Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : May | Volume : 17 | Issue : 5 | Page : ZC06 - ZC10 Full Version

Shear Bond Strength, Bonding Time and Adhesive Remnant Index of Adhesive Precoated Flash Free Adhesive System vs Conventional Adhesive System using Metal Brackets: An In-vitro Study


Published: May 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/62414.17875
Hrishikesh Borgikar, Jiwan Asha Agrawal, Manish Agrawal, Sangamesh Fulari, Lalita Nanjannawar, Shraddha Shetti, Vishwal Kagi, Amol Shirkande

1. Postgraduate, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. 2. Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. 3. Professor, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. 4. Associate Professor, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. 5. Associate Professor, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. 6. Associate Professor, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeet

Correspondence Address :
Hrishikesh Madan Borgikar,
Haripriya, Vidyanagar, Jath. Sangli, Maharashtra, India.
E-mail: borgikarhrishikesh@gmail.com

Abstract

Introduction: With advances in materials for bonding in orthodontics, errors regarding amount of adhesive to be used can be controlled. Adhesive Precoated (APC™) Brackets were introduced to reduce the step of applying conventional adhesive on base of the bracket. Moreover, APC™ Flash Free Adhesive System (FFAS) eliminated the step of removing excessive adhesive around the brackets.

Aim: To compare Shear Bond Strength (SBS), Bonding Time (BT) and Adhesive Remnant Index (ARI) between Conventional Adhesive System (CAS) and APC™ FFAS using metal brackets.

Materials and Methods: This in-vitro study was carried out in the Department of Orthodontics and Dentofacial Orthopaedics at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. A total of 78 teeth with metal braces were split into two groups, with 39 samples each receiving treatment with the CAS and the APCTM FFAS. Shear bond forces were applied to each sample using a universal testing machine and recorded in Megapascals (MPa) to provide an indication of SBS. Both Groups’ BT was quantified in terms of seconds. The stereomicroscope indexes of Artun J and Bergland S were used to determine ARI. Microsoft Excel was used for data entry, while Statistical Package for Social Sciences (SPSS) version 24.0 was used for analysis. The normality of the data was tested using two different t-tests. Descriptive statistics were represented in terms of mean and standard deviation. A significant level of 0.05 was used.

Results: The SBS values were 10.35±3.55 MPa and 11.23±3.82 MPa in CAS and FFAS respectively. No significant difference was found among the two groups (p≤0.29) in SBS. BT was significantly (p≤0.001) less in FFAS (95.54±8.72 seconds) compared to CAS (140.85±16.62 seconds). ARI was significantly (p≤0.002) less in FFAS (1.79±0.80) in comparison with CAS (1.23±0.74).

Conclusion: FFAS brackets perform better in comparison to CAS in case of BT and ARI. Both groups show no significant difference in SBS.

Keywords

Excess adhesive, Orthodontic bracket, Stereomicroscopy

In order to achieve successful orthodontic bonding, it is necessary to take into account the tooth’s surface, including its morphology and enamel preparation, the base of the individual orthodontic attachment, including its mechanical and material properties, and the bonding material, including its good SBS and material composition. The orthodontist has several different cements and resins from which to select (1).

Basic steps in direct bonding are enamel conditioning, priming the tooth surface and bonding the attachment. The bonding step consists of transfer of the bracket, positioning, fitting, removal of excess adhesive and curing. Introduction of Acid-etch technique in 1951 to bond dental restorations to teeth was an important step in history of orthodontic bonding (2). When directly bonding brackets, most orthodontists utilise either a precoated bracket system in which the base of the bracket already has orthodontic glue applied to it, or they manually apply orthodontic adhesive to the base of the bracket. Excess glue surrounding the bracket, which physicians sometimes fail to remove entirely (3) after insertion, is a prime location for the development of mature plaque (4),(5),(6).

A little amount of adhesive around the bracket surface area is still required to guarantee that the glue will be buttered into the bracket backing during the fitting process, even if surplus adhesive (Flash) has to be removed after bracket insertion (7). The innovative APCTM FFAS from 3MTM Unitek (Monrovia, Calif.) eliminates the requirement for flash removal during bracket placement or composite curing. The success of a bond depends heavily on the etching technique used, the adhesive’s mechanical qualities, and the clinician’s expertise. SBS values between 6 and 10 MPa are necessary for strong adhesion (8). Etching time, priming time, and curing time following bracket placement make up BT. ARI was used to measure the quantity of adhesive still present on enamel after debonding, as reported by Artun J and Bergland S (9). Ceramic brackets have been the primary focus of FFAS research in previous studies (10),(11),(12),(13). Only SBS, ARI, and/or BT have been evaluated independently using FFAS in metal brackets (14). This research set out to compare FFAS with CAS in metal brackets with regards to SBS, BT, and ARI.

Material and Methods

This in-vitro study was carried out in the Department of Orthodontics and Dentofacial Orthopaedics at Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Sangli, Maharashtra, India. On December 13, 2019, the Institutional Ethical Committee approved the study {Letter no. BV(DU)MC&H/IEC/Sangli/Dissertation2019-20/D-33}. Study was delayed because of COVID-19 pandemic. The procedure of study was followed in conformity with the Institute’s ethical standards from September 2020 to March 2021.

Teeth were obtained from a patient undergoing extraction at the Dental College and Hospital of the Bharati Vidyapeeth (Deemed to be University), Sangli, Maharashtra, India. Those utilising the 3MTM Unitek TransbondTM XT CAS for their 3MTM Unitek Victory Series low profile metal brackets served as the control group, while those using the 3MTM Unitek APCTM FFAS served as the experimental group.

Inclusion criteria: Newly extracted human premolars with intact and non carious buccal enamel surface.

Exclusion criteria: Pretreated teeth with bleaching, flurosis, restored teeth, teeth with cracks and previously orthodontically treated teeth.

Sample size calculation: Based on an alpha significance level of 0.05 and power of 80%, 78 samples were assessed according to Grünheid T and Larson BE (15). This in-vitro study was done using 39 human premolars in each group.

Study Procedure

The teeth were thoroughly cleansed of any remaining tissue tags. When the tooth’s root was firmly lodged, each tooth was placed vertically in self-cure orthodontic acrylic blocks. Oil, fluoride-free fine pumice, water, and a slow-speed handpiece were used to clean and polish the teeth’s buccal surfaces before being rinsed and dried. Bonding procedure was done in four steps. Etching was done using 37% orthophosphoric acid for 15 seconds. Etched surface was painted with with 3M™ Unitek Transbond™ XT primer.

In the CAS group, a 3MTM Victory series low profile bracket system was coated with TransbondTM XT light cure adhesive paste (3MTM Unitek) and then selected at random. After applying a steady force to bond the bracket to the tooth, any extra adhesive glue or flash was scraped off with an explorer, as seen in (Table/Fig 1). The APCTM Flash-Free Adhesive Coated Bracket was removed from its container and placed on the tooth in the FFAS group, as illustrated in (Table/Fig 2). Light-emitting Diodes (LED) curing light at 1200-1500 mW/cm2 was used for 20 seconds of curing. Occluso-gingival and mesio-distal bracket placement was optimised to the greatest extent feasible.

The SBS was measured at a crosshead speed of 1 mm/min on a universal testing equipment. To evaluate the SBS, a knife edge shaped equipment was positioned at the enamel-resin contact. By measuring the surface area of the bracket, we were able to convert the maximal force needed to de-bond it from Newtons to Megapascals (1 MPa=1N/mm2) (10). BT was arrived at by adding etching time comprising of priming and etching, to BT, which incorporated bracket placement and curing. An outsider used a stopwatch to time BT and report the results in seconds. To determine the kind of fracture, ARI was measured using a stereoelectronic microscope. The ARI provided by Artun J and Bergland S was used to assess the quantity of adhesive remaining on the tooth after de-bracketing (Table/Fig 3) (9). The following are some of the criteria used in the index: Adhesive removed from tooth=0. One means there is less than half the amount of glue on the tooth. More than half of the glue is still on the tooth if the number is two. Three remaining traces of glue on teeth.

Statistical Analysis

Pilot study was done using 10 samples that were not included in the study. Power was calculated to be 80%. This in-vitro study was done using 39 human premolars in each group. Statistical analysis was performed using SPSS 24.0 (IBM Corp., USA) for Microsoft Windows. Contrasts were analysed using T-tests for each group separately. If the probability value is less than 0.05, then the result is statistically significant.

Results

In the present study, 78 samples were divided equally into two groups as shown in (Table/Fig 4). All three parameters SBS (MPa), BT (seconds) and ARI (0-3) for 39 samples in each group are displayed in (Table/Fig 5).

Measurement and comparison of SBS: CAS exhibited SBS 10.35±3.55 (Mean±SD) MPa compared with FFAS having 11.23±3.82. Although the SBS of the CAS was non significant compared to the FFAS numerically but greater than 10 MPa (15), which is sufficient for orthodontic purposes. The measurements of SBS values from CAS and FFAS were statistically non-significant as shown in (Table/Fig 6).

Measurement and comparison of BT: The BT was significantly different between CAS (140.85±16.62) and FFAS (95.54±8.72) in seconds as shown in (Table/Fig 7).

Measurement and comparison of ARI: The FFAS exhibited less ARI 1.23±0.74 compared with CAS I having 1.79±0.80. Use of flash free bracket prevents extra adhesive to be distributed compared to conventional adhesive resulting in results in minimum adhesive left on tooth surface. Flash free brackets showed less ARI as shown in (Table/Fig 8). Distribution is shown in (Table/Fig 9).

Discussion

This study explored the differences between two different systems in SBS, BT and ARI. This is the first study evaluating all three parameters in two systems especially metal brackets.

Difference in SBS found in the present study was non significant between CAS (10.35±3.55 MPa) and FFAS (11.23±3.82 MPa). Furthermore, Akl R et al., and Guzman UA et al., reported no statistically significant differences between CAS and FFAS after 824 hours postbonding (p-value=0.574 and p=0.574, respectively) (16),(17). The difference between FFAS (10.97 MPa) and CAS (8.23 MPa) was statistically significant, as reported by Szuhanek C et al., (18). Both methods had comparable binding strength according to Grünheid T and Larson BE (19). According to Lee M and Kanavakis G, the SBS of the FFAS was 13.7MPa, whereas that of the CAS was only 10.8 2.0 MPa (20). Reynolds IR suggests that the SBS values obtained in the current investigation are sufficient however this is not the case (21). The FFAS contains a uniform layer of adhesive on non woven matrix on base of the bracket base eliminating the time to put adhesive on the base of bracket and remove excess flash after the bracket positioning. In our study, BT found was significantly different in the CAS (140.85±16.62 seconds) and FFAS (95.54±8.72 seconds). The average BT required for FFAS (19.5 seconds each tooth) was much lower than that for CAS (33.8 seconds per tooth) (22), as reported by Foersch M et al., Bonding took much less time (30.7 3.3 seconds) in the FFAS (P. 001) compared to the CAS (41.8 4.0 seconds) (20); this difference was statistically significant. In their study, Tumoglu M and Akkurt A found that BT administered via FFAS was over 4.22 minutes shorter per patient (23). The bonding period in the investigation was more extensive than that in the aforementioned studies. The same operator, with just two years of clinical experience, bonded all of the patients’ brackets, although a more skilled dentist could have been able to do so in less time. Usage of FFAS prevents excess adhesive to flow out of expected area of base of bracket compared to CAS resulting in lesser adhesive left on tooth surface. Results of present study indicate that the FFAS (1.23±0.74) exhibited significantly less mean ARI compared with CAS (1.79±0.80). ARI evaluation according to Artun J and Bergland S criteria explored a higher number of Score-2 in CAS (48.7%) and Score-1 in FFAS (56.4%) (9). This indicates that the tested samples in FFAS showed a greater number of bond failures occurring at the enamel to adhesive interface than CAS, which is consonant with reports by Henkin FS et al., and Lin CL et al., (24),(25). Vig P et al., suggested that bond failure at enamel to adhesive interface is favourable as clean up procedure required after debonding will be less, preventing loss of enamel surface making it less susceptible to plaque accumulation and sensitivity on exposure of the prism endings (26). Maxfield BJ et al., explains plaque accumulation leads to demineralisation and white spot lesions (27). Even the appearance may be unesthetic and unsatisfying. Studies by Hosein I et al., Ireland AJ et al., and Day CJ et al., suggest that production of airborne particles and inhalation of aerosols was result of more residual adhesive (28),(29),(30). A recent study by Brown JS et al., has explored the overestimation of concentration of particulates by sampling studies that will reach the lower respiratory tract (31). Penetration is affected by respiratory functions, e.g., nose versus mouth breathing and breathing patterns. This explores a fact that lesser the adhesive remnants better the cleanup and lesser amount of enamel loss and airborne particles. Previous comparative studies and results of present study are summarised in (Table/Fig 10) (16),(17),(20),(32),(33),(34),(35).

Limitation(s)

Present in-vitro study was done on human premolars. Thus, generalisation of results in clinical procedures should be done with caution. As the both adhesive systems belong to same manufacturer variability is limited. Thermocycling was not considered that could help in betterment of simulation in clinical process. High cost of FFAS should be considered. Future studies are required to evaluate relation between factors affecting SBS, BT and ARI in adhesives by different manufacturers and coloured adhesive system using metal brackets.

Conclusion

While bonding metal brackets, no significant variation in SBS was discovered between the two adhesives. The chances of bracket failure are lesser in APC™ FFAS according to absolute numbers. FFAS reduced time consumed by picking and holding bracket for application of adhesive, as well as the more important removal of flash which in conventional system increases the chair side time. This led to less BT in FFAS. FFAS resulted in less ARI compared to conventional system. This prevents enamel loss and smoother surface post debonding. APC™ FFAS performs well on base of all three parameters compared to CAS.

References

1.
Gange P. The evolution of bonding in orthodontics. Am J Orthod Dentofacial Orthop. 2015;147(4 Suppl):S56-63. [crossref][PubMed]
2.
Buonocore MG. A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J Dent Res. 1955;34:849-53. [crossref][PubMed]
3.
Tan A, Çokakog? lu S. Effects of adhesive flash-free brackets on enamel demineralization and periodontal status. Angle Orthod. 2020;90(3):339-46. [crossref][PubMed]
4.
Sukontapatipark W, el-Agroudi MA, Selliseth NJ, Thunold K, Selvig KA. Bacterial colonization associated with fixed orthodontic appliances. A scanning electron microscopy study. Eur J Orthod. 2001;23(5):475-84. [crossref][PubMed]
5.
Gwinnett AJ, Ceen RF. Plaque distribution on bonded brackets: A scanning microscope study. Am J Orthod. 1979;75(6):667-77. [crossref][PubMed]
6.
Weitman RT, Eames WB. Plaque accumulation on composite surfaces after various finising procedures. J Am Dent Assoc. 1975;91(1):101-06. [crossref][PubMed]
7.
Graber LW, Vanarsdall RL, Vig KW, Huang GJ. Orthodontics-e-book: Current principles and techniques. Elsevier Health Sciences; 2016;12(3):823-24.
8.
Gillis I, Redlich M. The effect of different porcelain conditioning techniques on shear bond strength of stainless steel brackets. Am J Orthod Dentofacial Orthop. 1998;114(4):387-92. [crossref][PubMed]
9.
Årtun J, Bergland S. Clinical trials with crystal growth conditioning as an alternative to acid-etch enamel pretreatment. Am J Orthod. 1984;85(4):333-40. [crossref][PubMed]
10.
Gupta SP, Shrestha BK. Shear bond strength of a bracket-bonding system cured with a light-emitting diode or halogen-based light-curing unit at various polymerization times. Clinical, Cosmetic and Investigational Dentistry. 2018;10:61-67. [crossref][PubMed]
11.
Almoammar KA, Alkofide E, Alkhathlan A, Alateeq Y, Alqahtani A, AlShaafi MM. Shear bond strength of orthodontic brackets with APC™ flash-free adhesive: An in-vitro study. Journal of Biomaterials and Tissue Engineering. 2017;7(8):671-77. [crossref]
12.
Marc MG, Bazert C, Attal JP. Bondstrength of pre-coated flash-free adhesive ceramic brackets. An in-vitro comparative study on the second mandibular premolars. Int Orthod. 2018;16(3):425-39. [crossref]
13.
Soliman TA, Ghorab S, Baeshen H. Effect of surface treatments and flash-free adhesive on the shear bond strength of ceramic orthodontic brackets to CAD/CAM provisional materials. Clin Oral Investig. 2022;26(1):481-92. [crossref][PubMed]
14.
Graber LW, Vig KW, Huang GJ, Fleming P. Orthodontics-e-book: Current principles and techniques. Elsevier Health Sciences; 2022 Aug 26.
15.
Grünheid T, Larson BE. Comparative assessment of bonding time and 1-year bracket survivalusing flash-free and conventional adhesives for orthodontic bracket bonding: A split-mouth randomized controlled clinical trial. Am J Orthod Dentofacial Orthop. 2018;154(5):621-28. [crossref][PubMed]
16.
Akl R, Ghoubril J, Le Gall M, Shatila R, Philip-Alliez C. Evaluation of shear bond strength and adhesive remnant index of metal APC™ Flash-Free adhesive system: A comparative in-vitro study with APC™ II and uncoated metal brackets. Int Orthod. 2022;20(4):100705. [crossref][PubMed]
17.
Guzman UA, Jerrold L, Vig PS, Abdelkarim A. Comparison of shear bond strength and adhesive remnant index between precoated and conventionally bonded orthodontic brackets. Prog Orthod. 2013;14:39. [crossref][PubMed]
18.
Szuhanek C, Golban DM, Negru R, Negrutiu ML, Marsavina L, Duma VF, et al. Flash-free orthodontic adhesive system compared with the conventional direct bonding method. Rev Chim. 2018;69(11):3193-95. [crossref]
19.
Grünheid T, Larson BE. A comparative assessment of bracket survival and adhesive removal time using flash-free or conventional adhesive for orthodontic bracket bonding: A split-mouth randomized controlled clinical trial. The Angle orthodontist. 2019;89(2):299-305. [crossref][PubMed]
20.
Lee M, Kanavakis G. Comparison of shear bond strength and bonding time of a novel flash-free bonding system. Angle Orthod. 2016;86(2):265-70. [crossref][PubMed]
21.
Reynolds IR. A review of direct orthodontic bonding. Br J Orthod. 1975;2:171-78. [crossref]
22.
Foersch M, Schuster C, Rahimi RK, Wehrbein H, Jacobs C. A new flash-free orthodontic adhesive system: A first clinical and stereomicroscopic study. Angle Orthod. 2016;86(2):260-64. [crossref][PubMed]
23.
Tumoglu M, Akkurt A. Comparison of clinical bond failure rates and bonding times between two adhesive precoated bracket systems. Am J Orthod Dentofacial Orthop. 2019;155(4):523-28. [crossref][PubMed]
24.
Henkin FS, Macêdo EOD, Santos KS, Schwarzbach M, Samuel SMW, Mundstock KS. In-vitro analysis of shear bond strength and adhesive remnant index of different metal brackets. Dental press J Orthod. 2016;21(6):67-73. [crossref][PubMed]
25.
Lin CL, Huang SF, Tsai HC, Chang WJ. Finite element sub-modeling analyses of damage to enamel at the incisor enamel/adhesive interface upon de-bonding for different orthodontic bracket bases. J Biomech. 2011;44(1):134-42. [crossref][PubMed]
26.
Vig P, Atack NE, Sandy JR, Sherriff M, Ireland AJ. Particulate production during debonding of fixed appliances: Laboratory investigation and randomized clinical trial to assess the effect of using flash-free ceramic brackets. Am J Orthod Dentofacial Orthop. 2019;155(6):767-78. [crossref][PubMed]
27.
Maxfield BJ, Hamdan AM, Tüfekçi E, Shroff B, Best AM, Lindauer SJ. Development of white spot lesions during orthodontic treatment: Perceptions of patients, parents, orthodontists, and general dentists. Am J Orthod Dentofacial Orthop. 2012;141(3):337-44. [crossref][PubMed]
28.
Hosein I, Sherriff M, Ireland AJ. Enamel loss during bonding, debonding, and cleanup with use of a self-etching primer. Am J Orthod Dentofacial Orthop. 2004;126:717-24. [crossref][PubMed]
29.
Ireland AJ, Moreno T, Price R. Airborne particles produced during enamel cleanup after removal of orthodontic appliances. Am J Orthod Dentofacial Orthop. 2003;124:683-86.[crossref][PubMed]
30.
Day CJ, Price R, Sandy JR, Ireland AJ. Inhalation of aerosols produced during the removal of fixed orthodontic appliances: A comparison of 4 enamel cleanup methods. Am J Orthod Dentofacial Orthop. 2008;133:11-17. [crossref][PubMed]
31.
Brown JS, Gordon T, Price O, Asgharian B. Thoracic and respirable particle definitions for human health risk assessment. Part Fibre Toxicol. 2013;10:10-12. [crossref][PubMed]
32.
Mahmoud E, Pacurar M, Bechir ES, Maris M, Olteanu C, Dascalu IT, et al. Comparison of shear bond strength and adhesive remnant index of brackets bonded with two types of orthdontic Adhesives. Materiale Plastice (Mater. Plast.). 2017;54(1):141-44. [crossref]
33.
Bhattacharjee D, Sharma K, Sahu R, Neha K, Kumari A, Rai A. Comparative Evaluation of Shear Bond Strength of Brackets Bonded with self Etch Primer/ Adhesive and Conventional Etch/Primer and Adhesive System. J Pharm Bioallied Sci. 2021;13(Suppl 2):S1168-73. [crossref][PubMed]
34.
Essop R, Ghabrial E, Becker PJ. In-vitro comparison of bonding time and strength of adhesive pre-coated and standard metal orthodontic brackets. South African Dental Journal. 2022;77(10):587-91. [crossref]
35.
Vorachart W, Sombuntham N, Parakonthun K. Adhesive precoated bracket: Is it worth using? Long-term shear bond strength: An in-vitro study. Eur J Dent. 2022;16(4):841-47.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/62414.17875

Date of Submission: Dec 21, 2022
Date of Peer Review: Feb 02, 2023
Date of Acceptance: Apr 07, 2023
Date of Publishing: May 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

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• Plagiarism X-checker: Dec 22, 2022
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• iThenticate Software: Apr 06, 2023 (3%)

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