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Orthodontics/Debonding of brackets

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Question
I have noticed that most patients having composite restorations on labial surfaces of their teeh or porcelain crowns who then opt for orthodontic treatment often face a problem with their braces.
 The brackets constantly debond at the slightest force!!!
Is there a solution to that, such as maybe a different etching technique, or a different bonding material to ensure less hassle for the patient and the doctor...
IF yes then please advice on what can be done..
And thank you so much for your time!

Answer

Hello F,

I have been doing some research on your question, and it really needs to be broken down into several questions.

First, a natural unrestored tooth will of course present little or no difficulties with normal bonding. Here are the different situations:

1) Restored tooth with composite restorative material
2) Restored tooth with metal surface such as a gold onlay or gold crown
3) Restored tooth with Ceramic restoration such as porcelain type veneers or crowns
4) Restored tooth with a buccal amalgam.

The brackets themselves can also come indifferent styles, namely traditional metal and ceramic.

F, if you think about this, there are a lot of combinations.

The bonding to teeth with composite restoration is perhaps the easiest to achieve. The composite  material is often similar to the agents used for bonding brackets. The restoration on the surface is often very smoothly polished, so a little roughening of the surface may be helpful. The primer is then applied to the roughened surface and the bracket attached.

For porcelain and other ceramic restorations, a series of pre-steps are needed. There are some agents which use variations of hydrofluoric acid to etch the "glass" surface of the crowns.  The various primers are then applied and the bracket applied.

For bonding brackets to metal, there are special bonding agents made for specifically bonding metal to metal I recommend that you search for these products if this situation arises.

Bonding to "silver fillings" or "amalgam restorations" is often a little more complex. In the instance of a small buccal it amalgam on a lower first molar for example, sometimes regular etching needs to be done. In the case of a very large amalgam, a special bonding material designed for metal to metal is recommended. I prefer NOT to make any specific brand name recommendations.  Look up amalgam bonding material.

Finally F, the type pf bracket may be important. Meta brackets ideally should have a #80 mesh on the pad of the bracket. Ceramic brackets may not rely strictly on mechanical locking, and therefore bonding ceramic brackets to the four types of restorations described above.

F, I am not certain what your particular situation is. Please feel free to resubmit your question.

You may wish to also visit:

http://www.braces.com
http://www.Leesburgbraces.com  

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Paul Supan, DDS, MA, MPH

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First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

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Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

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BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

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