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ORIGINAL ARTICLE Effect of surface treatment and type of cement on the retentive strength of orthodontic bands on gold alloy crowns Young-Ah Youn,a Yong-Keun Lee,b Dong-Yul Lee,c Na-Yeon Kim,d and Yong-Kyu Lime Seoul, Korea Introduction: The objective of this study was to evaluate the effect of surface treatment of gold alloy crowns and type of cement on the retentive strength of orthodontic bands cemented on gold alloy crowns. Methods: Two hundred eight crowns, made of type IV dental gold alloy, were divided into 16 groups based on surface treatment (C, no treatment; S, sandblasting; V, V-Primer; and S ⫹ V, sandblasting and V-Primer) and band cement (resin-modified glass ionomer cement, compomer, composite resin, and adhesive resin cement). Bands were cemented on the crowns, and tensile loads were applied to measure the retentive strength. Two-way analysis of variance (ANOVA) was performed for the retentive strength with the factors of surface treatment and type of cement, and the Scheffé multiple comparison test was performed as a post-hoc test (␣ ⫽ 0.05). Results: The retentive strength of the bands was influenced by surface treatment and type of cement, and there was significant interaction between the 2 variables based on 2-way ANOVA (P ⬍.05). Resin-modified glass ionomer cement showed the highest retentive strength regardless of surface treatment (⬎1.26 MPa). Conclusions: Resin-modified glass ionomer cement is the most desirable cement for attaching a band to a gold alloy crown. When an adhesive resin cement is used, sandblasting of the gold crown is recommended. (Am J Orthod Dentofacial Orthop 2007;132:728.e9-728.e14) A lthough there have been great improvements in direct bonding systems, banding on molars is still popular1 because of the high rate of bond failure in that area and the use of additional appliances such as headgear or palatal arch.2 In the oral cavity, retention of orthodontic bands is influenced by the morphology and the surface condition of a tooth, and the bond strength of band cements.3 Recent developments of orthodontic band cements such as glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), and polyacid-modified composite resin cement (compomer) were reported.4 Introduced in 1972,5 GIC has been used widely because of its great retentive ability,6 chemical bonding property a Graduate student, Department of Dentistry, College of Medicine, Korea University, Seoul, Korea. b Professor, Department of Dental Biomaterial Science and Dental Research Institute, College of Dentistry, Seoul National University, Seoul, Korea. c Professor, Department of Dentistry, College of Medicine, Korea University, Seoul, Korea. d Graduate student, Department of Orthodontics, College of Dentistry, Yonsei University, Seoul, Korea. e Associate professor, Department of Dentistry, College of Medicine, Korea University, Seoul, Korea. Reprint requests to: Yong-Kyu Lim, Department of Dentistry, College of Medicine, Korea University, 126-1, Anam-Dong, Sungbuk-Ku, Seoul, Korea; e-mail, yklim@kumc.or.kr. Submitted, October 2006; revised and accepted, January 2007. 0889-5406/$32.00 Copyright © 2007 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2007.01.016 to enamel,7,8 and anticaries effect.8,9 However, it has several shortcomings, such as the need for a precise powder-to-liquid ratio4,8 and the serious deteriorating effect of water on setting.4,10 Composed of GIC and resin matrix,11 RMGIC sets partly via an acid-base reaction and partly by photochemical polymerization.11,12 Therefore, RMGIC provides a longer working time4,9,13 and higher resistance to water on setting4,10 than GIC. RMGIC showed greater bond strength on orthodontic banding than GIC.14 It was reported, however, that there was no difference between GIC and RMGIC in the bond failure rates of molar bands in another study.15 Compomer, a mixed material of resin matrix and silica glass, sets via light-initiated polymerization of the resin matrix.4,11 Although it releases less fluoride than RMGIC, it still has an anticaries property.16 Saliva contamination was reported to decrease the bond strength of compomer when used to cement orthodontic bands.17 In the prosthodontic field, many studies have attempted to improve the bond strength between dental alloys and resin-based cements.18-24 To improve the bond strength, various surface treatment methods for alloys have been introduced,18-24 and several adhesive agents with functional monomers were also evaluated.24 Restorations could influence the retention of orthodontic appliances when appliances are bonded on their 728.e9 728.e10 Youn et al Table I. American Journal of Orthodontics and Dentofacial Orthopedics December 2007 Cement materials studied Code Brand name Batch number Manufacturer FOL UBL TBX SBC Fuji Ortho LC (RMGIC) Ultra Band Lok (compomer) Transbond XT (composite resin) Superbond C&B (adhesive resin cement) 0402231 0600053 5NA Monomer, LR1 Catalyst, LS1 Powder, LK1 GC, Tokyo, Japan Reliance, Itasca, Ill 3M Unitek, Monrovia, Califs Sun Medical, Moriyama, Japan surfaces. When orthodontic brackets were bonded on dental alloys, lower retentive strength was observed compared with that on natural teeth.25,26 Therefore, various attempts were made to increase the bond strength between dental alloys and orthodontic brackets. To increase the bond strength, the gold alloy surface was roughened with a greenstone,25 but it was ineffective. However, roughening the gold alloy surface with sandblasting was found to be an efficient method for improving bond strength.26 Metal primers are specific adhesive monomers used to increase the bond strength between resin cement and dental alloys. V-Primer (Sun Medical, Moriyama, Japan) was developed as an interim adhesive agent for precious metal alloys.27,28 In studies that used metal primers, it was found that the primer groups had higher bond strengths between dental alloy and resin cement than the groups without primers.27-29 Although there have been many studies on the bond strength between dental gold alloys and resin cements1824,27,28 and the influence of surface treatments of dental gold alloys and brackets on the bond strength,25,26 few studies have determined the retentive strength of orthodontic bands cemented on clinically simulated dental gold alloy crowns. Our aim in this study was to evaluate the retentive strength of orthodontic bands cemented on crowns of type IV dental gold alloy after various surface treatments on crowns with 4 types of band cements. The null hypothesis was that the surface treatment and type of cement do not influence the retentive strength of orthodontic bands cemented on gold alloy crowns. MATERIAL AND METHODS Crowns for maxillary right first molars were made of type IV dental gold alloy (B20; Heesung Engelhard, GyeongGi, Korea). The composition of the alloy is 75% gold, 3% palladium, and 18% silver. Sandblasting of the gold crown surface was carried out by using a sandblasting machine (Microetcher; Danville Engineering, San Ramon, Calif) with 50-␮m aluminum oxide powder. V-primer, which is specific for precious alloys, was chosen as an interim adhesive. Fig 1. Cast gold crown with orthodontic band mounted on resin block. Four band cements were studied: an RMGIC (FOL) (Fuji Ortho LC, GC, Tokyo, Japan), a compomer (UBL) (Ultra Band Lok; Reliance, Itasca, Ill), a composite resin cement (TBX) (Transbond XT; 3M Unitek, Monrovia, Calif), and an adhesive resin cement (SBC) (Superbond C&B; Sun Medical) that is set by autopolymerization (Table I). Two hundred eight full gold crowns, shaped to fit a maxillary first molar with several inner hooks, were fabricated. The hooks were added to enhance the binding of a gold crown to the resin block used as an abutment. The inner space of the gold crown was filled with an orthodontic resin (Ortho-Jet; Lang Dental, Garden City, NY), and the same resin was used to make a resin block that was fixed to the grip of a universal testing machine (4465; Instron, Canton, Mass). The gold crowns were divided into 4 groups by surface treatment method: C, no treatment; S, sandblasting; V, V-Primer; and S ⫹ V, sandblasting and V-Primer. Sandblasting was done at a distance of 1 cm between the nozzle and the gold crown; 50-␮m aluminum oxide powder was sprayed for 3 seconds under pressure of 7 kg per square centimeter. Then the crown surface was washed and dried. V-Primer was coated once according to the manufacturer’s instructions. Orthodontic bands of the same size (UR 17; Tomy, Tokyo, Japan) were fitted on each crown. Orthodontic lingual sheaths (601-60; Tomy) were welded on the buccal and lingual surfaces of the bands (Fig 1) to fix Youn et al 728.e11 American Journal of Orthodontics and Dentofacial Orthopedics Volume 132, Number 6 Table II. Comparison of retentive strength according to cement type and surface treatment FOL UBL TBX SBC C V S S⫹V 1.26 (0.20)a/A 0.15 (0.08)a,b/C 0.20 (0.08)a/C 0.49 (0.07)a/B 1.33 (0.30)a/A 0.16 (0.09)a,b/C 0.23 (0.06)a/C 0.89 (0.23)b/B 1.54 (0.21)a/A 0.25 (0.11)b/B 0.24 (0.05)a/B 1.36 (0.26)c/A 1.39 (0.31)a/A 0.14 (0.07)a/B 0.24 (0.07)a/B 1.40 (0.29)c/A In each row, means with same lower-case letters were not significantly different according to surface treatment method (P ⬎.05). In each column, means with same capital letters were not significantly different according to type of band cement (P ⬎.05). Standard deviations are in parentheses. Table III. Homogenous subsets by surface treatment regardless of type of band cement based on Scheffé multiple comparison test Subset for ␣ ⫽ 0.05 Fig 2. Experimental setup. the orthodontic ligature wire, which was used to connect to the load cell of the testing machine. Each of the 4 groups sorted by the surface treatment method was divided into 4 subgroups by the band cements used. In each subgroup, 13 specimens were tested. Band cements were mixed according to the manufacturers’ instructions. Bands were seated by using a band pusher with hand pressure by an operator (Y-A.Y.) using the same pressure, and excessive cement was removed with a dry gauze swab. The specimens cemented with RMGIC, compomer, and composite resin cement were polymerized with a visible light-curing unit (XL-3000; 3M Unitek, St Paul, Minn). The light was irradiated at the mesial, distal, buccal, and lingual sides of the crown for 10 seconds each. The specimens cemented with SBC were left at room temperature for 15 seconds for autopolymerization. After cementation, all specimens were stored in a 37°C water bath for 24 hours and then thermocycled in a thermocycling machine (KD-TCS 30; Kwangduk, Seoul, Korea) between 5°C and 55°C for 1000 cycles. The buccal and lingual sheaths of the band were connected with orthodontic ligature wires (.012 in; Ormco, Orange, Calif), and the retentive load of the Surface treatment n 1 C V S⫹V S P 52 52 52 52 0.53 2 3 0.65 1.000 1.000 0.79 0.85 1.000 Means for groups in homogenous subsets are shown. Based on type III sum of squares. Error term, mean square (error) ⫽ .033; ␣ ⫽ .05. band was measured with the testing machine in tensile mode with a cross-head speed of 1 mm per minute (Fig 2). Testing proceeded until the band was removed completely from the gold crown. The maximum debonding force recorded on the force/time curve was converted to a retentive strength value (MPa) by dividing the maximum force by the band surface. Statistical analysis Two-way analysis of variance (ANOVA) was performed for the retentive strength with the variables of surface treatment and type of cement at the significance level of 0.05 (version 12.0; SPSS, Chicago, Ill). Means were compared with the Scheffé multiple comparison test (␣ ⫽ 0.05). RESULTS Values for the retentive strengths of the bands are listed in Table II. The retentive strength of the bands was influenced by surface treatment method and type of band cement, and there was significant interaction between 2 variables based on the 2-way ANOVA (P ⬍.05). Homogenous subsets for the retentive strength of the bands by surface treatment regardless of type of 728.e12 Youn et al American Journal of Orthodontics and Dentofacial Orthopedics December 2007 Fig 3. Comparison of retentive strength according to type of band cement in each surface treatment group. Table IV. Homogenous subsets by type of cement regardless of surface treatment based on Scheffé multiple comparison test Subset for ␣ ⫽ 0.05 Type of cement n 1 UBL TBX SBC FOL P 52 52 52 52 0.17 0.23 2 3 1.03 0.503 1.000 1.38 1.000 Means for groups in homogenous subsets are shown. Based on Type III sum of squares. Error term, mean square (error) ⫽.033; ␣ ⫽ .05. cement are listed in Table III. Groups S and S ⫹ V showed the highest retentive strengths without a significant difference between them; ie, the application of the V-Primer on the sandblasted gold surface did not further increase retentive strength. On the other hand, only the group that used SBC as a band cement with sandblasting had a significant improvement in the retentive strength of the band (Table II). V-Primer showed a significant increase of retentive strength only in the SBC groups. In the groups that used UBL as a band cement, V-Primer decreased the effect of sandblasting. Figure 3 shows the type of cement groups according to surface treatment with their respective retentive strengths. Homogenous subsets for the retentive strength of the bands by type of cement regardless of surface treatment are listed in Table IV. The RMGIC (FOL) showed the highest retentive strength, with the adhesive resin cement (SBC) the next highest. The retentive strength of each surface treatment group according to type of band cement is shown in Figure 4. Fig 4. Comparison of retentive strength according to various surface treatments in each cement group. DISCUSSION There have been many studies on the effect of dental gold alloy surface treatments on the bond strength of brackets.25,26,30,31 However, few studies have evaluated the effects of various surface treatments of the gold alloy surface on the retentive strength of orthodontic bands. Therefore, the retentive strength of orthodontic bands cemented on dental gold alloy crowns with several band cements and different surface treatments were evaluated in the present study. SBC, which has 4-methacryloxy-ethyl-trimellitateanhydride and methyl methacrylate as main components, and tri-n-butylborane as an initiator, polymerizes to polymethyl methacrylate. It has great bond strength to teeth, metal, and composite resins, and it also shows high bond strength to dental gold alloy surfaces by making an oxide layer on the alloy surface.32,33 In the present study, SBC had higher retentive strength than the compomer and the composite resin groups. When sandblasting was performed, this cement group had the highest retentive strength along with the FOL group. Orthodontic bands cemented on extracted human third molars with the RMGIC (FOL) showed higher retentive strengths (1.72 MPa) than the compomer (Transbond Plus, 0.42 MPa).34 But in another study, it was reported that there were no significant differences between the RMGIC (FOL, 1.54 MPa) and the compomer (UBL, 1.58 MPa).35 In the present study, all groups that used FOL as a band cement and the SBC group treated with sandblasting had retentive strengths comparable with bands cemented on natural teeth,34,35 but TBX and UBL had lower retentive strengths when they were used on dental gold alloys. Herion et al36 reported that the shear-peel bond strength of orthodontic bands on porcelain teeth was lower (⬍0.9 MPa) than the values found on natural teeth regardless of the type Youn et al 728.e13 American Journal of Orthodontics and Dentofacial Orthopedics Volume 132, Number 6 of band cement. The shape of the teeth and the surface characteristics of porcelain were mentioned as possible causes. In a study in which molar tubes were bonded on extracted third molars and debonding was performed in the occlusal direction, the RMGIC (FOL) showed the highest bond strength (7.02 MPa), followed by the compomer (UBL, 4.63 MPa) and composite resin cement (Transbond, 3.04 MPa).37 These values were higher than those in the present study (⬍2.0 MPa) and those of Herion et al.36 However, it was difficult to compare the bond strength of an orthodontic appliance directly bonded to the tooth surface and the retentive strength of orthodontic bands cemented on a dental alloy crown. When metal coping was bonded on a tooth, the RMGIC showed the highest bond strength compared with composite resin cement, GIC, and zinc phosphate cement.38 In the present study, the RMGIC and the adhesive resin cement showed higher bond strengths than the other 2 cements; therefore, the RMGIC and the precious metal alloy appeared to have high affinity. Interim adhesives such as Metal Primer (GC, Tokyo, Japan) or V-Primer have specific adhesive monomers and are used to increase bond strength between metal alloy and composite resin by simple application after sandblasting the metal surface. V-primer is used for precious metal alloys and contains 6-[4-vinylbenzylN-propyl]amino-1,3,5-triazine-2,4-dithione monomer. The sulfur atom of V-Primer has a specific interaction with gold.39 Interim adhesives were reported to increase bond strengths between dental gold alloys and resin adhesives.39-42 V-Primer used with sandblasting was helpful for increasing bond strength between the dental gold alloy and the orthodontic bracket.31 But in another study,27 type IV gold alloy treated with V-Primer did not show improvement in bond strength when Imperva Dual (Shofu, Kyoto, Japan) or Panavia 21 (Kuraray, Kurashiki, Japan) was used as a resin cement, but bond strength was improved when SBC was used as a cement. In the present study, the groups treated with V-Primer showed improved retentive strength only when SBC was used as a band cement (P ⬍.05). Therefore, it seems that application of V-Primer is not always effective with all types of resin cements. Sandblasting makes irregularities on metal surfaces, increases the surface area, and mechanically removes debris on metal surfaces.26,42 The size of the aluminum oxide particles (110 and 50 ␮m) did not make a great difference in bond strength of the composite resin, but the 110-␮m particles caused more damage on metal surfaces.42 In the present study, sandblasting increased the retentive strength of the band (P ⬍.05). However, the effect of sandblasting was significant only in the group that used SBC as a band cement (P ⬍.05) based on the post-hoc test, which compared the retentive strengths of each cement by the surface treatment. Further study is recommended to determine why sandblasting was significantly effective only in SBC. The groups that used SBC as a band cement showed the greatest improvement in retentive strengths by the surface treatment of the gold alloy. Among them, the S and S ⫹ V groups had retentive strengths comparable to the groups in which FOL was used as band cement. Therefore, RMGIC is recommended when an orthodontic band is applied to a gold alloy crown, and, in the case of adhesive resin cement, pretreatment of the crown surface, such as sandblasting, is needed. Because only 1 brand of each type of cement was tested in this study, further studies with new materials and surface conditioning methods of gold alloy are recommended. In terms of force application, various directions of force should be tested as in one’s oral condition in further studies. Also, the effects of saliva and solubility of cements could be studied. CONCLUSIONS The RMGIC groups showed the highest retentive strengths of the orthodontic band regardless of surface treatment. 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