Andreas Karamouzos DDS, Athanasios E.

Athanasiou DDS,
MSD, Dr Dent & Moschos A. Papadopoulos DDS, Dr Med Dent.

RESHMI NINAN
1ST YEAR MDS
DEPT. OF ORTHODONTICS & DENTOFACIAL ORTHOPAEDICS
 David L. Turpin- current editor-in-chief
 Graduate in dentistry from University
of Iowa, Iowa city, 1962
 Master of Orthodontics from the
University of Washington, Seattle,
1966
 Diplomate from the American Board
of Orthodontics
 Editor of the Bulletin of the Pacific
Coast Society of Orthodontics, 1978-
1988
 Clinical professor, Dept. of
Orthodontics, University of
Washington, Seattle
 Author of more than 150 editorials,
scientific articles & book chapters.
 "American Journal of Orthodontics and Oral
Surgery
 "1938-1947"
 --------------------------------------------------------
 American Journal of Orthodontics “1948-
1986"
 --------------------------------------------------------
 "American Journal of Orthodontics and
Dentofacial Orthopedics"1986"
 An ideal orthodontic appliance should include good
esthetics and optimal technical performance.

 An increase in the number of adult patients led to

the development of various esthetically superior
appliances.

 Ceramic brackets were introduced in 1986 and since

then have become an integral part of the
orthodontists’ armamentarium.
 The aim of this article is to review the clinical
characteristics and properties of ceramic brackets.
 The following aspects are discussed:
 Types
 Physical properties
 Bond strength
 Frictional resistance
 Base surface characteristics
 Debonding techniques
 Enamel fracture risks
 Enamel abrasion & wear
 Bracket fracture
 Bracket recycling
 Ceramic brackets are composed of aluminium
oxide.
 The 2 common varieties are –
monocrystalline alumina & polycrystalline alumina.

 Difference between poly and monocrystalline

brackets is in their optical clarity, as single crystal
brackets are more clearer than polycrystalline
brackets, which tend to be translucent.
 Presence of pores, machining interferences &
propagation lines contribute to compromises of
bracket use anytime during clinical use

 Because production of polycrystalline brackets is

less complicated, these brackets are readily
available
 Ceramic brackets come in a variety of edgewise
structures such as
1) True Siamese

2) Semi- Siamese

3) Solid

4) Lewis/Lang design
 Aluminum oxide- significantly harder than stainless
steel
 Ceramic brackets – 9 times as hard as SS or enamel
 Tensile strength – Monocrystalline > polycrystalline
> SS
 Fracture toughness – SS > polycrystalline >
monocrystalline
 Surface imperfections like scratch drastically reduce
the fracture strength
 Ceramic brackets extremely brittle, fracture
toughness 20 -40 times less than SS
 Tensile strength characteristics of ceramic depends
on the condition of the ceramic surface.

 A shallow scratch on its surface drastically reduces

the load required for fracture.

 Since the elongation for ceramic failure is less than 1

%, the brackets are more brittle.
 Bond strength derived from the use of a silane
coupling agent on the bracket base, through
mechanical retention, or both.

 Since these bases have considerably fewer

mechanical undercuts than those found in mesh
base designs, they might have greater bond failure
rates, if they are used without a silane coupling
agent.
 Silane coupling
Glass +Al2O3 Silane + glass
agent

Free end

React with
any acrylic
bonding
material
MECHANICAL BONDING CHEMICAL BONDING
 Bond strength is also affected by:-

Type of
resin Etching
time Conditio Preparat
ns ion of
teeth
involved
 Polycrystalline> stainless steel > monocrystalline

 Winchester stated that for different ceramic

brackets :
Bond strength value in shear/peel testing > bond
strength value in tensile/peel testing.
Frictional forces:
Stainless steel Ceramic
brackets brackets

Wider metallic/ Narrower metallic/

Ceramic brackets Ceramic brackets

Injection molded Other ceramic

Ceramic brackets brackets
Various frictional forces when different wires
are used :
Ni-Ti wires < stainless steel/ cobalt-chromium

To reduce frictional resistance:

 Development of ceramic brackets with
smooth slot surfaces
 Brackets consisting of metallic or
ceramic/plastic slot surfaces.
Currently 2 types of ceramic bracket bases
are available.
 ceramic bracket base formed with
undercuts/grooves:
o they provide mechanical interlock
o Flat base with silane layer for mechanical anchoring
Diadvantage:
minimizes the mechanical retention & survives purely
on chemical adhesion.
 Ceramic bracket base with smooth surface:
o relies on chemical coating to increase the bond
strength.
o Makes use of silane coupling agent as a chemical
mediator because of the inert nature of Al2O3 .
Advantage :
Achieves higher bond strength when compared to the
previous type.
 a recent development is the use of polycrystalline
alumina with a rough base.
 Contain randomly oriented sharp crystals/spherical
glass particles
 They provide only micromechanical interlocking with
the adhesive.
 To prevent damage to the enamel during debonding, a
ceramic bracket with a thin, polycarbonate laminate
on the base has been manufactured.(CeramaFlex, TP
Orthodontics)
 The enamel bond is through this polycarbonate
laminate
 These brackets are as easy to remove as the metallic
ones.
 failure occurs at the
The first technique
adhesive-enamel
mechanical.
interface.

work by stressing the

adhesive to its
Specially designed
ultimate strength
pliers
causing cohesive
failure

pliers work through breaking the bond at

deformation of the the bracket-adhesive
bracket interface
 It is an alternative to where the bracket is heated with a
heating gun while applying tensile forces.
 Once enough heat is generated, the bracket separates
from the tooth surface.
 Bishara et al found the technique to be quick &
effective.
 When the question of pulpal damage due to heat was
asked, it was found that it was too low & the time was
too short for any pulp damage to occur.
Disadvantage :
bulky nature of the handpiece
Risk of dropping a hot bracket in the patient’s mouth
 A derivative of peppermint oil when applied around
the bracket base acts as an agent for easier
debonding.

 When it is left for on the base for 2 minutes before

debonding, bracket removal is facilitated at the
enamel/adhesive interface, without damaging the
tooth surface.
 Another method is the ultrasonic debonding technique.
 They are debonded with KJS ultrasonic tips & Cavitron
2002 ultrasonic unit.
Advantages :
Decreased chance of enamel damage
Decreased chance of bracket failure
Ease of removal of residual adhesive with the same
instrument after debracketing.
Disadvantages :
Time consuming
Excessive wear of ultrasonic tips
Requires water spray to control heating.
 Ceramic brackets are debonded by irradiating the
labial surface of brackets with laser lights.
Advantages :
Reduced residual debonding force

Reduced risk of enamel damage

Reduced incidence of failure

Less traumatic & painful for patient

The force needed to achieve bond failure causes enamel
fracture & bracket fracture also.

Removing the bracket fragments with a high speed

handpiece is time-consuming

produces ceramic dust which causes itchy skin & eye

irritation.

Monocrystalline types cause more enamel fracture

presence of developmental defects, enamel cracks, large

restorations or non vital teeth.
 Enamel damage
occurs during contact This type of damage More severe than with
of ceramic brackets may occur rapidly metallic brackets
with occluding teeth

Special elastomeric
rings that cover the Abrasive properties
occlusal surface of the are more in
ceramic brackets are monocrystalline
placed at the area of brackets
contact
Ceramic brackets have low fracture toughness due to presence of Al2O3

Bracket may break either in function or during debonding.

Internal defects & machining interference- primary causes of fracture

Common type of fracture- bracket wing fracture which leads to increased

chairside time

Patient might swallow/aspirate the bracket fragment

Difficult to locate because of radioluscent nature of alumina.

Second-order wire Third-order wire
activations don’t cause CB activations-more likely to
failure cause fracture

Care should be taken to Elastomeric rings/coated

avoid scratching of bracket ligatures used to prevent
surfaces with instruments. tie-wing fracture
 Intact debonded brackets do not lose their
angulation, torque & base contour.
 “recycling method”-effective in providing clean
surface.
 Their bond strength – clinically adequate although
significantly lower than that of new brackets.
 This weaker bond strength reduces the chances of
enamel removal during debonding.
 STAINING:
 polycrystalline has the property of staining.
 Due to dietary habits ( excessive intake of caffeine,
certain mouthwashes etc.)
 Also associated with type of bonding resins.
 Certain topical flourides don’t cause surface damage >
causes increased plaque accumulation
 Ceramic bracket for mand. incisors > very small in size >
limited biomechanical rotational control of teeth >
smaller brackets with 4 wings > weakening of the
bracket.
 Increased bulkiness > difficult to clean > increased tooth
decalcification.
 The efect of different bonding & debonding techniques on debonding
ceramic orthodontic brackets – Pramod K. Sinha BDS, DDS, Ram
S.Nanda DDS, MS, PhD, University of Oklahoma:
3 bonding & debonding techniques were compared on 2 types of ceramic
brackets.
The single crystal bracket used chemical means & poly crystal bracket used
mechanical means of bonding.
The result was that both bonding & debonding techniques affect bracket
failure or fracture & remnant adhesive significantly, during debonding.
 Effects of different debonding techniques on debonding forces &
failure modes of ceramic brackets in simulated clinical set-ups-Hsing-
Yu Chen, Ming-Zen Su, Hsin-Fu Frank Chang, Yi-Jane Chen, Wong-
Hong Lan, Chun-Pin Lin:
The aim of this study was to evaluate the different debonding techniques on
the in-vitro mea debonding forces & failure modes of 3 kinds of ceramic
brackets (Clarity; 3M Unitek, Monrovia; Inspire & Inspire Ice, ) bonded to
enamel. The results of failure modes showed that the presence of a ball
reduction band in the Inspire Ice bracket & vertical debonding slot in the
Clarity bracket significantly reduced the risk of ceramic fracture during
debonding.
Debonding the Inspire Ice bracket required much lesser force when
compared to that of the Inspire bracket.
 Evaluation of the debonding characteristics of 2 ceramic brackets: an
in vitro study - Lina P Theodorakopoulou DDS,MS, P. Lionel Sadowsky
DMD,BDS,Dip Orth, Alex Jacobson DMD,MS,MDS,PhD:
2 types of ceramic brackets (Clarity,3M,Unitek,Monrovia,Calif
polycrystalline & Inspire,Ormco,Orange,Calif monocrystalline) were used
for this study to compare the shear bond strength & bond failure locations.
The mean shear bond strength of Clarity brackets & Inspire brackets were
21.67±5.19 Mpa & 20.32 ±8 Mpa respectively.
85% of Clarity & 75% of Inspire failed at the bracket-adhesive interface. The
results showed that the safest way to remove these brackets without
causing enamel damage is to use the debonding technique specifically
designed for each.
 Ceramic brackets have been gaining popularity for
their esthetic appeal for the past 10 years.
 Inspite of some detrimental clinical characteristics,
some new designs offer excellent optical properties
without compromising on functional properties.
 They are durable, allow adequate force control over
long treatment periods .
 They have been widely accepted by all classes of
patients & contributed significantly in the
development of contemporary orthodontic
treatment modalities.