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116]

Original Article

Effect of Orthodontic Sealant Containing Antimicrobial Selenium on the

Shear Bond Strength of Orthodontic Bracket

Abstract Pinandi S. Pudyani,

Intoduction: Fixed orthodontic treatment has a high risk of enamel demineralization. Sealant containing Fibriana Safitri,
selenium is a material that has been developed to prevent enamel demineralization and stated to be Ananto A.
applicable as a primer bracket adhesion. Aim and Objective: This aim of this study was to investigate
Alhasyimi
the shear bond strength (SBS) of an orthodontic bracket after application of sealant containing selenium
Department of Orthodontics,
as a primer. Materials and Methods: A total of 100 extracted human premolars were used in this study,
Faculty of Dentistry, Universitas
which were randomly divided into two groups. Group I consisted of 50 teeth as the control group, to Gadjah Mada, Yogyakarta,
which a conventional primer (CP) was applied, whereas for group II comprising 50 teeth, a sealant Indonesia
containing selenium selenium primer (SP) was applied. SBS of the orthodontic brackets was measured
using a universal testing machine. The adhesive remnant index (ARI) scores were calculated to
determine the location of the bond failure using a stereomicroscope. A t test was used for analyzing
the SBS data, whereas the Mann–Whitney test was used for analyzing the ARI scores. Results: There
was no significant SBS difference (P > 0.05) between CP and SP groups. CP groups showed slightly
higher SBS [9.05 ± 3.10 megapascal (MPa)] than that in the SP groups (8.21 ± 3.78 MPa). The bond
failures of both the groups occurred at the adhesive–adhesive interface. Conclusion: The results showed
that sealant containing selenium can be used as a primer within orthodontic adhesive material, as the
physical–mechanical properties remained unchanged.

Keywords: Adhesive remnant index, orthodontic bracket, selenium, shear bond strength

Introduction adhesive material to prevent enamel

People who undergo orthodontic treatment are
at a higher risk of enamel demineralization
caused by Streptococcus mutans than that of
[1]
people who do not undergo such treatment. An
architecture of orthodontic bracket may create
challenges to maintain good oral hygiene,
leading to plaque accumulation that can raise
the level of microorganism in oral cavity and
provoke enamel demineralization. White spots
are an early sign of enamel demineralization,
[2]
which may lead to development of caries.
Enamel demineralization can be prevented
using an orthodontic sealant that can be
applied on the teeth around the bracket,
which results in greater protection of the
[3]
enamel. The orthodontic sealant material
must have the characteristics of being
resistant to oral environments, such as
brushing, food, and saliva, and also to
[4]
discoloration due to esthetic reasons.
Antibacterial agents can also be combined to
[5]
demineralization. Chlorhexidine (CHX) has
been added to orthodontic composites, but its
release is highly dependent on its initial
concentration within the material. At a higher
concentrations, CHX may interfere in the
mechanical and physical attributes of
[6]
adhesive materials. Furthermore, the long-
term use of CHX can be correlated with side
effects such as desquamation of mucous
membranes, a damaged sense of taste, tooth
staining, and specific irritation.
[2] Address for correspondence: Dr.
Ananto A. Alhasyimi, DDS,
Orthodontic sealant containing selenium is a MDSc, PhD, Department of
Orthodontics, Faculty of
material that has been developed to prevent Dentistry, Universitas Gadjah
[7]
enamel demineralization. Organo-selenium Mada, Jl. Denta Sekip Utara,
is polymerized into this dental sealant, which Bulaksumur, Yogyakarta 55281,
Indonesia.
is effective in restraining bacterial adherence
E-mail: anantoali@ugm.ac.id
and the development of biofilms by two
major oral pathogens, namely, S. mutans
[8]
and S. salivarius. Based on these facts, it Access this article online
is necessary to determine the shear bond
Website: www.jofs.in
strength (SBS) of the sealant containing
DOI: 10.4103/jofs.jofs_16_18
selenium as a primer that is used within
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For reprints contact: reprints@medknow.com
How to cite this article: Pudyani PS, Safitri F,
Alhasyimi AA. Effect of Orthodontic Sealant Con-
taining Antimicrobial Selenium on the Shear Bond
Strength of Orthodontic Bracket. J Orofac Sci
2018;10:96-100.

96 © 2019 Journal of Orofacial Sciences | Published by Wolters Kluwer - Medknow

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Pudyani, et al.: Effect sealant selenium on bracket SBS
orthodontic adhesive material, because as primer and sealant
material, they should be durable and can withstand daily
force. In this present study, we also used an artificial mouth
system (AMS) to approach and mimic the real situation in
oral cavity, as the oral environment dynamic conditions,
however, also influences the bonding strength.
Research Method
This experimental laboratory study was approved by the
Ethics and Advocacy Unit of the Faculty of Dentistry,
Universitas Gadjah Mada, Indonesia, with the number
001142/KKEP/FKG-UGM/EC/2017, on June 11, 2017.
The study was conducted using the maxillary first
premolars extracted for orthodontic plans. The inclusion
criteria for the teeth were as follows: the enamel surface
of the buccal tooth must not have undergone etching process,
and there should be no caries, fractures, and cracks on the
surface of the buccal tooth. The teeth were exposed to scaling
procedure using Ultrasonic Scaler (Woodpecker UDS-A
LED, China) to eliminate organic debris, washed, and
disinfected with 0.5% chlorine for 1 week at 25°C, which
was revived once for 2 days to restrict bacterial
contamination. A total of 100 premolar teeth were
randomly divided into two groups: a conventional primer
(CP) group and a sealant containing selenium (SP) group (n =
50).
Figure 1: Sample incubation in AMS: (1) teeth; (2) tube; (3) Falcon tube; (4) BHI broth+ Streptococcus mutans; (5) saline; (6) infuse set lock; (7) incubator
Journal of Orofacial Sciences ¦ Volume 10 ¦ Issue 2 ¦ July-December 2018
Bonding of brackets
One hundred stainless steel standard straightwire premolar
brackets (Forestadent, Germany) and a bracket base surface
area of 10.86 mm2 were used for the study. The bracket was
placed on the mid-axis of the buccal surfaces of the teeth with a
bracket holder gauge. The teeth were etched using 37%
phosphoric acid (Scotchbond; 3M Unitek, Monrovia,
California, USA). An uniform thickness of primer agent
(0.5–1 mm) was applied on the enamel surface of each
sample (CP materials in CP group and the sealant containing
selenium in SP group, respectively). Then, a resin composite
(Transbond XT; 3M Unitek) was applied on the base of the
bracket, followed by light curing for 40 s according to the
manufacturer (10 s for each side: mesial, occlusal, gingival,
and distal) using a quartz–tungsten–halogen light-curing
unit (Litex 680A; Dentamerica, Industry, California, USA)
with a light intensity of 450 mW/cm2. Next, the teeth were
soaked in sterile saliva for 1 h to form a pellicle and then
incubated for 1 day in the AMS that was described by Morita
[9]
et al. [Figure 1].
AMS process
The AMS consists of (1) a tube for storing brain heart
infusion (BHI) broth stock to be used as the bacterial
nutrition media, (2) a saline tube for soaking the teeth in
BHI media and then washing, and (3) a tube in the incubator
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Pudyani, et al.: Effect sealant selenium on bracket SBS
for maintaining the teeth in an anaerobic condition and
preventing contamination. The bases of the BHI and the
saline tubes were covered using a rubber stopper that was
connected to a hypodermal needle to maintain the number of
drops of media passing through the tube in the incubator, with
the drip rate being six drops per minute. The drops in the BHI
and the saline tubes were concentrated in the middle of the
teeth sample. The bottom of the tube in the incubator was
installed with a valve to dump residual media at the bottom of
the tube. The Falcon tube was covered to place the tooth on
the tube, which was then placed in the incubator equipped
with a thermostat to maintain the temperature at 37°C.
The bacterial suspension was prepared using a method
[9]
described by Morita et al. with some modification. S.
mutans ATCC 25175 bacteria were grown in BHI agar
and anaerobically incubated at 37°C for 24 h. The bacterial
suspension was prepared by taking 1 dose of S. mutans, added
Table 1: Formula of brain heart infusion broth
Formula
Brain infusion solids
Beef heart infusion solids
Proteose peptone
Glucose
Sodium chloride
Disodium phosphate
Figure 2: Brain heart infusion broth
98
to sterile distilled water, and then diluted to 0.5 McFarland
concentration (1.5 × 108 CFU/mL).
The BHI broth medium was prepared by mixing 18.5 g of
BHI broth powder (Oxoid, UK; Table 1 and Figure 2) and
500 mL of distilled water in an Erlenmeyer flask. The top of
the Erlenmeyer flask was covered with aluminum foil and fed
into an autoclave at 121°C for 20 min to prevent
contamination.
Saliva processing
Saliva was collected from individual saliva donors with good
oral and systemic health. Donors were instructed to eat
breakfast and brush their teeth, after which they were not
allowed to eat and drink 2 h before the saliva collection.
Saliva collection was conducted during 9.00 to 10.00 AM to
minimize the diurnal effect that may influence the
composition of saliva. The saliva collected in a tube was
centrifuged at 1000×g for 20 min; the obtained supernatant
[10]
saliva was sterilized by filtration using a Millipore filter
[11]
unit and then stored at 4°C in a cold room before being used
[10]
g/L for the study.
12.5
Determination of the shear bond strength and the
5.0
adhesive remnant index
10.0
The SBS test was carried out using a universal testing
2.0
machine (UTM) with a speed of 0.5 mm/min. The
5.0
obtained data included the maximum force on the UTM
2.5
when the bracket came off the dental surface, which is
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Pudyani, et al.: Effect sealant selenium on bracket SBS
Table 2: Descriptive statistics and results of the t tests
comparing the shear bond strengths among two groups
tested
Statistic Group P value
CP SP
Mean 9.05 8.21 0.71b
Standard deviation (SD) 3.10 3.78
Maximum 12.15 11.99
Minimum 5.92 4.41
Number of samples (n) 50 50
Values are presented as mean ± standard deviation or P value
only. b No significant differences between groups (P > 0.05).
expressed in Newton units and then converted into
megapascal (MPa) units by dividing the force over the
surface area of the bracket (N/mm2). The adhesive
remnant index (ARI) was calculated to determine the
location of attachment failure by observing the residual
adhesive that remained on the bracket base under a
stereomicroscope with 10× magnification. The observation
results were then scored as described by Artun and
[12]
Bergland.
The shear strength data and the ARI scores were analyzed
using a t test and the Mann–Whitney test, respectively.
Results
The normality test of groups I and II showed that the data
were normally distributed (P > 0.05). Data homogeneity was
then tested using Levene’s test, which showed that the tested
variants were homogeneous (P > 0.05), suggesting that
further analysis can be continued using the t test [Table 2].
The t-test results shown in Table 2 reveal that there were no
differences in the SBS between the CP group and the sealant
containing selenium group (P > 0.05).
The Mann–Whitney test showed that there were no
differences in the ARI scores after debonding between the
CP group and the sealant containing selenium group (P >
0.05).
Discussion
The SBS of the metal bracket attachment in the group that
received the sealant containing selenium was
8.21 ± 0.84 MPa, whereas the group that received the CP
application showed SBS of 9.05 ± 1.10 MPa [Table 2]. The
optimal SBS that is needed to bond with the enamel has been
[13]
reported to be an average of 4 to 10 MPa. Thus, the average
shear strength of the sealant containing selenium in this study
was found to be within the normal range of the optimal
strength of the bracket attachment.
Statistical analysis using the t test showed that there was no
difference in the average shear strength between the sealant
containing selenium application group and the CP group.
Journal of Orofacial Sciences ¦ Volume 10 ¦ Issue 2 ¦ July-December 2018
Table 3: Frequency distribution of the ARI scores of the
groups and results of the Mann–Whitney test
Group ARI scores* Kruskal–
Walis
0 1 2 3
n % n % n % n % P value
CP 0 (0) 25 (50) 25 (50) 0 (0) 0.374b
SP 0 (0) 23 (46) 27 (54) 0 (0)
Values are presented as number (%). ARI = adhesive remnant
index, n = number of samples. b No significant differences
between groups (P > 0.05).*ARI scores: 0, the entire bonding
material residue left on the base of the bracket; 1 = more than
half of the bonding material residue left on the base of the
bracket; 2 = less than half of the bonding material residue left
on the base of the bracket; 3 = no bonding material residue left
on the base of the bracket.
This suggests that the orthodontic sealant containing
selenium can be used as a primer material on the bracket
attachment using a composite resin based on its optimal shear
strength. The absence of differences in the bond strength
between the two groups could be because of the low viscosity
of the content of both the materials, which makes it easier to
enter into the enamel pores, resulting in mechanical
interlocking attachment.
The primary ingredients of a CP are 45% to 55% of bisphenol
A diglycidyl methacrylate (BisGMA) and 45% to 55% of
[14]
triethylene glycol dimethacrylate (TEGDMA). BisGMA
has high viscosity (1200 hPa), whereas TEGDMA has low
viscosity (0.01 hPa). TEGDMA is usually added to BisGMA
[15]
to dilute the highly condensed BisGMA. The primary
ingredients of sealants with selenium content are 46.34%
[16]
of BisGMA, 38.91% of TEGDMA, and 4.43% of selenium.
The selenium is diSe-acetoacetoxy ethyl methacrylate, which
[15]
is a low-viscosity monomer (0.9 hPa). Based on the
primary composition of both the materials, it can be stated
that the CP and the selenium-containing sealant have a
comparable low viscosity. Alkurdi and Abboud stated
[17]
that the adaptation of an adhesive material to the enamel
is related to the viscosity of the material; a low-viscosity
material will readily flow further the micropores, enabling
quick placement and precise adaptation to the contact
surfaces.
It is important to consider the location of the bonding failure
while selecting orthodontic adhesive materials as it is related
to the enamel damage. Failure of the bracket attachment
system may occur between adhesive–enamel,
[18]
adhesive–bracket, or adhesive–adhesive interfaces. As
shown in Table 3, both the CP material group and the
sealant containing selenium group have ARI scores of 1
and 2, which implies that some of the adhesive material
remains in the enamel and bracket base, thereby indicating
that the bonding failure occurs between the
adhesive–adhesive materials. Regarding the location of the
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Pudyani, et al.: Effect sealant selenium on bracket SBS
bonding failure, no difference was observed between
the CP material group and the sealant containing
selenium group, as shown in Table 3. Failure of bonding
between the adhesive–bracket and adhesive–adhesive
interfaces is generally considered safer than that of the
adhesive–enamel interface. This is because some studies
have shown that debonding can cause the loss of enamel
in the form of cracks that compromise enamel integrity and
cause esthetic problems if the failure occurs between the
[18]
enamel and the adhesive. An ideal adhesive material should
produce adequate bond strength, must prevent enamel
[19]
demineralization, and should not cause enamel damage
[20]
during debonding. Thus, the sealant containing selenium
material is quite ideal to be used as a primer on the composite
resins as it has adequate strength and also contains
antimicrobials that can prevent the occurrence of enamel
demineralization during fixed orthodontic treatment. Further
research is needed to analyze the bonding strength and the
location of the bonding failure of metal brackets with sealant
containing selenium that are used for a period of 1 to 2 years
(according to the orthodontic treatment), including research
on enamel structure after debonding.
Conclusion
The SBS of the sealant containing selenium material was found
to be similar to that of the CP when used for bracket attachment
with a conventional composite resin. The bonding failure of the
sealant containing selenium material and the CP materials
when used for bracket attachment with conventional
composite resins occurs between the adhesives themselves.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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