Buccal Tubes Research Articles

Shear bond strengths of buccal tubes

Abstract Aims To investigate the shear bond strengths of buccal tubes and to determine the sites of failure. Method Four orthodontic buccal tubes were selected: A, American Orthodontics; B, 3M Unitek - small base; C, 3M Unitek - large base; D, Hangzhou Dentop. Twenty buccal tubes from each group were bonded to the buccal surfaces of lower right first molars with the same light-cured composite resin. The buccal tubes were debonded with a universal testing machine and the data analysed. The amount of adhesive remaining on the teeth after debonding was classified with the modified adhesive remnant index (ARI). Results The groups ranked from the highest to lowest bond strength (MPa) were: B, A, D and C. The bond strengths of the buccal tubes, except Groups A and B, were significantly different (p < 0.05). The majority of the buccal tubes (63 per cent) had modified ARI scores of 1 and 2 and 25 per cent of the tubes had scores of 4 and 5. After debonding, no adhesive remained on 40 per cent of the teeth in Groups B and D. Conclusions The shear bond strengths of the buccal tubes fell below the value considered to be clinically acceptable. There were no differences between the shear bond strengths of the buccal tubes with photoetched and microetched bases. The buccal tubes with the largest base failed prematurely, possibly because the unsupported bonding pad flexed during debonding.

Microbial Contamination of Orthodontic Buccal Tubes from Manufacturers

This study aimed to test the sterility of new unused orthodontic buccal tubes received from manufacturers. Four different types of buccal tubes were used straight from the manufactures package without any additional sterilizing step. Of these buccal tubes tested, three genera of bacteria, implicated as opportunistic pathogens, namely Micrococcus luteus, Staphylococcus haemolyticus and Acinetobacter calcoaceticus were recovered from these buccal tubes. Our data showing microbial contamination on buccal tubes highlights the need of sterilization before clinical use. We also suggest that manufacturers should list the sterility state of orthodontic buccal tubes on their packaging or instructions stating the need for sterilization.

Weibull analysis of bond strength of orthodontic buccal tubes bonded to resin composite surface with various techniques

The objective of this study was to analyze the survival probabilities of various surface preparation techniques for bonding buccal tubes on resin composite surface. Resin composite specimens (hybrid), 33 per group were prepared. 8 experimental groups were (1) sandblast 90 μm; (2) sandblast 50 μm; (3) abrasion using diamond bur; (4) hydrofluoric acid etching for 1 min (HF 1 min); (5) HF 2 min; (6) HF 3 min; (7) 37% orthophosphoric etching for 10 min (H 3PO 4 10 min) and (8) control (unetched surface). Plastic conditioner was applied then buccal tubes were bonded. Shear bond strength was tested with the universal testing machine and the Weibull analysis was performed. The results at a stress level of 7.8 MPa and 10 MPa, revealed the probabilities of survival for sandblast 50 μm (100%, 99.9%), sandblast 90 μm (99.7%, 98.7%), diamond bur (98.3%, 93.4%), HF 2 min (95.9%, 85.3%), HF 1 min (78.3%, 61.4%), HF 3 min (70.6%, 46.3%), H 3PO 4 10 min (61.4%, 44.5%) and control (26.3%, 6.9%), respectively. Therefore, surface preparation by sandblast (50 μm and 90 μm), or diamond bur followed by plastic conditioner were highly effective for bonding orthodontic buccal tubes on hybrid resin composite surface. HF 2 min was acceptable. However, HF 1 min, 3 min, H 3PO 4 etching and unetched surface could not achieve adequate bond survival.

Bond failure in clinical practice

Abstract Background It has been suggested that the small bonding pads and prominent profiles of self-ligating brackets may lead to high failure rates when compared with conventional edgewise brackets. Aims To compare the bond failure rates of a self-ligating bracket (Speed, Strite Industries, Cambridge, Canada) and a twin edgewise bracket (Mini-Diamond, Ormco, Orange, CA, USA) bonded with different adhesives (Sequence, Ormco, Orange, CA, USA; Transbond XT, 3M Unitek, Monrovia, CA, USA); to compare the bond failure rates of a self-ligating bracket bonded with different adhesives (Enlight, Ormco, Orange, CA, USA; Lightbond, Reliance, Itasca, IL, USA); and to compare the bond failure rates of molar attachments (Speed, Strite Industries, Cambridge, Canada) using different adhesives (Enlight, Ormco, Orange, CA, USA; Lightbond, Reliance, Itasca, IL, USA; Sequence, Ormco, Orange, CA, USA; Transbond XT, 3M Unitek, Monrovia, CA, USA). Methods This retrospective study covered 17 years. Study A (1991–99): Speed and Mini-Diamond brackets were bonded in both arches with either Sequence (Group 1) or Transbond-XT (Group 2) adhesives and the number of bond failures compared. Study B (2000–07): Speed brackets were bonded with either Lightbond (Group 3) or Enlight (Group 4) adhesives and the total number of bond failures (first-time and re-failures) compared. In Study C (1991–2007) Speed upper molar mini-brackets, upper molar tubes or ER brackets were used in the upper arch, and Speed lower buccal tubes were used in the lower arch. The failure rates of the molar attachments were compared. Results In Study A the failure rates with Sequence adhesive were: Speed 7.3 per cent, Mini-Diamond 11.9 per cent (p = 0.05). With Transbond XT adhesive the failure rates were: Speed 5.9 per cent, Mini-Diamond 6.4 per cent (p > 0.05). The teeth with the highest failure rates (central incisors and second premolars) were similar for both appliances. In Study B the failure rates were: Group 3 (Speed/Lightbond) 4.2 per cent; Group 4 (Speed/Enlight) 6.9 per cent; Group 3 vs Group 4, p = 0.05. In Study C the failure rate of Speed upper molar mini-brackets was markedly higher than the failure rates of the molar tubes. Conclusions The failure rates of the Speed brackets reduced over time, possibly because of improvements in the adhesives. The small bonding pads and prominent profiles of Speed brackets did not result in high failure rates.

Temperature rise and shear bond strength of bondable buccal tubes bonded by various light sources

The objective of the present investigation was to determine the intrapulpal temperature changes and to compare the shear bond strength (SBS) of bondable buccal tubes bonded by high-intensity light sources. Ninety caries-free human first molar teeth extracted for periodontal reasons were used. For the temperature measurement test, 30 teeth were randomly divided into three groups (n = 10) whereas 60 teeth were used in three groups (n = 20) for SBS testing. Three light sources, high-intensity halogen, blue light-emitting diode (LED), and xenon plasma arc (PAC), were used for polymerization of Transbond XT. Temperature variations (Delta T) were recorded by a K-type thermocouple wire connected to a data logger. For SBS testing, a universal testing machine was used at a crosshead speed of 1 mm/minute until buccal tube bonding failure occurred. Data were analyzed using the Kruskal-Wallis test. The high-intensity halogen light resulted in significantly (P < 0.01) higher intrapulpal temperature changes than the LED or PAC. The results of the shear bond test revealed significant (P < 0.05) differences only between the halogen and LED groups. The findings of the present investigation showed that high-intensity curing devices can safely be used in bonding buccal tubes to molar teeth without causing a deleterious effect on the dental pulp.

Osteotomy Assisted Maxillary Posterior Impaction with Miniplate Anchorage

This case report presents orthodontic treatment with miniplate anchorage accelerated by osteotomy-assisted maxillary posterior impaction in a severe open bite case. A 14-year-old girl with a severe anterior open bite was treated by intrusion of the maxillary posterior teeth. A segmental osteotomy was applied, and the miniplates were fixed to the zygomatic buttress area. The intrusive force was applied with nickel-titanium closed coil springs using a force of 250 g between the miniplates and the upper first and second molar buccal tubes. The intrusion was completed 2.5 months after osteotomy. The treatment was continued with the fixed orthodontic appliances and completed after 12 months. At the end of treatment, optimal occlusion and the correction of the anterior open bite were achieved. The maxillary molars were impacted 4.0 mm, and the mandibular plane showed a counterclockwise autorotation of 3.0 degrees . The results showed that osteotomy-facilitated orthodontic treatment clearly reduced the treatment time and had no adverse effects. In conclusion, this one-stage osteotomy technique can be an effective option to help molar intrusion in severe open bite cases.

Weibull analysis of shear/peel bond strength of orthodontic buccal tubes bonded to five resin composites

Bonding orthodontic buccal tube on a large resin composite restoration of molar tooth can result in easier bond failure than bonding to intact enamel. The resin composite type may be one of several factors that influence the bond strength. The objective of this study was to analyze the survival probabilities of buccal tubes bonded to various resin composites. Resin composite discs, 33 specimens for each group were prepared as follows: (1) nanofill (Filtek Supreme), (2) compomer (F2000), (3) hybrid (Z100), (4) packable (P60) and (5) flowable (Filtek Flow). The surface was etched with 9.6% hydrofluoric acid, followed by plastic conditioner application. Orthodontic buccal tubes were then bonded. Shear/peel bond strength was tested with the universal testing machine. The Weibull analysis was performed to indicate the survival probability for each resin composite type. Scanning electron microscope comparison of unetched and etched surface of resin composite was demonstrated. The probabilities of survival at a stress level of 7.8 MPa ranked from highest to lowest as follows: hybrid (95.87%), packable (95.38%), flowable (91.81%), compomer (69.95%) and nanofill (36.03%). The survival probabilities of orthodontic buccal tube bonded on hybrid, packable and flowable resin composite were substantially high, while that of nanofill resin composite was remarkably low. From scanning electron microscope, different surface topography of etched surface exhibited unequal resistance to acid etching among different resin composites. Therefore, type of resin composite surface accounted for the differences seen in the survival probabilities of orthodontic buccal tubes.

Direct bonding in orthodontic treatment and retention a post-treatment evaluation

A post-treatment evaluation, after 9-20 months of routine orthodontic therapy, was made on the effectiveness of direct bonding with a chemically polymerized diluted composite material. A total of 612 brackets and buccal tubes on perforated metal backings were bonded to different teeth of 75 patients, including 237 incisors, 125 canines, 164 premolars and 86 first or second molars. To improve aesthetics, oral hygiene and gingival condition, slim bracket bases were used on all teeth and care was taken to use minute quantities of adhesive material. The same investigator bonded all the brackets and performed the orthodontic treatment. The results demonstrated an overall failure rate of 11 per cent for the whole treatment period. The brackets most prone to come loose were the maxillary first molars (27%), followed by the mandibular first (24%) and second (18%) molars. The failure rates on all other teeth were lower than 10 per cent, with the canines giving the lowest debonding rates (4-6%). An evident individual variation was noted, and a few patients had a high number of failures. Clinical and scanning electron microscopic studies of tooth surfaces following removal of the brackets demonstrated a ‘normal’ surface appearance when plain-cut tungsten-carbide burs rotated at low speed were used to remove composite material that could not be scraped off, while fine diamonds and even sand paper discs created marked surface scratching. It is concluded that carefully performed bonding techniques may be of value, particularly on anterior teeth, premolars and mandibular second molars, while the evidence at hand would suggest that first molars are better banded. Also, for retention purposes, direct bonding with composite material opens up a range of new possibilities, which seem to be very promising.

Orthodontic facebows: safety issues and current management.

Some patients treated with extra-oral traction provided by simple elasticated materials and a standard facebow have experienced problems with the standard facebow coming out of the buccal tubes at night and the catapult effect of the extra-oral traction. The disengagement of the facebow at night has affected the success of treatment and occasionally injured the patient. This paper draws on material from a variety of papers and lists the known causes and considers the associated safety issues. It also provides some clinical tips and makes several suggestions for the continued use of this very useful form of additional orthodontic anchorage.

Simplified approach to prevent lodgement of orthodontic cement in the molar buccal tube

ements have been used routinely in orthodontics for cementation of bands with buccal tubes on molar teeth. However, during cementation of a molar band. sometimes cement flows in the slot of the buccal tube, thereby blocking the entrance for wire placement. Forceful removal of cement from buccal tube slot in the patient's mouth may injure or tear the soft tissue or deform the band. This further complicates the patient's cooperation for fixed mechanotherapy. To overcome this problem. a simplified approach has been proposed to prevent blocking of the buccal tube slot by cement. This is a small segment of rectangular wire selected according to the dimensions of rectangular slot of the buccal tube. II is bent at right angle al ils one end and placed in the rectangular slot of Single buccal tube. II's other end is then bent at right angle distal to the buccal tube so as to prevent its slippage. The similar design is being proposed for double buccal lube with the wire segment passing through both

A clinical evaluation of a locking orthodontic facebow

Standard orthodontic facebows may accidentally detach from the appliance buccal tubes at night; this could reduce the effectiveness of extra oral traction and occasionally cause an injury. To try and prevent facebow detachment at night a facebow with a locking mechanism was introduced. This study assessed the ability of 706 consecutively treated patients to learn to wear and use this facebow. The facebows were fitted in 9 different practices supervised by 12 orthodontists. Data from the patients and orthodontists were collected over a 2-year period and covered approximately 166,550 nights. All the orthodontists were able to fit and adjust the facebow; a total of 697 patients successfully used the facebow. Accidental detachment of the facebow at night was reported to be less than 1%. This indicates a significant improvement in the safety of the facebow and should help to improve compliance by increasing the number of hours of wear achieved by the patients. (Am J Orthod Dentofacial Orthop 2000;117:344-50)

Improvement on Mandibular Ramus Repositioning System of External Fragments in Sagittal Split Ramus Osteotomy

In sagittal split ramus osteotomy, positioning and fixation of external fragments influences on relapse or temporo-mandibular-joint (TMJ) function. We take a line to keep preoperative TMJ positions, if we observe no sign of TMJ clinically and roentogenographically. Then we established external fragment repositioning system making use of “Wurzburg sagittal split system” and ready-made facebow and double buccal tubes for orthodontic treatments. This system requires no special instruments, materials and complex laboworks, do not elongates operation time too much to interfere the manipulations, and realizes sure and exact reposition of external fragment. From July 1990 to November 1991, we applied this system to 26 cases of mandibular prognathism or skeletal open bite, and obtained good clinical results.

Begg-edgewise diagnosis-determined totally individualized orthodontic technique: Foundations, description, and rationale

This article presents an appliance system designed to facilitate efficient treatment by the use of the biomechanical approach considered most suitable by the orthodontist for the individual patient. The system described uses narrow, single brackets with 0.022 × 0.028 inch edgewise arch wire slots and 0.020 × 0.020 inch vertical slots for various auxiliaries. There are five brackets that differ only in the torque of the arch wire slot—0 °, 5 °, 10 °, 15 °, and 20 °. Thus, an appropriate bracket can be selected for any tooth in any situation. The brackets and bonding pads are small in all dimensions to ensure optimal appearance and interbracket arch wire spans and minimal lip and cheek irritation. This also lessens occlusal interference, enamel surface involved in bonding, and problems with gingival proximity and oral hygiene. The basic buccal tubes are conventional 4.5 mm long, 0.022 × 0.028 inch torqued edgewise tubes. A buccal tube assembly with a similar additional rectangular tube carried diagonally at a 15 ° angle across the buccal surface of the basic tube (its mesial end pointing gingivally) is used in extraction cases with deep overbites or moderate-to-severe anchorage requirements. The angulated outer tube carries the main (working) arch wire during the bite-opening and retraction phases of treatment. A rectangular sectional wire in the inner tube and second premolar bracket locks the molar and premolar teeth together so that neither can tip independently. As a unit they provide anchorage for bite opening and retraction. The gingivally positioned and angulated outer tube directs the arch wire out of danger of distortion from mastication and provides a built-in bite-opening effect. The molar and premolar teeth, in effect, become a single large tooth with its center of resistance (CR) further mesial than the CR of the molar. Sectional wires result in a more favorable system of moments created by arch wires and elastics. This delivers more intrusive force to the incisors with less tendency to tip the anchor units. The appliance provides the orthodontist with an extensive range of options in treatment mechanics—from anchorage conservation and rapid movement of limited tipping by light forces to translation or stabilization with precise three-dimensional control.

Rotation of rectangular wire in rectangular molar tubes: Part II. Pretorqued molar tubes

Buccal tubes from five manufacturers producing the new generation of preadjusted (straight wire type) appliances were tested to determine the amount of rotation various-sized rectangular wires produced prior to binding within the tube. This rotation reflected the amount of torquing force dissipated because of the interaction of the wire and tube. In addition, it indicated the degree of compensatory third-order bends needed in the wire to deliver the desired torque force to the tooth. Wire and tube dimensions were measured and compared to manufacturers' stated specifications. The amount of rotation for each manufacturer's tube was compared to the theoretical values based on calculations. Theoretical calculations and published charts of deflection angles based on these calculations give a false impression in that they do not reveal a true expression of the amount of torque dissipated through rotation of the rectangular wire in that tube. There is variation between the manufacturer's stated lumen dimension and the actual lumen size, even beyond the manufacturer's stated tolerances. Rectangular wire will rotate within a rectangular buccal tube to varying degrees, depending upon the size of the wire used and the manufacturer of the appliance. This means that additional torsion or angulation may need to be placed in the wire prior to application intraorally. The amount of this additional torquing of the arch wire will depend upon the manufacturer of the appliance used and will vary from tube to tube of the same manufacturer.

Clinical Applications of Direct Orthodontic Bonding Systems

Utilization of direct bonding of attachments to tooth surfaces has greatly facilitated traditional full-banding procedures for patients undergoing complete orthodontic therapy. The bonding of plastic brackets best relegated to maxillary anterior teeth is supplemented with metal bracket bonding for posterior teeth. Buccal tubes attached to metal mesh pads may also be bonded, although conventional orthodontic bands and buccal tubes are ideal for posterior teeth. Bonded metal brackets can accommodate resilient arch wires, torque sectionals, and root paralleling springs. Direct bonding to recently exposed impacted cuspids facilitates elastic traction procedures--once difficult to do before at least partial eruption of these teeth. In addition to the treatment of full orthodontic cases, direct orthodontic bonding is also an adjunct in the correction of single tooth malpositions. The continual improvement of composite resin systems has truly provided a renaissance in orthodontic techniques and has greatly benefited treatment methods.

BEDDTIOT: The state of the art, 1980

Abstract The Begg-Edgewise Diagnosis Determined Totally Individualized Orthodontic Technique was developed in an attempt to assimilate and enhance the best aspects of the Begg and various Edgewise techniques, and to eliminate their deficiencies. The appliance is a combination of six different narrow brackets with horizontal slots (.022″ × .028″) and 0°, 3°, 7°, 11°, 17° and 22° degrees of torque. The brackets have a vertical, slot (.020″ × .020″) for auxiliary springs. In some cases double Edgewise buccal tubes (.022″ × .028″) on molar teeth are used with about 24° of angulation between the two tubes; triple tubes may be employed if required in the upper arch for extra-oral force. The appliance is illustrated with the records of seven cases presented, including non-extraction and extraction treatment plans. The cases illustrate the technique’s utilization in minimum, moderate and maximum anchorage situations, and various combinations of elastics, together with sectional Edgewise wires. The use of square and ribbon arch wires in preference to Edgewise configurations is also discussed.

Reference charts for controlled extraoral force application to maxillary molars

A lthough headgear appliances were originally designed by Norman William Kingsley in 1892, half a century elapsed before orthodontists began to employ extraoral force extensively. 1 Kloehn’$ results with the cervical neckstrap actually provided the impetus to preserve extraoral traction from near obliteration. Subsequently, a va-riety of methods have been developed to employ extraoral force in conjunction with almost every type of orthodontic appliance. Yet extraoral force is primarily used for two purposes: (1) to correct dental arch relationships and (2) as anchorage to support teeth that would be displaced while other movements are being carried out. The most commonly used extraoral devices are the neckstrap for cervical pull and headcaps for straight pull and for higher pull. Force delivery to the teeth is usually accomplished by means of a face-bow attached to an intraoral bow which is inserted into buccal tubes on the maxillary molar ba.nds or by direct attachment of the headgear arms to hooks on the maxillary arch wire itself. Extraoral traction has many advantages when used properly, but it may produce unfavorable tooth movements and treatment results when basic biomechanical principles governing the direction of the applied force are disregarded. The most common adverse effects are extrusion and tipping of molar teeth. Furthermore, Schudy3 stressed that molar elongation must be avoided in persons with retrognathic facial profiles since extrusion of posterior teeth tends to rotate the mandible dorsally, thereby aggravating their facial disfigurement. Poulton* warned particularly against the indiscriminate use of the cervical neckstrap because it harbors a considerable vertical force component. Kuhn5 considered the control of posterior tooth eruption a major factor in attempts to modify or maintain lower face height. Whatever the merits of these concepts and critiques may be, an understand-

Canine retraction

Distal wires are formed on the plaster casts so that the free ends rest on the buccal tubes of the banded maxillary permanent first molars. This greatly increases the stability of the removable appliance in the mouth. Wires are also bent to contact the mesial surfaces of the premolars to prevent them from drifting mesially when first premolars have been extracted in either the maxillary or the mandibular arch. Springs move the canines distally into the extraction areas in either one or both arches, as has been described. They may be moved entirely back to the second premolars in some cases or only part of the way back, depending upon the cephalometric appraisal and the operator's judgment. This, then, leaves the four incisors as an island to be moved back as a unit after bands and appliances have been placed on the teeth. Each maxillary removable appliance generally has a flat bite plane or ridge for the lower incisors to occlude against. The springs on the mandibular removable appliance may be formed in the same manner as on the maxillary appliance, and mandibular appliances must have occlusal rests on the permanent first molars. At times in either the maxillary or mandibular appliance it may be necessary to have only unilateral springs. Patients almost always apply extraoral traction during this phase of treatment. These appliances are never referred to as “bite plates” to the patients but, rather, as removable appliances, since that is what they are—tooth-moving appliances.

II. Adjustment of molar buccal tubes for the Johnson twin-wire mechanism

II. Adjustment of molar buccal tubes for the Johnson twin-wire mechanism

Orthodontic treatment of some cleft palate and fracture cases

CASE I.-This case well illustrates the benefits derived from orthodontic treatment which was instituted after surgical treatment of a harelip and cleft palate. Hisiori] and Etiology.-Boy sixteen years of age, with a congenital unilateral cleft palate and harelip. The father, mother, sister, and brothers have normal occlusion; th ere were no other cleft palates in the family so far as the parents could recall. Three or four surgical operations were performed during infancy and early childhood for proper closure of cleft and harelip. Description and Proced1(,re.-The facial expression and muscle tone before orthodontic treatment are shown in Fig. 1. Note the protruding mandible ·and lip and the retruding maxilla and lip, also the deviated nasal construction. Fig. 2 shows views of the malocclusion of the teeth and jaws. A mandibular labial arch was fitted to buccal tubes on molar bands, and a maxillary lingual arch was fitted to half round tubes on the maxillary molar bands. Intermaxillary elastic pressure, together with lateral expansion of maxillary lingual arch and lingual contraction of mandibular labial arch, was used in order to place the teeth in better occlusion . For esthetics. better function, and retention a bridge was constructed from maxillary canine to canine and a piece of luxene was used to fill out the maxillary anterior region, thus giving a more normal appearance to the upper lip. See Figs. 3 and 4. The duration of treatment was about one year. Prognosis.-Fig. 4 shows views of the patient about fifteen months after plastic surgery, orthodontia, and general dentistry had been completed. An efficient, fairly esthetic denture has been effected, and there is no reason to expect a relapse.