The effect of ceramic surface conditioning on bond strength of metallic brackets: An in vitro study.

Objective: To compare the shear bond strength (SBS) of brackets bonded to three different types of ceramic surfaces (feldspathic ceramic, lithium disilicate ceramic, and zirconia), conditioned with either hydrofluoric acid or sandblasting, using Assure^® Plus All bonding agent.

Materials and methods: A total of 72 monolithic CAD/CAM ceramic specimens were divided into six groups of 12 samples. Three groups (G1: feldspathic ceramic, G3: lithium disilicate ceramic, G5: zirconia surfaces) were conditioned with 9.6% hydrofluoric acid, while the remaining three (G2, G4, G6; with ceramic type in the same order as the previous three groups) were prepared with 50 μm aluminum oxide sandblasting. Premolar brackets were bonded using light-cured Assure^® Plus All. The SBS and adhesive remnant index (ARI) were recorded and submitted to inferential analysis using one-way analysis of variance and Kruskal-Wallis tests, respectively. The significance level was set at 5% (P ≤ 0.05).

Results: The mean SBS values for the three different ceramic groups conditioned with hydrofluoric acid (G1: 7.2 ± 1.5 MPa, G3: 9.3 ± 2.3 MPa, G5: 8.5 ± 2.0 MPa) were significantly higher than those obtained for the groups prepared by sandblasting before bonding (G2: 7.5 ± 1.8 MPa, G4: 4.4 ± 2.0 MPa, G6: 4.3 ± 2.8 MPa).

Conclusions: The hydrofluoric acid treatment produced a favorable SBS for all three examined ceramic types before bracket bonding with Assure^® Plus All. In comparison, sandblasting yielded a satisfactory SBS only with feldspathic surfaces. Furthermore, the ARI indicated a higher frequency of mixed-adhesive failures except for lithium disilicate conditioned with sandblasting. Therefore, using hydrofluoric acid is likely to be especially recommended when the clinician is not aware of the brand of ceramic restorative material.