CENTENNIAL SPECIAL ARTICLE

The evolution of bonding in orthodontics

Paul Gange
Itasca, Ill

In the early days of fixed-appliance orthodontic treatment, brackets were welded to gold or stainless steel bands.
Before treatment, the orthodontist had to create enough space around each tooth to accommodate the bands,
and then those spaces had to be closed at the end of treatment, when the bands were removed. This was time-
consuming for the orthodontist and uncomfortable for the patient. Banded appliances frequently caused gingival
trauma when fitted, and decalcification could occur under the band. In the mid-1960s, Dr George Newman, an
orthodontist in Orange, New Jersey, and Professor Fujio Miura, chair of the Department of Orthodontics at Tokyo
Medical and Dental University in Japan, pioneered the bonding of orthodontic brackets to enamel. Many devel-
opments have occurred in the decades that followed, including many new adhesives, sophisticated base de-
signs, new bracket materials, faster or more efficient curing methods, self-etching primers, fluoride-releasing
agents, and sealants. The purpose of this article is to review the history of orthodontic bonding, especially the
materials used in the bonding process. (Am J Orthod Dentofacial Orthop 2015;147:S56-63)

F
rom the inception of fixed-appliance orthodontic
treatment, brackets traditionally have been welded
to gold or stainless steel bands. The band encom-
passed the tooth circumferentially, requiring the crea-
tion of interproximal space to accommodate the width
of the band material. This separation process, which
was accomplished initially by placing wires and later
elastomerics, was time-consuming for the orthodontist
and uncomfortable for the patient. At the conclusion
of treatment, these interproximal gaps had to be ad-
dressed again. In addition, banded appliances frequently
caused gingival trauma when fitted, and decalcification
under bands sometimes occurred during treatment.
Therefore, the obvious solution to these problems was
for the clinician to attach the brackets directly to tooth
enamel, thus eliminating the need for bands.
Dr George Newman, an orthodontist in Orange, New
Jersey, and Professor Fujio Miura, chair of the Depart-
ment of Orthodontics at Tokyo Medical and Dental Uni-
versity in Japan, pioneered the bonding of orthodontic
brackets to enamel. Coincidentally, they both began
their experimentations in the mid-1960s. It is unfortu-
nate that they lived on different continents, since they
President, Reliance Orthodontic Products, Inc, Itasca, Ill.
Address correspondence to: Paul Gange, PO Box 678, Itasca, IL 60143; e-mail,
paulgropi@aol.com.
Submitted, revised and accepted, January 2015.
0889-5406/$36.00
Copyright Ó 2015 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2015.01.011
S56
both had the same passion and vision—the development
of an adhesive that would bond plastic brackets directly
to enamel with enough strength to withstand the forces
of occlusion during treatment, mastication, and arch-
wire stress while allowing for biomechanical control
and allowing for removal of the brackets without
causing significant damage to the enamel. In addition,
bonding had to be accomplished in a humid environ-
ment and needed to last from bracket placement
through the final phase of treatment.
In the early 1970s, Miura1 developed a technique for
bonding polycarbonate plastic brackets to phosphoric
acid etched enamel using a restorative filling material
developed by Masuhura et al,2-4 also at Tokyo Medical
and Dental University. The adhesive, Orthomite (Rocky
Mountain Orthodontics, Denver, Colo), consisted of
methyl methacrylate and polymethyl methacrylate with
tri-n-butylborane as the catalyst. Miura found that the
bond strength decreased with time as a result of expo-
sure to oral fluids. In addition, mastication and abrasive
metal archwires used with plastic brackets resulted in
broken tie wings and deformed archwire slots. However,
this system became popular as an alternative to bands
and fueled the research to develop stronger adhesives
and more durable plastic attachments, with an end
goal of eventually developing bondable metal brackets.
Other methyl methacrylate and polymethyl methacrylate
systems followed from GAC International (Bohemia, NY)
and TP Orthodontics (LaPorte, Ind) with the same suc-
cesses and drawbacks.
Gange
Newman continued his work with epoxy resins,5
while Retief et al6 from South Africa developed an adhe-
sive to bond metal brackets, based on research conduct-
ed by Bowen on epoxy resins.7 Epoxy resins did not
experience significant polymerization shrinkage when
setting, had the same coefficient of thermal expansion
as enamel, and were cross-linked to minimize water ab-
sorption. These characteristics produced the strength
needed to resist the inherent mechanical and mastica-
tory forces. The final hurdle was increasing the strength
of the brackets so that they could withstand the forces of
3-dimensional mechanics.
Retief et al partnered with 3M Unitek (Monrovia,
Calif) to develop a mesh grid welded onto flattened
stainless steel band material with a metal bracket welded
to it. Strangely, this metal bracket/pad design was not
available commercially until the late 1970s. The primary
drawback to that design was that the weld spots on the
mesh base prevented the adhesive from flowing between
the mesh and the foil pad properly, resulting in reduced
mechanical retention.
In the mid-1970s, Lexan plastic (General Electric,
Fairfield, Conn) was used to fabricate anterior brackets
for patients demanding better esthetics. This improved
polycarbonate was harder and consequently less suscep-
tible to wear and tie-wing fracture; however, it still was
not as durable or reliable as stainless steel. Eventually,
the continued demand for improved esthetics led to
the development of ceramic materials for clear brackets.
Ceramic was able to withstand forces, did not break or
discolor, and still is a material of choice for appliances
that are esthetically pleasing.
In the early 1970s, 3M Unitek's Concise and Adaptic
from Johnson & Johnson (New Brunswick, NJ) were pop-
ular composite restorative filling materials, formulated
from the research conducted previously by Bowen.8
Both systems used a 2-paste bisphenol A glycidyl meth-
acrylate (BisGMa) resin with quartz as a filler and amine-
peroxide as the catalyst. These systems were cross-linked
adhesives that experienced minimal polymerization
shrinkage. Both systems required acid etching of the
enamel with a 40% concentration of phosphoric acid.
An unfilled resin then was applied to the enamel as a wet-
ting agent, and the metal brackets were bonded to the
conditioned enamel with a chemically cured paste.
At this time, metal brackets were welded to a perfo-
rated base (Fig 1). The adhesive became interlocked
through the perforations to provide mechanical adhe-
sion. The only complaint with perforated base brackets
was that the adhesive covering the base through the per-
forations was affected by the oral environment so that it
often became stained and discolored during routine or-
thodontic treatment.
American Journal of Orthodontics and Dentofacial Orthopedics April 2015  Vol 147  Issue 4  Supplement 1
S57
Fig 1. Perforated metal bracket base.
To bond chemically to the 2-paste epoxy resin adhe-
sive, plastic brackets had to be coated with methyl meth-
acrylate plastic conditioner before paste application.
Several 2-paste chemically cured systems entered the
marketplace shortly thereafter. In 1974, Dentsply/Caulk
(Milford, Del) introduced the first single-paste ultraviolet
(UV) light curable bracket adhesive, Nuva Tach; this sys-
tem used a UV unfilled bonding resin (Nuva Seal) on the
enamel and a single UV curable paste (Nuva Tach).
The paste and the unfilled resin were polymerized
with light-emitting energy in the 280-nm range. These
UV light-cured composites, like their chemically cured
predecessors, originally were introduced as restorative
materials with a slight modification in paste viscosity.
Unlike the chemically cured systems, however, the UV
light-cured system did not have working-time con-
straints. This characteristic allowed the clinician unlim-
ited working time to place brackets, clean peripheral
paste flash, and, if necessary, change bracket position
before curing. However, the use of these UV light-
cured systems was cut short when it was discovered
that they were harmful to exposed skin and eyes, some-
times even resulting in burned soft tissues. Also, these
UV systems used the perforated base metal brackets.
In 1975, while working at Lee Pharmaceuticals
(South El Monte, Calif), I had an idea for a no-mix,
chemically cured direct bonding system that would
require the clinician to apply a liquid activator to the
etched enamel and to the metal (or plastic) bracket
base. A single paste would be applied to the primed
bracket base that then would be placed on the tooth
and pressed into position. The liquid activator from
the enamel and bracket base mixed with the paste and
resulted in polymerization. This system eliminated the
mixing steps of Adaptic and Concise. The system yielded
effective strength, but it depended on how well the
bracket base fit the corresponding enamel surface. A
flush fit produced the strongest bond. The chemistry
S58
of this product was perfected in 1980 by Dr Byoung Suh,
a renowned polymer chemist in the dental industry. His
formula for this type of adhesive still is used today.
The strength and working time of 2-paste self-curing
composites afforded manufacturers the flexibility to
develop specialty adhesives to suit the needs of clinicians.
In the early 1980s, McNamara9 and McNamara and
Howe10 introduced a version of the Herbst appliance,
the acrylic splint design, that was made from 3-mm-thick
splint Biocryl (Great Lakes Orthodontic Products, Tona-
wanda, NY). Soon thereafter, the acrylic splint expander
was developed as a mixed-dentition appliance for the
treatment of maxillary constriction and Class III maloc-
clusion.11 Both appliances necessitated the bonding of
splint Biocryl to the maxilla, a procedure that required
a strong, thin paste that adhered well to plastic and re-
sisted washout from under the appliance. Excel was
developed in 1983 by Reliance Orthodontic Products
(Itasca, Ill) specifically for bonding large acrylic appli-
ances. Excel allowed appliances to be bonded and
removed successfully without decalcification occurring
during treatment.
In 1979, Ormco (Orange, Calif) developed and
patented a technique to braze mesh to a metal foil
pad, eliminating strength-reducing weld spots (Fig 2).
This design allowed the adhesive to penetrate between
the mesh and the foil pad, thus increasing mechanical
retention (this process of brazing still is used by bracket
manufacturers that offer foil/mesh metal brackets.) The
new Ormco foil-mesh base contained the adhesive under
the pad where it would not be susceptible to discolor-
ation, resulting in improved esthetics.
In the early 1980s, visible light–cured restorative ma-
terials were introduced in all areas of dentistry. These
materials became increasingly popular for bonding or-
thodontic brackets, lingual retainers, and bands for the
same reason that the UV light–cured materials were pop-
ular—they allowed unlimited work time. Unlike their UV
predecessors, however, the catalyst for these adhesives
was camphorquinone, which cured in the visible light
range (440-480 nm) with a quartz-tungsten-halogen
light, making them safe for exposed eyes and skin.
An essential element of these systems (as is the case
today) is achieving proper light penetration under the
metal bracket base. The unfilled resin and paste in a
light-cured system contain a catalyst. All curing light
counterparts emit photons. The catalyst absorbs the
photons, and polymerization occurs. The key to success
with this system is to have as many photons as possible
contact the paste directly.
The 3 keys to complete light polymerization are in-
tensity, proximity, and duration. Keeping these factors
in mind, the operator curing the composite under a
April 2015  Vol 147  Issue 4  Supplement 1 American Journal of Orthodontics and Dentofacial Orthopedics
Gange
Fig 2. Foil mesh metal bracket base.
metal bracket base must be cognizant of the intensity
of the light to properly position it relative to the compos-
ite; the clinician also must use the correct amount of
time required to completely cure with a specific light.
To completely cure such a composite, 10,000 mJ of en-
ergy are required. The formula to accomplish this is the
following: intensity of curing light (MW/cm2) 3 curing
time (in seconds) 5 10,000 (mJ/cm2).
In the early 1980s, there were areas of the United
States in which the enamel of certain patients was so
hard because of the fluoride in the water supply that
etching the enamel with any concentration of phos-
phoric acid was unsuccessful. In 1985, Suh produced
Enhance for Reliance Orthodontic Products, which
made bonding to fluorosed and atypical surfaces
possible with any chemical or light-curing system.
Enhance was applied on the etched enamel before the
unfilled resin. In addition, the monomer in Enhance
(biphenyl dimethacrylate) bonded chemically to com-
posite and metal. Clinicians now had the ability to
bond to any metal surface without using a metal primer
(such as 4meta) or to a composite restoration without
using a plastic conditioner (methyl methacrylate).
Crypsis, a color-change adhesive, was introduced in
1986. This 2-paste dual-cure bracket adhesive was
developed and marketed by Orec (Beaverton, Ore). The
2-paste material was yellow after it was mixed and dur-
ing the gel period, but it turned tooth color when it poly-
merized. This color characteristic allowed the operator to
see the composite flash around the bracket base and re-
move it before it polymerized. The color-change mech-
anism was a function of the light-cure catalyst.
Gange
In 2004, several single-paste light-cured, color-
changing adhesives entered the market from Reliance
Orthodontic Products, 3M Unitek, and Ormco. The
color-change mechanism in the bracket adhesive from
Ormco was temperature induced and could be reversed
to show adhesive remnants left behind at debonding
by simply introducing cold water into the oral environ-
ment. Fluorescing light-cure pastes and sealants also
became available at this time with Lumilux LV (Honey-
well International, Chicago, Ill), a UV marker that dis-
closes adhesive before and after bonding when
illuminated with a black light.
In 1995, Silverman et al12 developed a technique for
bonding metal brackets to wet enamel with no acid
etching using Fuji Ortho LC (GC America, Alsip, Ill), a
dual-cure glass ionomer cement. This 2-part system
comprises a powder (fluoroaluminosilicate glass) and a
liquid (polyacrylic acid, water, hydroxyethyl methacry-
late [HEMA], and camphorquinone-light activator).
The patient's enamel is cleaned, rinsed, and dried. The
powder and liquid are mixed together and applied to a
metal bracket base, and the bracket is placed on the
enamel. The paste under the bracket base is light cured
for 20 seconds per bracket with a curing light. After
5 minutes, the clinician can place an active archwire.
How does this adhesive adhere to nonetched enamel?
The polyacrylic acid etches the enamel because it serves
as the catalyst for chemically cured polymerization. All
powder-liquid glass ionomer cements work in this
manner with a self-etching mechanism. However, unlike
chemically cured glass ionomer cements that take 20
minutes to reach adequate strength to ligate a bracket,
the addition of a light activator makes Fuji Ortho LC
practical for bracket bonding. In addition, the hydrophil-
ic property of Fuji Ortho LC allows a bracket to be placed
on a slightly contaminated surface.
Unfortunately, the shear bond strength of Fuji Ortho
LC in its ideal state is considerably less than that of the
highly filled, cross-linked hydrophobic bracket compos-
ite. Compton et al13 reported that even with nitric acid
conditioning of the enamel, the shear bond strength
value of a dual-cured glass ionomer cement to enamel
was 17.2 MPa. Proffit et al14 reported that forces gener-
ated on brackets in the posterior quadrants exceeded
20 MPa. Additionally, the hydrophobic composites
maintain their strength over time, enduring exposure
to oral fluids better than glass ionomer cements. Howev-
er, glass ionomer cement, especially dual-cure cement, is
a necessary tool when the clinician is trying to bond a
band, crown, or bracket in a wet field.
In 1996, 3M Unitek introduced a metal bracket sys-
tem with a light-cured adhesive preapplied to the base.
The operator simply etched the enamel surface, applied
American Journal of Orthodontics and Dentofacial Orthopedics April 2015  Vol 147  Issue 4  Supplement 1
S59
an unfilled resin to the enamel, and placed the bracket.
The prepasting by the bracket manufacturer eliminated
the need for an assistant to place the composite on the
bracket base.
In 1998, several hydrophilic primers were introduced.
Ortho Solo (Ormco), Assure (Reliance Orthodontic Prod-
ucts), and MIP (3M Unitek) were hydrophilic bonding resins
that bonded well to wet or dry enamel, making the bonding
procedure more forgiving. In addition, Assure would bond
to atypical enamel such as fluorosed enamel, aprismatic
enamel, and primary enamel and to dentin. Assure con-
tained biphenyl dimethacrylate, which allows the operator
to bond to gold, amalgam, stainless steel, and composite
restorations without metal or plastic primers.
Bonding to porcelain always has been a problem for
the orthodontic professional. Not only is adequate adhe-
sion required to withstand the forces of treatment, but
the surface must be restored to a high luster finish after
the appliance is removed. The first porcelain surface pro-
duced was fabricated from glass. Clinicians were able to
achieve acceptable shear bond strength values when the
porcelain was roughened with a fine diamond and
treated with silane. As time passed, a portion of the glass
was removed, and other materials such as aluminum ox-
ide were added to improve structural stability and es-
thetics. As a result, adhesion became more difficult.
Microetching (sandblasting) became the mechanical
preparation of choice in the dental restorative field in
the early 1990s. Aluminum oxide, the preferred abrasive
powder for intraoral microetching, created fine surface
roughness and significantly increased the mechanical
retention to artificial surfaces (Fig 3). In addition, micro-
etching allowed for a quick and easy high luster restora-
tion process. This mechanical preparation has been
shown to increase adhesion to these surfaces by as
much as 100%.15
After microetching a porcelain crown, the surface
was chemically etched with 8% hydrofluoric acid to
further increase the adhesive strength. Silane then was
applied followed by a bonding adhesive. At debonding,
if the porcelain surface had been sandblasted, the clini-
cian simply removed any residual composite with a fin-
ishing bur and polished the surface with a diamond
polishing paste. In addition to porcelain, sandblasting
has been shown to be effective in increasing adhesion
to gold, amalgam, and stainless steel; this is essential
when treating adult patients (Fig 4).
Cerec crowns (Sirona, Long Island City, NY), which
are fabricated in the dental office, presented another
problem for the orthodontist—is the material used por-
celain or a composite? Typically, Cerec crowns are clas-
sified as porcelain; however, if the dentist uses Paradigm
MX 100 (3M ESPE, Seefeld, Germany), it should be
S60 Gange

Fig 3. A, Sandblasted porcelain; B, bur-roughened porcelain.

Fig 4. A, Sandblasted metal; B, bur-roughened metal.

treated as a composite. If any other material is used in
the fabrication process, the porcelain bonding protocol
should be followed.
At the time of this publication, the material of the
future for posterior crowns is zirconia. Zirconium crowns
are strong enough to be used anywhere in the mouth and
are much more esthetic than porcelain crowns fused to
metal. Zirconium crowns have excellent esthetics, appear-
ing like a natural tooth and reflecting light in the same
manner. Assure Plus (Reliance Orthodontic Products),
All Bond Universal (Bisco, Schaumburg, Ill), and Scotch-
bond Universal (3M Unitek) are 3 primers that will bond
to sandblasted zirconia without additional primers.
In 2000, self-etching primers became effective in
conditioning dentin and enamel. Self-etching primers
such as Transbond Plus (3M Unitek) and SEP (Reliance
Orthodontic Products) now are part of the orthodontic
armamentarium because of their lack of rinsing and dry-
ing steps, steps that are necessary with traditional phos-
phoric acid etching. These self-etching primers have
multiple uses in an orthodontic treatment plan such as
conditioning enamel when cementing an occlusal plane
buildup/turbo, increasing adhesion with light-cured
band cement, placing Invisalign attachments (Align
Technology, Santa Clara, Calif), or rebonding a bracket
failure. However, like any bonding procedure, there is
a technique sensitivity that determines success or failure.
Both Transbond Plus and SEP are 2-liquid systems with
either a methacrylated phosphoric acid ester or a meth-
acrylated nitric acid ester. Water is used to activate the
acid in both systems—hence the separate components
in the packaging.
The enamel first is cleaned via a prophylaxis with
pumice, and then rinsed and dried. The 2 liquids must

April 2015  Vol 147  Issue 4  Supplement 1 American Journal of Orthodontics and Dentofacial Orthopedics
Gange
be mixed thoroughly. The active solution then is applied
and scrubbed into the enamel surface for 5 seconds. This
aggressive method is an obvious deviation from the con-
ventional technique of applying phosphoric acid in a
gentle dabbing motion. However, a self-etching primer
works in a similar manner to phosphoric acid as calcium
is dissolved from the hydroxyapatite. The only difference
is that the calcium is not removed by rinsing but, instead,
forms a bond with the phosphate group when polymer-
ized. Self-etching primers do not penetrate the enamel
as deeply as phosphoric acid etching, but the resultant
primer penetrates all the way to the depth of the etch.
Through this process, a self-etching primer achieves its
strength.
After scrubbing, the operator is instructed to dry the
surface for 1 to 2 seconds to displace the excess mate-
rial and dry the water from the area where the bracket
will be placed. Insufficient drying can affect the bond
strength adversely and is a variable that must be
controlled. Self-etching primers are hydrophilic, which
means that they can be applied to a slightly wet sur-
face. However, if contamination occurs before bracket
placement, the surface should be reconditioned or
treated with a hydrophilic primer (Solo, Assure, MIP)
to maintain strength.
These self-etching primers are compatible with
light-cured composites only. Conclusive evidence
from numerous studies shows that self-etching primers
produce lower bond strengths than the traditional
combination of phosphoric acid etching and a multi-
surface bonding resin. Cal-Neto et al16 reported a shear
bond strength value to enamel of 13.56 MPa, and
Shaikh et al17 recently reported a shear bond strength
value of 14.88 MPa to enamel with self-etching
primers. However, the combination of phosphoric acid
etching and a hydrophilic bonding resin consistently
produces a shear bond strength value to enamel greater
than 20 MPa.
Elimination of banded appliances and the direct
attachment of brackets to enamel meant that less
enamel surface was protected during treatment, thus
requiring better patient cooperation with regard to hy-
giene. Unfortunately, good patient compliance has not
always been the case. As a result, 23% of all orthodontic
patients exhibit decalcification on completion of treat-
ment. Since the inception of direct bonding, decalcifica-
tion has been a problem for the clinician. Although there
have been many suggested solutions for reducing the
amount of decalcification during treatment such as
fluoride-releasing composites, fluoride varnishes, and
highly filled fluoride-releasing sealants, none seemed
to have been effective in the long-term reduction of
decalcification.
American Journal of Orthodontics and Dentofacial Orthopedics April 2015  Vol 147  Issue 4  Supplement 1
S61
In 2003, Pro Seal (Reliance Orthodontic Products)
was introduced into the marketplace as a light-cured,
fluoride-releasing filled sealant that would remain intact
on the exposed enamel for 2 to 3 years even under tooth-
brushing conditions.18 This sealant was more durable
and effective than its predecessors, because the catalyst
trimethyl benzoyl diphenyl phosphine oxide (TPO) was
modified so that the resin was completely cured; this
eliminated the oxygen inhibition layer and the conse-
quent porosity. Without porosity, acid, bacteria, and
oral fluids could not penetrate and degrade the sealant.
In 2005, LED Pro Seal (Reliance Orthodontic Prod-
ucts) was introduced to accommodate the clinician
using the new, cordless light-emitting diode lights that
emitted a photon between 440 and 480 nm. This modi-
fied version of the original Pro Seal used camphorqui-
none as the catalyst because it cured in the same
range and therefore could be light cured with any dental
curing light. The long-term durability for LED Pro Seal
was the same as that of the original Pro Seal, as reported
by Mettenburg and Rueggeberg.19
In 2010, Select Defense (ClassOne Orthodontics,
Carlsbad, Calif) was introduced as an enamel sealant
that contained selenium, an antimicrobial. Tran et al20
reported that organo-selenium compounds covalently
attached to different biomaterials, thus inhibiting bacte-
rial biofilms. The key to protection, however, is the abil-
ity of the sealant to remain on the exposed enamel for
the duration of treatment without the need for periodic
reapplications.
INDIRECT BONDING
In 1972, Silverman and Cohen devised a method of
delivering a full arch of brackets onto the dentition at
one time. The operator obtained a stone model of the
patient's dentition and then treated the labial surface
of the model with a liquid foil-separating medium. Metal
or plastic brackets were bonded to the stone model with
a water-soluble adhesive such as caramel candy. The
caramel candy allowed the operator to change the posi-
tion of each bracket on the model by simply heating a
metal instrument, holding it to the bracket base, reposi-
tioning the bracket, and then allowing the candy to
resolidify.
After all brackets were in the correct positions for
clinical height and angulation, the operator placed a
light-body polyvinyl siloxane impression material
around the tie wings followed by a heavy-body polyvinyl
siloxane material to form a rigid custom tray. The light-
body material then tore away from under the tie wings
easily, with the heavy-body putty material forming a
stable tray that prevented movement when the transfer
S62
Fig 5. Orthodontic bonding timeline. MMA, Methyl methacrylate; PMMA, polymethyl methacrylate.
adhesive was curing intraorally. At chairside, the
brackets were transferred into the mouth with a 2-
paste, slow-setting chemical adhesive—Auto-Tach
(Dentsply/Caulk) in the early years and Excel Regular
(Reliance Orthodontic Products) in later years. After a
specified time, the 2 trays were removed from the arch
with the brackets in the correct position on each tooth.
The adhesion to the etched enamel was excellent; the
only drawback was the amount of cured adhesive flash
around each bracket. Flash removal was a time-
consuming but necessary step because the excess would
trap plaque if not removed.
In 1982, Dr Royce Thomas, an orthodontist in
Rolla, Missouri, developed an indirect bracketing tech-
nique called “custom base.”21 Metal or plastic
brackets were bonded to the separating medium-
treated stone model with Concise and later Phase II
(Reliance Orthodontic Products), both of which were
2-paste chemically cured composites. Thomas fabri-
cated a 2-tray system with light-body polyvinyl
siloxane around the tie wings and heavy-body polyvi-
nyl siloxane putty as the transfer tray, as described
previously. When the tray was removed from the stone
model after being immersed in warm water for
30 minutes, each bracket base had a custom pad of
polymerized composite that ideally had a precise fit
to the anatomy of that specific tooth. At chairside,
the brackets were delivered with a 2-part chemically
April 2015  Vol 147  Issue 4  Supplement 1 American Journal of Orthodontics and Dentofacial Orthopedics
Gange
cured unfilled bonding resin. After the resin had poly-
merized and the trays were removed, the brackets
were in position on each tooth without an excess of
highly filled flash around each bracket.
The primary drawback of using a chemically cured
paste to fabricate the custom pads is that the operator
is limited to a defined working time. If the bracket is
not in the correct position after setting, it must to be
removed and rebonded, a procedure that occasionally
damages the stone model. In later years, brackets were
bonded to the stone model with either a light-cured
bracket adhesive or a thermal set composite (Therma-
Cure; Reliance Orthodontic Products). These materials
allowed the operator to change the position of each
bracket a day or so after placement and cure, and after
the flash was removed and the bracket was in the desired
final position. This technique became the norm, but it
still depends on the custom base fitting flush with
each tooth.
The most recent technology developed for the fabri-
cation of the transfer matrix uses clear, thermoformed
plastic mouth-guard materials that allow for a light-
cured, flowable composite as a transfer adhesive instead
of opaque polyvinyl siloxane material. The benefit of a
flowable composite is that it can be light cured through
clear trays; this allows the composite to compensate for
small fabrication errors by filling voids between the
custom pad and the enamel. The use of flowable
Gange
composite translates to consistently better bond
strength and a reduced bond failure rate. Peripheral flash
after curing is reduced because flowable composites use
a needle tip to dispense the paste precisely on the custom
pad in small amounts. As with any indirect technique, a
flush interface between the tooth surface and the
custom pad is essential to a successful bond.
A LOOK INTO THE FUTURE
When we look at the last 45 years in orthodontics
(Fig 5), the changes have been dramatic: from brackets
welded to fixed metal bands to clear removable plastic
aligners moving the teeth. Such progress also has been
seen in the bonding of orthodontic attachments: from
messy, slow-setting, weak powder and liquid adhesives
bonding large brackets to enamel, to single-paste,
quick-setting adhesives that adhere to both enamel
and nonenamel surfaces. The ability to bond fixed appli-
ances to dentin, amalgam, porcelain, and zirconia with
new-generation primers has made adult treatment easier
and more esthetic.
Bonding cements and sealants have come a long way
during the last 45 years. However, the major hurdle from
the beginning has been contamination from condensa-
tion or saliva. Several hydrophilic primers such as Ortho
Solo, Assure, and MIP have been used successfully by or-
thodontists to bond in a slightly wet environment. The
most hydrophilic material, a powder and liquid glass ion-
omer cement, is more effective in a wet field than the hy-
drophilic primers. However, the resultant shear bond
strength still is significantly below that of bonding in a
dry field. The demand for esthetics has driven bracket
manufacturers to produce smaller and less visible appli-
ances, putting additional stress on the adhesive. There-
fore, the ideal adhesive of the future would be
hydrophilic, would not require acid etching of the
enamel, and would have a shear bond strength value
of over 20 MPa in both dry and wet fields.
REFERENCES
1. Miura F, Nakagawa K, Masuhara E. New direct bonding system for
plastic brackets. Am J Orthod 1971;59:350-61.
2. Masuhara E, Kojima K, Kimura T. Studies on dental self-curing
resins. Effect of alkylborane on the polymerization of methacrylate
with a benzyl-peroxide. Tokyo Ika Shika Daigaku Iyo Kizai Ken-
kyusho Hokoku 1962;2:368-74.
3. Masuhara E, Kojima K, Tarumi N, Hirasawa T, Sanjo D. Studies on
dental self-curing resins (4). Bonding of self-curing resins to
American Journal of Orthodontics and Dentofacial Orthopedics April 2015  Vol 147  Issue 4  Supplement 1
S63
dentin surface by the use of alkylboranes as initiator. Tokyo Ika
Shika Daigaku Iyo Kizai Kenkyusho Hokoku 1964;2:511-21.
4. Masuhara E, Kojima K, Tarumi N, Nakabayashi N. Studies on
dental self-curing resins. 7. Adhesive bonding to dentin improved
by polymer-ligand. Tokyo Ika Shika Daigaku Iyo Kizai Kenkyusho
Hokoku 1966;2:782-7.
5. Newman GV, Snyder WH, Wilson CE. Acrylic adhesives for
bonding attachments to tooth surfaces. Angle Orthodontist
1968;38:12-8.
6. Retief DH, Dreyer CJ, Gavron G. Direct bonding of orthodontic at-
tachments to teeth by means of an epoxy resin. Am J Orthod 1970;
58:21-40.
7. Bowen RL. Use of epoxy resins in restorative materials. J Dent Res
1956;35:360-9.
8. Bowen RL. Adhesive bonding of various materials to hard tooth tis-
sues. Forces developing in direct filling materials during hard-
ening. J Am Dent Assoc 1967;74:439-45.
9. McNamara JA Jr. Fabrication of the acrylic splint Herbst appliance.
Am J Orthod Dentofacial Orthop 1988;94:10-8.
10. McNamara JA Jr, Howe RP. Clinical management of the acrylic
splint Herbst appliance. Am J Orthod Dentofacial Orthop 1988;
94:142-9.
11. McNamara JA Jr. An orthopedic approach to the treatment of Class
III malocclusion in young patients. J Clin Orthod 1987;21:
598-608.
12. Silverman E, Cohen M, Demke RS, Silverman M. A new light cure
glass ionomer cement that bonds brackets to teeth without etching
in the presence of saliva. Am J Orthod Dentofacial Orthop 1995;
108:231-6.
13. Compton AM, Meyers CE Jr, Hondrum SO, Lorton L. Comparison
of shear bond strengths of light cure glass ionomer cements and
chemical cure glass ionomer cements for use as orthodontic
bonding agent. Am J Orthod Dentofacial Orthop 1992;101:
138-44.
14. Proffit WR, Fields HW, Nixon WL. Occlusal forces in normal and
long face adults. J Dent Res 1983;62:566-70.
15. Girish PV, Dinesh U, Bhat CS, Shetty PC. Comparison of shear bond
strength of metal brackets bonded to porcelain surface using
different surface conditioning methods. J Contemp Dent Pract
2012;13:487-93.
16. Cal-Neto JP, Carvalho F, Almeida RC, Miguel JA. Evaluation of a
new self-etching primer on bracket bond strength in vitro. Angle
Orthod 2006;76:466-9.
17. Shaikh MA, Kamat NV, Chalakkal P. Effects of light curing
conventional and self-etching primers. J Clin Orthod 2014;
48:231-7.
18. Hu W, Featherstone JD. Prevention of enamel demineralization.
Am J Orthod Dentofacial Orthop 2005;128:592-600.
19. Mettenburg D, Rueggeberg FA. In vitro toothbrush abrasion rates
of enamel sealants (poster session). Proceedings of the Interna-
tional Association of Dental Research; 2014 March 21-22; Chapel
Hill, NC.
20. Tran P, Hamood A, Mosley T, Gray T, Jarvis C, Webster D, et al.
Organo-Selenium containing dental sealant inhibits bacterial
biofilm. J Dent Res 2013;92:461-6.
21. Thomas RG. Indirect bonding: simplicity in action. J Clin Orthod
1979;13:93-106.