group B
27.

Minimum and maximum bond strength values

55

between groups using group B bonding agent


28.

Distribution of values of bond strength among

56

Group C
29.

Minimum and maximum bond strength values

56

between groups using group C bonding agent


30.

Comparison of mean values of bond strength


between the two methods

ORTHODONTIC BANDS........7

57

DR. PRIYA K, MDS

INTRODUCTION
Ort hodont ic band has been in clinical use for mo re t han 100 years. In spit e o f t he
wide spread use o f direct bonded bracket s and t ubes in clinical ort hodont ics, t he co nvent iona l
band st ill plays an import ant role in fixed appliance t herapy.
Alt hough bonding o f ort hodont ic t ubes t o t he t eet h is receiving much current
int erest in t he for m o f indirect bonding, t he vast majo r it y o f buccal att achment s are st ill being
cement ed using st ainless st eel bands and co nvent io nal cement s, consider ing t he force levels
in t he post erior regio n.
Enamel demineralizat ion under ort hodont ic bands is a ser ious, but a co mmo n
problem to all ort hodont ist s. Whit e spot formatio n or enamel decalcificat ion can occur
whenever bact erial plaque is ret ained on enamel sur face for a prolonged per iod.1,2 By t he
presence o f fixed appliance t he efficiency o f ho me pro phylact ic procedure is great ly reduced
and t here is a need for prot ect ion o f adjacent enamel sur face. 3 Inadequat e bonding st rengt h o f
dent al cement , seal break down, so lu bilit y o f t he current ly used dent al cement s in oral fluids
and poor oral hygiene all cont r ibut e to t he init iat ion o f decalcificat ion. 1, 4-6
Several st udies in t he past have invest igat ed t he chemical co mpo sit io n o f var ious
cement s, t heir phys ical and chemical propert ies and t heir app licat ion as well as use in
restorat ive dent ist ry.7,8
The ret ent ion of ort hodont ic bands to t he toot h surface is import ant to ensure fixed
appliance t herapy. Numerous agent s have been used to ret ain ort hodont ic bands. Gutt a
percha, zinc oxide eugeno l, zinc po lyacr ylat e cement , zinc po lycar boxylat e cement , resin
based cement s, zinc silicophosphat e and black copper cement have all been invest igat ed.
More recent ly att ent ion has been focused on glass io no mer cement (GIC).2,9

ORTHODONTIC BANDS........8

DR. PRIYA K, MDS

Zinc phosphat e cement and glass io no mer cement have been more ext ensively
t est ed bot h in laboratory and clinical t rials.10,11 In vit ro invest igat ions have shown t hat GIC
have great er ret ent ive capacit y t han ot her cement s and t his has been support ed by a reduced
failure rat e in vivo.12,13
In 1972, Wilson and Kent 14 int roduced glass io nomer cement .

Experiment ally it

has been demo nst rat ed t hat GIC chemically adheres to t he toot h enamel, dent in as well as to
st ainless st eel15 and t he laboratory t est s on ort hodont ic bands cement ed wit h t his mat eria l
showed t hat t hey had improved ret ent io n relat ive to t heir predecessors.3 It was shown t hat
GIC released fluor ide fro m t he set cement . The fluoride can be elut ed as a simp le io n or as a
complex such as fluoro phosphat e and is considered to be of clinical benefit s.
Ort hodont ist s have used t he for med bands for near ly half a cent ur y. Ear ly st ainless
st eel bands were anatomically crude and d iffic ult to adapt to t he t eet h wit hout creat ing
cement lines. Their po pular it y grew as manufact urers developed, improved chro me allo ys t
hat allowed bett er adapt at ion. In t he lat e 1960s, Washbon int roduced a mo lar band design t
hat has remained t he indust r y st andard.16
The advent of acid et ching17 has confined t he use of bands mainly t o t he t eet h in t he
post erior regions o f t he dent al arches. Ret ent io n of t he co nvent ional ort hodont ic bands is
t hrough mechanical means via it s close adapt at ion to t he toot h surface assist ed by t he lut ing
act ion o f t he cement . This pr inciple remains valid today in sp it e o f development s t hat have
t aken place wit h regard to bot h dent al cement s and ort hodont ic bands.
A review o f lit erat ure however reveals t hat t he mo st frequent sit e of failure is at t he
band-cement int erface9,12 and t he cement remaining on t he toot h surface. Hence, it warrant ed

ORTHODONTIC BANDS........9

DR. PRIYA K, MDS

add it ional invest igat ion on t he met hods to enhance bond st rengt h at t he met al-cement
int er face to improve ret ent io n.
Increasing t he bond st rengt h at t his int er face should reduce t he r isk o f band
lo osening dur ing t reat ment . Recent research has focused on t he t reat ment of met als to
increase t he ret ent ive area of t he bands and improve chemical and mechanical bonding.
Several met hods have been descr ibed one such st udy was w it h elect ron micrographs o f t he
met al sur face roughened wit h d iamo nd bur or green stone has shown t o provide less micro
mechanical ret ent ion when co mpared to sandblast ing.
Sand blast ing o f t he met al sur face improves ret ent ion by roughening, t hereby
increasing t he sur face area and providing a pot ential for a degree o f mechanical att achment .
It not only increases t he ret ent ive area o f t he band lut ing sur face, but also remo ves
cont aminant s and t hins t he st ainless st eel oxide layer leaving a more fir mly att ached layer for
bonding.
This t echnique o f air abrasio n or sand blast ing was int roduced in 1950s. It uses a
high-speed st ream o f aluminum o xide part icles propelled by co mpressed air. 18-20 Alt hough
in it ially reint roduced as a met hod to roughen the sur face of any dent al mat er ials before
cement at ion, it is ro ut inely used in cast met al rest o rat ion to enhance t he bond st rengt h, more
recent market ing includes it s app licat ion to ort hodont ics to roughen t he int ernal sur face o f t he
bands and bracket bases.

ORTHODONTIC BANDS........10

DR. PRIYA K, MDS

A sur vey o f lit erat ure unraveled a large number of co nt ribut io ns on t he subject of
cement s and cement ing procedures in t he field of ort hodont ics. Yet , of all t he rout ine
operat ions, which we as ort hodont ist s are called upon to perform, pro bably no ne is more
fundament al or fraught wit h great er pot ent ialit ies t han t he seemingly simple act of
cement at ion o f bands. The unplanned debanding is a co mmo n occurrence amo ng t he
pat ient s, which is ver y frust rat ing to recement t he loose bands as it o ft en goes undet ect ed.
Loose bands t end to while away significant amount of clinical t ime.
Despit e t he increased po pular it y o f bonded appliance in ort hodont ics, t he use o f
bands st ill prevails which is pr incipally confined to t he posterior segment wherein t he
mo lars play a pr ime ro le in serving as an anchor unit .
One o f t he major, but a basic problem confro nt ing t he clinicians is band fa ilure.
The pr inciple sit e o f band failure usually being t he band-cement int er face. Severa l
met hods are emp lo yed to enhance ret ent ion o f bands by roughening t he inner sur face
wit h d iamo nd or carbide burs or wit h green stone et c. One such met hod of roughening t he
lut ing sur face in order to secure t he bands in place is by sand blast ing, which also aids in
add it io nal ret ent ion by increasing t he surface area.
Thus, t his in vit ro st udy is under t aken to explore and emphasize t he po ssibilit ies o f
increasing bond st rengt h wit h newer hybr id cement s and su bsequent ly sand blast ing t he
inner sur face o f t he bands to det ermine if t his procedure of increasing t he sur face area he lps
in enhancing bond st rengt h.

ORTHODONTIC BANDS........11

DR. PRIYA K, MDS

OB JECTIVES
 To det ermine t he increase in bo nd st rengt h fo llowing sandblast ing.
 Compar ison o f t he bond st rengt h wit h t hree different lut ing cement s.
 Effect of in-o ffice sandblast ing procedure on t he retent ion o f ort hodont ic bands
using different cement s.
 To correlat e t he effect iveness of t his procedure of sandblast ing in a clinica l
sit uat ion fo llowing t he use of a plain bands init ially.

ORTHODONTIC BANDS........12

DR. PRIYA K, MDS

DEFINITIONS dental cements


Dental cements are subst ances t hat harden t o act as a base, liner, filling mat eria l, or
adhesive and prost heses to toot h struct ure or to each ot her. Cement s set by acid- base
react ion.21
Ret ent ion o f t he convent ional ort hodont ic bands is t hrough mechanical means via
it s close adapt at ion to t he toot h surface assist ed by t he lut ing act ion o f t he cement . 11 Thus, in
spit e of t he develo pment s in t he field o f cement s as well bands t his pr incip le is st ill valid.
One o f t he aims o f ort hodont ic t reat ment is to reduce t he incidence o f car ies by
br inging malposed t eet h int o correct po sit io n. This aim is part ly de feat ed because o f t he
appearance o f t he areas o f decalcificat ion and car ies on t he banded t eet h, which ma y
accompany ort hodont ic t reat ment .
Gibbon22 po int ed out t hat much unfavorable cr it icism was direct ed at ort hodont ic
services by bot h t he lait y and t he pro fessio n and t hat many be lieved t hat excessive toot h
dest ruct ion was t he penalt y paid for having t eet h st raight ened.

Numerous agent s have been used to ret ain o rt ho dont ic bands. Gutt a percha (LOWE
YOUNG, 1912)23, zinc oxide eugeno l (WILLIAMS et al, 1965)24, zinc po lyacr ylat e
cement (RICH et al, 1975)25, zinc po lycarboxylat e cement (RICH et al, 1975)25, resin
based cement s (LEE et al, 197326; SADOWSK Y AND RETIEF, 1976)22; zinc
silicophosphat e (CLARK et al, 1977)27 and red copper cement (RICH et al, 1975)25 have
all been invest igat ed.

ORTHODONTIC BANDS........13

DR. PRIYA K, MDS

Zinc phosphat e and silico phosphat e cement s, t he che mical and p hysica l
charact er ist ic o f which have been well document ed over a number of years and have lo ng
been t he accept ed mat erials for cement ing o rt ho dont ic bands to t he t eet h.21
Zinc phosphat e cement was int roduced in 1878,3 the cement soon became t he go ld
st andard by which ot her cement s are co mpared because o f it s lo ng and well document ed
history o f clinical use in band cement at ion.
A st udy by BERK SON (1950)28 invest igat ed t he adhesive propert ies o f zinc
phosphat e cement and claimed t hat some adhesio n to enamel occurred.
According t o ADAMS (1955), 29 who st udied t he mechanical propert ies o f zinc
phosphat e cement and had provided useful in fo rmat ion on t he mixing t echnique, liquid
powder rat io and adhesive propert ies under var ying cond it io ns concluded, t hat t here was no
difference whet her t he sur face was cleaned wit h alcohol or dist illed wat er and also st at ed t hat
if t he powder was exposed to air for a long per iod gave a poor mix consist ency.
The co mparat ive in vit ro t est by WILLIAMS et al (1965)24 had report ed t he fo rces
required, for removing bands cement ed to ext ract ed t eet h wit h different cement s namelyzinc phosphat e, silico phosphat e, and EBA reinfo rced zinc oxide eugeno l cement s. Using
solder reinforced bands, he demo nst rat ed t hat zinc phosphat e and silico phosphat e were
similar in t heir abilit y t o ret ain ort hodont ic bands and t hat t he ret ent ive st rengt hs o f t hese t wo
cement s were slig ht ly more t han twice t hat of t he EBA cement . The possible har mful effect
of zinc phosphat e cement on surface enamel was anot her aspect t hat has also been
report ed.30,31

ORTHODONTIC BANDS........14

DR. PRIYA K, MDS

According t o NORRIS et al3 in t he 1960s, fluoride was added t o zinc phosphat e


cement to reduce t he acid so lu bilit y and to impart ant icar iogenic propert ies to toot h enamel t o
which st ainless st eel bands were cement ed. There were cert ain drawbacks inherent to t he use
of zinc phosphat e cement . It was br itt le, had a relat ively high so lu bilit y in t he mout h, and it
did not adhere to toot h subst ance. Zinc phosphat e cement relied on mechanical int er locking
for it s ret ent ive e ffect and on close physical adapt at ion for sealing restorat ion margins, but it
did not provide any chemical bonding to toot h or metal sur faces. Researchers have developed
ot her dent al cement s to overcome t hese drawbacks.
However, WISTH JOHAN (1970)30 st udied t he effect of zinc phosphat e cement
on t he enamel sur face and t he difference in t he rat e of demineralizat ion and he concluded t
hat t he cement , of t he consist ency rout inely used in t he clinic is not of any import ance in t he
development of decalcificat io n. Under cert ain co nd it io ns it prot ect s t he enamel fro m
demineralizat io n.

Wit h t he development of po ly car boxylat e cement by Smit h in 1968, anot her group
of cement s became available for cement ing ort hodont ic bands. He has descr ibed carbo xylat e
cement as t he first dent al cement , which does not solely rely upon irregu lar it ies o f t he
ad jo ining sur faces for mechanical ret ent io n. He also noted t he po lyacr ylic acid mo lecules
have t he abilit y to chemica lly bo nd to calcium io ns on t he calcified enamel t oot h surface as
well as t o st ainless st eel. Also carboxylat e cement achieved a chemical bo nd w it h t oot h
enamel and it was proven to be super ior to zinc phosphat e cement .
According t o NORRIS et al,3 one disadvant age of t his cement was short sett ing
and working t imes t hat made t he cement at ion o f more t han t wo bands fro m a single mix

ORTHODONTIC BANDS........15

DR. PRIYA K, MDS

difficult . In add it io n t he mixed cement s viscosit y could make band cement at ion d ifficu lt .
Different fluo ride preparat ions had been added to polycar boxylat e cement to

le nd

ant icar iogenic propert ies and alt er t he mechanical propert ies.

The development of t he orig inal glass io no mer cement by Wilson and Kent in 1972
was significant , as it made available, for t he first t ime a restorat ive dent al mat er ial t hat had
lo ng-t erm ad hesio n to toot h st ruct ure and also possessed car iost at ic propert ies due t o
sust ained release o f fluor ide. Mc Lean and Wilso n lat er developed it during t he 1970s. This
class o f mat erial has achieved wide spread use as a translucent mat er ial.32 True adhesio n to
enamel and met al 15 probably occurs via io nic or polar mo lecular int eract ions.
A t hree- mo nt h st udy was conduct ed by CRISP and WILSON (1976)33 on t he
chemist r y o f wat er erosion o f t he t wo for ms o f GIC t hat was made. The st udy invest igat ed t
he effect of var ying t he consist ency and cur ing time. The result was descr ibed in t er ms o f
chemistr y and st ructure of t he cement . It also compared t he chemistry o f dent al silicat es, zinc
polycar boxylat e wit h glass io no mer.
According t o M.H REISBICK (1981),34 glass io no mer o ffered several advant ages,
which were good flow, adherence t o t eet h, ample working t ime and t he cast ing seat ed
readily. The drawbacks obser ved were d ifficu lt y in remo ving fro m t eet h and cast ing, if left
for a lo ng per iod, lacked o pacit y, adhered t o dry gingiva and caused slight pain for 2-5min in
unanaest het ized t eet h.

Alt hough GIC has de mo nst rat ed high levels o f fluoride release, t hey have shown t o
have poor bond st rengt h and great er bond failure rat es t han co mposit e resins. 35,36 In an

ORTHODONTIC BANDS........16

DR. PRIYA K, MDS

att empt to provide great er fluor ide release and obt ain adequat e bond st rengt h, combinat ion o f
composit es and GIC had been developed. Resin- modified glass io no mer (RMGIC) are such
co mbinat ions, consist ing of 2 component s, term originally used by ANTONUCCI.32
Polyacid modified co mposit e resins (PMCR) or co mpo mer consist of similar co mbinat ions
t hat behave pr imar ily like resins. 32
S ince t he int roduct ion o f s ilicat e cement s, fluoride release fro m restorat ive
mat er ials has been advocat ed as having t he abilit y to prevent secondary or cont act surface
car ies. Glass io no mer and t heir mo dified fo r mu lat ions are t he main fluoride releasing
mat er ials used today. 37
In t he search o f ideal cement for lut ing purpose several co mparat ive st udies have
been undert aken over t he last few years.

According t o t he st udy by CAMERON et al (1963),38 on t he physical propert ies o f


dent al cement s t hat were commerc ially available, concluded t hat t he best physical propert y is
possessed by silico phosphat e cement and t hose cement s wit h higher liquid powder rat io did
not have bett er physical propert ies.
A review by SAMUEL T. SAK AMAK I and ARTHUR N. BAHU (1969),39
report ed t he effect of banding on t he localized lactobacilli count , which increased fo llo wing
banding and it ret urned to t he original level aft er t he bands were removed. The
microorganisms were increased at t he gingival margins t hus increasing t he suscept ibilit y to
car ies.

ORTHODONTIC BANDS........17

DR. PRIYA K, MDS

According t o WISTH JOHAN (1972),31 who compared t he sealing abilit y o f zinc


phosphat e and hydro phosphat e cement under band spaces, report ed t hat no difference
exist ed bet ween t he t wo groups. The result also sust ained t he hypot hesis t hat t he cement
layer could be penet rat ed by fluoride io ns, which possibly act as a fluor ide depot and
increased t he enamel resist ance to demineralizat ion.
A reliable met hod to t est t he ret ent ion of cement s was invest igat ed by RICH et al
(1975)25 and co mpared t he ret ent ive charact erist ics o f zinc phosphat e, polycarboxylat e and
red copper cement . They conc luded t hat t he st rengt h required t o init ially fract ure t he cement
bond ho lding t he bands, was used as a measure of ret ent ion and zinc phosphat e had t he
highest ret ent ive value fo llowed by red copper and t hen po lycar boxylat e.
A co mparat ive st udy by SADOWSK Y and RETIEF (1976)22 on so me cement s
used in ort hodont ics inferred t hat composit e cement had great er ret ent ion t o enamel as we ll
as to bands t han zinc phosphat e, silico phosphat e and po lycarbo xylat e.
MIZRAHI (1977)11 st at ed t hat, t wo major factors affect ed t he ret ent io n o f bands,
t hose relat ed to t he operator and t hose relat ed to the pat ient . He concluded t hat t here was no
difference in recement at ion rat es bet ween bo ys and gir ls, however, Class II div 2 and Klo ehn
cervical face bow t herapy had more rat es of recement at ion.
Furt her MIZRAHI (1979),40 in a clinical st udy including t wo prospect ive groups
and t wo ret rospect ive groups concluded t hat ret rospect ive groups cement ed wit h zinc
phosphat e had

more

failure rat es t han prospect ive groups cement ed wit h

ORTHODONTIC BANDS........18

zinc

DR. PRIYA K, MDS

polycar boxylat e which could have been due to different t ypes o f bands, cement s, cement ing
procedures of different operators.
In anot her st udy MIZRAHI et al (1981), 41 report ed t he effect of toot h sur face
co nt aminat ion on band ret ent ion w it h different cement s. The result s showed t hat no
significant difference was seen wit h bands cement ed by eit her zinc phosphat e or silico
phosphat e on sur face co nt aminat ion. Wit h po lycarboxylat e t he ret ent ion decreased fo llowing
co nt aminat ion. They also concluded po lishing t eeth wit h pu mice pr ior to cement at ion did not
appear to benefit band ret ent ion.

On t he incidence o f whit e spot fo rmat io n aft er bonding and banding GORELICK


LEONARD et al (1982) 1 concluded t hat no significant difference occurred bet ween t he t wo
procedures.
Furt her MIZRAHI (1983)5 had st udied t he enamel o pacit ies fo llowing ort hodont ic
t reat ment . The st udy revealed, t here was st at ist ically significant increase in t he prevalence o f
enamel opacit ies on t he vest ibular and lingual sur face o f t he dent it ion. The increase was seen
great est at t he cervical and middle t hirds of t he crowns.
A co mpar ison st udied by EINAR K VAM and MEYER (1983), 42 bet ween zinc
phosphat e and GIC concluded t hat glass io no mer was a bett er lut ing medium in ort hodont ics.
A report by COPENHAVER (1986), 43 on co mpar ing zinc phosphat e and GIC for
it s abilit y t o inhibit decalc ificat io n st at ed t hat GIC had bett er abilit y t o inhibit decalcificat ion.

ORTHODONTIC BANDS........19

DR. PRIYA K, MDS

Ret ent ive bo nd st rengt h of t he ort hodont ic band cement s surveyed by NORRIS
STEPHEN et al (1986) 3 using zinc phosphat e, polycar boxylat e and GIC, inferred t hat bot h
poly carbo xylat e and GIC were as effect ive as orthodont ic lut ing cement as zinc phosphat e.
GIC was more favorable because o f t he prot ect ion against decalc ificat io n.
An updat e on GIC was provided by MIZRAHI (1988)12 in ort hodont ics t hat
det ermined t he failure rat es of t he bands cement ed wit h GIC. The failure rat e was muc h
lesser t han t hat recorded for polycarboxylat e.

Bond st rengt h o f light cure and chemical cure GIC for ort hodont ic bonding was
compared by COMPTON et al (1992).44 They concluded t hat light cure GIC was superior to
chemical cure dur ing t he first t went y- four hours and for bot h t he bond st rengt h increased
fro m t he first one to t went y four hours but light cure was t he more preferred mat er ial.
Mechanical propert ies o f light cure and chemical cure GIC as bonding agent were
compared by Mc CARTHY and HONDRUM (1994). 45 They concluded t hat light cure was
bett er t han self cure.
An invest igat io n by DURNING et al (1994)46

on cement s used to ret ain

ort hodont ic bands concluded t hat in vivo simu lat io n yields less in fo r mat ion and GIC was a
bett er alt ernat ive t han phosphat e; t he band ret ent ive abilit y o f bot h reduced wit h t ime.
Furt her, WRIGHT et al (1996)47 evaluat ed t he clinical per for mance of resinmodified GIC for bonding and also it s effect on cert ain microorganisms. T hey conc luded t hat
resin- mo dified GIC bonded bracket s effect ively, decreased t he proport ion o f t he S. mut ans
and Lacto bacilli when co mpared to resin adhesive.

ORTHODONTIC BANDS........20

DR. PRIYA K, MDS

MILLET et al (1998)48 compared dual cure compo mer and convent ional GIC fo r
band cement at ion and concluded t hat dual cure showed sig nificant ly higher bond st rengt h t
han convent ional GIC and t he failure was at t he enamel ce ment int erface for co mpo mer a nd
t he cement band int erface for convent ional GIC.
RMGIC was st udied under different surface co nd it io ns by ANNE BERESS et al
(1998). 49 They inferred t hat et ched enamel had t he highest st rengt h. No significant difference
was not iced in mo ist and dr y fields.
Anot her co mparat ive st udy by STEPHEN M.COHEN et al (1998),50 on t he bond
st rengt h of chemical cure and light cure resin- mo dified GIC concluded t hat t he et ched light
cure had t he highest bond st rengt h.
Compar ison o f t wo RMGIC to porcelain by CH UN- HIS CHUNG et al (1999)51
concluded t hat silane increased t he bo nding t o porcelain in bot h cases and t hat composit e as
well as resin- modified GIC had co mparable bond st rengt h.
The effect of t he enamel co nd it io ner on t he bond st rengt h of resin-reinforced GIC
evaluat ed by SAMIR BISHARA et al (2000)52 concluded t hat acid et ching wit h 37%
proved to be bett er t han 10% poly acr ylic acid.
Var ious ort hodont ic banding cement s have

been descr ibed by NICOLA

JOHNSON (2000).53
In a clinical ret rospect ive st udy by MILLET et al (2001)54 on t wo different band
cement s namely modified co mposit e and convent io nal GIC concluded t hat no significant

ORTHODONTIC BANDS........21

DR. PRIYA K, MDS

difference was not ed in t he t reat ment t ime and t he band failure w it h eit her o f t he t wo
cement s.
According t o TJ Gillgrass et al (2001),55 in t heir st udy on co mpar ison o f t he t ime
of first fa ilure, t he po sit io n o f band failure and t he change in whit e spot enamel lesio n dur ing
fixed ort hodont ic t reat ment wit h modified composit e and convent ional GIC for band
cement at ion fo und t hat t here was no significant difference in t he failure. They not ed t hat t he
band fa ilure was at t he enamel-cement int er face for modified co mposit e and band-cement
int er face for convent ional GIC.

Fluoride release by resin- mod ified GIC and polyacid modified co mposit e was
st udied by DOUGLAS RIX et al (2001)56 and t hey demo nst rat ed t hat init ial fluoride release
was more fro m po lyacid modified co mposit e and lat er it was fro m resin- modified GIC.
The shear bond st rengt h to enamel was st udied by TOLEDANO et al (2003)57
using self and light cure GIC and a co mposit e as cont rol used for direct bonding. The y
inferred t hat resin modified GIC should be st rongly reco mmended as a mode of direct
bonding.
However, YOSHITAK A K ITAYAMA et al (2003)58

measured t he t ensile

st rengt h and t he shear bond st rengt h o f resin-reinforced GIC to porcelain and concluded t hat
resin adhesive had higher bond st rengt h to porcelain t han resin-reinforced GIC. They also
st at ed t hat resin-reinforced GIC could serve as an advant ageous alt ernat ive.
Furt her COUPS SMITH et al (2003)59 have assessed t he shear bond st rengt h o f
resin-re inforced GIC, bot h self and light cur ing. They concluded t hat self cure had higher

ORTHODONTIC BANDS........22

DR. PRIYA K, MDS

st rengt h t han light cure under all enamel preparat ions. The st udy also st at ed t hat GIC had
sufficient bond st rengt h to ret ain ort hodont ic bracket s and served as a reservo ir of fluor ide
io ns.

An in vivo st udy to det ermine t he effect of resin- modified GIC on t he ename l


demineralizat ion by RENATA CORREA PASCOTTO et al (2004)60 concluded t hat glass
io no mer was a suit able alt ernat ive to adhesive for bracket placement .
A co mpar ison by K NOX et al (2004)61 on resin- mod ified GIC and po lyacid
modified co mposit e inferred t hat resin- modified GIC had higher bond st rengt h. The failure
was at t he band-cement int er face for GIC and for polyacid modified co mposit e it was at t he
enamel-cement int erface.

ORTHODONTIC BANDS........23

DR. PRIYA K, MDS

DEFINITIONS - Orthodontic Band


An O rthodontic Band is defined as A r ing, usually made o f a t hin st rip o f st
ainless st eel t hat serves to secure ort hodont ic att achment s to a toot h.62
The var ious mat er ials used for band const ruct ion are base mat erials like Ger ma n
silver or Nickel silver, precious met als like go ld, irid io p lat inum et c.
PULLEN (1921)63 descr ibed t he var ious qualit ies a band mat er ial should possess
and co mment ed on t he direct met hods of mak ing mo lar bands.
POLLOCK (1923)64 described t he var ious st eps invo lved in fit t ing a band to t he
mo lars or ancho r t eet h.
He quot ed Like unt o t he house built upon t he shift ing sands, t hese bands are t he
fo undat ion o f a fixed ort hodont ic appliance. If t hey are not st rong, durable and at t he same t
ime well fitt ed an o rt ho do nt ic appliance cannot be efficient , regardless o f how beaut iful a
piece o f jewelr y it may be. He also point s out t he var ious requirement s in choosing an idea l
band mat erial.
ALLAN BRODIE (1932)65 described t he t echnique of band pinching.
According to SHELDON FRIEL (1935),66 a compar ison bet ween plain and cla mped bands
demonst rat ed t hat plain band was as good as t he clamped one if well fabr icat ed and adapt ed
to t he t eet h.

ORTHODONTIC BANDS........24

DR. PRIYA K, MDS

HERBERT PASK OW (1950)67 described an easy way o f fabr icat ing t apered
mo lar bands.
According to SIDNEY BRANDT (1968)68 t he bands have cert ainly been improved
over t he years. The advent of t he prefor med band was a major st ep forward. The saving in t
ime and effo rt to t he pro fessio n was enor mous. It made fit t ing o f difficult and inco mplet e ly
erupt ed teet h easier and possible, ear lier t han before. Preformed bands made t he pro fessio n
aware of t he frequency o f mis mat ches in t oot h size. When bands were well fitt ed, well placed
and well cared for t hey made possible a high level of ort hodont ic achievement .

In t he era of bonded ort hodont ic appliance, prefo rmed st ainless st eel bands re ma in
import ant for ort hodont ic t herapy.
GEORGE V. NEWMAN (1974)69 comment ed that prefor med mo lar bands were
so well adapt ed t hat t he fr ict ional forces alo ne could almost ret ain t hem on t he t eet h.
The preformed bands o ffered several advant ages as descr ibed by WARREN
HAMULA et al (1996). 16 He also descr ibed a new band design.
Bonded mo lar t ubes were st udied by MILLET (1999)70

who found t he mean

survival rat e was 699 days and t hat t he gender and malocc lusio n had no significant role but t
he age at t he st art of t he t reat ment and t he operator were determined to be useful predict ors
of t he bonded mo lar t ube.

ORTHODONTIC BANDS........25

DR. PRIYA K, MDS

The evo lut ion fro m pinching go ld - p lat inum or chro me allo y st raight , flat st rips t o
fit toot h for m, to pinching pre for med st rips, to having an invent ory o f preformed band s
cont aining fully-shaped sizes has been an amazing ser ies of advances.

Wit h t he coupling o f prefor med bands, appliance placement and t he philosophy o f


light force toot h movement , ort hodont ics has reached a new plat eau.

ORTHODONTIC BANDS........26

DR. PRIYA K, MDS

DEFINITIONS - Sandblasting
Sandblasting is a procedure to clean or roughen a sur face by a iming a jet of sand at
it .71
The most frequent sit e of band failure is at t he band-cement int er face9,12 and t he
laboratory st udies support t his finding.3
According to HODGES et al (2001)72 increasing t he bond st rengt h at t his int er face
would decrease t he risk o f band loosening dur ing treat ment .
The current focus is on t reat ment of t he met al to increase t he ret ent ive sur face area
of t he band and enhance t he chemical and mechanical bo nding.

Early in 1943, DR. ROBERT BLACK 20 began his pio neer ing st udies using air
abrasive t echno logy in dent ist r y. The t echnique int roduced in t he 1950s, used a high-speed
st ream of aluminum o xide part icles propelled by compressed air. 18,19 In 1951 air abrasive
inst rument was int roduced.20
Air abrasives were init ially used for modifying the sur face of enamel, dent in and
restorat ive mat er ials, 20 before cement at ion and t o enhance t he bond st rengt h. More recent ly
market ing includes it s app licat ion t o ort hodont ics to roughen t he int ernal sur face o f bands
and bracket bases.73
A st udy by ZACHRISSON AND BUYUK YILMK AZ (1993)74 on elect ron
micrographs of t he met al sur face t hat has been roughened wit h d iamo nd bur or green stone
demonst rat ed t hat t he apparent roughness was caused by per iodic r idges and grooves, whic h

ORTHODONTIC BANDS........27

DR. PRIYA K, MDS

provide lit t le micro mechanical ret ent ion and concluded t hat t he micro mechanical ret ent io n
provided by sand blast ing was more advant ageous.

Furt her WOOD et al (1996)75 co mpared t he bond st rengt h of zinc phosphat e, zinc
po lycar bo xylat e and GIC before and aft er sandblast ing and inferred t hat sandblast ing
improved t he ret ent ion and t hat GIC was a bett er lut ing agent .

Compar ison o f failed bracket s by SONIS L. ANDREW (1996)73 t reat ed wit h air
abrasio n and t he unt reat ed bracket s inferred t hat t he fa iled air abraided bracket s, had t he
same bond st rengt h as an unt reat ed new bracket. Air abrasio n increased t he mechanica l
ret ent ion.

Anot her st udy by STANLEY MILLER, JOSEPH H. ZERNIK

(1996),76

compared t he effect of sand blast ing on t he bo nd st rengt h and concluded t hat sand blast ing
increased t he bond st rengt h and, when co mbined wit h glass io no mer decreased t he failure
rat e.

Different met hods o f sur face roughening descr ibed by ENIS GURAY, ALI IHYA
K ARAMAN (1997)77 concluded all t he met hods increased t he ret ent ion but micro -et ching
provided ho mogenous microscopic undercut s.

They roughened t he maxillar y first premo lar bands by micro -et ching wit h
alum inum oxide, and a low speed micro motor wit h t ungst en carbide and green stone. The y

ORTHODONTIC BANDS........28

DR. PRIYA K, MDS

concluded t hat t he t reat ed bands had sig nificant ly great er ret ent io n t han unt reat ed and no
st at ist ically significant difference was found bet ween t he different met hods emp lo yed.
A st udy was conduct ed by MILLET et al (1999)78 using co mpo mer and resin
modified GIC under laboratory co nd it io ns for bonding. The resu lt s showed no significant
difference in debonding force bet ween t he t wo convent ional adhesive. The ARI inde x
indicat ed no cement was seen on t he toot h sur face aft er debonding wit h RMGIC; half t he
cement was on t he toot h, wit h co nvent ional GIC. For co mpo mer and co mposit e most of t he
adhesive was on t he toot h aft er debonding. They also suggest ed micro et ching t he base to
minimize t he amount of cement on t he toot h surface.
Bond st rengt h st udied by MUI et al (1999), 79 on t he bonded and rebonded
ort hodont ic bracket base t reat ed wit h different co nd it io ning met hods also compar ing t he light
cure and t he self-cure syst ems, concluded t hat the best reco ndit ioning met hod fo llowing
debonding appeared t o be removal o f t he residual co mposit e wit h t ungst en carbide bur and
acid et ching t he enamel. The rebonding procedure was done using t he self cure s yst em and
new bracket s. If t he bracket s were to be reused t hen t he base could be micro -et ched.

A co mpar ison by MENNEMEYER et al (1999)80 evaluat ed t he use o f hybr id


io no mer, resin cement s and GIC cont rol, bonded to photo-et ched and st andard band mat eria ls
t est ed in as received and air abraded co nd it io ns, they inferred t hat air abrasio n increased t he
bond st rengt h o f bot h cement s.
MANISH AGGARWAL et al (2000)81 compared t he shear peel st rengt h o f five
different cement s using factory and in-o ffice mic ro-et ched bands and concluded t hat t here

ORTHODONTIC BANDS........29

DR. PRIYA K, MDS

was no difference bet ween RMGIC and PMCR and amo ng t he t wo RMGIC but st at ist ically
significant difference was seen w it hin PMCR. There was low bo nd st rengt h wit h t he in
pract ice-sand blast ing group.
However, CANAY et al (2000)82 co mpared acid et ching wit h air abrasio n for
sur face preparat ion t echnique on enamel. The st udy inferred t hat sandblast ing fo llowed by
acid et ching had t he highest bond st rengt h and t hat sandblast ing alo ne proved to have lo w
bond st rengt h and should not be advocat ed as enamel co nd it io ner.

Anot her compar ison by HODGES et al (2001)72 on t reat ed and unt reat ed bands
concluded t hat t he t reat ed bands had bett er ret ent ion.
The vert ical loading o f t he micro-et ched bands cement ed wit h modified co mposit e,
RMGIC and co nvent ional GIC was co mpared by MILLET et al (2003).83 They concluded
t he ret ent ive st rengt h was lower for modified co mposit e fo llowed by convent ional GIC t ha n
RMGIC wit h micro-et ched bands.
Recent ly METE OZER and SELIM ARICI (2005)84 st udied clinical per formance
of sandblast ed met al bracket s bonded wit h self cure RMGIC. They however concluded t hat
no difference bet ween sandblast ed and non sandblast ed bracket wit h RMGIC aft er 20-mo nt h
o bservat ion.

ORTHODONTIC BANDS........30

DR. PRIYA K, MDS

SELECTION AND GROUPING OF TEETH


Fort y- five non-car ious, unrestored human mandibular mo lars, which were freshly ext ract
ed because o f severe per iodont al disease, were used for t his invest igat ion. The ext ract ed t
eet h were stored in 10% for malin at room t emperat ure pr ior to use.

INSTRUM ENTS AND M ATERIALS USED (Fig. 1, 2,3,4 and


5)
 P.V.C. SLEEVES
 AUTO POLYMERISING ACRYLIC RESIN
 CONVENTIONAL GIC (FUJI, TYPE I)
 DUAL CURE COMPOMER (RELIANCE ORTHODONTIC PRODUCT)
 RESIN-MODIFIED GIC (3M, MULTI CURE)
 PREFORMED ORTHODONTIC BANDS (3M Unit ek)
 BUCCAL TUBES [NIBHA,  ROUND, int ernal diamet er of 0.9mm (0.036'')
lengt h 6.3mm (0.25'') ]
 LINGUAL BUTTONS (NIBHA)
 0.9mm (0.036'') SS WIRE AND 0.5mm (0.020'' SS) WIRE (LEONE)
 INCUBATOR (YORCO, INDIA)
 INSTRON MACHINE (TIRA 2820S, GERMANY)
 ULTRASONIC TANK (Dent aurum)
 SANDBLASTER (Bio-art , Brasil. ALUMINA - 50 SIZE)
 SEM (LEO 440 I)
 WELDER (Dent aurum)
 LIGHT CURE UNIT (Spect rum 800, Dent sply)

ORTHODONTIC BANDS........31

DR. PRIYA K, MDS

SPECIM EN PREPARATION
A per fo rat io n was made t hrough t he cent er of each t oot h near t he furcat ion area
and a 0.9mm (0.036'') SS wire was placed in t he ho le to aid in t he ret ent ion of t he t eet h
wit hin t he acr ylic. The t eet h were t hen mo unt ed wit h auto-polymer izing acr ylic resin in
custom- made P.V.C sleeves of appro ximat ely 30mm (1.18'') in lengt h and 25.6mm
(1.00'') dia met er. The lingual sur faces o f t he t eet h were kept parallel t o t he analyz ing rod
of t he Neys surve yor and were mount ed (Fig. 6, 7 and 8). Root s wit h t he ret ent ive wire
in place were fully encapsulat ed by t he resin. T he exposed crowns were c leaned wit h
non- fluor idat ed pro phylact ic past e for 1 minut e to remove any fo reign debr is.
Prefor med st ainless st eel ort hodont ic bands were select ed for each specimen and checked
for size and fit on each mo lar. The buccal t ubes and lingual buttons were welded at
3.5mm fro m t he occlusal sur face at 4 Amps wit h five spot welds.
The t eet h were rando mly divided int o 3 groups of 15 specimens each t o t est t hree
commercially available lut ing cement s. The t eeth spec imens were numbered and t he
bands were placed in numbered bott les respect ively as t hey were t o be recement ed.

GROUP A Co nvent ional Glass Ionomer Cement (GIC) (Fig.9 and 12).
GROUP B Resin-Modified Glass Ionomer Cement (RMGIC) (Fig 10 and 13).
GROUP C Dual cure Co mpo mer / Polyacid Modified Co mposit e Resin (PMCR) (Fig.11
and 14).
The convent ional cement was manipu lat ed on t he mixing pad as per t he
manufact urers reco mmendat ions. Aft er mixing each cement , t hey were loaded int o t he
ort hodont ic bands. Each band was seat ed on t he select ed t eet h wit h hand pressure and t he n

ORTHODONTIC BANDS........32

DR. PRIYA K, MDS

wit h t he band seat er. The excess cement was remo ved fro m t he occlusal and cer vical margins
of t he bands w it h dr y cotton roll so t hat it would not int erfere wit h t he t est result s. The
RMGIC and co mpo mer were t hen light cured wit h t he dent al cur ing light , for 40 seconds in
case o f RMGIC and 20 seconds in case o f PMCR fro m t he occlusal aspect of t he band, as
direct ed by t he manufact urer. Pet roleum jelly was applied around t he band per ipher y.
Aft er wait ing for t en minut es, t he specimens were stored in saline at 37 C and
100% hu mid it y for 24 hours in an incubat or. The bond st rengt h was t est ed aft er 24 hours
using TIRA.
The mo unt ed t eet h were clamped to t he ho lding device w it h a large diamet er ho le
allowing each mo lar crown t o protrude and sit direct ly below t he att achment apparat us o f
TIRA. This arrangement allowed all t he fo rces t o be direct ed parallel t o t he lo ng axis o f t he
toot h during band remo val. T he ort hodont ic bands were att ached wit h 0.5mm (0.020 '') SS
wire s ling, t he loop of which engaged t he buccal t ube and t he lingual button of each ba nd
(Fig.15 and 16).
Using TIRA in t he t ensile mode wit h t he crosshead speed o f 0.5mm (0.02'') per
minut e, t he maximum force recorded during debanding was chosen fro m t he st ress-st rain
curve for each specimen and was measured in Newtons, which was used t o calculat e t he
bond st rengt h wit h t he band sur face area dat a, and final readings were t abulat ed in MPa.
Aft er debanding t he bands were placed int o t he respect ive numbered bott les (Fig.
17). The debanded t eet h were stored back in wat er and cleaned wit h scaler and pumice. The
bands were cleaned in an ult rasonic cleaner for 20 minut es to remo ve any residual cement .

ORTHODONTIC BANDS........33

DR. PRIYA K, MDS

The second part of t he st udy invo lved measur ing t he force required t o deband aft er
t he lut ing surface was sandblast ed.
The bands were t reated wit h alu minum oxide (50 m) part ic les direct ed fro m t he
sandblast er under 60 psi o f air pressure at a dist ance of 10mm fro m t he band u nt il a unifo r m
frost y appearance was visible (Fig.19). Typically t his required 15-20 seconds. Any residua l
sand was remo ved using t he air syr inge. The sandblast ed band sur face was obser ved under a
magnifying lens.

The sandblast ed bands were recement ed to t heir respect ive t eet h. The

cement at ion was carr ied out according t o t he manufact urers reco mmendat io n as ment ioned
above.
One non sandblast ed (Fig. 20 and 22) and one sandblast ed band (Fig. 21 and 23)
was photographed under SEM at 25KV, magnificat ion of 1000X.

METHOD OF STATISTICAL ANALYSIS


The dat a were co llect ed on for ms and ent ered into a Microso ft Excel Worksheet and
analyzed using SPSS (ver 7.5) st at ist ical package.
The result s were averaged ( mean + st andard deviat ion) for bond st rengt h bet ween t he
met hods and t he lut ing agent s. Two -way analys is o f var iance t est used to find a
significant difference bet ween t wo means.

ORTHODONTIC BANDS........34

DR. PRIYA K, MDS

Analysi s of Variance:
In t his st udy, t wo independent var iables namely met hod and lut ing cement s were
compared w it h respect to bond st rengt h. This exper iment al design is called a t wo -way
analys is o f var iance.
If F value is significant , t here is a significant difference bet ween group means.
Tukeys t est was t hen used to det ect significant difference bet ween group means.
In above t est p value o f < 0.05 was accept ed as ind icat ing st at ist ica l
significance.

ORTHODONTIC BANDS........35

DR. PRIYA K, MDS

ORTHODONTIC BANDS........36

DR. PRIYA K, MDS

ORTHODONTIC BANDS........37

DR. PRIYA K, MDS

ORTHODONTIC BANDS........38

DR. PRIYA K, MDS

ORTHODONTIC BANDS........39

DR. PRIYA K, MDS

ORTHODONTIC BANDS........40

DR. PRIYA K, MDS

ORTHODONTIC BANDS........41

DR. PRIYA K, MDS

ORTHODONTIC BANDS........42

DR. PRIYA K, MDS

ORTHODONTIC BANDS........43

DR. PRIYA K, MDS

ORTHODONTIC BANDS........44

DR. PRIYA K, MDS

ORTHODONTIC BANDS........45

DR. PRIYA K, MDS

ORTHODONTIC BANDS........46

DR. PRIYA K, MDS

ORTHODONTIC BANDS........47

DR. PRIYA K, MDS

ORTHODONTIC BANDS........48

DR. PRIYA K, MDS

The st udy was conduct ed in t he Depart ment of Ort hodont ics and Dent ofacia l
Ort hopedics, M.S.R.D.C, Bangalore and HAL - Foundr y and Forge Depart ment ,
Bangalore. The st udy was conduct ed to evaluat e t he effect of in-o ffice sand blast ing on t
he ret ent ion o f ort hodont ic bands w it h t hree different lut ing cement s. The shear bond
st rengt h was t est ed on a universal t est ing machine. (TIRA). The values were recorded in
Newton and convert ed int o MPa for st at ist ical analysis (Table I).

Table I: Retentive bond strength values obtained from the study in MPa
Sl
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Group A

Group A

Group B

Group B

Group C

Group C

NonSandblast ed
sandblast ed

Nonsandblast ed

Sandblast ed

Nonsandblast ed

Sandblast ed

1.2431
1.4490
1.4080
1.4129
1.4265
1.4150
1.3067
1.3599
1.3331
1.4308
1.4406
1.4202
1.3877
1.4617
1.3380

1.9501
2.1865
2.2035
2.1557
2.1827
2.1750
2.1348
2.0672
2.1929
2.2321
2.1869
2.1607
2.1353
2.2341
2.0404

1.1153
1.0373
1.1466
1.0110
0.9922
1.0356
1.0856
1.1003
1.1251
0.9962
1.0360
1.0678
1.1714
1.0180
0.9314

1.5768
1.4916
1.6654
1.4746
1.4350
1.4834
1.5455
1.5820
1.6099
1.4456
1.4909
1.4424
1.6567
1.4487
1.4221

0.8650
0.9106
0.8265
0.9744
0.9721
0.9123
0.8662
0.8321
0.9300
0.9544
0.9076
0.9409
0.9156
0.9224
0.8714

1.8464
1.9499
1.8918
1.9352
1.9082
1.9048
1.8312
1.7438
1.9897
1.9762
1.9454
1.9970
1.9781
1.9434
1.8791

The dat a fro m t he st udy was subject ed to ANOVA t est.

The Mean values and St andard Deviat ions o f shear bond st rengt hs o f non
sandblast ed and sandblast ed bands are present ed in Table II.

ORTHODONTIC BANDS........49

DR. PRIYA K, MDS

Table II: Comparison of mean values of bond strength between nonsandblasted and sandblasted bands, also among different luting ce ments.
Method
Non Sandblasted Bands

Sandblasted Bands

Group

N Mean Median Std Dev Minimum Maximum

GROUP A 15

0.907

0.912

0.046

0.827

0.974

GROUP B 15

1.389

1.413

0.061

1.243

1.462

GROUP C

15

1.058

1.037

0.066

0.931

1.171

GROUP A 15

1.915

1.935

0.069

1.744

1.997

GROUP B 15

2.149

2.175

0.077

1.950

2.234

GROUP C

1.518

1.491

0.082

1.422

1.665

15

Class Level Informatio n


Class

Levels Values
2 Non Sandblasted and Sandblasted

Method

Band
3 GROUP A, GROUP B & GROUP C

Group

Number o f observatio ns 90

The result s were st at ist ically analyzed. ANOVA test was used for ana lyzing t he
significance bet ween t he ret ent ion of non sandblast ed and sandblast ed bands.
The result s o f analys is o f var iance in co mpar ison amo ng non sandblast ed and
sandblast ed bands showed t hat t here was st at ist ically significant difference bet ween t he
t wo met hods (Table III, Fig. 30)
The Test revealed t hat t here was Significant Mean difference in bo nd st rengt h
bet ween group A, B and C.

ORTHODONTIC BANDS........50

DR. PRIYA K, MDS

Group A
ANOVA t est indicat ed t hat non-sandblast ed bands had sig nificant ly less ret ent io n
t han sandblast ed bands. (P<0.05). Range fro m a minimum o f 0.827 to maximum o f 0.974
for t he no n sandblast ed group wit h a mean o f 0.0907 and for t he sandblast ed group
minimum being 1.744 and maximum o f 1.997 and a mean o f 1.915 (Table.IV and V,
Fig.24 and 25).

Group B
ANOVA t est indicat ed t hat non-sandblast ed bands had sig nificant ly less ret ent io n
t han sandblast ed bands. (P<0.05). Range fro m a minimum o f 1.243 to maximum o f 1.462
and a mean o f 1.389 for t he no n sandblast ed group and for t he sandblast ed group
minimum being 1.950 and maximum o f 2.234 wit h mean of 2.149 (Table IV and V, Fig.
26 and 27).

Group C
ANOVA t est indicat ed t hat non-sandblast ed bands had sig nificant ly less ret ent io n
t han sandblast ed bands. (P<0.05). Range fro m a minimum o f 0.931to maximum o f 1.171
wit h a mean o f 1.058 for t he non sandblast ed group and for t he sandblast ed group
minimum being 1.422 and maximum o f 1.665 wit h mean of 1.518 (Table IV and V,
Fig.28 and 29).

ORTHODONTIC BANDS........51

DR. PRIYA K, MDS

Table III: Co mparison of the mean values of bond strength between non
sandblasted bands and sandblasted bands.

Methods

Mean

Non-Sandblast ed

45

1.117

Sandblast ed

45

1.860

F value

P value

2707.62

<0.05

S ince t here was also st at ist ically significant value exist ing amo ng t he t hree
groups, Tukeys t est was perfor med.

Table IV: Co mparison of the mean values of bond strength among different
luting ce ments in the Non Sandblasted method.

Cement groups

Mean

Group A (Red)
Convent ional GIC
Group B (Yello w)
RMGIC
Group C (Green)
Compo mer

15

0.907

15

1.389

15

1.058

F value

P value

269.16

<0.05

ORTHODONTIC BANDS........52

DR. PRIYA K, MDS

Table V: Co mparison of the mean values of bond strength among different


luting cements in the Sandblasted method.

Cement groups

Mean

Group A

15

1.915

Group B

15

2.149

Group C

15

1.518

F value

P value

264.09

<0.05

Thus in co mpar iso n, t he sandblast ed bands showed st at ist ically higher result s t han
non sandblast ed ones. Amo ng t he groups Group B exhibit ed higher ret ent ive values
st at ist ically.

ORTHODONTIC BANDS........53

DR. PRIYA K, MDS

F ig . 2 4 : D is t r i b u t io n o f V a l u e s o f B o n d s t r e n g th a m o n g G r o u p A
.5

o n - s a n d b la s t e d
th o d

1. 8791

1. 9434

1. 997

1. 9781

1. 9454

1. 9762

1. 9897

1. 8312

m e th o d

1. 7438

1. 9352

a n d b la s t e d

1. 9048

me

0. 8714

0. 9224

0. 9409

0. 9156

0. 9544

0. 9076

0. 93

0. 8662

0. 8321

0. 9721

0. 9123

0. 9106

0. 865

0. 9744

1 .5

0. 8265

Observed Values

1. 9499

1. 8464

1. 8918

1. 9082

0 .5

0
1

10

11

12

13

14
15
14
15

10

11

a m p le N u m b e
r

Fig. 25 : Minimum and Maximum Bond Strength values between Groups using Group A
bonding agent
2.5

1.997
2

Bond Strength (MPa)

1.7438

1.5

0.9744

1
0.8265

0.5

0
Minimum
Maximum
Non-sandblasted method

ORTHODONTIC BANDS........54

Minimum
Maximum
Sandblasted method

12

13

DR. PRIYA K, MDS

Fig. 26: Distribution of Valu es of Bond strength among Group B

2.0404

2.2341

2.1353

2.1869

2.2321

2.1929

2.1348

2.1607

Non-sandblasted method

2.0672

2.175

2.1557

2.2035

2.1865
1.9501

2.2

2.1827

Sandblasted method

2.7

1.338

1.4617

1.3877

1.4406

1.4202

1.4308

1.3599

1.3331

1.3067

1.4265

1.415

1.4129

1.408

1.449
1.2431

Observed Values

1.7

1.2

0.7

0.2

1
13
14

10

11

12

13

14

15 1

15

-0.3
Sa mple Nu mber

ig . 2 7 : M i n i m u m a n d M a x i m u m B o n d S t r e n g t h
p s u s in g
G
r o u p B b o n d in g a
g en t

v a lu e s b e tw e e n

G ro u

2 .5

Bond Strength (M Pa)

.2 3 4 1

1 .9 5 0 1

1 .4 6 1 7

.5

.2 4 3
1

0 .5

0
M

in im u m
N

o n -s a n db la s te d

M a x im u m
m e th o d

ORTHODONTIC BANDS........55

M in im u m

M a x im u m

S a n d b la s t e d m e t ho d

10

11

12

DR. PRIYA K, MDS

Fig. 28: Distribution of Values of Bond strength among Group C


2

1.4487

0.9314

1.1714
1.018

1.0678

1.036

1.1251
0.9962

1.1003

1.0856

1.0356

0.9922

1.1466
1.011

1.1153

1.2

1.0373

Observed Values

1.4

0.8

0.6

0.4

0.2

0
1

10

11

12 13
10
11 12
13 14 15

14 15 1

Sample Nu mber

i g . 2 9 : M i n i mu m a n d M a x i m u m B o n d S tr e n g th v a lu e s
s u s in g
G r o u p C b o n d in g a g
ent

b e tw e e n

G ro u p

1 .8
1

.6 6 5 4

1 .6
1
1

.4 2 2 1

.4

Bond S treng th (MPa )

1 .1 7 1 4

.2

0 .93 1 4

0 .8

0 .6

0 .4

0 .2

0
M

in im u m
N

M a x im u m

M in i m u m

o n - s a n d b l a s te d m e th o d

ORTHODONTIC BANDS........56

M a x im u m

S a n d b l a s te d m e t h o d

1.4221

1.6567
1.4424

1.4909

1.6099
1.4456

1.4834

1.5455

1.6654

1.435

Non-sandblasted method

1.4746

1.6

1.4916

1.5768

1.8

1.582

Sandblasted method

DR. PRIYA K, MDS

Fig. 30: Comparision of M ean values of Bond strength b et ween two methods
2.500

Non-sandblasted m ethod
Sandblasted method
2. 149

Mean Values of Bond Strength (Mpa)

2.000

1.915

1.518
1.500

1.389

1.058
1.000

0.907

0.500

0.000

Group A

Group B

ORTHODONTIC BANDS........57

Group C

DR. PRIYA K, MDS

Int egrit y o f an ort hodont ic appliance is essent ial to t he co nt inu it y o f t reat ment
mechanics. Alt hough direct bond ing of fixed ort hodont ic appliance att achment , is a
rout ine pract ice for ant er ior t eet h, mo lars are o ft en banded because t he failure rat es t end
to be lower t han t hat of bonded attachment s.70 Improved ret ent ion is mainly due to
increase in sur face area of t he bands.

Unlike a cast crown or inlay, an ort hodont ic band is not in int imat e cont act wit h
enamel. There are areas, part icular ly around t he cervical margin, where t he band does not
cont act t he enamel sur face. Space bet ween band and enamel are filled w it h cement . Band
ret ent ion is a co mplex p heno menon and may be influenced t o a var ying ext ent by t he fit
of t he band, t he t ype o f band mat erial, band widt h, band po sit ion and cement ing
procedures.
Zinc phosphat e was in wide spread use for mo lar band ce ment at io n u nt il 1980s
but due to t he incidence o f increased so lu bilit y and enamel de mineralizat ion under loose
bands, Glass io no mer cement (GIC) has beco me a more attract ive alt ernat ive especially
due to it s propert y o f fluor ide release.3

COMPOSITION AND SETTING REACTION OF GIC


GI cement has t wo co mponent s: a powder calcium aluminum fluorosilicat e glass;
and a carbo xylic acid copolymer, which exist s eit her in dr ied for m or as hydrous so lut ion.
It capit alizes on t he carboxyl chelat ion to enamel, dent in and most met als by emp lo ying
var ious mixt ures of carbo xyl cont aining acids (po lyalkeno ic acids) react ing wit h
alumino silicat e glass. Alu mino silicat e glass fused in t he presence of fluoride fluxes result

ORTHODONTIC BANDS........58

DR. PRIYA K, MDS

in an alkaline co mpo sit io n t hat releases fluor ide io ns when react ed wit h acids. Mixing
process occurs in hydrous phase.
The fluoride co mplexes o f calc ium and aluminum react wit h carboxylic acid
copolymer. In t his acid- base react ion a po lysalt gel is for med in which t he glass part icles
are embedded. Sett ing process t akes place in t wo st eps:85
1. In t he first , rapid st ep, t he calcium io ns (which may t ake t he for m o f fluoride co mple x
io ns, CaF+) are incorporat ed bet ween t he polycarboxylic acid mo lecules.
2. In t he fo llo w ing, slower st ep, a co mplet e int er lacing occurs by t he react io n o f
aluminum io ns wit h t he carboxylic acid groups t hat have not yet react ed.
Ad hesio n probably resu lt s fro m io nic or polar mo lecular int eract ions.15 The fluid
past e wet s t he sur face and is att ached by hydrogen bo nds, which are progressively
replaced by io nic ones, as t he react ion proceeds. This is so met imes called chemica l
adhesio n. Alt hough a chemical react io n may be invo lved in for ming t he adhesive bo nd,
it is not ent irely correct. It is almost cert ainly t he result of secondar y fo rces o f mo lecular
att ract ion rat her t han pr imar y chemical bonds. The t erms specific adhesio n or a
phys ico-chemical adhesio n is a more accurat e t erm, which serves t o dist inguish t his t
ype o f att achment fro m mechanical ad hesio n, which relies on mechanical int er locking.
It was seen t hat a st rong polar bo nd bet ween t he toot h, cement and t he met al
restorat ion reduces micro leakage patt erns arising fro m fau lt y ce ment margins. Fluor ide
release has been measured dur ing t he GIC sett ing react ion, as well as aft er sett ing86
Add it io nal fluor ide is released when GIC is exposed to acids.

However, GIC is more

prone to early mo ist ure cont aminat ion and t akes 24 hours to reach maximum st rengt h. 44

ORTHODONTIC BANDS........59

DR. PRIYA K, MDS

St ephen and Wilso n87,88 had obser ved similar findings in t heir st udy o f sett ing
react ion of GIC. The phys ical propert ies o f GIC had also been evaluat ed and st udied by
var ious aut hors.89,90,91 The so lu bilit y o f t his cement had been evaluat ed by Mit chem.92

HYBRID CEMENTS
In an att empt to provide great er fluor ide release and obt ain adequat e bond
st rengt h comparable to composit es, co mbinat ion of GIC and co mposit e resin has bee n
developed t o creat e Hybr id cement s, which allowed snap set , decreases mo ist ure
co nt aminat io n and increases rat e of st rengt h development . Resin- modified glass io no mer
cement s (RMGIC) are such co mbinat io n, consist ing of t wo component s; t hey self cure by
acid- base react ion o f GIC. They have a diffusio n-based ad hesio n bet ween t he cement and
toot h surface and co nt inuously release fluor ide. Po lyacid modified co mposit e res ins
(PMCR) also consist of similar co mbinat ion. They are essent ially resin mat r ix co mposit es
in which filler is replaced by io n leachable aluminosilicat e glass t hat will not self-cure by
acid- base react io ns of GIC and behave pr imar ily like resins,32 which set s by
polymer izat ion of met hacr ylat e group (oft en light act ivat ed).

The first mo lars st ill show highest incidence o f band fa ilure. One reason is t he
convergence o f t he t hree st rongest muscles o f mast icat io n masset er, t emporalis and
int er nal pt er ygo id in t he area of first mo lar and second bicuspid. Mandibu lar mo lars have
a great er t endency t o have loose bands; hence, t hey were chosen for t his st udy.
According to Mat asa,93 t he st rongest bonding is achieved when t he bond is
cohesive t hat is, t he adhesive remains aft er debonding in almost equal proport ion on

ORTHODONTIC BANDS........60

DR. PRIYA K, MDS

bot h t he subst rat es. To achieve t his goal, t here have been var ious met hods t hat have bee n
t est ed such as development of cement s, t reat ment of t he inner sur face o f t he bands and
t he t eet h surface.
RMGIC have been int roduced to restorat ive dent ist r y dur ing t he mid 1990s and t
hen su bsequent ly int o ort hodont ics. Several studies have been carr ied out on t his
mat er ial and t he resu lt s have been ver y encouraging. Mu lt iple uses and handling
charact er ist ics have been discussed in dept h on it s clinical imp licat ion by S. K S idhu. 94
Thus, t his in vit ro st udy was undert aken at t he Depart ment of Ort hodont ics and
Dentofacial Ort hopedics, M.S.Rama iah Dent al College, Bangalore to evaluat e t he effect
of in-o ffice sand blast ing on t he ret ent ive st rength of used plain bands wit h different
lut ing agent s. Fort y- five ext ract ed human mo lars were used for t he st udy. The t eet h were
in it ially cement ed wit h t he hybr id cement s namely one RMGIC and one Po lyacid
modified co mposit e resin, wit h t he co nvent ional GIC act ing as t he cont rol.
The pr imar y goal was to det ermine t he effic iency of t hese newer hybr id cement s
and to det ect if t he in-o ffice sand blast ing o f t he used pla in bands would aid in add it io na l
ret ent ion simu lat ing a clinical sit uat ion.
The present st udy co mpared t he different lut ing cement s and inferred t hat RMGIC
has great er bo nd st rengt h t han t he PMCR and co nvent io nal GIC, bot h, before and aft er
sandblast ing, which is in accordance t o Menneme yer et al, Sadiq and Hodges. 80,95 The
mean values before sand blast ing were 1.389 MPa for RMGIC, 1.058 MPa for co mpo mer
and 0.907MPa for t he co nvent io nal GIC, where as Millet 54 had found t hat no significant
difference exist ed bet ween RMGIC and PMCR.

ORTHODONTIC BANDS........61

DR. PRIYA K, MDS

The mean value o f 2.149 MPa for RMGIC and t he value o f 1.518 MPa for
co mpo mer and1.915 MPa for convent ional GIC respect ively were t abulat ed aft er
sandblast ing.
Fro m our st udy, we also inferred t hat t he procedure of sand blast ing increased t he
ret ent io n, which was in accordance w it h t he find ings of Wood et al,75 Hodges et al72 and
ot hers.73,76 Millet et al96 has also emphasized t hat t he sand blast ing procedure had almost
increased t he mean survival t ime of t he ort hodont ic bands by t hree fo lds.

SETTING REACTION OF RMGIC


RMGIC has a sett ing mechanism by t hree react ions, when t he powder and liquid
are mixed; an acid base react ion similar t o t hat of convent ional GIC is in it iat ed. In
add it io n, t his mat erial can be cured quickly by light act ivat ion fro m t he visible lig ht cur ing device. T he light act ivat es free radical po lymer izat ion o f HEMA and ot her 2
mo no mers t o form a po ly HEMA mat rix t hat hardens t he mat erial. T he t hird react io n is
self-cur ing o f resin mo no mers. It is t he light init iat ed react ion t hat allows for t he ear ly
placement of t he arch wires, while t he acid base react ion occurs simult aneously and
co nt inues for a per iod aft er t he mass has been cured by light act ivat ion. It is believed t hat
poly HEMA and polyacr ylic met al salt u lt imat ely for ms a ho mogenous mat rix t hat
surrounds t he glass part icles. As a result , light act ivat ed po lymer izat io n react ion is well
har mo nized wit h acid base react ion in t his fo r mat ion.
The advant ages o f t he hybr id io no mer and t he resin cement over t he t radit iona l
GIC include t he fo llowing- improved sett ing t ime, lo nger working t ime due to snap set by
photo curing and a rapid development of early increase in st rengt h, which makes t he set

ORTHODONTIC BANDS........62

DR. PRIYA K, MDS

mat r ix more tolerant to t he effect s o f mo ist ure and t hese superior propert ies, account ing
for increase in bo nd st rengt h.

Anot her o bservat ion t hat was made, inferred t hat , pr ior to sandblast ing t he cement
remained on t he toot h wit h respect to RMGIC and co nvent ional GIC whereas, wit h
PMCR, t he cement remained on t he band. Aft er sandblast ing t he fa ilure sit e was wit hin t
he cement , which is more advant ageous in t he two GI groups and at t he band-cement
int er face in case o f t he co mpo mer group.53
Co mpo mer as ment ioned earlier behaves pr imar ily like co mposit es, t hough
sandblast ing procedure had increased t he ret ent ion, it is not significant enough whe n
compared to RMGIC and PMCR. It was cat egorized as t he least effect ive group in our
st udy as co mposit e requires t he sur face of enamel to be et ched to aid in micro ret ent io n
which has been demo nst rat ed, where t he highest bond st rengt h to enamel is att ained w it h
phosphor ic acid, primer and a mo ist bonding sur face.97
The current st udy did not include any sur face t reatment of ename l.
However, in t he st udy by Gillgrass55 it was obser ved t hat t here was no significant
difference bet ween convent ional GIC and co mpomer used for band cement at ion. S imilar
co nclusio ns were drawn by Aggarwal et al. 81

SETTING REACTION OF PMCR


Co mpo mer or PMCR are co mposed of io n leachable alumino silicat e glass in a
po lymeric mat rix o f carboxyl modified resin mo no mer. They set by light cured resin
react ion and not acid base and rely upon wat er diffusio n int o t he set polymer which is

ORTHODONTIC BANDS........63

DR. PRIYA K, MDS

post ulat ed to allow a delayed acid base react ion t hat may release fluoride and ot her
remineralis ing io ns fro m aluminosilicat e glass.98 There are dual past e syst ems, which set
by dual cure and single past e syst ems t hat are light cure. They do not chemically adhere
since t hey do not contain any po lyacid but adhesio n, inst ead, is a resin t ype. 53
In t he search of an ideal restorat ive mat er ial, a st udy co mpared var ious mat er ials
t hat were rout inely used, which concluded t hat co mpo mers had sig nificant ly higher
hardness and co mpress ive st rengt h t han RMGIC, but composit e had t he super ior
propert ies. 99

The fluoride releasing abilit y bet ween PMCR and RMGIC concluded t hat t he
fluoride levels increased dur ing t he first t hree mont hs and lat er decreased when co mpared
to RMGIC.56 However, Ko mori100 and Karant akis37 showed t hat co mpo mer has less
fluoride release t han RMGIC and convent ional GI C fro m t he init ial per iod it self.
In order to det ermine a suit able lut ing media for ceramic restorat ion Begazo et
al101 concluded t hat sandblast ing, et ching and silanizing showed increased bond st rengt h
for RMGIC fo llowed by co nvent ional GIC but highest bond st rengt h was obt ained wit h
composit e resin.
Gladys102 has ext ensively st udied physico -mechanical charact erist ics o f new
hybr id cement wit h co nvent io nal GIC and co mposit e and inferred t hat t he bond st rengt h
in t he decreasing order as composit e fo llo wed by PMCR, RMGIC and t he least being
co nvent io nal GIC.
The lat est int roduct ion has been t he past e-past e t ype o f RMGIC, which makes
clinical hardening safe and easy and had per formed well w it hout clinical failure over a

ORTHODONTIC BANDS........64

DR. PRIYA K, MDS

21- mont h per io d103, it is easy t o handle and is more consist ent since t he need for
measur ing and mixing is eliminat ed.100
Sand blast ing has been regarded as a for m o f macro etching, which cleans and
roughens t he sur face. 82 It has beco me t he preferred surface t reat ment in met al bonding
today. This procedure invo lves spraying a st ream of aluminum oxide part icles under hig h
pressure against t he met al sur face int ended for bonding. 80-100 psi o f air pressure is
required and aluminum oxide part icle o f 50m has been found t o be most desirable for
use in sand blast ing and resu lt ing in excellent bond st rengt h.75

The failure rat es of 2% for t he co mmercially sandblast ed bands co mpares


favorably w it h t hat found by Millet et al96 who carried out t heir own sand blast ing
process.
Anot her st udy was conduct ed by M illet 54 compar ing t wo band cement s. They
concluded no significant difference bet ween RMGIC and PMCR. Debonded bracket s,
which were rebonded fo llowing sandblast ing, showed comparable st rengt h to t hat of a
new bracket .73
A half mout h clinical t rial co mpar ing non sandblast ed and sandblast ed bands by
Hodges72 had also demo nst rat ed t hat sandblast ing sig nificant ly increases bo nd st rengt h
and reduced t he clinical failure rat es.
However, in a recent clinical st udy report ed by Ozere84 on t he self-cur ing
RMGIC concluded no significant difference bet ween sandblast ed and non sandblast ed
bracket s during a 20 mo nt h observat ion per iod.

ORTHODONTIC BANDS........65

DR. PRIYA K, MDS

Mc Coll and Rossouw,104 conduct ed an invest igat ion to det ermine

t he

relat io nship bet ween shear bond st rengt h and base sur face area for t he st andard and fo il
mesh bracket bases, also to assess t he effect of sandblast ing t he bracket s at chair side and
compared it wit h micro et ched bracket s. They fo und significant increase in shear bond
st rength associat ed w it h sand blast ing o f fo il mesh bases for all base sizes but t here was
no difference bet ween t hese t wo groups. They co ncluded t hat to maximize t he shear bond
st rengt h, t here is no need t o increase base sur face area and t hat sand blast ing t he bases
should be carr ied out rout inely just before bonding.
Sand blast ing increases t he ret ent ion by roughening t he sur face o f all met als
including st ainless st eel and as a result , increases sur face area for bot h chemical and
mechanical bo nding. It remo ves t he cont aminant s and decreases t he t hickness o f oxide
layer, leaving a more fir mly att ached layer for bonding. A t hin o xide layer is needed for
good wett ing and bonding t o t he met al. Bot h the procedure of sand blast ing whet her
carr ied out commercially or at t he chair side affects t he bond st rengt h.
Grabouski105 has po int ed out t hat among co nvent ional bracket , a newly et ched
bracket , a debonded and sandblast ed bracket t here was no significant difference bet ween
t he bond st rengt hs. Thus advocat ing in-o ffice sand blast ing.
In our st udy fo llowing sand blast ing we not ed a stat ist ically significant increase in
force value for deband ing. However, t he great est increase was seen in t he RMGIC group.
It must be not ed t hat t he process o f sand blast ing may also enhance t he chemical bonding
capabilit y o f t he cement s. Alt hough, as wit h no n sand blast ing, mechanical bonding
capabilit y is t he pr imary det er minant for increased adhesio n o f sand blast ed bands.

ORTHODONTIC BANDS........66

DR. PRIYA K, MDS

The non sandblast ed and sandblast ed bands were photo graphed using a Scanning
Elect ron Microscope (SEM) direct ed at t he lut ing sur face o f t he band. The photographs
were t aken at 20KV and a mag nificat ion o f 1000X. The SEM photograph illust rat es t he
relat ively smoot h lut ing sur face o f t he non sandblast ed bands, in co mpar iso n wit h t he
corrugat ed surface o f sandblast ed bands; t he increase in t he sur face area was seen to
enhance t he pro babilit y o f mechanical and che mical bonding t hat took place wit h t he
var ious cement s used and t hereby reducing t he failure rat es.

EFFECT OF OTHER EXPLANATORY VARIABLES


Sand blast ing procedure has been carr ied out at 60psi as t he levels can be increased
only t o t his ext ent wit h t he in-o ffice sandblast ing.
There could be a furt her increase in bond st rengt h if t he t eet h surfaces were et ched for
co mpo mers because t hese cement s do not cont ain any acid and ad hesio n is, inst ead a
resin t ype. The ot her lut ing agent s can be cement ed, subsequent to cond it ioning t he t eet h
sur face.
 Last ly, t his was an in vit ro st udy and would not be able to complet ely simu lat e an oral
environment where t he t eet h are const ant ly subject ed to occlusal forces.
Furt her invest igat ions int o t his field o f hybr id cement s would provide a
meaningful insight int o t hese upcoming and pro mising mat erials.

ORTHODONTIC BANDS........67

DR. PRIYA K, MDS

This in vit ro st udy was aimed at evaluat ing t he increase in bond st rengt h
fo llo wing sand blast ing w it h different hybr id cement s namely one RMGIC and one
PMCR and t he convent ional GIC as t he cont rol and to correlat e t he effect iveness o f t his
procedure of sand blast ing in a clinical sit uat ion fo llowing t he use o f a plain prefor med
bands and sandblast ing in o ffice.
Fort y- five ext ract ed human mo lars were used for t he st udy t hat was conduct ed at
t he Depart ment of Ort hodont ics and Dento facial Ort hopedics, M. S. Ramaiah Dent al
College. The t eet h were banded using prefor med ort hodont ic plain bands t hat were used
in it ially to det ermine t he bond st rengt h o f different hybr id cement s and t hen su bsequent ly
sandblast ing t he same bands to det ermine t he effect of t his procedure on bond st rengt h.
The resu lt s inferred t hat t here was a st at ist ically significant increase in t he bo nd
st rengt h fo llowing t he procedure of sand blast ing. It also demonst rat ed t hat RMGIC has
great er bond st rength t han t he PMCR and co nvent ional GIC. The mean values before
sandblast ing were 1.389MPa for RMGIC, 1.058MPa for co mpo mer and 0.907MPa for
t he co nvent ional GIC, where as Millet 63 has found t hat no significant difference exist ed
bet ween RMGIC and PMCR.
The mean value o f 2.149MPa for RMGI and t he va lue o f 1.518MPa for
co mpo mer and1.915MPa for convent ional GI respect ively were t abulat ed aft er
sandblast ing.
ANOVA revealed st at ist ically significant difference bet ween t he met hods and
among t he lut ing cement s.
The RMGIC lut ing cement gives ever y ind icat ion o f beco ming t he mat er ial o f
cho ice for cement at ion o f crowns, space maint ainers and ort hodont ic bands. Alt hough

ORTHODONTIC BANDS........68

DR. PRIYA K, MDS

more lo ng-t erm dat a is needed concer ning RMGIC, t hey show remarkable pro mise for
mat er ials at t his st age of development .
Wit h all t his development on RMGIC, it might be t empt ing t o conclude t hat
original self hardening GIC is obso let e. However t his is far fro m t he case. These
mat er ials t oo are indulg ing in excit ing development s o f t heir own for eg. Ket ac mo lar in
case o f crowns and br idges, which set s by neut ralizat ion react ion and has propert ies t hat
r ival or exceeds t hose of RMGIC. Sett ing is rapid,

early mo ist ure sensit iv it y is

considerably reduced and so lu bilit y in oral fluids is slow.


Alo ng wit h t he increase in bond st rengt h o f RMGIC, t he fluo ride release fro m t he set
cement is also comparable w it h t hat of co nvent io nal GIC providing a similar ant i
car iogenic effect . The sett ing react ion is in it iat ed in t he po ly HEMA mat r ix o f RMGIC
by photo act ivat ion, since t he sett ing of GIC is seen t o be t he most crit ical dur ing t he first
one hour due to t he for mat ion o f a weak mat rix complex o f calcium io ns and subsequent
vu lnerabilit y to mo ist ure cont aminat io n, RMGIC has proven to be t he current chosen
mat er ial.
Wit h t he use o f pre-adjust ed edgewise syst ems, which are more popular today
wherein t he placement o f att achment is more cr it ical, a light act ivat ed GIC will st ret ch t
he luxur y and over co me t he hurdles, ort hodont ist s face wit h bonding o f bracket s to t he
post erior region also. The advent of t his mat er ial has ext ended it s use for sp lint
cement at ion and bands t hat receive a face bow.
Over all GIC are import ant mat erials for modern clinical dent ist ry. Development
of RMGIC has opened a new d imensio n in restorat ive dent ist ry as well as in
ort hodont ics.

ORTHODONTIC BANDS........69

DR. PRIYA K, MDS

No mat erial is per fect , but wit h current levels of int ensive research on
GIC, deficiencies t hat exist s seems t o be eliminat ed or at least reduced, result ing in
an ever improving range of mat erial o f t his t ype.
The research is be ing direct ed towards t he impro vement of RMGIC in order
to use it in t he post erior as well as ant erior segment s for bonding bracket s.

ORTHODONTIC BANDS........70

DR. PRIYA K, MDS

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ORTHODONTIC BANDS........81

INDEX

A
Abrasive 27, 72
Abrasives 27
Abu-bakr 81
Acrylic 31
Adams 14, 73
Adhesive 1, 13, 14, 20, 22, 23, 29,
59, 60, 76
Aggarwal 29, 63, 79
Akca 79
Alcohol 14
Alkaline 59
Alumina 31
Aluminum 2, 10, 27, 59, 65
Andrew 28
Anusavice 72
Armamentarium 6
Arthur 17
Auto-polymer 32

B
Band 6, 7, 8, 9, 10, 11, 14, 16, 18,
19, 20, 21, 22, 24, 25, 26, 27,
29, 32, 33, 34, 50, 58, 60, 63,
65, 67, 71, 72, 73, 75, 76, 77,
78, 79, 80
Band-cement 9, 11, 22, 23, 27,
63
Benington 76
Benzoic 1
Berkson 73
Bishara 21
Bonded 8, 11, 20, 25, 29, 30, 58,

78, 79, 81
Bonding 7, 8, 10, 15, 19, 20, 22,
29, 54, 60, 63, 65, 66, 67, 69,
70, 71, 72, 74, 79
Bracket 8, 10, 20, 23, 27, 28, 29,
30, 65, 66, 69, 70, 77, 78, 79,
81
Braem 81
Brandt 25, 78
Burgess 71
Buyuk 27
Buyukyilmaz 78

C
Calcified 15
Calcium 69
Cameron 17
Canay 30, 79
Carbide 28, 29
Carboxyl 58, 63
Carboxylic 59
Carthy 20
Cement 3, 8, 9, 10, 11, 12, 14, 15,
16, 17, 18, 19, 20, 21, 27, 29,
30, 32, 33, 35, 49, 52, 53, 58,
60, 61, 63, 64, 65, 67, 68, 71,
72, 73, 74, 75, 76, 77, 78, 79,
80, 81
Cementation 3
Cements 2, 5, 13, 53, 60
Ceramic 64, 81
Cervical 18, 58
Charbeneau 74
Chemistry 16
Clinical 8, 9, 11, 14, 18, 20, 21,
30, 61, 64, 65, 68, 69, 71, 72,
73, 75, 76, 78, 80, 81
Cohesive 60
Commercially 32, 66
Compton 20

Conventional 2, 6, 31
Copenhaver 19, 75
Coupling 26
Coups 22
Crown 33, 58
Crowns 3, 19, 32, 68, 69
Cure 20, 21, 22, 23, 29, 30, 31,
32, 60, 64, 76
Curing 62
Custom 32

D
Dasch 79
Debanded 33
Debanding 2, 6, 11, 33
Debonding 29, 60
Deficiencies 70
Definition 13, 24, 27
Dental 13, 72, 80, 81
Dentofacial 74, 75, 76, 81
Dual-cured 75
Durable 24

E
Electron 1, 6
Embedded 59
Enamel 8, 14, 15, 16, 18, 19, 21,
23, 27, 29, 30, 58, 63, 71, 72,
73, 76, 77, 79, 80
Enamel-cement 22, 23
Environment 67
Etching 65
Ethoxy 1
Experiment 9
Explanatory 67
Extracted 2

F
Fadzean 79
Failure 9, 11, 20, 21, 22, 23, 58,
64, 65, 71
Fluid 59
Fluids 8, 69
Fluoride 15

G
Garcia-godoy 77
George 25
Germany 31
Gibbon 13
Gillgrass 22, 63, 76
Gordon 73, 75, 80
Grabouski 66, 81
Gronas 80

H
Hallgren 76, 78
Hamula 25
Hardening 64, 69, 80
Hardness 64
Hershey 73
Hondrum 20, 75
Hybrid 60
Hydro 18, 73
Hygiene 8

I
Incubator 6, 31
Investigation 2

Ionomer 1
Itayama 22
Iwaku 81

Jakobsen 81
Jan-feb 74, 80
Jelly 33
Johan 15, 18
Johnson 21, 76, 78
Johnston 71
Joseph 28
Journal 76, 77, 80

Mechanical 10, 14, 15, 20, 27, 59,


66, 75
Mechanics 58
Meerbeek 81
Mennemeyer 29, 79
Method 3, 5, 34, 52, 53, 54, 55,
56, 57
Methodology 4
Micrographs 10, 27
Microscope 1, 6
Microscopy 78
Miller 28, 78
Millet 21, 25, 29, 30, 61, 62, 65,
68, 73, 75, 76, 78, 79, 80
Mizrahi 18, 19, 20
Molars 2

Knox 77
Kocadereli 79

Nakahara 77
Newton 49
Newtons 2, 33
Non-sandblasted 2, 54, 55, 56,
57
Nov-dec 79, 80
Nox 23

L
Laboratory 9, 27, 29, 75, 79
Lactobacilli 17, 74
Leachable 60, 63
Lewi 74
Lingual 6, 19, 31, 32, 33

M
Machine 31, 49
Mamandras 76
Materials 72, 81
Mccluskey 76
Mcinnes-ledoux 71

O
Orthodontic 1, 2, 3, 4, 5, 6, 7, 8,
9, 10, 11, 12, 13, 14, 15, 16, 17,
18, 19, 20, 21, 22, 23, 24, 25,
26, 27, 28, 29, 30, 31, 32, 33,
34, 35, 36, 37, 38, 39, 40, 41,
42, 43, 44, 45, 46, 47, 48, 49,
50, 51, 52, 53, 54, 55, 56, 57,
58, 59, 60, 61, 62, 63, 64, 65,
66, 67, 68, 69, 70, 71, 72, 73,
74, 75, 76, 77, 78, 79, 80, 81

Orthodontics 76, 77, 80


Oxide 2, 8, 10, 28, 34, 65, 66
Ozere 65

Q
Quintessence 74, 81

P
Parkins 72
Particles 2
Pascal 1
Pascotto 23, 77
Paskow 78
Periodontal 2
Phillipps 72
Phillips 73, 79, 80
Photograph 67
Photographs 67
Plaque 8
Pollock 24
Polyacid 17, 22, 23, 32
Polymerising 31
Porcelain 22, 77
Primer 63
Priya 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11,
12, 13, 14, 15, 16, 17, 18, 19,
20, 21, 22, 23, 24, 25, 26, 27,
28, 29, 30, 31, 32, 33, 34, 35,
36, 37, 38, 39, 40, 41, 42, 43,
44, 45, 46, 47, 48, 49, 50, 51,
52, 53, 54, 55, 56, 57, 58, 59,
60, 61, 62, 63, 64, 65, 66, 67,
68, 69, 70, 71, 72, 73, 74, 75,
76, 77, 78, 79, 80, 81
Procedure 2, 6, 8, 11, 12, 27, 29,
62, 63, 65, 66, 67, 68, 79
Procedures 11, 19, 58
Product 31, 76
Pullen 24, 77
Pumice 33
Pvc 6

R
Reisbick 16
Renata 23
Research 10, 70, 81
Researchers 15
Resin-modified 31, 32
Resin-reinforced 22
Resins 16, 17, 60, 77

S
Sadowsky 73
Saline 33
Saliva 74
Samuel 17
Sand 10, 11, 27, 28, 34, 49, 61,
62, 65, 66, 67, 68, 78
Sandblast 10, 12, 28, 30, 34, 49,
50, 51, 52, 53, 61, 62, 63, 64,
65, 66, 67, 68, 78, 79, 80
Sandblasted 2, 5, 6, 7, 50, 52, 53,
54, 55, 56, 57
Sandblaster 2, 31
Sandblasting 2, 3, 6, 27
Sands 24
Saunders 72
Sced 72
Schlenker 76
Schwaninger 71
Science 72
Shear-peel 79
Sheldon 24
Sidney 25

Silane 21
Silanizing 64
Silver 24
Smith 22
Stainless 1, 2
Stanley 28
Stephen 20, 21
Strength 2, 7, 49, 50, 52, 53, 54,
55, 56, 57
Stress-strain 2

T
Technique 77
Teeth 2, 6, 31
Tensile 77
Theodori 74
Toledano 22
Tukey 35

Wilson 9, 16, 72, 74, 79, 80


Wood 28, 62, 78
Wright 20

X
Xylic 58

Y
Yamada 81
Yilmk 27
Yoneda 81
Yoshitak 22
Young 13, 75

Z
U
Ultrasonic 6, 31

V
Value 2, 18, 35, 52, 53, 62, 66, 68
Values 5, 7, 49, 50, 52, 53, 54, 55,
56, 57, 61, 68, 71
Vonwald 76

W
Welder 31
Williams 13, 14, 73

Zachrisson 27
Zerni 78
Zernik 28
Zinc 8, 9, 13, 14, 15, 16, 18, 19,
20, 28, 58, 71, 72, 73, 75

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