Debris and friction of self-ligating and conventional orthodontic brackets after clinical use

Objective:To compare the degree of debris and friction of conventional and self-ligating orthodontic brackets before and after clinical use.Materials and Methods:Two sets of three conventional and self-ligating brackets were bonded from the first molar to the first premolar in eight individuals, for a total of 16 sets per type of brackets. A passive segment of 0.019 × 0.025-inch stainless steel archwire was inserted into each group of brackets. Frictional force and debris level were evaluated as received and after 8 weeks of intraoral exposure. Two-way analysis of variance and Wilcoxon signed-rank test were applied at P < .05.Results:After the intraoral exposure, there was a significant increase of debris accumulation in both systems of brackets (P < .05). However, the self-ligating brackets showed a higher amount of debris compared with the conventional brackets. The frictional force in conventional brackets was significantly higher when compared with self-ligating brackets before clinical use (P < .001). Clinical exposure for 8 weeks provided a significant increase of friction (P < .001) on both systems. In the self-ligating system, the mean of friction increase was 0.21 N (191%), while 0.52 N (47.2%) was observed for the conventional system.Conclusion:Self-ligating and conventional brackets, when exposed to the intraoral environment, showed a significant increase in frictional force during the sliding mechanics. Debris accumulation was higher for the self-ligating system.     

Effects of third-order torque on frictional force of self-ligating brackets

Objective:To investigate the effects of third-order torque on frictional properties of self-ligating brackets (SLBs).Materials and Methods:Three SLBs (two passive and one active) and three archwires (0.016 × 0.022-inch nickel-titanium, and 0.017 × 0.025-inch and 0.019 × 0.025-inch stainless steel) were used. Static friction was measured by drawing archwires though bracket slots with four torque levels (0°, 10°, 20°, 30°), using a mechanical testing machine (n  =  10). A conventional stainless-steel bracket was used for comparison. Results were subjected to Kruskal-Wallis and Mann-Whitney U-tests. Contact between the bracket and wire was studied using a scanning electron microscope.Results:In most bracket-wire combinations, increasing the torque produced a significant increase in static friction. Most SLB-wire combinations at all torques produced less friction than that from the conventional bracket. Active-type SLB-wire combinations showed higher friction than that from passive-type SLB-wire combinations in most conditions. When increasing the torque, more contact between the wall of a bracket slot and the edge of a wire was observed for all bracket types.Conclusions:Increasing torque when using SLBs causes an increase in friction, since contact between the bracket slot wall and the wire edge becomes greater; the design of brackets influences static friction.     

Dimensional accuracy of ceramic self-ligating brackets and estimates of theoretical torsional play

Objective:To ascertain the dimensional accuracies of some commonly used ceramic self-ligation brackets and the amount of torsional play in various bracket–archwire combinations.Materials and Methods:Four types of 0.022-inch slot ceramic self-ligating brackets (upper right central incisor), three types of 0.018-inch ceramic self-ligating brackets (upper right central incisor), and three types of rectangular archwires (0.016 × 0.022-inch beta-titanium [TMA] (Ormco, Orange, Calif), 0.016 × 0.022-inch stainless steel [SS] (Ortho Technology, Tampa, Fla), and 0.019 × 0.025-inch SS (Ortho Technology)) were measured using a stereomicroscope to determine slot widths and wire cross-sectional dimensions. The mean acquired dimensions of the brackets and wires were applied to an equation devised by Meling to estimate torsional play angle (γ).Results:In all bracket systems, the slot tops were significantly wider than the slot bases (P < .001), yielding a divergent slot profile. Clarity-SLs (3M Unitek, Monrovia, Calif) showed the greatest divergence among the 0.022-inch brackets, and Clippy-Cs (Tomy, Futaba, Fukushima, Japan) among the 0.018-inch brackets. The Damon Clear (Ormco) bracket had the smallest dimensional error (0.542%), whereas the 0.022-inch Empower Clear (American Orthodontics, Sheboygan, Wis) bracket had the largest (3.585%).Conclusions:The largest amount of theoretical play is observed using the Empower Clear (American Orthodontics) 0.022-inch bracket combined with the 0.016 × 0.022-inch TMA wire (Ormco), whereas the least amount occurs using the 0.018 Clippy-C (Tomy) combined with 0.016 × 0.022-inch SS wire (Ortho Technology).     

A prospective randomized split-mouth study on pain experience during chairside archwire manipulation in self-ligating and conventional brackets

Objective:To investigate patient discomfort during archwire engagement and disengagement in patients treated with self-ligating and conventional brackets using a split-mouth design.Materials and Methods:Eighteen consecutive patients (15 female, 3 male; age: 22.2 ± 6.4 years) who requested treatment with fixed orthodontic appliances were randomly assigned for bonding with SmartClip self-ligating brackets on one side of the dentition and conventional standard edgewise brackets on the other. During the course of treatment, patients rated the discomfort experienced during every archwire engagement and disengagement using a numeric rating scale. Results were evaluated for round and rectangular nickel titanium and rectangular stainless steel, titanium molybdenum, and Elgiloy archwires. Patients also rated their overall experience retrospectively for both bracket systems.Results:Regardless of archwire type, disengagement was rated as being significantly more painful on the SmartClip side (P  =  .027). For rigid, rectangular archwires, engagement and disengagement were rated as being significantly more painful on the SmartClip side (P  =  .031; P  =  .004). Retrospective ratings favored conventional brackets beyond ratings recorded during treatment.Conclusion:Engagement and disengagement of rigid rectangular archwires caused more pain with SmartClip self-ligating brackets than with conventional ones. Careful archwire manipulation and patience during full alignment are essential for limiting chairside pain. Low pain levels will help ensure treatment satisfaction and compliance.     

Super-elasticity in vitro assessment of CuNiTi wires according to their Austenite finish temperature and the imposed displacement

ObjectivesTo assess the super-elasticity of CuNiTi wires (Ormco, Glendora, Calif) according to their Austenite finish temperature (Af) and to the imposed displacement. The secondary objective was to compare the wire dimensions with the stated measurements and to study interbatch variability.Materials and Methods10 types of CuNiTi wires (Ormco, Glendora, Calif) (n = 350) were investigated at 36 ± 1°C, with conventional brackets (Victory Series, 3M Unitek, Monrovia, Calif). Tensile test with coronoapical displacement ranging from 1 to 5 mm of the canine bracket was imposed. The wire dimensions were initially measured from two batches (n = 10).ResultsDimensional heterogeneity varied by ± 2.00% compared to the manufacturer''s data, and even up to 5.54% for 0.014-inch CuNiTi (P = .00069). However, all unloading forces were reproducible. In decreasing order, the forces delivered by a CuNiTi 27 were greater than those with CuNiTi 35 and 40. The super-elasticity was expressed only for displacements of 1 to 2 mm, at best up to 3 mm for 0.014-inch CuNiTi 27.ConclusionsThe value of Af as well as the amount of imposed displacement seem to influence the expression of the super-elasticity of CuNiTi wires and the amount of corrected malocclusion. Among the tested wires, under these experimental conditions, 0.014-inch wire could be suitable as a first archwire. CuNiTi 35, therefore, seems to offer the best compromise among the force level, the expression of super-elasticity and the amount of malocclusion correction.     

Effects of self-ligating and conventional brackets on halitosis and periodontal conditions

Objective:To evaluate the effects of fixed orthodontic treatment with steel-ligated conventional brackets and self-ligating brackets on halitosis and periodontal health.Materials and Methods:Sixty patients, at the permanent dentition stage aged 12 to 18 years, who had Angle Class I malocclusion with mild-to-moderate crowding were randomly selected. Inclusion criteria were nonsmokers, without systematic disease, and no use of antibiotics and oral mouth rinses during the 2-month period before the study. The patients were subdivided into three groups randomly: the group treated with conventional brackets (group 1, n  =  20) ligated with steel ligature wires, the group treated with self-ligating brackets (group 2, n  =  20), and the control group (group 3, n  =  20). The periodontal records were obtained 1 week before bonding (T1), immediately before bonding (T2), 1 week after bonding (T3), 4 weeks after bonding (T4), and 8 weeks after bonding (T5). Measurements of the control group were repeated within the same periods. The volatile sulfur components determining halitosis were measured with the Halimeter at T2, T3, T4, and T5. A two-way repeated measures of analysis of variance (ANOVA) was used to compare the groups statistically.Results:No statistically significant group × time interactions were found for plaque index, gingival index, pocket depth, bleeding on probing, and halitosis, which means three independent groups change like each other by time. The risk of tongue coating index (TCI) being 2 was 10.2 times higher at T1 than at T5 (P < .001). Therefore, the probability of higher TCI was decreased by time in all groups.Conclusions:The self-ligating brackets do not have an advantage over conventional brackets with respect to periodontal status and halitosis.     

Debris,Roughness and Friction of Stainless Steel Archwires Following Clinical Use

Objective:To investigate the degree of debris, roughness, and friction of stainless steel orthodontic archwires before and after clinical use.Materials and Methods:For eight individuals, two sets of three brackets (n  =  16) each were bonded from the first molar to the first premolar. A passive segment of 0.019- × 0.025-inch stainless steel archwire was inserted into the brackets and tied by elastomeric ligature. Debris level (via scanning electron microscopy), roughness, and frictional force were evaluated as-received and after 8 weeks of intraoral exposure. Mann-Whitney, Wilcoxon signed-rank, and Spearman correlation tests were used for statistical analysis at the .05 level of significance.Results:There were significant increases in the level of debris (P  =  .0004), roughness of orthodontic wires (P  =  .002), and friction (P  =  .0001) after intraoral exposure. Significant positive correlations (P < .05) were observed between these three variables.Conclusion:Stainless steel rectangular wires, when exposed to the intraoral environment for 8 weeks, showed a significant increase in the degree of debris and surface roughness, causing an increase in friction between the wire and bracket during the mechanics of sliding.     

Comparison of root resorption between self-ligating and conventional preadjusted brackets using cone beam computed tomography

Objective:To compare the magnitude of external apical root resorption (EARR) of incisors in patients undergoing the initial phase of orthodontic treatment with two sets of brackets.Materials and Methods:According to the results of the power analysis for sample size calculation, 19 Angle Class I patients (anterior crowding: 3 to 5 mm; mean age: 20.6 years) were included in the study and randomly divided into two groups: group I (n  =  11, self-ligating brackets) and group II (n  =  8, conventional preadjusted brackets). The degree of EARR was detected in 152 upper and lower incisors by using cone-beam computed tomography (CBCT) scans and a three-dimensional program (Dolphin 11.5, Dolphin Imaging & Management Solutions, Chatsworth, Calif) with 25% level of sensitivity. The CBCT scans were obtained before (T1) and 6 months after initiation of treatment (T2). Differences between and within groups were analyzed by nonpaired and paired t-test, respectively, with 5% significance level.Results:Significant differences were found for both groups between T1 and T2. However, no differences in the degree of EARR were detected between the groups studied.Conclusions:Although EARR has occurred in all teeth evaluated, the bracket design (self-ligating or conventional) did not demonstrate any influence on the results observed.     

Suitability of orthodontic brackets for rebonding and reworking following removal by air pressure pulses and conventional debracketing techniques

Aim:To test the null hypothesis that there are no significant differences in the reusability of debonded brackets with regard to debonding technique and adhesive used.Method:Ninety-six osteotomed third molars were randomly assigned to two study groups (n  =  48) for bonding of a 0.018-inch bracket (Ormesh, Ormco) with either a composite adhesive (Mono-Lok2; RMO) or a glass ionomer cement (GIC; Fuji Ortho LC;GC). Each of these two groups were then randomly divided into four subgroups (n  =  12) according to the method of debonding using (1) bracket removal pliers (BRP; Dentaurum), (2) a side cutter (SC; Dentaurum), (3) a lift-off debracketing instrument (LODI; 3M-Unitek), or (4) an air pressure pulse device (CoronaFlex; KaVo). The brackets were subsequently assessed visually for reusability and reworkability with 2× magnification and by pull testing with a 0.017- × 0.025-inch steel archwire. The proportions of reusable brackets were individually compared in terms of mode of removal and with regard to adhesives using the Fisher exact test (α  =  5%).Results:The null hypothesis was rejected. Not taking into account the debonding method, brackets bonded with GIC were judged to a significant extent (81%; n  =  39; P < .01) to be reworkable compared with those bonded with composite (56%; n  =  27). All brackets in both adhesive groups removed with either the LODI or the CoronaFlex were found to be reusable, whereas 79% (46%) of the brackets removed with the BRP (SC) were not. The proportion of reusable brackets differed significantly between modes of removal (P < .01).Conclusion:With regard to bracket reusability, the SC and the BRP cannot be recommended for debonding brackets, especially in combination with a composite adhesive.     

Self-Ligation Esthetic Brackets with Low Frictional Resistance

Objective:To test the frictional resistance forces (FRS) generated between several archwires and (1) interactive self-ligating (ISL) brackets and (2) conventionally ligated (CL) brackets.Materials and Methods:Frictional forces produced between three different archwire combinations and self-ligating (SL) brackets (ceramic and metal-slot or all-metal) and CL brackets (metal or ceramic) were evaluated in a dry environment. The three ISL brackets tested were In-Ovation-C, In-Ovation-R, and Damon 3. The three CL brackets were Mystique with Neo Clip, Clarity, and Ovation. Each bracket was tested with 0.020″ SS, 0.019″ × 0.025″ SS and 0.018″ × 0.018″ coated SS.Results:The ISL brackets generally exhibited the lowest frictional forces irrespective of the bracket material and the wire size, and CL brackets exhibited consistently higher frictional forces. Mystique with Neo Clip produced the lowest frictional resistance of all brackets. The In-Ovation-C brackets demonstrated significantly lower frictional resistance than the SL brackets In-Ovation-R and Damon 3 as well as the CL brackets Clarity and Ovation.Conclusions:The ISL ceramic brackets produced the lowest frictional resistance of all the self-ligating brackets. The CL ceramic brackets produced the greatest friction.     

Maxillary canine retraction with self-ligating and conventional brackets: A randomized clinical trial

Objective:To measure space closure during the retraction of upper permanent canines with self-ligating and conventional brackets.Materials and Methods:Fifteen patients who required maxillary canine retraction into first premolar extraction sites as part of their orthodontic treatment completed this study. In a random split-mouth design, the retraction of upper canines was performed using an elastomeric chain with 150 g of force. The evaluations were performed in dental casts (T0, initial; T1, 4 weeks; T2, 8 weeks; T3, 12 weeks). The amount of movement and the rotation of the canines as well as anchorage loss of the upper first molars were evaluated.Results:There was no difference between self-ligating and conventional brackets regarding the distal movement of upper canines and mesial movement of first molars (P > .05). Rotation of the upper canines was minimized with self-ligating brackets (P < .05).Conclusion:Distal movement of the upper canines and anchorage loss of the first molars were similar with both conventional and self-ligating brackets. Rotation of the upper canines during sliding mechanics was minimized with self-ligating brackets.     

Comparison of orthodontic space closure using micro-osteoperforation and passive self-ligating appliances or conventional fixed appliances:: A randomized controlled trial

ObjectivesTo examine the effect of micro-osteoperforation (MOP) on the space closure rate using passive self-ligating or conventional brackets.Materials and MethodsThis was a two-arm parallel randomized controlled trial undertaken at the outpatient department of a dental college. There were 60 participants (30 women and 30 men) who fulfilled the inclusion criteria. Both the study and control groups were subjected to MOPs throughout the period of space closure. MOPs were repeated every 28 days. The experimental group (mean age 19.5 ± 1.66 years) was bonded with passive self-ligating brackets while the control group (mean age 19.9 ± 1.13 years) was bonded with conventional brackets. Both groups were examined and compared for rate of space closure. An evaluation was conducted for both groups until the entire extraction space was closed and confirmed by evaluation of a tight contact between the canine and the second premolar using a piece of dental floss.ResultsBefore the initiation of retraction, all initial criteria were similar between the two groups (P > .05). No difference was observed between the two groups in the rate of space closure (P > .05).ConclusionsMOP in conjunction with passive self-ligation does not increase the rate of orthodontic space closure when compared with MOP used with conventional brackets.     

Self-ligating vs conventional brackets as perceived by orthodontists

Objective:To determine if there are significant clinical differences between self-ligating brackets (SLB) and conventional brackets (CB) during orthodontic treatment, as perceived by orthodontists.Materials and Methods:A survey was developed and distributed to evaluate how SLB compare to CB in terms of orthodontists'' perceptions (n  =  430).Results:SLB were preferred during the initial stage of treatment based on the shorter adjustment appointments and faster initial treatment progress they provided (P < .0001). On the other hand, practitioners preferred CB during the finishing and detailing stages of treatment (P < .0001). CB were also preferred over SLB because they were cheaper and resulted in fewer emergency appointments.Conclusions:The orthodontists'' preference was significantly influenced by (1) the proportion of patients treated with SLB (P < .0001), (2) the number of cases it took them to become accustomed to SLB (P < .0001), and (3) the average appointment intervals associated with SLB (P < .0001).     

Torque Expression in Stainless Steel Orthodontic Brackets: A Systematic Review

Objective:To evaluate the quantitative effects on torque expression of varying the slot size of stainless steel orthodontic brackets and the dimension of stainless steel wire, and to analyze the limitations of the experimental methods used.Materials and Methods:In vitro studies measuring torque expression in conventional and self-ligating stainless steel brackets with a torque-measuring device, with the use of straight stainless steel orthodontic wire without second-order mechanics and without loops, coils, or auxiliary wires, were sought through a systematic review process.Results:Eleven articles were selected. Direct comparison of different studies was limited by differences in the measuring devices used and in the parameters measured. On the basis of the selected studies, in a 0.018 inch stainless steel bracket slot, the engagement angle ranges from 31 degrees with a 0.016 × 0.016 inch stainless steel archwire to 4.6 degrees with a 0.018 × 0.025 inch stainless steel archwire. In a 0.022 inch stainless steel bracket slot, the engagement angle ranges from 18 degrees with a 0.018 × 0.025 inch stainless steel archwire to 6 degrees with a 0.021 × 0.025 inch stainless steel archwire. Active stainless steel self-ligating brackets demonstrate an engagement angle of approximately 7.5 degrees, whereas passive stainless steel self-ligating brackets show an engagement angle of approximately 14 degrees with 0.019 × 0.025 inch stainless steel wire in a 0.022 inch slot.Conclusions:The engagement angle depends on archwire dimension and edge shape, as well as on bracket slot dimension, and is variable and larger than published theoretical values. Clinically effective torque can be achieved in a 0.022 inch bracket slot with archwire torsion of 15 to 31 degrees for active self-ligating brackets and of 23 to 35 degrees for passive self-ligating brackets with a 0.019 × 0.025 inch stainless steel wire.     

Active and passive self-ligation—a myth?

Objective:To compare the frictional behavior of several self-ligating brackets with that of normal brackets both with and without tipping force-moments and in combination with different archwire dimensions.Materials and Methods:The resistance to sliding (RS) of seven self-ligating brackets, a conventional bracket, and a ceramic bracket with a low-friction clip were evaluated in combination with three different archwires and tipping force-moments of 0 and 10 Nmm. The center of rotation for the measurements was set within the center of the bracket or with a 10-mm offset. Resistance to sliding was measured using an Instron 3344 at a cross-head speed of 10 mm/min at a temperature of 36°C.Results:Without a tipping moment, RS increased with the active self-ligating brackets with increasing archwire size. No RS was found for any of the passive self-ligating brackets. The 10-Nmm tipping moment resulted in more RS and was similar for all bracket and archwire combinations. RS was approximately doubled when the center of rotation was located at the bracket rather than with a 10-mm offset.Conclusions:RS between brackets and archwires is highly dependent on the experimental setup. Different setups can result in contradictory results. Almost 1 N of traction force is lost in RS when a moment of 10 Nmm is placed at a rotational center 10 mm from the bracket.     

Evaluation of friction of stainless steel and esthetic self-ligating brackets in various bracket-archwire combinations.

This study measured and compared the level of frictional resistance generated between stainless steel self-ligating brackets (Damon SL II, SDS Ormco, Glendora, Calif), polycarbonate self-ligating brackets (Oyster, Gestenco International, G?thenburg, Sweden), and conventional stainless steel brackets (Victory Series, 3M Unitek, Monrovia, Calif), and 3 different orthodontic wire alloys: stainless steel (Stainless Steel, SDS Ormco), nickel-titanium (Ni-Ti, SDS Ormco), and beta-titanium (TMA, SDS Ormco). All brackets had a.022-in slot, whereas the orthodontic wire alloys were tested in 3 different sections:.016,.017 x.025, and.019 x 0.025 in. Each of the 27 bracket and archwire combinations was tested 10 times, and each test was performed with a new bracket-wire sample. Both static and kinetic friction were measured on a custom-designed apparatus. All data were statistically analyzed (Kruskal-Wallis and Mann Whitney U tests). Stainless steel self-ligating brackets generated significantly lower static and kinetic frictional forces than both conventional stainless steel and polycarbonate self-ligating brackets, which showed no significant differences between them. Beta-titanium archwires had higher frictional resistances than stainless steel and nickel-titanium archwires. No significant differences were found between stainless steel and nickel-titanium archwires. All brackets showed higher static and kinetic frictional forces as the wire size increased.     

Lock-loose托槽与传统托槽摩擦力特性的比较研究

目的 在干燥和人工唾液环境中测量Lock-loose托槽结扎中间翼和结扎全翼时与弓丝之间滑动摩擦力和静摩擦力的大小,并与传统四翼托槽和自锁托槽进行对比。方法 应用原子力显微镜观察不锈钢弓丝与不同托槽摩擦前后的表观形貌。选用Lock-loose托槽、传统四翼托槽和自锁托槽,分别与0.406 4 mm、0.457 2 mm不锈钢圆丝和0.457 2 mm×0.634 9 mm、0.482 6 mm×0.634 9 mm不锈钢方丝组合,其中Lock-loose托槽使用结扎中间翼和结扎全翼两种结扎方式。使用电子万能力学实验机测量干燥和人工唾液两种环境下弓丝在托槽内滑动的动、静摩擦力。结果 不同尺寸弓丝与不同托槽摩擦前后的表面粗糙度无明显差异（P>0.05）;Lock-loose托槽结扎中间翼与4种弓丝组合的动、静摩擦力均接近于0,与传统四翼托槽有明显差异（P<0.05）;与0.457 2 mm×0.634 9 mm不锈钢方丝组合时,Lock-loose托槽结扎全翼可以获得最大动、静摩擦力,与传统四翼托槽和自锁托槽的差异有统计学意义（P<0.05）;人工唾液环境中的摩擦力小于干燥环境中的摩擦力（P<0.05）。结论 Lock-loose托槽可以通过不同的结扎方式调节并获得临床所需的摩擦力,有效解决了低摩擦力与强支抗控制的矛盾问题。     

A comparison of self-ligating and conventional orthodontic bracket systems.

Abstract

This ex-vivo study compared the static frictional resistance of three self-ligating brackets with a conventional steel-ligated Ultratrimm bracket. The effects of archwire size (0.020, 0.019 x 0.025 and 0.021 x 0.025-inch), bracket/archwire angulation (0, 5 and 10 degrees) and the presence of unstimulated human saliva were investigated. The study demonstrated that both increases in wire size and bracket/archwire angulation resulted in increased static frictional resistance for all bracket types tested, with the presence of saliva having an inconsistent effect. Mobil-Lock Variable-Slot had the least friction for all wires for 0 degree angulation. However, with the introduction of angulation, the values were comparable to those of the other brackets. Activa brackets had the second lowest frictional resistance, although high values were found with 0.019 x 0.025-inch wires. SPEED brackets demonstrated low forces with round wires, although with rectangular wires or in the presence of angulation, friction was greatly increased. Ultratrimm brackets produced large individual variation, confirming the difficulty in standardizing ligation force, although under certain conditions, significantly larger frictional forces were observed. In conclusion, self-ligating brackets showed reduced frictional resistance in comparison to steel ligated brackets only under certain conditions.     

Failure patterns of different bracket systems and their influence on treatment duration: A retrospective cohort study

Objectives:To compare the failure pattern of four different bracket types and to assess its effect on treatment duration.Materials and Methods:A total of 78 white patients (28 male, 50 female) with a mean age of 12.6 years were included in this retrospective cohort study and treated for a mean period of 30.6 months. The patients were treated in a private practice with stainless steel conventionally ligated brackets, ceramic conventionally ligated brackets, stainless steel self-ligating brackets, or nickel-free self-ligating brackets. The loss of at least one bracket during the course of treatment was analyzed with Cox proportional hazards survival analyses and generalized linear regression.Results:The overall bracket failure rate at the tooth level was 14.1% (217 brackets), with significant differences according to tooth type (between 8.0%–23.4%) and bracket type (between 11.2%–20.0%). After taking confounders into account, patients treated with ceramic brackets lost more brackets (hazard ratio = 1.62; 95% confidence interval = 1.14–2.29; P = .007) than patients with stainless steel brackets. On average, treatment time increased by 0.6 months (95% confidence interval = 0.21–1.05; P = .004) for each additional failed bracket.Conclusions:Bracket failure was more often observed with ceramic brackets and was associated with increased treatment duration.     

Adhesive performance of precoated brackets after expiration

Objective:To evaluate adhesive performance in terms of debonding forces of precoated metal and ceramic brackets 4 years after expiration.Materials and Methods:Buccal and lingual surfaces of embedded extracted maxillary premolars were etched with 34% Tooth Conditioner Gel (Dentsply Caulk, Milford, Del), rinsed, and dried. Transbond MIP (3M Unitek, Monrovia, Calif) was applied prior to placing adhesive precoated brackets (APC II Victory stainless steel and APC Plus Clarity ceramic brackets, 3M Unitek). The preexpiration brackets had 29–35 months before, and the postexpiration brackets were 45–52 months past, their expiration dates. Sample size was 17–21 per group. Debonding forces were determined by subjecting the bonded brackets to a shear force in a universal testing machine. Debonding forces were compared using two-way ANOVA. Debonded surfaces were examined under a stereomicroscope to determine failure modes, which were compared using the chi-square test.Results:No statistically significant difference was found in debonding forces (P  =  .8581) or failure modes (P  =  .4538) between expired and unexpired brackets. Metal brackets required statistically significantly higher debonding forces than did ceramic brackets (P  =  .0001). For both expired and unexpired brackets, failure modes were mostly cohesive in the adhesive layer for ceramic brackets, and mixed between adhesive and cohesive failure in the adhesive layer for metal brackets.Conclusions:Adhesive precoated brackets did not have any reduction in enamel-adhesion properties up to 4 years after their expiration date. Extended shelf life testing for precoated dental brackets may be worth considering.