1. Introduction
In recent years there has been an increase in demand for orthodontic treatment within the adult population. As of 2015, according to the American Association of Orthodontics, the demand within this age group has doubled over a four year period and this number is set to increase further in the future [1]. This can be attributed not only to evergrowing aesthetic concerns [2] but also to the expeditious evolution of orthodontic techniques [1]. In this age group, there is a high likelihood that an orthodontist will encounter complex restorative treatments using ceramic structures [1,2,3] due to their numerous advantages, namely biocompatibility, excellent aesthetics, reduced bacterial plaque accumulation, low thermal expansion, resistance to abrasion or fracture along with colour stability [4,5,6,7]. The most used ceramic used in dental practices are feldsphatic, lithium and zirconia [4,8].
Nonetheless, these types of restorations can reveal themselves quite complex for orthodontists, since achieving a reasonable bond strength on ceramic surfaces is challenging due to the presence of a glaze layer that hinders the adhesion process [7,8,9,10]. This is evident in the clinical practice as well with some studies having reported bracket adhesion failure rates on ceramic surfaces of around 9.8% after two years [7]. Consequently, orthodontists may encounter difficulties in achieving an optimal adhesion force on ceramic surfaces that is not only effective but also harmless [3,7], that is, an adhesion force that is resistant to orthodontic and masticatory forces while also retaining the function and aesthetics that are provided by this type of restoration after bracket debonding [3,7,10,11]. Recurrent bracket debonding reduces the success of orthodontic treatment, as it creates adverse consequences in terms of appliance efficiency, cost, treatment duration and patient’s comfort which can all be avoided by achieving adequate adhesion [4,10,12].
As a response to the referred difficulties, different conditioning methods of ceramic surfaces have emerged, whether they are mechanical, chemical or a combination of both, these are applied to change the ceramics’ properties and increase bonding strength [9,13]. Mechanical methods like sandblasting with aluminium oxide, the use of diamond burs and laser irradiation help produce micromechanical retentions. As for chemical methods, which are used to establish a porous surface on the ceramic, the most commonly used products include phosphoric acid (PhA), hydrofluoric acid (HF), silane and, as of recently, universal adhesives [1,4,8,9,10,13,14,15].
However, it is not only the ceramic surface treatment method that influences the bond strength, factors such as ceramic type, bracket material and design, light curing source, adhesive system properties and clinician’s experience are as equally important when trying to achieve the best results [4,7,8,13,15].
According to the current available literature, the most commonly used protocol for ceramic surface treatment starts with an oxide aluminium sandblasting, followed by conditioning with hydrofluoric acid, application of silane, and lastly the placement of bonding resin [10,16]. Despite being a highly successful technique in terms of adhesion strength, this protocol also presents itself with a few handicaps. This sequence is not only long and complex, but the use of hydrofluoric acid requires a very careful application due to its high corrosiveness, meaning that in the sequence of a direct contact it can lead to soft tissue necrosis [2,9,16,17].
The current state of the art isn’t consensual regarding the most effective and safest method to achieve a reasonable bond strength of brackets on ceramic surfaces. Several studies were performed with different ceramic types and used different surface treatment protocols. As such, it becomes necessary to gather and evaluate all the scientific information presently available to determine the best protocol.
2. Materials and Methods
This systematic review was drawn up in accordance with the Preferring Items for Systematic and Meta-Analyses and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO with the ID 282131 number. The Population, Intervention, Comparison and Outcome (PICO) question is outlined in Table 1.
PICO question: What is the most effective technique for bonding brackets on ceramic crowns or veneers?
The literature search was carried out in several databases, namely PubMed (
The last search was performed on 1 September 2021. The search formula for was the following: (bracket * OR ‘brace’/exp OR brace OR ‘orthodontic bracket’/exp OR ‘orthodontic bracket’ OR ‘orthodontic device’/exp OR ‘orthodontic device’) AND (‘dental porcelain’/exp OR ‘dental porcelain’ OR porcelain * OR ‘glass ceramics’/exp OR ‘glass ceramics’) AND (‘shear strength’/exp OR ‘shear strength’ OR ‘dental bonding’/exp OR ‘dental bonding’ OR ‘adhesion’/exp OR adhesion OR bond *). The same formula was applied was applied to the other databases. Articles published from 2011 to 2021 in English, Portuguese, and Spanish were searched.
Four independent reviewers scrutinized the studies, in accordance with defined inclusion criteria: in vitro or ex vivo studies evaluating the shear bond strength of brackets to ceramic substrate. There were included metallic, polycarbonate, sapphire, zirconia and ceramic brackets. Excluded criteria were all subtracts that differ from ceramic such as gold, amalgam, other metallic alloy, resins and polycarbonate/polycarboxylate; ex-vivo studies with enamel surfaces, polymerization techniques studies and surface characteristics studies.
Three external elements were consulted in case of doubt or in the absence of consensus. For each study the following information was extracted: author and date, study design, adhesion technique type (type, time, clinical application), porcelain type, sample size, test group and control group, bracket type, intervention test, results, and main conclusions.
Two reviewers independently assessed the methodological quality of included studies. In the case of discrepancies, a third reviewer was consulted. The methodological quality was checked using the guidelines for reporting of preclinical studies on dental materials by Faggion Jr. [18].
Statistical Analysis
Studies were polled by surface treatment and porcelain type (either feldspathic or lithium disilicate). For each porcelain, treatments were compared using an ANOVA with post-hoc comparisons through the Mann-Whitney test with Bonferroni correction. To perform the comparisons, the sample variability was computed for each study considering the pool of studies which have analyzed the same treatment, and study weights were computed as a percentage of the total sample variance.
The IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp.: Armonk, NY, USA) was used to perform the statistical analysis.
The synthetic measure based on weighted means for each treatment, as well as its variance, were used to plot the confidence intervals on a descriptive forest plot, using Excel (Microsoft Corporation, Redmond, WA, USA) and a bubble plot.
3. Results
The search results and the initial number of abstracts selected according to the selection criteria from the various databases are provided in Figure 1. From the 655 studies collected from all the databases based on their title and abstract, 90 studies were screened by title and abstract. 71 articles satisfied the final selection criteria and were included in the present systematic review and meta-analysis. Figure 1 presents the PRISMA flow of the article selection process.
The results are described in detail in Table 2. The sample size (n) ranged from 8 to 960, obtaining a total sample of n = 7246. The final selection of studies was 64 in vitro, 5 ex vivo e 2 in vitro/ex vivo, from 2011 to 2021.
All the articles evaluated various methods of conditioning the ceramic surface to obtain an adequate bond strength when bonding brackets. The types of adhesion technique mostly present in the included articles are application of orthophosphoric acid or hydrofluoric acid in various concentrations, silane application, sandblasting/air abrasion with aluminum oxide or silicon dioxide, diamond bur roughening, single bond universal adhesive and the application of different types of lasers such as Er:YAG laser, CO2 laser, Er:CrYSGG laser, Nd:YAG laser, Cr:YSGG laser, FS laser.
All types of porcelain (feldsphatic, lithium dissilicate glass ceramic, leucite reinforced glass ceramic, monolithic zirconia, hybrid porcelain, silica-based ceramic, lithium dissilicate-reinforced ceramic, fluoroapatite-leucite glass-ceramic, fluoroapatite, and leucite-reinforced ceramic, glazed ceramic porcelain fused to metal) were studied.
Regarding the type of brackets, metallic, ceramic, polycarbonate, sapphire, and zirconia brackets were included.
All articles used shear bond test for the application of force, except for one study that used tensile strength test [19] and another one that used the adhesion strength test [20].
3.1. Risk of Bias
The results of the quality assessment of the in vitro studies included are reported in Figure 2.
Only two studies not reported a structured abstract, calculation of the sample size [59,75] or scientific background and rationale [38,76]. Regarding the randomization process, only two studies reported these items [4,23,47]. All studies not reported researcher blinding to the interventions. Y—yes; N—no. Only a few studies reported the estimated size of outcomes [5,7,27,30,46]. No studies reported information relative to the protocol domain, except for three [15,43,74].
3.2. Meta-Analysis
For the quantitative analysis, only studies that used metallic brackets adhered to felspathic ceramics and lithium disilicate were selected. These studies were pooled regarding the main surface treatment used, although different protocols (concentrations, applications times, energies…) were used. Studies that presented other bracket types presented highly heterogeneous methodologies, making impossible its comparison. Also, regarding the other ceramic types, it was not possible to find studies with similar methodologies to be compared.
The meta-analysis regarding the feldspathic ceramics (Figure 3) presents the lower adhesion values for the treatments with fine bur (T1) and orthophosphoric acid (T3), without statistically significant differences between them, but significantly lower than all other treatments (p < 0.001). With increased adhesion values the sandblasting technique alone (T2), presents statistically significant differences (p < 0.001) for all groups, including the sandblasting + hydrofluoric acid group (T6), although less significant (p < 0.05). The group that uses LASER (T5) for surface preparation presents the following highest adhesion value with statistically significant differences (p < 0.001) T1, T2, T3, T4 and T7 groups and p < 0.05 to T5 group. The highest adhesion values were found in the LASER with hydrofluoric acid (T7) or hydrofluoric acid alone (T4) groups, without statistically significant differences between them, but being significantly higher than the others (p < 0.001).
The meta-analysis that evaluates lithium disilicate ceramics (Figure 4) presents the statistically significant lowest adhesion values for the orthophosphoric acid (T3) group (p < 0.001). Still with low adhesion values, but higher than the previous ones, we find the fine bur group (T1), with statistically significant differences regarding all the other groups (p < 0.001). With increased adhesion values, we have the sandblasting technique (T2) and the hydrofluoric acid alone (T4) groups, without statistically significant differences between them, but with statistically significant differences (p < 0.001) with all other groups. The highest adhesion values are found in the LASER alone group (T5), with statistically significant differences from all other groups (p < 0.001).
For the two ceramic types evaluated in the meta-analysis, the surface presenting the lowest results is the orthophosphoric acid, with adhesion values close to 0 MPa, such as 3.99 MPa ± 0.48 for felspathic ceramics and 0.7 MPa ± 0.07 for lithium disilicate. These low adhesion results are also observed in surface treatments using only fine drill wear, with 5 MPa ± 0.51 and 6.9 MPa ± 0.91; and sandblasting with 9.13 MPa ± 0.97 and 9.7 MPa ± 1.05 for feldspathic ceramics and lithium disilicate respectively.
The treatment with the highest values for lithium disilicate ceramics is the LASER treatment with 19.87 MPa ± 2.01, while for feldspathic ceramics it is the LASER treatment with hydrofluoric acid with 26.79 MPa ± 2.7 and the treatment with hydrofluoric acid alone with 27.32 MPa ± 2.89.
When comparing the same surface treatments on the two types of ceramics, substantially different adhesion values are obtained, as an example of hydrofluoric acid with such different performances as 27.32 MPa ± 2.89 for feldspathic and 9.18 MPa± 1.05 for disilicate. The LASER treatment also presents some differences when we compare feldspathic ceramics with lithium disilicate with 13.56 MPa ± 1.38 and 19.87 MPa ± 2.01, respectively.
4. Discussion
The main purpose of this review was to identify the most efficient and reliable bonding protocol for orthodontic brackets to ceramic surfaces. As this is a complex and sensitive process it is essential to determine the best protocol to achieve the best results [2,4,10,12].
The last systematic review regarding this topic was published in 2014. This previous paper, that solely included in vitro studies, concluded that the best protocol would be etching with 9.6% hydrofluoric acid for 60 s, rinsing for 30 s, air-drying, and finally applying the silane [78]. With new articles emerging in recent years a new systematic review is warranted. Since we included papers published from 2011, all recent literature was scrutinized and included if relevant.
As previously stated, to ensure an acceptable shear bond strength (SBS) capable of resisting not only chewing but also forces induced by orthodontic appliances, optimal ceramic surface conditioning techniques are necessary. The present results revealed that the most studied conditioning methods include 37%/37.5% orthophosphoric acid, 4%/9%/9.5%/9.6%/10% hydrofluoric acid, silane application, sandblasting/air abrasion with aluminum oxide, diamond bur roughening, single bond universal adhesive and the use of different types of LASER, such as Er:YAG laser, CO2 laser, Er:CrYSGG laser, Nd:YAG laser, Cr:YSGG laser, FS laser.
4.1. Design and Bracket Material
The included studies present several different combinations of ceramic surface conditioning techniques to understand which one achieves a better SBS value. Some studies prove that although the ceramic surface conditioning method is the most important factor in achieving acceptable clinical values for SBS, it is not exclusive. Factors such as the material and design of the bracket, type of ceramic surface, and etch time also affect SBS. Mehmeti et al. states that the bracket type used significantly affects the SBS value and is a valid clinical concern [57]. On the other hand, Guida et al. showed that the failure rate is closely related to the glass-ceramic surface conditioning and that the bracket type is inconsequential [73]. According to Mehmeti et al., metallic brackets seemingly provide stronger adhesion with all-zirconium surfaces when compared to ceramic polycrystalline brackets, which can be attributed to their improved base surface design [59]. However, this is opposed to the findings of Al-Hity et al. which revealed that bonding strength of ceramic brackets on porcelain significantly exceeds that of metal brackets [19]. Different testing protocols and materials used can explain the contradictory results, since these two factors have a profound impact on the obtained results.
4.2. Orthophosphoric Acid, Fine Burr and Sandblasting
In our systematic analysis, the lowest adhesion values were verified with orthophosphoric acid, fine burr, and with slightly higher values, sandblasting treatments. Although these treatments created microroughness that could improve adhesion, their use alone presented unsatisfactory results. According to three authors (Mohammed et al., Mehta et al. and Girish et al.), the sandblasting method in association with the application of silane reaches the maximum SBS, while the use of 37% orthophosphoric acid has the lowest SBST and is deemed unsuitable for bonding ceramic brackets [21,27,31]. In this situation, we can attribute the good SBS scores to the use of silane, which alone presents high bond strength forces.
Other studies, regarding surface roughening revealed that the use of sandblasting or diamond burs along with the application of hydrofluoric acid significantly improved bond strength [52]. Sandblasting with SiO2 was shown to have no advantage when compared to sandblasting with AL2O3 [70].
4.3. Hydrofluoric Acid
The etching process partially dissolves the ceramic matrix, increasing the surface area by creating microchannels, this allows for the penetration of resin cement, thus providing finer conditions for increased bond strength.
However, since the available brands of porcelain have dissimilar particle sizes and crystalline structure, different outcomes are to be expected when testing various ceramic surfaces and brands. The heterogeneity of the reviewed studies can be attributed to structural differences in porcelain surfaces (besides the brackets’ base designs), which may result in higher or lower bond strength. As example, a paper by Kurt et al. published in 2019, reported that the highest SBS value was found in feldspathic ceramics previously treated with hydrofluoric acid [24]; however, Saraç et al. demonstrated that for any conditioning method, leucite-reinforced ceramic, in general, showed a higher SBS when compared to feldspathic and fluoroapatite ceramics [47].
As stated above, the etching agent HF increases the available surface area for adhesion. Higher HF concentrations promote more ceramic dissolution, which may be linked to higher bond strength values [79]. Such results support the use of HF as surface treatments when bonding ceramic restorations [80]. This can explain the results obtained in the feldspathic ceramics group, where the HF groups (alone or in combination with a laser) presented higher adhesion values. However, the HF promoted significantly lower adhesion values in the disilicate lithium group. Lithium silicate is more susceptible to HF action than feldspathic. HF concentrations above 5% used for more than 20 s significantly influence the characteristics of the material, promoting a decrease in the material strength [81]. Additionally, higher HF concentrations can also result in worse adhesion, as shown in an in vitro study by Pérez et al. [82].
The use of HF also produces insoluble fluorosilicate salts that remain on the material’s surface (if not removed by other methods, such as ultrasonic cleaning), which can affect the adhesion [83]. Also, the overall reduced number of studies included for this material and the different experimental methodologies used can affect the observed results. Taken together, such factors and differences in the material composition regarding feldsphatic ceramics can explain the obtained values for the disilicate lithium group.
Also, the acid etching time was inconsistent as different studies used different methodologies. According to Falkensammer et al. this factor is not preponderant for achieving SBS, according to their study an etching time of 30 s was as effective as standard conditioning (60 s) [70]. However, Costa et al. revealed that an etching time of 60 s significantly improved the SBS of brackets to feldspathic ceramic surfaces [34].
4.4. Silane
The use of silane improves the bond strength of brackets to ceramic surfaces [23,67]. Silane forms chemical bonds with both organic and inorganic surfaces, resulting in a stronger connection between surfaces. Furthermore, Zhang et al. reported that HF acid etching followed by silane was the best suited method for bonding on silica based ceramics and, according to Tahmasbi et al. SBS of bracket to porcelain mainly relies on the use of silane rather than the type of adhesive chosen [9,25].
4.5. Adhesive System
The chosen adhesive protocol will influence the bond strength of brackets to ceramic surfaces. According to the results of the studies reviewed, ceramic surfaces treated with blasting aluminum oxide followed by Single Bond Universal™ application had an improved SBS and caused less cohesive damage to the ceramic [51].
4.6. LASER
Recent publications studied alternatives that involve irradiating the ceramic surface with different laser types. The bond strength obtained through the combination of Er:YAG laser and HF acid on the ceramic surface may be sufficient for bonding brackets [28]. Also, according to Cevik et al. hydrofluoric acid and phosphoric acid etching methods were not suitable as surface treatment methods for feldspathic porcelains [17]. Contrarily, other studies revealed that the Er:YAG laser with the recommended settings (intensity and duration) is not a suitable alternative to the application of HF, however the laser Nd: YAG has been shown more promising results [30,65].
The results of this systematic review indicated that laser irradiation and/or HF-etching are the two surface treatments that allow greater resin-ceramic bonding. Laser irradiation emits a wavelength which is absorbed by ceramic materials, creating micro-retentions which improve resin-ceramic bonding [84]. Feitosa et al. compared 5 types of surface treatment and have found that Er:YAG laser promotes higher surface roughness, producing an improvement in the tensile strength. Regarding laser application time, these authors suggested times greater than 5 s, since some regions on the laser-treated surface had a similar morphologic appearance to the control group [85]. An article published in 2013 compared fractional CO2 laser with different intensities with hydrofluoric acid, showing that 10 and 15 W laser were higher shear bond strength than HF-etching with better results in deglazed specimens [29]. More recently, Mirhashemi et al. suggested that laser combined with HF promotes higher shear bond strength than laser groups only [30].
In lithium disilicate ceramic crowns, the results revealed that irradiation with different types of lasers can be effective in obtaining an adequate SBS. Conditioning with Er,Cr:YSGG and CO2 laser has the potential to be used in clinical settings alternative to HF+S when bonding to metallic brackets [66]. However, contrary to the previously mentioned statements, the study by Alavi et al. concluded that neither CO2 nor Nd:YAG lasers resulted in adequate surface changes for bonding ceramic brackets when compared to conditioned samples with HF [16]. This is also confirmed by Mirhashemi et al. who demonstrated that although conditioning with Er:CrYSGG met SBS requirements for orthodontic brackets, the SBS must be improved through refinement of the irradiation details [30]. Regarding zirconia crowns, FS laser at 200 mW and 60 μm is ideal treatment for conditioning, producing good SBS while also having a more sustainable energy consumption [53].
Importantly, no studies regarding the combined use of HF with laser (T7) included lithium disilicate ceramics, so we cannot ascertain if high bond values similar to the ones observed in the feldspathic ceramics could be obtained, or if the ceramic type is a decisive factor, like for the HF treatment.
Due to the lack of homogeneity in methodology within the currently available literature investigating the bond strength of orthodontic brackets to ceramic surfaces, the present review results present some limitations. To overcome this, calibrated studies analyzing the same parameters using the same protocols should be performed, hence providing stronger evidence. Further research focusing on surface changes, the architecture of the bracket base and the type of the adhesive resin should be performed.
5. Conclusions
Surface treatment protocols cannot be universal for all ceramic and/or all bracket types. Based on our results, we can conclude that for felspathic ceramics, the surface treatment which provides the best adhesion values is the use of hydrofluoric acid alone or concomitantly with LASER. For lithium disilicate ceramics, the treatment with the best results is the use of LASER alone, although combination with HF was not evaluated.
Lower bond strengths were observed in the orthophosphoric acid and fine burr groups. Further high-quality studies with similar methodologies regarding the ceramic type, surface protocol, surface changes, the architecture of the bracket base and the type of the adhesive resin are required.
Conceptualization, A.B.P. and I.F.; Methodology, F.M.; Software, C.M.M.; validation, C.N., R.T. and M.R.; Formal analysis, B.O. and F.P.; Investigation, F.V.; Resources, I.F. and C.M.M.; data curation, B.O. and E.C.; Writing—original draft preparation, A.B.P.; Writing—review and editing, F.M. and M.R.; visualization, C.N., R.T., F.P.; Supervision, F.V. and E.C.; Project administration, F.V.; Funding acquisition, E.C. All authors have read and agreed to the published version of the manuscript.
This research received no external funding.
Not applicable.
Not applicable.
The data presented in this study are available on request from the corresponding author.
The authors declare no conflict of interest.
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Enlarge this image.Figure 3. Forest plot of brackets adhesion to feldspathic ceramics with diverse superficial treatments. T1: Fine bur group; T2: Sandblasting (Al2O3) group; T3: orthophosphoric acid group; T4: hydrofluoric acid group; T5: LASER group; T6: Sandblasting (Al2O3) with hydrofluoric acid group; T7: LASER with hydrofluoric acid group. For each surface treatment, the number of studies included, the totality of samples evaluated, mean and standard deviation (SD), and 95% confidence intervals are described. Adhesion values are presented in MPa.
Enlarge this image.Figure 4. Forest plot of the evaluation of brackets adhesion to lithium disilicate ceramic with diverse superficial treatments. T1: Fine bur group; T2: Sandblasting (Al2O3) group; T3: orthophosphoric acid group; T4: hydrofluoric acid group; T5: LASER group. For each surface treatment, the number of studies included, the totality of samples evaluated, mean and standard deviation (SD), and 95% confidence intervals are described. Adhesion values are presented in MPa.
The PICO question.
| Population | Ceramic subtracts (crowns, veneers) … |
| Intervention | Adhesion Techniques … |
| Comparison | Diverse techniques (fluoride acid, sand blasting, adhesive, silane) …. |
| Outcome | Which is the most effective …. |
Summary of parameters and results from in vitro and ex vivo included studies.
| Authors, Year | Study Design | Type of Adhesion Technique (Type, Time, Clinical Application) | Type of Porcelain | Sample Size (n) | Test Group | Control Group | Bracket Type | Intervention Test | Results | Conclusions |
|---|---|---|---|---|---|---|---|---|---|---|
| Mohammed et al., 2019 [ |
Ex vivo | Five different surface conditioning methods: |
Porcelain | 60 | 50 ceramic crowns fabricated onto the premolar teeth following crown preparation | Natural teeth were acid etched in conventional manner using 37% H3PO4 acid (n = 10) | Metallic | SBST | G4 produced maximum bond strength of 12.34 ± 0.95 MPa comparable or even better than the control group 11.03 ± 1.63 MPa; G2 and G3 9% HF acid 11.48 ± 0.98 MPa; G5 F 9.28 ± 1.11 MPa. |
G4 produced maximum bond strength comparable or even better than the control group followed by G3 and G5. |
| Dilber et al., 2016 [ |
In vitro | Three surface conditioning methods: |
Feldspathic ceramic; Lithium disilicate glass ceramic; Nanocomposite; Polymer infiltrated ceramic network | 204 | CAD/CAM blocks (n = 204, n = 17 per group) of |
Specimens were mechanically roughened with fine diamond burrs placed with their shafts parallel to the specimen |
Metallic | SBST | Mean bond strength (MPa) values were significantly affected by the surface conditioning |
All CAD/CAM materials tested benefitted from additional surface conditioning either with HF acid or silica coating and silanization; |
| Miersch et al., 2019 [ |
In vitro | (1) Roughening, etching with 9% buffered HF acid; |
Leucite reinforced |
60 | 60 identical molar crowns with the morphology of tooth 36 were computer-aided designed and computer-aided manufactured (CAD/CAM) from a leucite-reinforced |
In group 6 (control), the |
Metallic | SBST | The highest mean value of SBST was examined in group 1 (61.56 MPa), followed by group iii (45.53 MPa), group 2 (41.65 MPa), and group 4 (23.14 MPa). |
A suitable coupling agent system produced clinically acceptable shear bond strengths capable of withstanding orthodontic forces. |
| Kurt et al., 2019 [ |
In vitro | G1: HF acid 9,6% for 2 min + silane; |
Feldspathic porcelain monolithic zirconia hybrid porcelain | 168 | 56 feldspathic porcelain, 56 monolithic zirconia, and 56 hybrid porcelain |
NR | Metallic | SBST | Of the materials conditioned with HF acid, the feldspathic porcelain group had the significantly highest bonding resistance (8.84). The surface-conditioning method did affect the SBST on different surfaces. | Variations of surface types of the materials affected the bonding resistance of orthodontic attachments. |
| Zhang et al., 2016 [ |
In vitro | G1: 9.6% HF acid for 2 min (HF); |
Silica based ceramic | 80 | G1 (HF); |
NR | Metallic | SBST | The HF-acid-treated group revealed the lowest bond strength value (3.1 MPa), which was significantly lower than those of the other three groups (p = 5.82 9 10–13). Silica-coating with silane (12.3 MPa) and sandblasting with silane (11.6 MPa) groups yielded similar bond strengths (p = 0.14), and both showed significantly higher shear bond strength than that of the HF acid with silane group. | Shear bond strengths exceeded the optimal range of ideal bond strength for clinical practice, except for the isolated HF group. |
| Recen et al., 2021 [ |
In vitro | Four surface conditioning methods: |
Feldspathic |
40 | G1: Sandblasting; |
NR | Metallic | SBST | No statistically significant difference (p > 0.05) was found in SBST between the groups | Considering the mean SBST values, all treatment methods except use of a diamond bur |
| Mehta et al., 2016 [ |
In vitro | Hydrofluoric acid 4% (HF), porcelain conditioner silane primer, reliance assure primer, reliance assures plus primer, and z prime plus zirconia primer | Feldspathic porcelain and zirconia | 72 | 36 zirconia specimens divided into 2 groups: G 1- sandblasting + HF + silane + ra primer; G 2- sandblasting + silane + ra plus primer. 36 glazed feldspathic porcelain specimens divided into two groups: G1- sandblasting + z prime plus primer; G2- sandblasting + ra plus primer. | One control group for zirconia porcelain group (sandblasting + porcelain conditioner (silane)) and |
Metallic | TBST | No statistically significant mean differences were found in tbs among the different bonding protocols for feldspathic and zirconia, 𝑝 values = 0.369 and 0.944, respectively. | Silanization following sandblasting resulted in tensile bond strengths comparable to other bonding protocols for feldspathic and zirconia surface. |
| Xu et al., 2018 [ |
In vitro | G1 9% HF acid for 2 min; G2 and G3 Er:YAG laser with two energy parameters: 250 mJ, 20 Hz and 300 mJ, 20 Hz; |
NR | 90 | 90 ceramic chips were divided into five groups (n = 18 each): | NR | NR | SBST | The SBST in G2 and G3 (treated by laser only) were low, only 2.97 and 3.11 MPa respectively; it was 5.28 MPa in G1 (HF). The SBST of G4 and G5, treated by both laser and HF, were 6.73 and 7.09 MPa respectively, much more than G1, G2, and G3. Based on the comparison between G1 and G2, there is a statistical difference in SBST (p < 0.05). By comparing G1 and G3, the SBST has statistical difference (p < 0.05). The comparison between G2 and G4 indicates the statistical difference in SBST (p < 0.05). Moreover, the statistical difference in SBST exists between G2 and G5 (p < 0.05), G3 and G5 ( p < 0.05). | The exclusive use of HF acid, or Er:YAG laser could not achieve sufficient bracketing bonding strength. |
| Ahrari et al., 2013 [ |
In vitro | G1, G2, G3: CO2 laser for 10 s a silane coupling agent was applied before bracket bonding; G4: 9.6% hydrofluoric HF acid gel was used for 2 min. | Feldspathic porcelain | 80 | Four groups of 20: |
NR | NR | SBST | Deglazing caused significant increase in SBST of laser treated porcelain surfaces (p < 0.05 but had no significant effect on SBST when HF acid was used for etching (p < 0.137). ANOVA revealed no significant difference in SBST values of the study groups when glazed surfaces were compared (p < 0.269). However, a significant between group difference was found among the deglazed specimens (p < 0.001). Tukey test revealed that the bond strengths of 10 W and 15 W laser groups were significantly higher than that of the HF acid group (p < 0.05). | Application of 9.6% hydrofluoric acid produced bond strength values that surpassed the minimum strength required in clinical conditions, either used on glazed or deglazed porcelain; due to the significantly higher bond strength, porcelain treatment with a fractional CO2 laser could be recommended as a suitable alternative technique to HF acid for bonding orthodontic brackets to deglazed feldspathic porcelain. |
| Mirhashemi et al., 2018 [ |
In vitro | G1: 9% HF for 2 min; |
Feldspathic porcelain | 60 | 60 specimens of maxillary incisor crown were prepared and randomly assigned to five groups: |
NR | Metallic | SBST | The average SBST [mean ± SD)] values in the five groups were as follows: HF (32.58 ± 9.21 MPa), Er:CrYSGG + HF (27.81 ± 7.66 MPa), Er:YAG + HF (23.08 ± 9.55 MPa), Er:CrYSGG (14.11 ± 9.35 MPa), and Er:YAG (6.30 ± 3.09 MPa). A statistically significant difference in SBST existed between the first three groups and the two laser groups (df = 4, F = 18.555, p < 0.001). | The Er:YAG laser with the stated specifications is not a suitable alternative to HF etching. In the case of Er:CrYSGG laser, although the conditioning outcome met the bond strength requirement for orthodontic brackets (that is, 6–8 MPa). Therefore, the bond strength must be further improved by fine-tuning the irradiation details. |
| Alavi et al., 2021 [ |
In vitro | G1: 9.6% hydrofluoric acid HF; G2: neodymium-doped yttrium aluminium garnet (Nd:YAG) laser; |
lithium disilicate–reinforced ceramic | 36 | 36 lithium disilicate ceramic blocks were assigned to three groups (n = 12): |
NR | Metallic | SBST | The median and interquartile range of SBST values in three groups were 6.48 (1.56–15.18), 1.26 (0.83–1.67), and 0.99 MPa (0.70–2.10), respectively. | Neither CO2 nor Nd:YAG lasers resulted in adequate surface changes for bonding of brackets on ceramics compared with the samples conditioned with HF. |
| Girish et al., 2012 [ |
G2: Bur for 10 s; |
NR | 70 | G2: bur; |
G1- untreated surface (n = 10) | Metallic | SBST | Sandblasting with silane produced the highest SBST among all the groups and showed a mean value of 15.18 MPa. The weakest SBST was seen in the control group with a mean of 1.57 MPa. The statistical results showed that there was a significant difference between all the groups. | Sandblasting with silane combination produced the highest SBST, so it is a clinically suitable method for bonding orthodontic metal brackets onto ceramic surface. | |
| Ji-Yeon Lee et al., 2015 [ |
In vitro | G0: No-primer (np); G1:porcelain conditioner (pc); G2: z-prime plus (zp); |
Zirconia | 100 | Four primer groups (n = 20 per group), and each primer was divided into two subgroups (n = 10 each) to examine by thermocycling protocols. | 1 control group (np) (n = 20) | Metallic | SBST | The SBST of all experimental groups decreased after thermocycling. Before thermocycling, the SBST was G4, G2 ≥ G3 ≥ G1 > G0 but after thermocycling, the SBST was G4 ≥ G3 ≥ G2 > G1 = G0 (p > 0.05). | Surface treatment with a zirconia primer increases the SBST relative to no-primer or silane primer application between orthodontic brackets and zirconia prostheses. |
| Ihsan et al., 2019 [ |
In vitro | G1: transbondtm XT primer; |
Zirconia | 30 | Single bond universal adhesive group (n = 10); |
G1: control group (n = 10) | Metallic | SBST | The highest value of the mean shear bond strength was in G2 (16.299 ± 2.201 MPa), followed by that of G3 (15.373 ± 1.575 MPa), while the G1 had the lowest value (5.337 ± 1.274 MPa). ANOVA showed that there was a statistically highly significant difference (p ≤ 0.01) among the mean values of the shear bond strength of all groups. | The two types of 10-mdp-containing adhesive systems provide good value of shear bond strength for buccal tubes bonded to zirconia surface, however, single bond universal adhesive/composite resin is the best. |
| Mehmeti et al., 2019 [ |
In vitro | Two different etching materials were used for conditioning of the surface of ceramic crowns: 5% HF and 37% H3PO4 for 120 s, and subsequently silane. | Zirconia and lithium-disilicate ceramics | 96 (all-ceramic crowns, |
Eight groups: |
NR | Ceramic and metallic orthodontic brackets | SBST | Lithium-disilicate showed better bond strength in almost all groups. However, no significant difference between the groups was noticed and none of the factors had a significant influence on the mean values of SBST (p > 0.05). | The use of HF for surface etching of zirconia and lithium-disilicate, does not cause a significant increase in the SBST values as compared to etching with H3PO4 and silane application. |
| Costa et al., 2012 [ |
In vitro | G1 and G2: 10% hydrofluoric acid gel for 20s with or without silane; |
Feldspathic porcelain | 8 | G1 and G2: cylinders were etched using 10% hydrofluoric acid gel for 20 s only (n = 2) and 10% hydrofluoric acid gel for 20 s and silane (n = 2); |
NR | Metallic | SBST | Silane application increased bond strength significantly (p < 0.05) compared with no silane application; the bonding material transbond XT promoted a significantly higher (p < 0.05) shear bond strength than fuji ortho lc, with or without silane application and for both etching times. The specimens etched for 20 s showed significantly lower (p < 0.05) shear bond strengths than those etched for 60s, for both bonding materials. | Etching time of 60 s, application of silane and transbond XT resin significantly improved the shear bond strength of brackets to feldspathic ceramics. |
| Dalaie et al., 2016 [ |
In vitro | 9% hydrofluoric acid for 2 min and silane | Feldspathic |
40 | 40 porcelain-fused-to-metal restorations and four different bracket base designs were bonded to these specimens | NR | Metallic and ceramic | SBST | One-way ANOVA showed that the SBST values were significantly different among the four groups (p < 0.001). Groups 1, 2, and 4 were not significantly different, but group 3 had significantly lower SBST (p < 0.001). | The bracket base design significantly affects the SBST of brackets to feldspathic porcelain. |
| Juntavee et al., 2020 [ |
In vitro | 9.6% HF for 15 s | Feldspathic based ceramic; lithium disilicate glass-ceramic; fluoroapatite-leucite glass-ceramic; BIS-GMA, BIS-EMA, TEGDMA 73–77% silanated |
60 | Machined ceramic specimens (10 × 10 × 2 mm) were prepared from vitablocs mark II (vita) and IPS e.max® CAD (ivoclar). Layered porcelain fused to metal was used to fabricate PFM specimens. Half of specimens (n = 30) were etched. Three resin bonding systems were used for attaching metal brackets to each group (n = 10): transbond™ XT (3 m), light bond™ (reliance), or blugloo™ (Ormco), all cured with |
Control group (n = 30) specimens nonetched | Metallic | SBST | There were significant effects on SBST of metal bracket to the ceramic veneering materials due to the factor of different types of ceramic materials, surface treatment, resin bonding materials, interaction between types of ceramic materials, and types of adhesive resin cement (p < 0.05). The mean SBST of metal bracket bonded to vitablocs™ mark II was higher than bonded to IPS e.max® CAD and bonded to IPS d.SIGN® porcelain (p < 0.05). The mean SBST of metal bracket bonded to IPS d.SIGN® porcelain for PFM was significant lower than the mean SBST of metal bracket bonded to vitablocs™ mark II ceramic materials (p < 0.05). Also, the mean SBST of metal bracket bonded to IPS e.max® CAD ceramic reveals significantly lower than the mean SBST of metal bracket bonded to vitablocs™ mark II ceramic materials (p < 0.05). | Etching ceramic surface enhanced ceramic-bracket bond strength. However, bond strengths in nontreated ceramic surface groups were still higher than bond strength required for bonding in orthodontic treatment. |
| Kaygisiz et al., 2015 [ |
In vitro | G1: Sandblasting with AL2O3 for 4 s; |
Three groups: metal, sapphire and zirconia (n = 28/group). | 84 | The mounted specimens were randomly divided into four groups: |
NR | Metallic, saphire and zirconia | SBST | Statistical analysis indicated significant differences among surface treatment procedures (p < 0.0001). In addition, the effect of the first and second bonding factors on SBST behaviors was shown to be significant for the brackets (p < 0.001). | The use of sandblasting, HF treatment and silanization procedure could be used for improving the rebond shear bond strength of zirconia brackets to porcelain surface. |
| Topcuoglu et al., 2013 [ |
Ex vivo | Sandblasted + 9.6% HF gel for 2 min; Er:YAG laser short pulse (sp); Er:YAG laser super short pulse (ssp); sandblasted+ sp, or sandblasted + ssp | Porcelain-fused-to-metal | 150 | Nine groups differing in adhesive system and surface treatment. In five groups, the adhesive system was Relyx u 200 and in the other four, Transbond XT was used. For each adhesive system, the porcelain surfaces were treated in one of five different ways: sandblasted + HF, Er:YAG laser sp, Er:YAG ssp, sandblasted + sp, or sandblasted + ssp. | Sandblasted group with transbond XT (n = 15) | Metallic | SBST | There were statistically significant differences among groups (p = 0.002). The highest SBST were observed in G2 (8.83–3.3 MPa), followed by groups 1, 8, 10, and 9 (in that order) with values of 8.25–3.2, 3.48–1.7, 3.11–0.93, and 1.56–0.86 MPa, respectively. The results of the independent samples t-test indicated that there were no statistically significant differences between G1 and the control group (p = 0.635). There were no statistically significant differences between G8 and G10 (p = 0.502). | Er:YAG laser application did not allow for elimination of the hydrofluoric acid step. |
| Gonçalves et al., 2011 [ |
In vitro | G1: 10% hydrofluoric acid for 20 s + silane; |
Feldspathic ceramic | 60 | The specimens for each etching time were assigned to four groups (n = 15), according to the light source: xl2500 halogen light, Ultralume 5 LED, Acucure 3000 argon laser, and Apollo 95e plasma arc. Light-activation was carried out with total exposure times of 40, 40, 20 and 12 s, respectively. | NR | Metallic | SBST | Specimens etched for 20 s presented significantly lower bond strength (p < 0.05) compared with those etched for 60 s. | Only the etching time had significant influence on the bond strength of brackets to ceramic. |
| Akpinar et al., 2015 [ |
In vitro | G1: SB for 3 s with Al2O3; |
Feldspathic porcelain | 80 | G1: Group sandblasting; |
NR | Metallic | SBST | The bond strength in G3 (5.11–1.53) was significantly lower than the other groups (p < 0.05). There were no statistically significant differences among G1 (9.07–3.76), G2 (9.09–3.51), and G4 (11.58–4.16) (p = 0.28). | G4 treatment produced high SBST of the processes assessed; therefore, it appears to be an effective method for bonding orthodontic metal brackets to prepared porcelain surfaces. |
| Asiry, et al., 2018 [ |
In vitro | G1: HF; |
NR | 120 | Four groups of 30 specimens: |
60 | NR | SBST | Group 4 exhibited highest SBST at baseline (14.68 ± 0.28) and after thermo-cycling (12.67 ± 0.22) while G1 specimens exhibited lowest SBST at baseline (6.32 ± 0.15) and after thermo-cycling (4.32 ± 0.26). G1 specimens demonstrated lowest SBST; and G4 specimens showed the highest SBST. | Increased surface roughness enhanced SBST of the specimens. |
| Erdur et al., 2015 [ |
In vitro | G1: Sandblasting for 20 s; |
Feldspathic and IPS Empress e-Max | 150 | 150 ceramic discs were prepared and divided into two groups. In each group, the following five subgroups (n = 15) were set up: G5 Ti:sapphire laser, |
NR | NR | SBST | Feldspathic and IPS Empress e-Max ceramics had similar SBST values. The Ti:sapphire femtosecond laser (16.76–1.37 MPa) produced the highest mean bond strength, followed by sandblasting (12.79–1.42 MPa) and HF acid (11.28–1.26 MPa). The Er:YAG (5.43–1.21 MPa) and Nd:YAG laser (5.36–1.04 MPa) groups were similar and had the lowest SBST values. | Ti:sapphire laser- treated surfaces had the highest SBST values. Therefore, this technique may be useful for the pretreatment of ceramic surfaces as an alternative to conventional’ techniques. |
| Asiry et al., 2018 [ |
In vitro | G1: IPS ceramic etching gel™ and Monobond plus™; |
Lithium disilicate | 40 | The specimens were randomly assigned to two experimental groups (n = 20), G1 specimens were treated with two-step surface conditioning system (IPS ceramic etching gel™ and Monobond plus™) and G2 specimens were treated with one-step surface conditioning system (Monobond etch and prime™). Ten |
N = 20 | NR | SBST | The specimens treated with two-step conditioning system had higher bond strength than one-step conditioning system. | Traditional two-step conditioning provides better bond strength. The clinical importance of the study is that, the silane promoted adhesion significantly reduces on exposure to thermo-cycling. |
| Franz et al., 2019 [ |
In vitro | The bonding agent |
Zirconia | 20 | The ceramic blocks (n = 20) were randomized and divided into two groups and fixation of brackets was done either by using |
NR | Metallic | SBST | SBST resulted in significantly higher shear bond values when Monobond Etch & Prime was used compared to the use of Monobond S. | The use of Monobond Etch & Prime has great potential for the bonding of brackets on dental zirconia ceramics. |
| Yu et al., 2021 [ |
In vitro | All specimens were etched with 9.5% hydrofluoric acid for 20 s. |
Lithium |
80 | Four groups |
NR | Metallic | SBST | In all groups, the mean SBST values were statistically significantly lower (p < 0.001) after thermocycling than before. Furthermore, specimens |
The application of a silane-containing universal adhesive without silane pretreatment achieves adequate durability of the bond of metal brackets to dental glass ceramics |
| Abdelnaby, 2011 [ |
In vitro | G1: 9.6% HF for 2 min; |
Feldspathic porcelain | 100 | The specimens |
NR | Metallic | SBST | Embrace First-Coat and silane exhibited a comparable SBST. The sandblasting process significantly increased SBST. No significant difference was found in bond SBST utilizing either hydrofluoric acid and Embrace First-Coat or sandblasting and silane. With regard to CSBS, the use |
Embrace First-Coat primer could be used successfully as an alternative to silane. |
| Cevik et al., 2017 [ |
In vitro | G1: 37.5% orthophosphoric acid for 4 min; |
Feldspathic and |
120 | Five subgroups depending on surface treatment (n = 10) G1: 37.5% orthophosphoric acid; |
Control group (n = 10) | Metallic | SBST | G4 demonstrated significantly higher shear bond strengths |
Surface conditioning methods, except for sandblasting and grinding, were associated with lower shear bond strengths; however, thermocycling may have had negative effects on bond strengths of specimens. Furthermore, in each ceramic system, there was a significant difference between surface-conditioning methods and surface roughness with regard to shear bond strength. |
| Saraç et al., 2011 [ |
In vitro | G1: Air-particle abrasion (APA) with 25 mm for 4 s |
Feldspathic, fluoro-apatite, and leucite-reinforced ceramic. | 60 | 20 feldspathic, 20 fluoro-apatite, and 20 leucite-reinforced ceramic specimens were examined following two surface-conditioning methods: G1: APA with 25 mm Al2O3 and G2: silica coating with 30 mm Al2O3 particles modified by silica. | NR | Metallic | SBST | The lowest SBST was with APA for the fluoro-apatite ceramic (11.82 MPa), which was not significantly different from APA for the feldspathic ceramic (13.58 MPa). The SBST for the fluoro-apatite ceramic was significantly lower than that of leucite-reinforced ceramic with APA (14.82 MPa). The highest SBST value was obtained with silica coating of the leucite-reinforced ceramic (24.17 MPa), but this was not significantly different from the SBST for feldspathic and fluoroapatite ceramic (23.51 and 22.18 MPa, respectively). The SBST values with silica coating showed significant differences from those of APA. | Chairside tribochemical silica coating significantly increased mean bond strength values; With all surface-conditioning methods, leucite-reinforced ceramic, in general, showed a higher SBST than feldspathic and fluoro-apatite ceramics. |
| Hsu et al., 2015 [ |
In vitro | G1: 37% phosphoric acid solution for 60 s, and porcelain primer (H3PO4) was applied to the etched porcelain crown surface for another 60 s; |
Glazed ceramic porcelain fused to metal (PFM) | 50 | Five groups for bonding, each group n = 10; |
NR | Metallic | SBST | The Porcelain Primer group had the lowest bond strengths and the H3PO4-Jeneric/Pentron silane group had the highest bond strengths (p < 0.0005). Cross-matching of acid and silane showed that acid had a statistically significant effect on bond strength. The H3PO4-Jeneric/Pentron silane group had the highest bond strength among all acid silane groups. | The Porcelain Primer group had the lowest bond strength, showing statistically significant differences to those of the Jeneric/Pentron groups (either phosphoric acid or HF acid etching) (p < 0.0005). Although acid might be more important than silane (p = 0.005) for bond strength, there were no statistically significant differences in bond strength among the other four etching-silane groups (phosphoric acid vs. HF acid; Ultradent vs. Jeneric/Pentron). |
| Durgesh et al., 2016 [ |
In vitro | A silane-based primer consisting of 1.0 vol-% of 3 acryloxypropyltrimethoxysilane (ACPS) in 95.0 vol-%/5.0 vol-% ethanol/water, with a ph of 4.5; experimental primer, a novel silane system consisting of 0.5 vol-% of a cross-linker silane monomer bis-1,2-(triethoxysilyl) ethane (BTSE) which was added to 1.0 vol-% of acps, corresponding to a final 1.5 vol-% of silanes. | Glazed ceramic porcelain fused to metal (PFM) | 180 | Two groups of 90 specimens, according to the primer used. Each group was further divided into three subgroups according to the surface treatment to be received, thus there were 6 study groups; |
NR | NR | SBST | The highest SBST at baseline (26.8 + 1.7 MPa) and after thermocycling (24.6 + 1.7 MPa) was observed in group 2c, and the lowest (9.6 + 1.5 MPa and 4.5 + 1.1 MPa) was found in G1a. | The application of experimental silane primer system on specimens pretreated with tribochemical silica-coating demonstrated increased adhesion of orthodontic brackets making it an excellent choice in orthodontic bonding for a relatively long term use. |
| Bavbek et al., 2014 [ |
In vitro | Air abrasion with 30-μm silica coated aluminum oxide (Al2O3) particles (cojet) for 20 s; air abrasion with 50-μm Al2O3 particles. | Monolithic zirconium oxide ceramic (mz). | 120 | Two types of MZ (BruxZir Solid Zirconia, n = 60; Prettau-Zirkon, n = 60) with two types of surface finish (glazed, n = 30 per group; polished, n = 30 per group) were tested after two surface conditioning methods: 1. air abrasion with 30-μm silica coated aluminum oxide (Al2O3) particles (CoJet), or 2. air abrasion with 50-μm Al2O3 particles. | The non-conditioned group acted as the control. | NR | SBST | Mean μSBST values (MPa) did not show a significant difference between the two brands of MZ (p > 0.05). In both glazed (44 ± 6.4) and polished (45.9 ± 4.8) groups, CoJet application showed the highest μSBST values (p < 0.001). The control group (34.4 ± 6) presented significantly better results compared to that of Al2O3 (30 ± 3.8) (p < 0.05) on glazed surfaces, but it was the opposite in the polished groups (control: 20.3 ± 4.7; Al2O3: 33.8 ± 4.7; p < 0.001). | Air abrasion with CoJet followed by the application of universal primer improved the μSBST (microshear bond strength) of orthodontic resin to both the polished and glazed monolithic zirconium oxide materials tested |
| Sandoval et al., 2020 [ |
In vitro | Hydrofluoric acid 10% + silane; sandblasting with aluminum oxide + silane; hydrofluoric acid 10% + Single Bond Universal; blasting with aluminum oxide + Single Bond Universal. | NR | 60 | G1: hydrofluoric acid + 10% silane; G2: blasting with aluminum oxide + silane; G3: hydrofluoric acid 10% + Single Bond Universal and G4: blasting with aluminum oxide + Single Bond Universal. | NR | Metallic | SBST | The average shear strengths were: G1 = 24.2 MPa; G2 = 21.3 MPa; G3 = G4 = 19.1 MPa to 14.2 MPa. There were differences between all groups (p < 0.05) except for G3 (p > 0.05). | Single Bond Universal treated with blasting aluminum oxide had the best performance, and promoted good shear strength, it caused less cohesive damage to the ceramic. |
| Najafi et al., 2014 [ |
In vitro | Roughened with a diamond bur and etched with hydrofluoric acid (HF) gel for 4 min; roughened with a bur and irradiated by a CO2 laser with a 2W power setting for 20 s; CO2 laser; sandblasted with 50 μm aluminum oxide for 20 s. Before bonding, the bracket silane was applied on the porcelain surfaces. | Feldspathic porcelain fused to metal. | 48 | Four groups: |
NR | Metallic | SBST | ANOVA revealed significant differences in SBS among the four groups (p < 0.001). G1 demonstrated significantly higher bond strength |
Deglazing combined with HF etching produced the highest bond strength, but CO2 laser irradiation provided adequate bond strength and allowed for elimination of the HF step. Deglazing is not recommended as a preliminary step before CO2 laser conditioning. |
| Durgesh, 2020 [ |
In vitro | Grit-blasted with various distance (5 mm, 10 mm and 15 mm) with 1.0 vol. % 3 methacryloyloxypropyltrimethoxy-silane (ep1) or their blends with 0.5% (ep2), and 1.0 vol. % (ep3) 1, 2-bis-(triethoxysilyl) ethane (all in ethanol/water). | Zirconia | 180 | A total of 180 zirconia specimens were used for three test groups (n = 60), and then grit-blasted with various distance (5 mm, 10 mm and 15 mm). The grit-blasted specimens were allocated to three silanizations (n = 30): with 1.0 vol. % 3 methacryloyloxypropyltrimethoxysilane (EP1) or their blends with 0.5% (EP2), and 1.0 vol. % (EP3) 1, 2-bis-(triethoxysilyl) ethane (all in ethanol/water). | NR | NR | AST | ANOVA showed a significant influence of the grit-blasting distance, silane blend and artificial |
Grit-blasting at 10 mm and silane primer blend of 1.0 vol. % 3-MPS and 0.5 vol. % BTSE provided acceptable orthodontic bonding with least surface damage to zirconia surface. |
| García-Sanz et al., 2019 [ |
In vitro | Air particle abrasion (APA) with alumina particles (Al2O3) for 20 s; femtosecond Ti:sapphire laser for 12 min. | Zirconia | 180 | Five groups (n = 30) according to surface treatment: |
G1- control group: No treatment applied (n = 30). | NR | SBST | SBST in groups 3 and 6 was significantly higher than the other groups (5.92 ± 1.12 MPa and 5.68 ± 0.94 MPa). No significant differences were found between groups 1, 2, 4, and 5 (3.87 ± 0.77 MPa, 4.25 ± 0.51 MPa, 3.74 ± 0.10 MPa, and 3.91 ± 0.53 MPa). | FS laser at 200 mW, 60 μm can be recommended as the ideal settings for treating zirconia surfaces, producing good SBST and more economical energy use. |
| Stella et al., 2015 [ |
In vitro | G1: 37% gel phosphoric acid etching for one minute + Silane application for one minute; |
NR | 52 | Four experimental groups (n = 13) were set up according to the ceramic conditioning method: |
NR | Metallic | SBST | The highest shear bond strength values were found in groups G3 and G4 (22.01 ± 2.15 MPa and 22.83 ± 3.32 Mpa, respectively), followed by G1 (16.42 ± 3.61 MPa) and G2 (9.29 ± 1.95 MPa). | Acceptable levels of bond strength for clinical use were reached by all methods tested; however, liquid phosphoric acid etching followed by silane application (G2) resulted in the least damage to the ceramic surface. |
| Epperson et al., 2021 [ |
Ex vivo | 9.6% HF was for 4 min; 35% phosphoric acid (PA) with subsequent silanation; 50 μ aluminum oxide microetching (MIC) | Hybrid ceramics | 60 | G1: Lava (HF); |
Enamel control group (n = 10) (35% phosphoric acid for 30s and rinsed |
Metallic | SBST | The SBST of all groups, except the HF Enamic® group, were significantly lower than the mean SBS of the enamel control group (8.8 MPa). The mean shear bond strength values of Enamic® were significantly higher than those of Lava™ Ultimate |
Statistically, only Enamic® treated with HF exhibited sufficient SBST when compared with the enamel control. |
| Al-Hity et al., 2012 [ |
In vitro | The influence of using different combinations of bracket, adhesive, and light- curing source on the tensile bond strength to porcelain Tensile tests were performed using: one ceramic bracket versus one metal bracket, two orthodontic composites; type bisphenol A-glycidyldimethacrylate and urethane dimethacrylate (UDMA), and four light- curing units with the same range of emission spectrum but various light intensities: three light- emitting diode (LED) units and one halogen-based unit. | Fluorapatite glass-ceramic- | 160 | 160 porcelain samples were randomly divided into 16 equal groups. The porcelain surface was conditioned with 9% hydrofluoric acid before silane application. The composite was photo- polymerized for 40 s. | NR | Metallic and ceramic | TBST | The bond strength in all groups was sufficient to withstand orthodontic treatment (>6 MPa). There was no statistical difference between the adhesives, but comparing bracket × light interaction, it was significantly higher with the ceramic bracket. No significant differences were seen between the metal bracket groups, but for the ceramic bracket, the results were significantly higher with the LED light | No significant difference between adhesives’ composition related to the bonding strength on porcelain. |
| Ghozy et al., 2020 [ |
In vitro | 9.5% HF for 1 min; 37% PA gel for 1 min. | VITABLOCS Mark II, VITAENAMIC, and IPS e.max CAD. | 120 | 120 CAD/CAM ceramic blocks in 12 groups were fabricated from three |
NR | Metallic and ceramic | SBST | There were no significant differences in SBS values between the three CAD/CAM ceramic materials. The HF-treated specimens exhibited significantly higher SBS values than the PA-treated specimens. Also, the SBS values of CBs were significantly higher than the BM. | The CAD/CAM ceramic type did not influence SBST; however, HF exhibited significantly higher SBST compared to PA. |
| Ramos et al., 2012 [ |
Ex vivo | G2: Diamond bur and processed with phosphoric acid 37% for 30 s; |
NR | 40 | n = 10 for each group. G2: fine diamond bur + orthophosphoric acid gel 37%; G3: HF 10%; |
G1-control group: No surface treatment (n = 10). | Ceramic | SBST | There was a significant difference (p < 0.05) between the control group and all other groups. There was no significant difference (p < 0.05) between treated porcelain surface with diamond bur + orthophosphoric acid gel 37% (4.8 MPa) and HF 10% (6.1 MPa), but the group treated with HF 10% had clinically acceptable bond strength values. The group treated with HF 10% + silane (17.5 MPa) resulted in a statistically significant higher tensile bond strength (p < 0.05). In G4, 20% of the porcelain facets displayed damage. | Etching of the surface with HF 10% increased the bond strength values. Silane application was recommended to bond a ceramic bracket to the porcelain surface to achieve bond strengths that are clinically acceptable. |
| Mehmeti et al., 2018 [ |
In vitro | G1: 5% HF for 2 min; |
Feldspar-based porcelain PFM. | 48 | Four groups (n = 12): |
NR | Metallic and ceramic | SBST | SBST values of the groups etched with HF and silane, compared to the groups etched with phosphoric acid and silane, are not significantly increased. However, ceramic brackets show significantly higher SBST values than metallic brackets. | Both types of ceramic surface conditioning procedures have similar features and provide strong enough SBST values to realize the orthodontic treatment. Also, the assumption that only the type of bracket significantly affects the SBST value can be accepted. |
| Baeshen, 2021 [ |
In vitro | G1: Er-YAG laser for about 30 s + S coupling agent for 30 s; |
Lithium di silicate (LDC) | 70 | Seven groups according to ceramic surface conditioning. |
G3 HF + S (control). | Metallic | SBST | SBST values of G2 HF acid + S displayed highest bond durability (22.28 ± 1.09 MPa). Whereas, specimens in G4 surface treated with 120 μm Al2O3 displayed lowest SBST scores (11.81 ± 0.55 MPa) and these bond scores were comparable to PDT using MBP + S (12.54 ± 1.09 MPa) (p > 0.05). LDC surface treated by Er,Cr:YSGG + S (21.11 ± 3.85 MPa), HF + UB + S (19.28 ± 0.52 MPa) exhibited results comparable to HF acid + S (p > 0.05). | LDC conditioned with HF–S still remains as gold standard. Use of PDT for surface treatment of LDC and bonded to metallic bracket is not recommended as it results in decreased bond durability. Use of Er,Cr:YSGG-S and HF + UB + S has a potential to be used alternatively to HF–S for LDC conditioning. |
| Tahmasbi et al., 2020 [ |
In vitro | G1: universal adhesive (ScotchbondTM Universal adhesive) 20 s, air spray 5 s, light cured 10 s 650 mW/cm3; |
Feldspathic porcelain | 56 | n = 14–universal adhesive; |
NR | NR | SBST | The highest SBST was noted in the universal adhesive/silane group (12.7 MPa) followed by conventional adhesive/silane (11.9 MPa), conventional adhesive without silane (7.6 MPa), and universal adhesive without silane (4.4 MPa). | SBST of bracket to porcelain mainly depends on the use of silane rather than the type of adhesive. Both universal and conventional adhesives yield significantly higher SBST in the presence of silane compared to that in the absence of silane |
| Mehmeti et al., 2017 [ |
In vitro | Phosphoric acid 120 s, composite resin-based bonding system, T light cured 40 s using light-emitting diode. | All-zirconium ceramic | 20 | n = 10–metallic bracket; |
NR | Metallic and ceramic polycrystalline | SBST | Force necessary to debond metallic brackets (sum of 10 tests = 70,797 N) of the zirconium crowns were higher than those of ceramic brackets (sum of 10 tests = 59,770 N), with a significant difference. | Metallic brackets compared with ceramic polycrystalline brackets, seem to create stronger adhesion with all- zirconium surfaces due to their better base surface design or retention mode. Also, ceramic brackets show higher fragility during debonding. |
| Yassaei et al., 2013 [ |
In vitro | G1: 9.6% HF; |
Porcelain | 100 | Four groups: |
NR | Metallic | SBST | The mean shear bond strength in the laser group with power of 1.6 W (7.88 MPa) was more than that of the HF (7.4 MPa), 2-W power (7.52 MPa), and 3.2-W power (7.45 MPa) groups, but this difference was not statistically significant. | Er:YAG laser can be a suitable method for bonding of orthodontic brackets to porcelain surfaces. |
| Gardiner et al., 2019 [ |
In vitro | Hydrofluoric acid etch | Zirconia; |
60 | Zirconia (n = 20): 9.6%HF+silane (n = 10), silane (n = 10); |
Enamel (n = 10): 35% PA etch | Metallic | SBST | SBST of the lithium silicate infused with zirconia groups were significantly less than the chemically pre-treated lithium disilicate group, however both materials, when chemical pre- treatment protocol was used, were not statistically different than the enamel control. | Orthodontic bonding to lithium silicate infused with zirconia yielded a weaker shear bond strength than bonding to traditional lithium disilicate, however, when the surface was pre- treated with hydrofluoric acid etch it provides a bond strength that is within an acceptable clinical range. |
| Golshah et al., 2018 [ |
In vitro | 10% HF acid 2 min and the following bonding protocols: |
Glazed feldspathic porcelain | 40 | G1: Transbond XT bonding agent (n = 10); G2: silane plus Transbond XT bonding agent (n = 10); |
NR | Metallic | SBST | The highest and the lowest SBST values were noted in groups silane plus universal adhesive (17.06 ± 2.58 MPa) and universal adhesive (9.85 ± 4.76 MPa), respectively. Type of adhesive had no significant effect on SBST (p = 0.611). However, the effect of application of silane on SBST was significant (p = 0.000). Groups subjected to the application of silane showed higher SBST values than others. | Universal adhesive and Transbond XT were not significantly different in SBST. |
| Hosseini et al., 2013 [ |
In vitro | 0.75-, 1-, 1.25-, 1.5- and 2-W neodymium-doped yttrium aluminum garnet (Nd:YAG) laser 10 s; |
Glazed porcelain | 72 | n = 12–HF; |
NR | Metallic | SBST | The mean ± SD of the shear bond strength in the laser group 0.75, 1, 1.25, 1.5, and 2 W and HF group was 2.2 ± 0.9, 4.2 ± 1.1, 4.9 ± 2.4, 7 ± 1.7, 9.6 ± 2.7, and 9.4 ± 2.5, respectively. Together with the increased power of laser, the mean shear bond strength was increased continuously and no significant differences were found between the HF group and the laser groups with power of 1.5 or 2 W. | 1.5 and 2 W powers of Nd:YAG laser can be used as an alternative method for porcelain etching. |
| Naseh et al., 2018 [ |
In vitro | 9.6% hydrofluoric acid and divided into two groups: silane, air-dried, Transbond XT primer light-cured; |
Feldspathic; lithium disilicate | 40 | n = 10–feldspathic with Assure Plus; |
n = 10–feldspathic with silane+Transbon; |
Metallic | SBST | Bracket bond to lithium disilicate by Assure Plus was significantly stronger than that to Feldspathic porcelain (p = 0.041). | Assure Plus provided high bond strength between ceramic and brackets and minimized damage to lithium disilicate ceramic during debonding. Assure Plus is recommended for use in orthodontic treatment of adults with ceramic restorations. |
| Cevik et al., 2018 [ |
In vitro | G1: 37% phosphoric acid 4 min; |
Feldspathic porcelain | 60 | G1: 37% phosphoric acid (n = 10); |
Without surface treatment (n = 10). | Ceramic | SBST | Using G5 specimens resulted in the highest shear bond strength value of 8.58 MPa for feldspathic porcelain. However, the other specimens showed lower values: G3 (6.51 MPa), G4 (3.37 MPa), G2 (2.71 MPa), G1 (1.17 MPa), and control group (0.93 MPa). | Airborne-particle abrasion and grinding can be used as surface treatment techniques on the porcelain surface for a durable bond strength. |
| Juntavee et al., 2018 [ |
In vitro | Er-YAG laser power 200 mJ, 10 W, 20 Hz, 10 s-pulse length for 20 s; |
Machined ceramic specimens: |
45 | n = 15–Er-YAG laser; |
NR | Ceramic | SBST | Significant differences in bond strength among groups were found related to surface treatment (p < 0.05), but not significant difference upon type of ceramics (p > 0.05). E15 provided higher bond strength than Er-YAG laser and E5 (p < 0.05). | Bond strength was affected by surface treatment. Both Er-YAG laser and E15 treated surface provided higher bond strength than E5. Considering possibly inducing defect on ceramic surface, Er-YAG laser seems to provide better favorable surface preparation than others. Treated ceramic surface with Er-YAG prior to bracket bonding is recommended. |
| Sabuncuoglu et al., 2016 [ |
In vitro | G1: Cylindrical diamond bur rotate at 40,000 rpm 3 s; |
Feldspathic | 70 | G1: Diamond bur (n = 10); |
NR | NR | SBST | The highest SBST values were observed for SB + HF, with no significant difference between SB+HF and HF. SBST values for Diamond bur were significantly lower than those of all other groups tested. | Diamond bur alone is unable to sufficiently etch porcelain surfaces for bracket bonding. SB+HF results in a significantly higher shear-bond strength than HF or SB alone. Nd:YAG or Er:YAG laser was found to be more effective and less time-consuming than both HF acid and SB. |
| Aksakalli et al., 2015 [ |
Ex vivo | G1: SB with alumina particles 50 μm, at 65–70 psi, 10 s, 10 mm (SB); |
Porcelain laminate veneer | 39 | G1: SB (n = 13); |
NR | NR | SBST | The highest shear bond strength values were obtained with group HF (10.8 ± 3.8 MPa) and group ER (9.3 ±1.5 MPa), whereas group SB revealed the lowest values. The sandblasting method did not demonstrate any ideal bond strength values; however, the 9.6% hydrofluoric acid etching and Er: YAG laser did. | The Er: YAG laser can be selected for bonding brackets to porcelain surfaces with acceptable bond strength and minimal surface damage as compared to the other methods. |
| Lestrade et al., 2021 [ |
In vitro/Ex vivo | G1: Bond enhancer (Assure, Reliance, IL, USA); |
Lithium disilicate | 70 | G1: Porc-Etch, 9.6% HF, Porcelain Conditioner, silane, bond enhancer (Assure, Reliance, IL, USA) (n = 10); |
n = 10–HF + silane; |
Metallic | SBST | No significant differences were found in SBST values, with the exception of surface roughening with a green stone prior to HF and silane treatment. This protocol yielded slightly higher bond strength which was statistically significant | The present in-vitro study found that SBST values for ceramic pretreatment all fell within an acceptable clinical range and similar to the bond strength of enamel. No significant differences were found in the SBST values, with the exception of roughening with a green stone prior to HF and silane treatment, which yielded slightly higher bond strength. |
| Poosti et al., 2012 [ |
In vitro | Tungstem carbide burrs; |
Glazed porcelain | 100 | G1: tungsten carbide burs (n = 20); |
NR | Metallic | SBST | Although Tukey’s test showed SBST in tungsten carbide burs+ 9.6% hydrofluoric acid and Nd:YAG laser were significantly higher than the other groups, they did not differ with each other significantly (p > 0.05). The results revealed that SBST of 9.6% hydroflouric acid and Nd:YAG Laser was in an acceptable range for orthodontic treatment. | Nd:YAG laser was shown to be an acceptable substitute for hydrofluoric acid while Er:YAG laser with the mentioned power and duration was not a suitable option. |
| AlShahrani et al., 2019 [ |
In vitro | G1: 9.6% Hydrofluoric acid+ S 60 s; |
Lithium disilicate | 50 | G2: Er,Cr:YSGG laser+ S (n = 10); |
G1: HF+ S (n = 10). | Metallic and ceramic polycrystalline | SBST | The highest SBST values were presented by HF + S (21.08 ± 1.06). The lowest SBST values were displayed by Al2O3 (12.61 ± 0.45). SBST of samples conditioned with self-etch glass ceramic primer showed significant difference amongst all experimental groups (16.76 ± 0.81). | Lithium disilicate ceramics photosensitized with CO2 and Er,Cr:YSGG has a potential to be recommended in clinical settings alternate to HF+S when bonded to metallic bracket. |
| May et al., 2015 [ |
In vitro | 10% HF 20 s; aluminum oxide blasting 15 s, pressure at 80 psi, 5 mm; 35% phosphoric acid 30 s; |
Eris ceramic; d. Sign ceramic | 120 | n = 60–Eris Ceramic; n = 15 -10% HF; n = 15–10% HF + S; n = 15 -aluminum oxide blasting + 35% phosphoric acid + S; n = 15 -CoJet blasting + 35% phosphoric acid + S); |
NR | Metallic | SBST | There were statistically significant differences among the ceramics (p = 0.01) and surface treatments (p = 0.0001), but it did not show interaction among them (p = 0.14). | The tested ceramics performed similarly in terms of bond strength; the use of S after HF was responsible for the increase of bond strength values; HF+ S, as well as aluminum oxide +phosphoric acid+S provided significantly higher bond strength values to metallic brackets; the CoJet system did not result in significantly higher values than those observed for aluminum oxide blasting, becoming similar to the groups treated with HF without S; aluminum oxide blasting followed by phosphoric acid etching and S presented results similar to the treatment with HF + S. |
| Alqerban, 2021 [ |
In vitro | G2: S; |
Lithium disilicate | 90 | G2: S 30 s (n = 15); |
G1: HF + S 20s (n = 15). | Metallic | SBST | The highest SBST values were observed in HF+ UB + S (18.21 ± 1.241) and the lowest SBST values IN S only (5.21 ± 0.23). Specimens surface conditioned with HF+ S (17.85 ± 1.25), HF+ UB + S (18.21 ± 1.241) and Er,Cr:YSGG laser+ S (17.09 ± 1.114) unveiled comparable SBST values (p > 0.05). | Lithium disilicate conditioned with Er,Cr:YSGG laser has a potential to be used in clinical settings alternate to HF. |
| Elsaka, 2016 [ |
In vitro | 9% HF 1 min; |
Vita Enamic (VE) CAD/CAM hybrid ceramic | 240 | n = 120–ceramic bracket (n = 30-HF; n = 30-H3PO4; n = 30–diamond ceramic grinding bur; n = 30-CJ). |
NR | Ceramic and metal brackets | SBST | SBST was significantly affected by the type of bracket and by type of treatment (p < 0.001). Specimens treated with CJ presented with significantly higher SBST compared to other groups (p < 0.05). Improvements in SBST values (MPa) were found in the following order: CJ [ HF [ Bur [H3PO4. Ceramic bracket showed higher SBST compared to metal bracket. | Surface treatment of VE CAD/CAM hybrid ceramic with silica coating enhanced the adhesion with ceramic and metal brackets. Ceramic bracket provided higher bond strength com- pared to metal bracket. |
| Falkensammer et al., 2012 [ |
In vitro | 5% HF 60/30 s, 9.6% buffered HF 9.6%, 60/30 s; |
Metal- and all-ceramic veneering: feldspathic; leucite; leucite-free; |
960 | The four types of ceramic were allocated to each of the six conditioning groups, resulting in 24 subgroups of 40 brackets each. | NR | NR | SBST | HF 5% or SB resulted in significantly (p < 0.001) higher bond strengths (mean values: 34.11 and 32.86 MPa, respectively) than with HF 9.6% (mean value: 12.49 MPa). Etching time or SB particles had no statistical (p > 0.001) influence on bond strength. | Different conditioning procedures have an effect on ceramic microstructures and bracket adhesion. High SBST (29.74–36.80 MPa) were found for all ceramic surfaces when HF 5% or SB, indicating a higher risk of ceramic fracture. The HF 9.6% appeared to have a minor conditioning effect, resulting in a lower SBST (9.34–15.92 MPa), but fewer ceramic fractures. A short etching time (30 s) was as effective as standard etching (60 s). SB SiO2 showed no advantage as compared with SB AL2O3. |
| Kim et al., 2017 [ |
In vitro | SB Al2O3 and CO (Colet TM); |
Zirconia | 120 | n = 10–Al2O3 + S-T; |
NR | Metallic | SBST | CO-SBU had the highest bond strength after T. CO-S significantly higher SBST than Al2O3-S. CO-ZPP lower bond strength than Al2O3-ZPP before thermocycling, but the SBST increased after T. | CO-SBU showed the highest shear bond strength. Sandblasting with either AL or CO improved the mechanical bonding by increasing the surface area, and all primer groups showed clinically acceptable increase of SBST for orthodontic treatment. |
| Alaqeel, 2020 [ |
In vitro | Heat-treatment | Lithium disilicate glass-ceramic | 120 | n = 60–heat treated specimens (n = 15–neutralized, bonded with resin based cement; n = 15–neutralized, bonded with water based cement; n = 15–non-neutralized, bonded with resin based cement; n = 15–non-neutralized, bonded with water based cement). | n = 60–non-heat treated specimens (n = 15–neutralized, bonded with resin based cement; n = 15–neutralized, bonded with water based cement; n = 15–non-neutralized, bonded with resin based cement; n = 15–non-neutralized, bonded with water based cement). | NR | SBST | The heat-treated showed statistically significant higher bond strength in all the sub- groups, and the acid-neutralized samples showed higher bond strength using both types of cement; however, the increase was statistically significant only in resin-based cement-bonded samples. Resin-based cement-bonded samples showed higher bond strength than water-based cement-bonded samples. | Pre-etching heat treatment and post-etching acid neutralization of the cementing surface of lithium disilicate glass-ceramic significantly improve the initial bond strength to orthodontic brackets. |
| Guida et al., 2019 [ |
In vitro | 10% HF 60s; |
Lithium disilicate-based glass–ceramic. | 240 | n = 20–BM-HF; |
BM—Stainless steel, metal bracket (Abzil, 3M Brazil, São Jose do Rio Preto, SP, Brazil) with a traditional mesh for mechanical retention | Metallic (BM) and ceramic brackets (monocrystalline (BCm) and polycrystalline (BCp). | SBST | BCm with HFS or HF showed the highest median σ values, 10.5 MPa and 8.5 MPa respectively. In contrast, the BCp with MDP showed the lowest median σ value (0.8 MPa), which was not statistically different from other MDP-treated groups. | The failure mode was governed by the glass–ceramic surface treatment, not by the bracket type. Quantitative (σ values) and qualitative (fracture mode) data suggested a minimum of 5 MPa for brackets bonded to glass–ceramic, which is the lower critical limit bond strength for a comprehensive orthodontic treatment. |
| Martalia et al., 2020 [ |
In vitro | 9% HF; |
Porcelain veneers | 28 | n = 7–9% HF 90 s, aquades 5 s, air spray 5 s, Silane, air spray 60 s, Ortho Solo, Grenglo adhesive, light-curing 20 s; |
n = 7–Single Bond, light-curing 10 s, apply Grenglo adhesive to bracket mess and the last step do light-curing for 20 s. | Metallic | SBST | The shear bond strengths between groups were significantly different (p < 0.05). The greatest bracket shear bond strength and lowest porcelain surface roughness were found in hydrofluoric acid, silane, bonding, and adhesive. | Silane applied separately from bonding and acid has great shear bond strength and low porcelain surface roughness. |
| Jivanescu et al., 2014 [ |
In vitro | Relyx U200 dual cure resin cement; |
Porcelain-fused-to-metal | 16 | n = 8-Relyx U200 dual cure resin cement; |
NR | Metallic | TBST | No statistically significant differences among the two cements in terms of tensile bond strength. | Both dental materials may be recommended for orthodontic bracket bonding to ceramic surfaces, with equally successful results. However, further testing on an increased number of specimens may be considered for more accurate data. |
| Park et al., 2013 [ |
In vitro | 37% Phosphoric acid 1 min, wash, dry with electric light 5 min, light curing 40 s, Transbond 37 °C of water bath for 24 h. |
Zirconia and Ceramic | 150 | n = 10-Metal with phosphoric acid; |
n = 10-Tooth with Phosphoric acid; |
NR | SBST | Changed as the most in ceramic in laser irradiation. Bonding strength according to the etching method was the most in laser irradiation and acid etching in ceramic and in zirconia. | Ceramic crown with acid treatment was recommended because of relatively high in bonding strength. |
| Hellak et al., 2016 [ |
In vitro/Ex vivo | Self-etching no-mix adhesives (iBondTM and ScotchbondTM); |
Glass-ceramic veneering (IPS e.maxTM Press, IPS e-max ZirCAD for inLabTM was used as high-strength zirconia and VITAblocsTM Mark II, C2II4 for CERECTM/inLab (VITA Zahnfabrik, Bad Sackingen, Germany) was used as a monochromatic feldspathic ceramic. | 270 | n = 240 divided into eight restorative surface groups (n = 30), of which Glass-ceramic veneering (n = 90) and all of the surfaces were divided into three subgroups with different adhesives (n = 10). | n = 30-Human enamel with Transbond XT primer; |
Metallic | SBST | Significant differences in SBST were found between the control group and experimental groups. | Transbond XT showed the highest SBST on human enamel. Scotchbond Universal on average provides the best bonding on all other types of surface (metal, composite, and porcelain), with no need for additional primers. It might therefore be helpful for simplifying bonding in orthodontic procedures on restorative materials in patients. |
| Lee et al., 2015 [ |
In vitro | G1: SB 50 µm, 5 s at pressure of 40 psi, 5 mm; |
Zirconia | 40 | G1: nonglazed zirconia treated with SB + ZP (n = 10); |
NR | Metallic | SBST | Group G2 showed significantly lower shear bond strength than did the other groups. |
Porcelain primer is the more appropriate choice for bonding a metal bracket to the surface of a full-contour glazed zirconia crown with resin cement. |
ACPS—3-acryloxypropyltrimethoxysilane; Al2O3—aluminium oxide; ANOVA—one-way analysis of variance; APA—Air-particle abrasion; ARI—adhesive Remnant Index; AST—adhesion strength test; atm—standard atmosphere; BCm—monocrystalline brackets; BCp—polycrystalline brackets; BIS-EMA—bisphenol A diglycidyl methacrylate ethoxylated; BIS-GMA—bisphenol A-glycidyl methacrylate; BM—metallic brackets; BTSE—bis-1,2-(triethoxysilyl) ethane; CB—ceramic brackets; Cj—CoJet system; CO—Colet TM; CO2—carbon dioxide; CSBS—cyclic shear bond strength; DB—deglazing using diamond bur; df—degrees of freedom; E15—hydrofluoric acid 15s; E5—hydrofluoric acid 5s; Er: CrYSGG—erbium, chromium:yttrium-scandium-gallium-garnet; Er:YAG—Erbium:yttrium-aluminum-garnet; FC—feldspathic ceramic; G—group; H3PO4—orthophosphoric acid; HF—hydrofluoric acid; Hz—hertz; IP—IPS e.max CAD; LDC—lithium di silicate; Led—light—emitting diode; LU—lava ultimate; MB—methylene blue; MDP—10-methacryloyloxydecyl dihydrogen phosphate; MEP—monobond etch & prime; MIC—aluminum oxide microetching; min—minute(s); mj—millijoule; mm—millimeter; MPa—megapascal pressure unit; mz—Monolithic zirconium oxide ceramic; Nd:YAG—neodymium-doped yttrium aluminium garnet; np—no-primer; NR—not reported; p—p-value; PA—phosphoric acid; PDT—photodynamic therapy; PFM—porcelain fused to metal; PP—porcelain primer; psi—pounds of force per square inch of área; rpm—revolutions per minute; s—second(s); S—silane; S@SB2—adper single bond 2; S@SBU—silane + single bond universal; SB—sandblasting; SB2—single bond 2; SBST—shear bond strength test; SBU—single bond universal; sd—standard deviation; SECP—monobond etch and prime; SiO2—silicon dioxide; sp—short pulse; ssp—super short pulse; T—thermocycled; TBST—tensile bond strength test; TEGDMA—triethylene glycol dimethacrylate; TS—tribochemical silica coating UB—ultrasonic bath; UDMA—bisphenol A-glycidyldimethacrylate and urethane dimethacrylate; VE—Vita Enamic; VM—VITA Mark II; ZP—zirconia primer; ZPP—zirconia prime plus.
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; Travassos, Raquel 1 ; Nunes, Catarina 1 ; Ribeiro, Madalena 1
; Marques, Filipa 1 ; Pereira, Flávia 1 ; Carlos Miguel Marto 2
; Carrilho, Eunice 3
; Oliveiros, Bárbara 4
; Anabela Baptista Paula 5
; Vale, Francisco 1
1 Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal;
2 Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal;
3 Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal;
4 Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal;
5 Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal;