THE KOREAN JOURNAL of

Original Article ORTHODONTICS

pISSN 2234-7518 • eISSN 2005-372X

http://dx.doi.org/10.4041/kjod.2012.42.1.32

Evaluation of different enamel conditioning

techniques for orthodontic bonding
Çagrı Türköz, Objective: The aim of this study was to compare the effects of different enamel
Çagrı Ulusoy conditioning techniques for bracket bonding. Methods: Ninety-one human
premolars were randomly divided in six groups of 15 specimens each. The enamel
surfaces of the teeth were etched with 35% orthophosphoric acid in Group 1,
with a self-etching primer in Group 2, sandblasted in Group 3, sandblasted and
etched with 35% orthophosphoric acid in Group 4, conditioned by Er:YAG laser
in Group 5 and conditioned by Er:YAG laser and etched with 35% phosphoric
acid gel respectively in Group 6. After enamel conditioning procedures, brackets
were bonded and shear bonding test was performed. After debonding, adhesive
remnant index scores were calculated for all groups. One tooth from each group
Department of Orthodontics, Dental
Faculty, Gazi University, Ankara,
were inspected by scanning electron microscope for evaluating the enamel surface
Turkey characteristics. Results: The laser and acid etched group showed the highest mean
shear bond strength (SBS) value (13.61 ± 1.14 MPa) while sandblasted group
yielded the lowest value (3.12 ± 0.61 MPa). Conclusions: Although the SBS values
were higher, the teeth in laser conditioned groups were highly damaged. Therefore,
acid etching and self-etching techniques were found to be safer for orthodontic
bracket bonding. Sandblasting method was found to generate inadequate bonding
strength.
[Korean J Orthod 2012;42(1):32-38]

Key words: Bonding, Adhesive, Resin

Received April 22, 2011; Revised August 24, 2011; Accepted September 16, 2011.

Corresponding author: Çagrı Türköz.

Research Assistant, Gazi Universitesi Dis Hekimligi Fakultesi Ortodonti AD Emek, Ankara
06510, Turkey.
Tel +90-312-203-4289 e-mail cturkoz@hotmail.com

The authors report no commercial, proprietary, or financial interest in the products or companies
described in this article.
© 2012 The Korean Association of Orthodontists.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License
(http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and
reproduction in any medium, provided the original work is properly cited.

32
Türköz and Ulusoy • Enamel conditioning techniques

INTRODUCTION each, by using a random numbers table. All samples were

embedded vertically in cold-curing acrylic (Orthocryl;
The strength of the bond between the bracket and the Dentaurum, Ispringen, Germany) by using metal ring
enamel surface depends on 3 factors, namely, the reten­ moulds.
tion mechanism of the bracket base, the adhesive material Phosphoric acid (35%) gel (Gel Etch; 3M Unitek, Mon­
or bonding resin, and the preparation of the tooth sur­ rovia, CA, USA) was used for etching the teeth in group
face.1 Commonly used adhesive systems employ an ena­­mel 1 for 15 s. The teeth were then rinsed with water infused
conditioner, a primer solution, and an adhesive resin from a 3-in-1 syringe for 15 s and dried with an oil- and
to bond the orthodontic brackets to the enamel sur­ moisture-free source for 10 s.
face. These adhesive systems generally contain 35 - 37% The teeth in group 2 were treated with a self-etching
orthophosphoric acid, which conditions the enamel sur­ primer (SEP; Transbond Plus; 3M Unitek, Monrovia,
face. CA, USA), which was rubbed onto the enamel by gentle
Zachrisson and Büyükyilmaz2 found that sandbla-sting pressure for 5 s. Then, a gentle air burst was applied to dry
improves the strength of bonds to gold, porcelain, and the primer into a thin film.
amalgam. Further, Faltermeier and Behr3 reported that In group 3, the teeth were sandblasted from a distance
the process of sandblasting improves the shear bond strength of 1 mm at 65 - 70 psi for 10 s with 50 µm aluminium
(SBS) of stainless steel brackets. Further, Chung et al.4 found oxide (Dynaflex Inc., St. Ann, MO, USA). To prevent
that sandblasting is a more viable alternative to chemical unnecessary etching, a 4 × 5 mm aperture was made
etching techniques in terms of bond strength, while Berk on a 0.040 inch thick thermoplastic retainer material
et al.5 and Canay et al.6 reported that sandblasting the (Dentsply Raintree Essix Inc., Sarasota, FL, USA), and the
enamel surface does not provide ade­quate SBS for bracket sandblaster device (Microetcher II; Dan-ville Engineering,
bonding. San Ramon, CA, USA) was directed perpendicular to the
Laser energy enables localized melting and ablation of enamel surface through this aper-ture. After sandblasting,
the enamel surface; it affects etching through a pro-cess the specimens were thoroughly rinsed for 15 s and dried
of continuous vaporization and micro-explosions, which for 10 s.
occur due to the vaporization of the water trapped within In group 4, the samples were initially treated with the
the hydroxyapatite matrix.7 Irrigation of the enamel by same procedure mentioned in group 3; thereafter, the
laser energy may be beneficial since it inhibits enamel enamel surface was etched by 35% phosphoric acid gel for
demineralization and, thereby, caries formation.8 15 s. The teeth were then rinsed with water for 15 s and
To date, studies on laser etching have addressed various dried for 10 s.
issues, such as power output differences,9,10 application The enamel surfaces of the teeth in group 5 were con­
distance,11 and microleakage under orthodontic brac­ ditioned by Er:YAG laser (KaVo Key 3, hand-piece
kets.12 However, none of them compare all the known 2060TM; KaVo Dental GmbH, Biberach, Germany)
enamel-conditioning techniques. administered at 350 mJ/pulse with a frequency of 4 Hz,
The aim of this study was to compare the effects of dif­ from a distance of 1 mm. This frequency rate was chosen
ferent enamel conditioning techniques for bracket bon- to ensure a homogenous ablation pattern by distributing
ding in terms of the SBS, adhesive remnant index (ARI),13 1 pulse per square millimeter to prevent excess ablation
and scanning electron microscope (SEM) find-ings. of the enamel. Since the bracket base area was determined
to be 10.41 mm2, a 3 × 4 mm area was conditioned with
MATERIALS AND METHODS 12 pulses. The tooth was prepared under water-spray
cooling (7 ml/min), as per the recommendations of the
Ninety human premolars that had been extracted for manufacturer for hard tissue preparation. In order to
orthodontic treatment were used in this study. After ex­ standardize the procedure, an operation microscope
traction, the teeth were stored at room temperature in (OPMI®Pico; Carl Zeiss Meditec, Munich, Germany) was
distilled water containing thymol crystals (1% wt/vol) used at 10 × magnification.
to inhibit bacterial growth. The teeth were cleaned and For group 6, in addition to the steps followed for group
polished with a fluoride-free pumice slurry and rubber 5, the enamel surface was etched by 35% phosphoric acid
cups for 10 s and thoroughly washed and dried by ex­ gel for 15 s. The teeth were then rinsed with water for 15 s
posure to oil-free air stream. They were then examined and dried for 10 s.
under a light stereomicroscope (SMZ460; Nikon, Osaka, After the enamel-conditioning procedures of all the
Japan) at × 10 magnification to rule out caries and groups, the stainless steel premolar brackets (Mini Mas-
enamel cracks. Teeth with caries, restorations, and surface ter Roth; American Orthodontics, Sheboygan, WI, USA)
abnormalities were excluded from the study. The samples were bonded to the teeth with an orthodontic adhesive
were randomly divided in 6 groups of 15 specimens (Transbond XT; 3M Unitek). The brackets were pressed

www.e-kjo.org http://dx.doi.org/10.4041/kjod.2012.42.1.32 33
 Türköz and Ulusoy • Enamel conditioning techniques

firmly onto the tooth surface, and excessive adhesive for each group by one-way analyses of variance (ANOVA)
was removed using a sharp scaler. The adhesive was to determine whether there was any signi-ficant difference
polymerized for 40 s by a halogen light source (Hilux between the enamel conditioning sys-tems. The Scheffé
Ultra Plus; 600 mW/cm 2; Benlioglu Dental, Ankara, test was used for multiple comparison of the bonding
Turkey) placed at the mesial, distal, occlusal, and gingival forces. The ARI scores were evaluated by the chi-square
aspects for 10 s each. The average base surface areas of test.
the brackets were calculated as 10.41 mm 2 by using a Six teeth, one from each group, were selected randomly
digital caliper (Absolute Di-gi-matic; Mitutoyo, Miyazaki, for SEM evaluation. The coronal parts of the teeth were
Japan). separated after debonding and prepared for observation
All specimens were stored in water at 37oC for 24 h. under a SEM by serial dehydration of graded ethanol
The shear debonding test was performed using a uni­ solutions (50 - 100%), mounted on aluminium stubs, and
versal testing machine (Instron Co., Canton, MA, coated with platinum. The specimens were then observed
USA). The specimens were subjected to stress from a under an SEM (JSM-7000F; JEOL, Tokyo, Japan) at an
vertical direction, at a crosshead speed of 1 mm/min. accelerating voltage of 15 kV to evaluate the intergroup
The maximum shear force necessary to debond each difference in the surface quality.
bracket was recorded in Newton and then converted into
megapascal (MPa). RESULTS
The debonded enamel surfaces were examined under a
stereomicroscope (SMZ460; Nikon, Kyoto, Japan) at 20 × The average bond strength forces; their standard devia­
magnification to assess the residual adhesive remaining tions; and standard errors of the means, minimum, and
on the tooth surface by a blinded examiner (Ç.U). maximum shear bond strengths are shown in Table 1.
The ARI was used to quantify the amount of adhesive The groups subjected to laser and acid etching showed
remaining on the tooth surface. The following scale was the highest mean SBS values (13.61 ± 1.14 MPa), while
used to grade the amount of adhesive retained on the the group subjected to sandblasting yielded the lowest
tooth surface: 0, indicating no adhesive; 1, less than half value (3.12 ± 0.61 MPa). One-way ANOVA test showed
of the adhesive; 2, more than half of the adhesive; and 3, statistically significant differences among the 6 different
all the adhesive. surface-conditioning methods with respect to SBS (F:
The mean SBS and standard deviations were calculated 228.709, p < 0.001; Table 2).

Table 1. Average bond strength; standard deviation; and standard errors of the mean, minimum, and maximum shear
bond strengths
(Unit: MPa)
Groups N Mean SD SE Min Max
Group 1 (acid) 15 10.55 0.84 0.22 9.05 11.91
Group 2 (self-etch) 15 9.23 0.91 0.23 7.90 10.52
Group 3 (sandblasting) 15 3.12 0.61 0.16 2.12 3.92
Group 4 (sandblasting + acid) 15 9.68 0.71 0.18 8.79 10.97
Group 5 (laser) 15 9.45 0.92 0.23 8.06 10.69
Group 6 (laser + acid) 15 13.61 1.14 0.30 11.88 15.70
N, Number of teeth in each group; SD, standard deviation; SE, standard error of the mean; Min, minimum values; Max,
maximum values.

Table 2. Analysis of variance for force of debonding

(Unit: MPa)
Source of variation Df Sum of squares Mean squares F p
Between groups 5 877.082 175.416
Within groups 84 64.427 0.767 228.709 0.000
Total 89 941.509

34 http://dx.doi.org/10.4041/kjod.2012.42.1.32 www.e-kjo.org
Türköz and Ulusoy • Enamel conditioning techniques

Table 3. Comparison of bonding force; results of the Scheffé test

Groups Acid Self-etch Sandblasting Sandblasting + acid Laser Laser + acid
Group 1 (acid) - * * NS * *
Group 2 (self-etch) * - * NS NS *
Group 3 (sandblasting) * * - * * *
Group 4 (sandblasting + acid) NS NS * - NS *
Group 5 (laser) * NS * NS - *
Group 6 (laser + acid) * * * * * -
NS, Not significant. *The mean difference is significant at the 0.05 level.

Table 4. The adhesive remnant index (ARI) scores; results of the chi-square test
ARI scores
Groups Chi-square
0 1 2 3
Group 1 (acid) 2 12 1 0
Group 2 (self-etch) 3 9 2 1
Group 3 (sandblasting) 15 0 0 0 42.711 (p < 0.001)
Group 4 (sandblasting + acid) 1 5 8 1
Group 5 (laser) 0 13 2 0
Group 6 (laser + acid) 0 3 10 2
ARI scores were: 0, indicating no adhesive; 1, less than half of the adhesive; 2, more than half of the adhesive; and 3, all the
adhesive.

Figure 1. Photomicrograph of the acid-treated enamel Figure 2. Photomicrograph of the enamel surface treated
surface after debonding. The entire enamel surface is with self-etching primer after debonding. Spurs (arrow-
coated with resin. head) can be observed on the tracings of enamel rods.

The results of the Scheffé post-hoc test showed that groups p < 0.001; Table 4).
3 and 6 were significantly different from other groups The SEM evaluation of the 6 groups after debonding and
(Table 3). The intergroup differences and their levels of the control group, which was not subjected to any surface
significance are shown in Table 3. treatment, are shown in Figures 1 - 6 at 1,000× magni­
The chi-squared test revealed statistically significant fication.
differences in the ARI scores of the 6 groups (χ2 = 42.711,

www.e-kjo.org http://dx.doi.org/10.4041/kjod.2012.42.1.32 35
 Türköz and Ulusoy • Enamel conditioning techniques

Figure 3. Photomicrograph of the sandblast-treated Figure 5. Photomicrograph of the Er:YAG laser-treated

enamel surface after debonding. Broken enamel surface enamel surface after debonding. Ablation on the enamel
(circles), sand particles (arrowheads), and a few remnant surface can be observed.
resins (brackets) can be observed.

Figure 4. Photomicrograph of the sandblast-treated and Figure 6. Photomicrograph of the enamel surface
acid-etched enamel surface after debonding. The entire treated with Er:YAG laser followed by acid etching after
surface is coated with resin. debonding. Remnant adhesive sites (A), rough enamel
rods (B), and fractured enamel (between arrows) can be
observed.

DISCUSSION
amount of enamel loss.16
Currently, research is on to develop time-conserving The bonding force in groups 3 and 6 were significantly
and tooth-friendly enamel conditioning systems for brac- different from those in all the other groups (Table 3).
ket bonding. In the present study, we evaluated the effects The bond strength values in all groups, except group 3,
of all well-known enamel conditioning techniques for were consistent with the minimal bond strength values
bracket bonding in terms of SBS, ARI, and SEM findings. reported by Reynolds’17 as clinically acceptable (5.9 - 7.8
Phosphoric acid treatment is the most common techni­ MPa; Table 1). Group 3 had a mean SBS value of 3.12 ±
que used in the bonding procedure. However, acid et­ 0.61 MPa, which is not suitable for clinical usage. This
ching has been implicated in decalcification and loss of result is consistent with those reported in stu­dies evaluating
enamel.14,15 Although the enamel-etching technique is a the sandblasting technique for enamel conditioning.6,18,19
useful and accepted orthodontic procedure for bonding These findings suggest that as a form of macro-etching,19
orthodontic brackets, it needs to be improved to establish only sandblasting the enamel may not be sufficient for
clinically useful bond strengths while minimizing the orthodontic bonding. Another disadvantage of sandblas-

36 http://dx.doi.org/10.4041/kjod.2012.42.1.32 www.e-kjo.org
Türköz and Ulusoy • Enamel conditioning techniques

ting is that the aluminium oxide-containing aerosol used debonding showed differences in the surface charac­
may be swallowed or inhaled by the patient or doctor. teristics of the teeth in the 6 groups. For groups 1 (Figure
Laser irradiation results in an increase in the calcium 1) and 4 (Figure 4), the entire enamel surface was coated
to phosphorus ratio, 20 thereby rendering the enamel with resin, thereby indicating good enamel-resin bonding.
more acid resistant and less susceptible to caries attack.8 Photomicrography (Figure 2) revealed that primer
Therefore, using laser for enamel conditioning may be bonding to the enamel surface was achieved in group 2.
beneficial for orthodontic bonding. The enamel surface does not show a prismatic view with
In the present study, group 5 had attained the bond ena­mel rods, but spurs (arrowhead) can be observed on
strength of 9.45 ± 0.92 MPa, which was comparable to the tracings of rods. This appearance may be indicative of
that achieved in the acid-etched group; however, group bond failure at the primer-resin interface.
6 had a mean SBS of 13.61 ± 1.14 MPa, which was much The photomicrographs obtained for group 3 showed
greater than that in the other groups, and some specimens physical roughness of the enamel surface, indicating
in this group also showed fractured enamel surfaces (Table that chemical demineralization did not occur with sand­
1). This suggests that laser etching, both alone and with blasting (Figure 3). Fractured enamel surfaces (circles)
acid etching, provided enough SBS for bonding. These due to sandblasting, sand particles (arrowheads), and a
findings concur with the findings of some studies,11,21-23 few remnant resins (brackets) can be observed.
but are contrary to those of others.7,9,24,25 This discrepancy Group 5 exhibited the ablation of enamel surfaces and
may be attributed to differences between the studies in enamel rods (Figure 5). The ablated enamel surface may
the power outputs, application distances, and laser types, have fractured during debonding; this may have resulted
but this study showed that treatment with Er:YAG laser in the separation of the enamel surface from the resin
at 350 mJ/pulse and a frequency of 4 Hz administered as material and the formation of roughened area.
1 pulse/mm2, from a distance of 1 mm afforded sufficient Teeth in group 6 (Figure 6) exhibited remnant adhesive
SBS. sites (A), rough enamel rods (B), and fractured enamels
The use of the SEP in adhesive systems for enamel con­ (bet­w een arrows). The presence of fractured enamel
di­t ioning has become popular among orthodontists sites reflects the high SBS between the enamel and resin.
because it produces a gentler etch pattern compared to The irradiated and roughened enamel surface may have
other methods 26 and because the combination of the become more irregular with acid etching, and some of
etchant and primer in this method simplifies the clinical the residual resin may have been retained on the surface
procedure. In this study, group 2, which was subjected while some enamel fractures may have occurred during
to SEP treatment, showed a mean SBS of 9.23 ± 0.91 debonding.
MPa. Despite having the lowest SBS value, acceptable
levels of bond strength were achieved in this group. CONCLUSION
Con­sistent with our results, the 4 SEP systems tested by
Scougall Vilchis et al.26 afforded SBS of levels adequate for Although laser conditioning afforded high SBS, the pro­
orthodontic bonding. Similarly, Özer et al.23 and Bishara cedure resulted in considerable damage to teeth. There­
et al.27 reported that SEPs provided SBS values adequate fore, the acid-etching and self-etching techniques were
for orthodontic bonding. found to be safer for orthodontic bracket bonding. Since
A previous study reported that the amount of remnant the sandblasting method did not afford sufficient bonding
adhesive tends to increase at high SBS.28 The ARI values strength alone, this technique must be accompanied by
in our study groups were significantly different, indicating acid etching in order to achieve better results.
discrepancies in the bond failure sites among the groups.
Except for group 3, all the groups showed bond failures REFERENCES
within the bracket base and the adhesive surface; in group
3, all the teeth had ARI scores of 0 since the bond failure 1. Urabe H, Rossouw PE, Titley KC, Yamin C. Com­
occurred between the tooth surface and the adhesive. The binations of etchants, composite resins, and bracket
teeth in groups 1 and 5 showed similar ARI scores but systems: an important choice in orthodontic bonding
greater extent of adhesive on the tooth surface in group procedures. Angle Orthod 1999; 69:267-75.
6. Excessive residual adhesives result in increased chair 2. Zachrisson BU, Büyükyilmaz T. Recent advances
time during debonding. Considering the high SBS value in bonding to gold, amalgam, and porcelain. J Clin
in group 6 and the acceptable SBS value in all the groups Orthod 1993;27:661-75.
except group 3, we think that laser conditioning followed 3. Faltermeier A, Behr M. Effect of bracket base condi­
by acid etching may be unnecessary since it results in tioning. Am J Orthod Dentofacial Orthop 2009;135:
greater amount of remnant adhesive on the tooth. 12.e1-5.
In this study, the SEM evaluation of the samples after 4. Chung K, Hsu B, Berry T, Hsieh T. Effect of sandbla­

www.e-kjo.org http://dx.doi.org/10.4041/kjod.2012.42.1.32 37
 Türköz and Ulusoy • Enamel conditioning techniques

sting on the bond strength of the bondable molar tube Br J Orthod 1975;2:171-8.
bracket. J Oral Rehabil 2001;28:418-24. 18. Olsen ME, Bishara SE, Damon P, Jakobsen JR. Com­
5. Berk N, Basaran G, Özer T. Comparison of sandbla­ parison of shear bond strength and surface structure
sting, laser irradiation, and conventional acid etching between conventional acid etching and air-abrasion
for orthodontic bonding of molar tubes. Eur J Orthod of human enamel. Am J Orthod Dentofacial Orthop
2008;30:183-9. 1997;112:502-6.
6. Canay S, Kocadereli I, Akça E. The effect of enamel air 19. Reisner KR, Levitt HL, Mante F. Enamel preparation
abrasion on the retention of bonded metallic ortho­ for orthodontic bonding: a comparison between the
dontic brackets. Am J Orthod Dentofacial Orthop use of a sandblaster and current techniques. Am J
2000;117:15-9. Orthod Dentofacial Orthop 1997;111:366-73.
7. von Fraunhofer JA, Allen DJ, Orbell GM. Laser 20. Hossain M, Nakamura Y, Tamaki Y, Yamada Y, Mura­
etching of enamel for direct bonding. Angle Orthod kami Y, Matsumoto K. Atomic analysis and knoop
1993;63:73-6. hardness measurement of the cavity floor prepared by
8. Klein AL, Rodrigues LK, Eduardo CP, Nobre dos Er,Cr:YSGG laser irradiation in vitro. J Oral Rehabil
Santos M, Cury JA. Caries inhibition around com­po­ 2003;30:515-21.
site restorations by pulsed carbon dioxide laser ap­ 21. Walsh LJ, Abood D, Brockhurst PJ. Bonding of resin
plication. Eur J Oral Sci 2005;113:239-44. composite to carbon dioxide laser-modified human
9. Üşümez S, Orhan M, Üşümez A. Laser etching of enamel. Dent Mater 1994;10:162-6.
enamel for direct bonding with an Er,Cr:YSGG hydro­ 22. Visuri SR, Gilbert JL, Wright DD, Wigdor HA, Walsh
kinetic laser system. Am J Orthod Dentofacial Orthop JT Jr. Shear strength of composite bonded to Er:YAG
2002;122:649-56. laser-prepared dentin. J Dent Res 1996;75:599-605.
10. Basaran G, Ozer T, Berk N, Hamamci O. Etching ena­ 23. Ozer T, Başaran G, Berk N. Laser etching of enamel
mel for orthodontics with an erbium, chro­mium: ytt­ for orthodontic bonding. Am J Orthod Dentofacial
rium-scandium-gal-lium-garnet laser sys­tem. An­gle Orthop 2008;134:193-7.
Orthod 2007;77:117-23. 24. Roberts-Harry DP. Laser etching of teeth for ortho­
11. Basaran G, Hamamci N, Akkurt A. Shear bond dontic bracket placement: a preliminary clinical study.
strength of bonding to enamel with different laser Lasers Surg Med 1992;12:467-70.
irra­diation distances. Lasers Med Sci 2011;26:149-56. 25. Corpas-Pastor L, Villalba Moreno J, de Dios Lopez-
12. Hamamci N, Akkurt A, Basaran G. In vitro evaluation Gonzalez Garrido J, Pedraza Muriel V, Moore K, Elias
of microleakage under orthodontic brackets using two A. Comparing the tensile strength of brackets adhered
different laser etching, self etching and acid etching to laser-etched enamel vs. acid-etched enamel. J Am
methods. Lasers Med Sci 2010;25:811-6. Dent Assoc 1997;128:732-7.
13. Artun J, Bergland S. Clinical trials with crystal growth 26. Scougall Vilchis RJ, Yamamoto S, Kitai N, Yamamoto
conditioning as an alternative to acid-etch enamel pre­ K. Shear bond strength of orthodontic brackets
treatment. Am J Orthod 1984;85:333-40. bonded with different self-etching adhesives. Am J
14. Lehman R, Davidson CL. Loss of surface enamel after Orthod Dentofacial Orthop 2009;136:425-30.
acid etching procedures and its relation to fluoride 27. Bishara SE, VonWald L, Laffoon JF, Warren JJ. Effect of
content. Am J Orthod 1981;80:73-82. a self-etch primer/adhesive on the shear bond strength
15. Shey Z, Brandt S. Enamel loss due to acid treatment of orthodontic brackets. Am J Orthod Dentofacial
for bonding. J Clin Orthod 1982;16:338-40. Orthop 2001;119:621-4.
16. Yamada R, Hayakawa T, Kasai K. Effect of using self- 28. Hosein I, Sherriff M, Ireland AJ. Enamel loss during
etching primer for bonding orthodontic brackets. bonding, debonding, and cleanup with use of a self-
Angle Orthod 2002; 72:558-64. etching primer. Am J Orthod Dentofacial Orthop
17. Reynolds IR. A review of direct orthodontic bonding. 2004;126:717-24.

38 http://dx.doi.org/10.4041/kjod.2012.42.1.32 www.e-kjo.org