Evaluation of bond strength and failure mode of attachments in clear aligner orthodontic appliance using self-adhesive composite resin

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Siriwan Thongkom
Supassara Sirabanchongkran


Objectives: The study was designed to 1) compare the shear bond strength (SBS) between self-adhesive composite resin and etch and rinse adhesive systems with a conventional flowable composite resin in fabricating the attachment of clear aligner on enamel surface and 2) to evaluate the mode of failure.

Materials and Methods: The rectangular attachment size of 2.5x3x2 mm was fabricated on 48 upper first premolars. These premolars were randomly allocated into three groups based on the attachment bonding protocols: Group 1 (etch and rinse + conventional flowable composite resin), Group 2 (self-adhesive composite resin) and Group 3 (etching + self-adhesive composite resin). The samples were subjected to thermocycling (1,000 cycles between 5°C and 55°C). The SBS was measured by universal testing machine. The data were analyzed using one-way analysis of variance (ANOVA) with a significance level of p < 0.05. All samples were examined under a stereomicroscope at 20x magnification to evaluate the Adhesive Remnant Index (ARI) scores. The scores were presented in percentages.

Results: 62.5% of the attachments in Group 2 became dislodged after thermocycling. The mean SBS of Group 1 (17.3±5.76 MPa) and Group 3 (18.91 ± 9.94 MPa) were statistically significantly higher than that of Group 2 (3.69 ± 1.30 MPa) (p < 0.05). No statistically significant differences were observed between Group 1 and Group 3 (p > 0.05). For ARI evaluation, the majority of samples in Group 1 showed mixed failure, Group 2 show Interfacial failure between composite resin and enamel and Group 3 show cohesive failure in composite resin.

Conclusion: The attachment that were fabricated with self-adhesive composite resin had the lowest SBS in this study. However, etching prior to using self-adhesive composite resin enhanced SBS comparable to etch and rinse + conventional flowable composite resin in fabricating the attachment.


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Thongkom S, Sirabanchongkran S. Evaluation of bond strength and failure mode of attachments in clear aligner orthodontic appliance using self-adhesive composite resin. M Dent J [Internet]. 2023 Oct. 19 [cited 2023 Dec. 1];43(suppl):S11-S18. Available from: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/264658
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