Clinical and Laboratory Perspectives of Improved Orthodontic Bonding to Normal, Hypoplastic, and Fluorosed Enamel

Success in fixed orthodontic treatment is highly dependent on the maintenance of the bond between orthodontic attachments, and etched enamel for the duration of treatment. Bracket debonding can significantly increase treatment time, operator time, material costs, and patient discomfort. It is therefore essential for the orthodontist to be able to obtain reliable bonding to enamel at the initial bonding appointment. At times, the orthodontist may need to bond to compromised enamel surfaces with the standard acid-etch protocol. The advent of adhesion promoters has provided orthodontists the possibility to potentially increase the bond strength of orthodontic attachments to these compromised enamel surfaces. The current paper presents a summary of investigations of bond strengths of orthodontic attachments to normal, hypoplastic, and fluorosed enamel as well as recent advances in biomaterials technology and their impact on adhesivity.