Shape of the Base

An ideal base should follow the curvature of the respective tooth surface for a good fit. This should enable the operator to place the bracket securely in the appropriate position on the tooth without rocking. A poorly fitting base can result in unprecise torque, angulation, and rotation once the full-sized wire is completely engaged. In order to produce an appropriately fitting bracket base, the manufacturer needs to pay attention to a number of factors.

The buccal surfaces of individual teeth show only very minor anatomical variations. An anatomically preformed bracket base is ideal and will fit well in the majority of cases. A precisely fitting base needs to take into account both the occlusal–gingival and also the mesiodistal curvature of the tooth surface. This is a challenge from the manufacturing point of view as a tooth surface is not built with a uniform curvature and a single radius like a circle, where a bracket can be positioned anywhere on the surface with equally good results. A tooth surface has many diverse radii and curvatures, depending on the location on the surface-and this applies to both the occlusal–gingival and mesiodistal directions ( Fig. 2.2 ).

The importance of the congruence of the bracket base and the surface of the tooth has been known for a long time. Most manufacturers now offer brackets that have different surface characteristics with increased or decreased convergence. These convergences were originally determined by cross-sectional analysis of teeth that were cut in order to measure the curvature. It was therefore only possible to obtain a small number of convergences per analyzed tooth; due to the intense labor involved, the sample size per tooth type was usually small. Despite this, the results from the original studies are still often used in the manufacturing of bracket bases even today. Modern three-dimensional reconstructions of tooth surfaces are nowadays used in computer models and this method allows better correlation of the bracket base with the actual surface of the teeth, due to the increased number of teeth that can be analyzed and averaged ( Fig. 2.3 ). Some manufacturers use this technique to design and construct their bracket bases and therefore claim to produce better-fitting bracket bases than others, but it is important for the bracket base to be manufactured in such a way that the data obtained can be used in a meaningful way. This is most likely to be possible with metal injection molding (MIM) or ceramic injection molding (CIM). Both of these techniques allow the individualized and fitted shape to be transferred when the bracket is produced. A number of bracket manufacturers produce a bracket base from premanufactured plates, which are then bent into the desired shape. In a separate step, this bracket base is then connected to the bracket itself (see the section on “Bracket Body” below). It is not possible to produce the ideal surface characteristics that a bracket should have using these techniques. This is due to the very small size of the bracket base, resistance to deformation by the metal itself, and manufacturing issues with the application of forces to the small surfaces.

Positioning errors can also result from canting the bracket or from migration of the bracket between positioning and polymerization. This may lead to poor slot orientation and in turn to undesired tooth movement ( Fig. 2.4 ).

Bond Strength

The ideal orthodontic bracket adhesive should have two main properties: on the one hand, it should ensure a sufficient bond strength to be able to withstand the everyday stresses of mastication and manipulation. On the other hand, it should also allow easy removal of the bracket without damage to the enamel. As these two properties are diametrically opposed, orthodontic adhe-sives compromise by trying to deliver an adequate bond strength for most clinical situations-neither too strong nor too weak.

Most studies would agree that the minimum bond strength necessary for orthodontic treatment is in the range of 8–10 MPa.8 ^, 15 More frequent bracket failures can be expected if the bond strength values are below this. At retention values above 20 MPa, there is a greater risk of enamel fracture on debonding.12 ^, 15

The Opal bracket (Ultradent) had a shear bond strength of only 4 MPa when the adhesive suggested by the manufacturer was used ( Fig. 2.5 ). This was insufficient to withstand everyday stresses and strains.4 Other brackets have a retention strength of more than 20 MPa, and these values are similar to those used in restorative dentistry. Brackets that produce retention values of that order may therefore pose a greater risk to the integrity of the enamel on debonding.4 As a general rule, the weak point during debonding shifts from the bracket-adhesive (at lower values) to the adhesive–tooth interface.13 ^, 15

There is an extensive literature on the shear bond strength of brackets, but it is difficult to compare the different studies. Even in studies that use similar brackets and adhesives, the results are often not comparable, as there are too many variables that are not standardized—such as different teeth (bovine or human), the thickness of the adhesive, the direction and type offorce application (torsion or shear force), and so forth. The German Institute for Standardization (DIN) recommends a standard methodology for testing the shear bond strength of adhesives for orthodontic attachments (DIN 13990), which could lead to the standardization of research findings if it was internationally accepted.

The bond between the bracket base and the adhesive can be obtained in a number of ways. For metal brackets, it is usually mesh, laser-etching, or other retentive elements that provide the undercuts necessary for mechanical retention. In addition, for ceramic brackets chemical retention is usually achieved through silane coupling. Generally, the bracket base should come with a retentive pattern that allows the adhesive to sit in the undercuts, creating a tight mechanical connection between the bracket base and the tooth. With metal injection molding, a number of bracket bases can be created in this way, some better than others ( Fig. 2.6 ).

The acid-etching technique and the bonding of brackets with composites has been the standard for many years now. A more recent trend using self-etching primers improves workflow and time efficiency by up to 60%, as claimed by some manufacturers. Having fewer steps in the process means fewer potential mistakes during enamel conditioning, which should improve treatment outcome ( Fig. 2.7 ). Self-conditioning primers contain acidic hydrophilic monomers, which etch the surface of the teeth and at the same time apply a very thin coating of unfilled composite (primer). A number of investigations have shown that although none of the currently available self-etching primers achieve the same depth of action as 35% phosphoric acid, comparable shear strengths result.2 ^, 7 ^, 8 ^, 22 However, due to the reduced penetration depth, the fracture point on debonding is typically located at the enamel-adhesive interface, which means that less composite residue is left on the tooth surface.3 ^, 15 The advantages of self-etching primers in orthodontics are the reduced surface erosion they cause during conditioning and the enamel proximity of the fracture point on debonding, and factors that make this primer attractive in the clinical setting.1 ^, 2