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Bonding brackets with composite resin is considered the gold standard in orthodontics. However, this can be challenging, especially where there is a requirement to bond to surfaces other than enamel, or where the enamel is defective. A choice of bonding modalities exists for these situations, and it is important that clinicians keep up-to-date with current techniques and practice. An overview of the evidence and techniques available for bonding to enamel and other surfaces (composite, porcelain, gold, amalgam and acrylic) is presented. Furthermore, a summary table providing a step-by-step guide for bonding techniques to various surfaces is provided.
CPD/Clinical Relevance: We provide an overview of the evidence and techniques available to the orthodontist for bonding brackets to enamel and other surfaces including: composite, porcelain, gold, amalgam and acrylic.
Article
Advancements in restorative dentistry over the last 50 years have meant that teeth previously considered of hopeless prognosis can now be restored and maintained. Despite the obvious advantages of tooth maintenance, this poses several challenges for the orthodontist, including the various surfaces to which brackets may need to be attached. This necessitates modifications to conventional bonding techniques.
This article provides an overview of the evidence and techniques available for bonding to enamel and other surfaces (composite, porcelain, gold, amalgam and acrylic). Furthermore, a summary table providing a step-by-step guide on bonding techniques for the various surfaces discussed is provided as an aide memoire.
Direct bonding to enamel utilizes three principal agents: an enamel surface conditioner, a primer solution and an adhesive resin.
This creates micro-porosity and a high-energy enamel surface. Scanning electron micrographs are presented of normal enamel (Figure 1) and enamel that has been etched with 37% phosphoric acid for 15 seconds (Figure 2).
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