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A scanning electron microscopic investigation
of ceramic
orthodontic brackets
F. McDonald, BDS,
MSc, FDS, M.Orth,* A.P. Toms, BDS, FDS, M.Orth**
*Guy's Hospital Dental
School London,
England,**Armed Forces Hospital,
P.O.Box 7897, Riyadh 11459, Saudi Arabia.
Ceramic brackets were introduced to overcome the
esthetic disadvantages of stainless steel brackets. The clinical impression of
these brackets is very favorable. However, the sliding mechanics used in the Straightwire
("A" Company, San Diego, CA, USA)
system appear to produce slower tooth movements with ceramic compared to
stainless steel brackets. To determine whether this was due to
any obvious mechanical problem in the bracket slot, Transcend (Unitek Corporation/3M, Monrovia,
CA, USA) ceramic brackets were examined by a scanning electron microscope and
compared to stainless steel brackets.Consistently, large surface defects were
found in the ceramic bracket slots that were not present in the metal bracket
slots. These irregularities could obviously hinder the sliding mechanics of the
bracket slot-archwire system and create a greater demand on anchorage.
Conversely, the fitting surface of the Transcend ceramic bracket showed
extremely smooth surface characteristics, and it would seem advisable for the
manufacturers to incorporate this surface within the bracket slot.
As the demand for orthodontic treatment has
grown, the variety of appliances and techniques to correct dental malocclusions
has increased. Since the development of adhesive resins, bands are no longer
used on anterior teeth, and the metal brac kets that are now bonded to the
tooth are becom ing smaller and less obtrusive. The development of the
lingual appliance, with the absence of any labial attachments on the anteriors,
was hailed as being the ultimate in orthodontic esthetics.1 This lingual system, however, was not without
its disad vantages. The increase in chairside time, both to fit and adjust the
appliance, patient discomfort, and the management of the anchorage requirements
were amongst the most problematical. These prob lems, together with the finer
control afforded by labially bonded brackets, have resulted in the demise of
the lingual system by most practicing orthodontists.
The development of polycarbonate plastic brac
kets was the first step towards an esthetic labial orthodontic system. These
brackets were also not without their clinical problems. Firstly, they
were very prone to staining and discoloration, especially in patients who smoke
or drink a lot of tea and cof fee. Secondly, the polycarbonate resin was much
less dimensionally stable than the materials used, and so the bracket slot
dimensions could not be manufactured to the same precision. Thirdly, fric tion
generated between the plastic bracket and metal archwire made it very difficult
to slide teeth along the archwire.2 These
plastic brackets have now been superceded by the new generation of ceramic and
quartz brackets.3
Ceramic brackets are most commonly made out of tooth colored
polycrystalline alumina, and many different shapes and prescriptions are
available. Due to strength limitations of ceramics, only Edgewise and
Straightwire brackets are available at the present time since the Begg bracket
system does not lend itself to the design demands of the material. Ceramic
brackets have been investigated to determine their mechanical properties, and
it has been found that their strength correlates closely with surface defects
often found on their sur faces.4,5 The failure of the material is
due to crack growth propagation originating at these surface defects and so the provision of a defect-free
surface is paramount for clinical longevity of the brackets.
Ideally, the bracket-archwire system should be frictionless to enable
free movement of the tooth in all three planes. In reality, however, a large
part of the anchorage is consumed by the frictional com ponent of the system.
Previous work on friction in fixed appliances has quantified some components of
the frictional force, but these studies have only investigated metal brackets
in conjunction with stainless steel, Nitinol and titanium molybdenum alloy
archwires.6-8 It was found that frictional bind ing was
related to the surface topography of the slot, the mesiodistal width of the
bracket, the archwire dimensions, the type of archwire, the applied force and
the method of archwire ligation. A recent study9 was undertaken to investigate the bracket-archwire
interaction when a tooth was retracted through a viscous material using sliding
mechanics with the Edgewise technique. The con clusions were in general
agreement with the previ ous studies in identifying the importance of surface
irregularities in the bracket slot as well as the archwire selection, both in
terms of dimension and composition.
This study is the first of a two-part investigation into the clinical
impression that sliding mechanics with ceramic Straightwire prescription
brackets produces slower tooth movement than when using similar metal brackets.
The study examines the sur face characteristics of the ceramic bracket slots
to identify defects or irregularities which could increase frictional binding
of the system. The sec ond part will attempt to quantify the frictional resis
tance of moving ceramic brackets along a continu ous archwire.
Fifty Transcend ceramic orthodontic brackets
were prepared for examination by a Hitachi S405A scan ning electron microscope. The brackets were
coated with a minimal layer of conducting medium to improve the signal generated by the ceramic
surface within the microscope. These were compared with fifty stainless
steel brackets, twenty-five Andrews' Siamese Straightwire, and twenty-five
standard Edgewise.* The metal brackets were
attached to the specimen mounts using magnetic tape. The fitting surface
of the brackets (that part which lies against the enamel tooth surface) and the
slot (that part which engages the wire) were examined at known magnification
and photographed.
The dimensions of the bracket slot were also measured using the
electron microscope at mag nifications between X15 and X60, and these values
were compared to the manufacturers stated values.
The scanning electron micrographs (SEM) of the metal brackets are
shown in Figs. 1a and 1b. Notice the surface debris that is present. The SEM of
a typical ceramic bracket slot (Transcend) is shown in Figs. 2a, 2b, and 2c
under increasing magnification. It is observed that many of the defects on
closer examination actually protrude from the bracket surface. In contrast, the
fitting sur face of the ceramic bracket, as shown in Figures 3a and 3b, has a
relatively free defect field which at higher magnification still shows minimal
defects.
The dimensions of the bracket slot, as measured by the electron
microscope, are compared with the manufacturers' figures in Table 1. The slot
sizes are given in inches
(International Standard) together with the standard deviation values for all
the metal and ceramic brackets. The values measured accorded well with the
manufacturers' stated dimensions, and there was no significant difference
between the ceramic and metal bracket slot size tolerances.
With the ever increasing demand for orthodontic treatment, especially
from adults, the need for an esthetic and clinically efficient bracket remains
paramount. Metal brackets are becoming more compact, and with the recent
development of ceramic and quartz designs, the labially placed bracket with its
improved mechanics over the lingual approach is here to stay. The Straightwire
appliance,10 with its various prescriptions, has become the
orthodontic system of choice for most Edgewise operators. The inclusion of the
Straightwire system in ceramic bracket design together with their superior
esthetics is largely responsible for the increased usage of these brac kets
worlwide.
Inherent to the Straightwire system, whether it be with metal or
ceramic brackets, is the integral use of sliding mechanics. This has been
extensively inves tigated in both wet and dry conditions9,11,12 and there is no doubt that oral saliva is
important in reducing the frictional component between the bracket and the
archwire. It has also been shown that the inhomogeneity of the bracket slot
plays an important role in the development of friction which can lead to the
hindrance of free tooth movement. This has important implications in terms of
calculat ing the anchorage requirements for certain orthodontic tooth movements.13
The slots of the metal brackets were consistently smooth, whereas
those of the ceramic brackets showed equally consistent surface defects which
seemed to project above the surface layer in many cases [Fig. 2c]. This was
distinct from the fitting sur face of the ceramic brackets which showed a
smooth surface. Even allowing for the fact that this surface has a minimal
coating of a silane bonding agent, similar to that used when bonding to porce
lain crowns and veneers to enhance the tooth-bracket bond strength, the absence
of surface defects was extremely obvious.
It would, therefore, seem advisable for the man ufacturers to
incorporate this smooth surface within the bracket slot in order to reduce the
fric tional component of the archwire- bracket interac tion to a minimum.
This would then ensure that the ceramic brackets were comparable to metal brac
kets in terms of reduced frictional interference.
The dimensions of the bracket slots accorded well with the
manufacturers stated figures and there was no significant difference between
the tolerance values of metal compared to ceramic brackets.
The authors would like to thank the staff of the Scan ning Electron
Microscope Department of Guys Hospital, England for their help and assistance,
and to the Riyadh-Al-Kharj Hospital Program for the study and travel sup port
given to Dr. Toms in presenting this paper to the 56th Congress of the European
Orthodontics Society on 16-18 May 1989 in Weirzburg, Germany.
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