REBONDING BRACKETS

Dislodgment of an

orthodontic bracket

accidental

intentional

Elements to consider when rebonding:

when was the bracket dislodged?Faliure type.Reconditioning enamel surface.The use of new brackets or original brackets.Type of bracketsThe bonding system to be used.

The best way to avoid loose brackets is to adhere strictly to the

RULES for Good Bonding

Orthodontics, current principles and techniques , third edition

REMEMBER

Procedure /according to graber/The loose bracket is removed from the

archwire.Any adhesive remaining on the tooth surface is

removed with a tungsten-carbide (TC) bur.The adhesive remaining on the loose bracket is

treated by sandblasting until all visible bonding material is removed from the base.

The tooth is then etched with Ultraetch 35% phosphoric acid gel for 15 to 30 seconds.

After sealing, the bracket is rebonded in its right position.

Orthodontics, current principles and techniques , third edition,2000

The Microetcher is an FDA-approved intraoral sandblaster that is most useful for preparing microretentivesurfaces in metals and other dental materials, whenever needed.

The appliance consists of a container for the aluminum oxide powder, a pushbutton for fingertip control, and a movable nozzle where the abrasive particles are delivered. The Microetcher is also useful for removing old composite resin and improving the retentive surface of loose brackets before rebondingOrthodontics, current principles and techniques , third edition,2000

Blue Ultratech 35% phosphoric acid gel for acid etching.

Orthodontics, current principles and techniques , third edition,2000

The bond strength for sandblasted rebonded brackets is comparable tothe success rate for new brackets

Orthodontics, current principles and techniques , third edition,2000

European Journal of Orthodontics 15 (1993) 125-135The tensile bond strength of new and rebonded stainless steel orthodontic bracketsD. Regan, B. LeMasney, and R. van Noort

Rebonding new brackets to an enamel surface which had been previously etched and bonded resulted in a statistically significant fall in tensile/peel bond strength. This reduction was not considered sufficient to be important clinically since the brackets should still have an adequate bond strength to withstand normal orthodontic and occlusal forces.

There was no difference in tensile/peel bond strength following removal of the adhesive from the enamel surface with either a hand scaler or a tungsten-carbide bur prior to rebonding.

Rebonding previously used brackets resulted in a significant fall in tensile/bond strength.

There was no difference between the results obtained following bracket base preparation with a green stone and a more complicated process involving heating in a bunsen flame, sandblasting and electropolishing. The fall in bond strength was considered to be important clinically and certain types of bracket base should not be reused.

No difference was found in rebond strength when using a chemically-cured adhesive and a light-cured adhesive.

the optimal procedure for rebonding dislodged orthodontic brackets is to resurface the enamel using a tungsten carbide bur, acid-etch the enamel, and use a new or re-use an old bracket after microetching.

Angle Orthod. 1999 Jun;69(3):276-81.Optimization of a procedure for rebonding dislodged orthodontic bracketsMui B, Rossouw PE, Kulkarni GV.

Angle Orthodontist, Vol 76, No 2, 2006Effect of Resin-removal Methods on Enamel and Shear Bond Strength of Rebonded BracketsNeslihan Eminkahyagila; Ayca Armanb; Alev C¸ etins¸ahinc; Erdem Karabulutd

The shear rebond strengths after resin cleaning with low-speed tungsten-carbide bur (TCB), high-speed TCB, and Sof-Lex discs are higher than the initial bond strengths.

Rebonding after resin removal by microetching presents shear bond strengths similar to the first bonding.

Although resin removal with high-speed TCB was the quickest procedure, it represented the most hazardous enamel scars.

Sof-Lex disc showed a decrease in surface irregularities, but it was the highest time-consuming method, and there were too many remnants on the enamel surface.

Angle Orthodontist, Vol 78, No 3, 2008Rebonding of Orthodontic BracketsPart I, a Laboratory and Clinical StudyMona A. Montassera; James L. Drummondb; Carla A. Evansc

Objective: To compare rebonding of orthodontic brackets based on the hypothesis that no difference would be found between the adhesive systems with respect to shear bond strength, mode of failure, and clinical failure rates.

Materials : The three adhesive systems included two self-etch primers (Transbond and M-Bond) and a conventional phosphoric acid etch (Rely-a-Bond).

Conclusions: The two self-etching primers showing higher or comparable bond strength to the conventional phosphoric etch with less adhesive remnant on the enamel surface after the first debonding.

With repeated bonding/debonding, the differences in the bond strength and failure site were not significantly different.

There was no difference in the clinical performance of the three adhesive systems

Angle Orthodontist, Vol 78, No 3, 2008Rebonding of Orthodontic BracketsPart II, an XPS and SEM StudyMona A. Montassera; James L. Drummondb; John R. Rothc; Lulwa Al-Turkid; Carla A. Evanse

Objective: The hypothesis of this study is that adhesive systems for bonding orthodontic brackets (ie, two self-etch primers [Transbond and M-Bond] and a conventional phosphoric acid etch [Rely-a-Bond]) would show a difference with respect to rebonded enamel surface morphology and chemical composition.

Conclusions: The results confirm the original hypothesis that differences in adhesive systems are manifested in less aggressive etches and less adhesive left on the enamel surface for the self-etching adhesive systems.

Angle Orthodontist, Vol 79, No 3, 2009Shear Bond Strength of Brackets Rebonded with a Fluoride-Releasingand -Recharging Adhesive SystemToshiya Endoa; Rieko Ozoeb; Koichi Shinkaic; Makiko Aoyagid; Hiroomi Kurokawae;Yoshiroh Katohf; Shohachi Shimookag

The fluoride-releasing and -recharging adhesive system with the self-etching primer had clinically sufficient shear bond strength in repeated bracket bonding; this finding can help orthodontists to decrease the risk of damage to enamel at debonding.

Angle Orthodontist, Vol 80, No 4, 2010Suitability of orthodontic brackets for rebonding and reworking followingremoval by air pressure pulses and conventional debracketing techniquesMichael Kno¨ sela; Simone Mattysekb; Klaus Jungc; Dietmar Kubein-Meesenburgd;Reza Sadat-Khonsarie; Dirk Ziebolzf

The proportions of reusable or reworkable brackets differed significantly depending on the mode of removal and the adhesive used.

In the case of those bonded with the GIC Fuji Ortho LC, a significantly higher number of brackets could be recovered or reused compared with those bonded with the composite MonoLok2.

All brackets removed with the a lift-off debracketing instrument LODI and with the impulse device were reusable, that is, intact according to the evaluation criterion, regardless of the adhesive used, whereas 79% (46%) of the brackets removed with the removal pliers, a side cutter(SC) were not.

When assessed in terms of bracket reusability, especially in combination with the MonoLok2 composite adhesive, the SC and the bracket removal pliers BRP cannot be recommended for debonding brackets.