ORIGINAL ARTICLE

Shear bond strength of composite, glass ionomer, and acidic

primer adhesive systems
Samir E. Bishara, BDS, DDS, DOrtho, MS,a Valeria V. Gordan, DDS, MS,b Leigh VonWald, BA,c and
Jane R. Jakobsen, BA, MSd
Iowa City, Iowa, and Gainesville, Fla

The purpose of this study was to determine the shear bond strengths of orthodontic brackets bonded with
one of three methods: (1) a glass ionomer adhesive with a 20% polyacrylic acid enamel conditioner; (2) a
composite resin adhesive used with 37% phosphoric acid etchant and a conventional primer; or (3) the
same composite resin used with an acidic primer that combines the etchant with the primer in one
application. The brackets were bonded to the teeth according to one of three protocols. Group I teeth were
etched with 37% phosphoric acid and bonded with Transbond XT (3M Unitek, Monrovia, Calif) following the
manufacturers instructions. Group I acted as the control group. Group II teeth were etched with an acidic
primer (Clearfil Liner Bond 2. J.C. Moritta Kuraway, Japan) that contains both the acid (Phenyl-P) and the
primer (HEMA and dimethacrylate) and was placed on the enamel for 30 seconds; the adhesive used to
bond the brackets was Transbond XT as in Group I. Group III teeth were etched with 20% polyacrylic acid
and the brackets were bonded with Fuji Bond LC (G.C. America, Chicago, Ill). A steel rod with one flattened
end was attached to the crosshead of a Zwick test machine (Zwick GmbH & Co, Ulm, Germany). An
occlusogingival load was applied to the bracket, producing a shear force at the bracket-tooth interface. The
results indicated that the resin/phosphoric acid adhesive system (control group) provided the strongest
shear bond strength x = 10.4 2.8 MPa). The glass ionomer adhesive system provided a significantly lower
bond strength (xx = 6.5 1.9 MPa). The least shear bond strength was present when the acidic primer was
used with an orthodontic adhesive ( x = 2.8 1.9 MPa). In the present study, the use of either a fluoride-
releasing glass ionomer or an acidic primer in combination with an available orthodontic composite
adhesive resulted in a significantly reduced shear bond strength when compared with that of the
conventional composite resin adhesive system. At the present time, the orthodontist and the patient are
better served by using phosphoric acid/composite resin adhesive system or other equivalent systems that
provide a clinically reliable bond strength between the bracket, the adhesive, and the enamel surface. (Am J
Orthod Dentofacial Orthop 1999;115:24-8)

I
n their attempt to minimize the incidence of
decalcification around orthodontic appliances, ortho-
dontists have always emphasized the need for good oral
hygiene.1 The role of fluoride in preventing caries has
also been well documented.2,3 As a result, the applica-
tion of fluoride solutions topically to the etched tooth
during bonding and the use of fluoride rinses during
treatment have been suggested.4 In addition, several
fluoride-releasing cements have been developed and
used clinically to reduce decalcification.5-7
Fluoride-releasing resins have been studied for
more than 30 years.8-12 In discussing fluoride-releasing
materials, Gwinnett and Ceen13 recommended that flu-
oride availability should be independent of patient
aProfessor, Orthodontic Department, College of Dentistry, University of Iowa.
bInstructor, Department of Operative Dentistry, University of Florida.
cResearch Assistant, College of Dentistry, University of Iowa.
dAdjunct Assistant Professor, Department of Preventive and Community Den-
tistry, College of Dentistry, University of Iowa.
Reprint requests to: Professor Samir E. Bishara, BDS, DDS, DOrtho, MS,
Orthodontic Department, College of Dentistry, University of Iowa, Iowa City,
IA 5242
Copyright 1999 by the American Association of Orthodontists.
0889-5406/99/$8.00 + 0 8/1/88896
24
cooperation and that the fluoride ion should diffuse or
dissolve over a prolonged period. In addition, it would
be beneficial if the fluoride ion release were site spe-
cific to those areas most susceptible to demineraliza-
tion, namely, adjacent to bonded orthodontic brackets.
Underwood et al14 examined in vivo, the durability and
caries-inhibition properties of a fluoride-exchanging
resin for 60 days after bonding. They concluded that
the fluoride-exchanging resin has a caries-preventive
potential and reduces the incidence of very early dem-
ineralization of enamel around orthodontic appliances.
Fluoride-releasing composite resins have been
introduced for clinical use; some were discontinued
because of an increased incidence of bond failure. Fur-
thermore, the composite resin initially released fluoride
in very small amounts, with no measurable fluoride
release detected after 3 days.15,16 In a study on a light-
cured fluoride-releasing resin, Chan et al17 evaluated
its various properties including fluoride release, tensile
bond strength, and polymerization through metal
brackets. They concluded that the tensile bond strength
of the fluoride-releasing resin was significantly less
than the conventional resin at 2 and 42 days after bond-
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 115, Number 1
ing. They also found that the composite resin was hard-
est in areas outside the brackets, regardless of the expo-
sure time.
Glass Ionomers
In general, glass ionomer products are divided into
three different categories: luting cement, restorative
material, and liners. Liner glass-ionomer materials are
differentiated from other glass-ionomer cements by
their extremely small particle size (about 5 m or less).
Because of the favorable characteristics of glass
ionomer liners,18-28 particularly the long-term release
of fluorides,22-24 attempts were made to improve their
physical properties to make them more useful in areas
where strength is of primary importance. Properties of
glass-ionomer liners includes high compressive resis-
tance,18 effective bonding to dentin,19-21 release of flu-
oride,22-24 radio-opacity,25 low thermal conductivity,26
and higher dentinal bond strengths than conventional
glass-ionomer restorative material.27,28 Fuji Bond L.C.
(G.C. America, Chicago, Ill.) is a light-cured resin-
reinforced glass ionomer used as a dentin/enamel
bonding agent and liner. Like conventional bonding
agents, this product has its own conditioner (20% poly-
acrylic acid) that removes the smear layer and prepares
the surface for the resin tag to interlock, thus facilitat-
ing the chemical bond. Mixing the components of the
material initiates the conventional glass-ionomer acid-
base setting reaction. Furthermore, exposure to visible
light initiates polymerization of both the water-soluble
resin monomers and the methacrylate groups attached
to the glass-ionomer acid chains. This occurs in addi-
tion to the spontaneous polymerization of HEMA.18,25
A glass ionomer hybrid was also introduced29 that
combines the properties of composite and glass
ionomers.
Acidic Primers
Conventional adhesive systems use three different
agents when bonding orthodontic brackets to the tooth,
namely an enamel conditioner, a primer solution, and
an adhesive resin. A unique characteristic of some new
etching systems is that they combine the conditioning
(Phenyl P) and priming (HEMA and dimethacrylate)
agents into a single acidic primer solution that can be
used on enamel and dentin.30,31 Combining condition-
ing and priming into a single treatment step saves time
and should increase the cost-effectiveness of the pro-
cedure to the clinician and indirectly to the patient.
These new acidic primers were used originally on
dentin.30,32
The findings from a recent study 33 indicated that
the use of acidic primers to bond orthodontic brackets
Bishara et al 25
to the enamel surface
_ can provide clinically acceptable
shear bond forces (x = 10.4 4.4 MPa) when used with
a highly (77%) filled adhesive (Panavia 21). The
authors suggested that more research was needed to
determine whether the currently available orthodontic
adhesive systems can be used with an acidic primer.33
The purpose of this study was to determine the
shear bond strength of orthodontic brackets bonded
with one of three methods: (1) a glass ionomer adhesive
with a 20% polyacrylic acid enamel conditioner; (2) a
composite resin adhesive used with either a 37% phos-
phoric acid etchant and a conventional primer, or (3)
the same composite resin used with the newly intro-
duced acidic primer that combines the etchant with the
primer in one application.
MATERIAL AND METHODS
Teeth
Seventy freshly extracted human molars were col-
lected and stored in a solution of 0.1% (weight/vol-
ume) thymol. The criteria for tooth selection included:
intact buccal enamel, not subjected to any pretreat-
ment chemical agents, eg, hydrogen peroxide, with no
cracks due to the pressure of the extraction forceps,
and no caries. The teeth were cleansed and then pol-
ished with nonfluoridated pumice and rubber prophy-
lactic cups for 10 seconds and randomly separated
into three groups.
Brackets Used
Orthodontic metal brackets (Victory Series. 3M
Unitek, Monrovia, Calif) were used in this study. The
average bracket base surface area was determined to be
12.2 mm.2
Bonding Procedure
The brackets were bonded to the teeth according to
one of following three protocols:
Group I: Teeth were etched with 37% phosphoric acid and
bonded with Transbond XT (3M Unitek) following the
manufacturers instructions. This group acted as the con-
trol group.
Group II: Teeth were etched with 20% polyacrylic acid
and the brackets were bonded with Fuji Bond L.C. (G.C.
America, Chicago, Ill).
Group III: An acidic primer (Clearfil Liner Bond 2. J.C.
Moritta Kuraway, Japan) that contains both the acid
(Phenyl-P) and the primer (HEMA and dimethacrylate)
was placed on the enamel for 30 seconds. The adhesive
used to bond the brackets was Transbond XT as in Group
I.
Each bracket was subjected to a 300 g force, fol-
lowing which excess bonding resin was removed with
a small scaler.
26 Bishara et al
Table I. Descriptive statistics in MegaPascals (MPa) and results of analysis of variance comparing the shear bond
strength of the three groups tested
Groups tested
Transbond + phosphoric acid
Fuji bond LC
Transbond + acidic primer
F - Ratio = 79.34.
P = .0001.
x = Mean
SD = Standard deviation.
P = Probability.
*Groups with different lettering are significantly different from each other (P .05).
Debonding Procedure
The teeth were embedded in acrylic placed in phe-
nolic rings (Buehler, Ltd, Lake Bluff, Ill). A mounting
jig was used to align the facial surface of each tooth to
be perpendicular with the bottom of the mold. All sam-
ples were stored in deionized water at 37C for 48
hours. During testing, each tooth was oriented with the
testing device as a guide, so its labial surface was par-
allel to the force applied. A steel rod with one flattened
end was attached to the crosshead of a Zwick test
machine (Zwick GmbH & Co, Ulm, Germany). An
occlusogingival load was applied to the bracket base,
producing a shear force at the bracket-tooth interface.
A computer electronically connected with the Zwick
test machine recorded the results of each test. Shear
bond strengths were measured at a crosshead speed of
5 mm/minute.
Residual Adhesive
After failure, the teeth and brackets were examined
under 10 magnification. Any adhesive remaining after
bracket removal was assessed according to the Adhe-
sive Remnant Index (ARI) and scored with respect to
the amount of resin material adhering to the enamel
surface. The ARI scale has a range between 5 and 1: 5
indicates that no composite remained on the enamel; 4,
less than 10% of composite remained on the tooth sur-
face; 3, more than 10% but less than 90% of the com-
posite remained on the tooth; 2, more than 90% of the
composite remained; and 1, all of the composite
remained on the tooth along with the impression of the
bracket base. The ARI scores were also used as a more
complex means of defining the sites of bond failure
between the enamel, the adhesive, and the bracket base.
Statistical Analysis
Descriptive statistics including the mean, standard
deviation, and minimum and maximum values were
American Journal of Orthodontics and Dentofacial Orthopedics
January 1999
x SD Range P*
10.4 2.8 6.4-19.1 A
6.5 1.9 3.5-10.6 B
2.8 1.9 1.1-7.8 C
calculated for each of the three groups of teeth tested.
The analysis of variance was used to determine whether
significant differences existed between the various
groups. If a statistically significant difference was pre-
sent, a Duncans multiple range test was used to identi-
fy which of the groups were different. The chi-square
(2) test was used to determine significant differences
in the ARI scores between the different groups. When
calculating 2, the ARI scores under 1 and 2 were com-
bined as were groups 4 and 5. Significance for all sta-
tistical tests was predetermined at P .05.
RESULTS
Shear Bond Strength Comparisons
The descriptive statistics for the shear bond
strengths of the three groups tested are presented in
Table I. Analysis of variance indicated that the shear
bond strengths of the three groups were significantly
different from each other (P = .0001). When compared
_
with Transbond/phosphoric acid etch (x = 10.4 2.8
MPa), the glass ionomer adhesive had a significantly
_
lower shear bond strength (x = 6.5 1.9 MPa). The use
of an acidic primer with the Transbond _adhesive pro-
duced the lowest shear bond strength (x = 2.8 1.9
MPa).
Adhesive Remnant Index (ARI) Comparisons
The results of the 2 comparisons indicated that
there were significant differences (2 = 39.3, P = .001)
between the three groups tested. There was a greater
frequency of ARI scores of 1 and 2 with the Trans-
bond/phosphoric acid group (ie, more residual adhesive
was left on the enamel after debonding). On the other
hand, with the Transbond/acidic primer group, there
was a higher frequency of ARI scores of 4 and 5 (ie,
less residual adhesive left on the enamel after debond-
ing). Furthermore, two of the brackets failed before
testing. With the glass ionomer, there was a greater fre-
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 115, Number 1
Table II. Frequency distribution of the Adhesive Remnant Index (ARI) of the three groups evaluated
Groups tested 1 2
Transbond + phosphoric acid 2 8
Fuji bond LC - 2
Transbond + acidic primer - -
*1 = All composite on tooth, 2 = > 90% of composite on tooth, 3 = > 10% but < 90% remains on tooth, 4 = < 10% composite on tooth, 5 = no
composite remains on tooth.
quency of ARI scores of 3 (ie, there was as much adhe-
sive on the tooth as it was on the bracket).
DISCUSSION
The direct bonding of orthodontic brackets has rev-
olutionized and improved the clinical practice of ortho-
dontics. The use of acid etchants followed by primer
materials has been an essential part of the bonding pro-
cedure in order to allow good wetting and penetration
of the adhesive tags. However, there is a need to
improve our ability to maintain a clinically useful bond
strength while minimizing the amount of enamel loss.
In the present study, two types of adhesives with
different types of etchant and primers were compared.
The results indicated that the resin/phosphoric acid
adhesive system (control
_ group) provided the strongest
shear bond strength x = 10.4 2.8 MPa). The glass
ionomer adhesive system provided a significantly
_
lower bond strength (x = 6.5 1.9 MPa). The lowest
shear bond strength was present when the _acidic primer
was used with an orthodontic adhesive (x = 2.8 1.9
MPa).
The use of glass ionomer adhesive systems has the
advantage of releasing fluoride ions from the bonding
material. On the other hand, the shear bond strength
was not found to be as strong as with composite resins,
yet it was still above the minimal bond forces required
for orthodontic purposes suggested by Reynolds.34
The use of acidic or self-etching primers is thought
to simplify the clinical handling of adhesive systems by
combining the etching step with primer application in
one mix.30-32 In an earlier study,33 the same acidic
primer was combined with a highly filled adhesive
used in restorative dentistry and was
_ found to provide
comparable shear bond strength (x x = 10.4 4.4 MPa)
as conventional orthodontic adhesive systems. The
results from the present study indicated that current
orthodontic adhesives might not be compatible with
acidic primers. Therefore, more research is needed to
find an acidic primer-orthodontic adhesive combina-
tion that can be successfully used to bond orthodontic
brackets.
Bishara et al 27
ARI Scores*
3 4 5 N
8 6 1 25
16 4 1 23
1 4 15 20
The findings on the ARI scores should be of inter-
est to the clinician (Table II). There was a tendency to
have less residual adhesive remaining on the tooth
when an acidic primer was used, ie, there was a higher
frequency of ARI scores of 4 and 5 as compared with
the scores when phosphoric acid was used as an
etchant. The latter combinations and resulted in higher
frequency of ARI scores of 1 and 2. This should be
advantageous to the clinician because it will require
less time to clean the teeth after debonding. On the
other hand, with the glass ionomer there was a greater
tendency for the adhesive to be equally present on the
tooth surface and the bracket (higher frequency of ARI
score of 3).
CONCLUSIONS
In the present study, the use of either a fluoride-
releasing glass ionomer or an acidic primer in combi-
nation with an available orthodontic composite adhe-
sive resulted in a significantly reduced shear bond
strength when compared with that of the conventional
composite resin adhesive system. At the present time,
the orthodontist and the patient are better served by
using a phosphoric acid/composite resin adhesive sys-
tem or other equivalent systems that provide a clini-
cally reliable bond strength between the bracket, the
adhesive, and the enamel surface until a compatible
acidic primer/orthodontic adhesive is introduced to
the market.
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