In vivo evaluation of a moisture-activated orthodontic adhesive: a comparative clinical trial.
OBJECTIVE
To evaluate and compare the clinical performance of a water-activated, ethyl-cyanoacrylate adhesive to a conventional composite resin. The null hypothesis tested was that there was no difference in bracket survival distribution, over a period of orthodontic treatment, for brackets bonded with either bonding agent.


METHODS
Single center randomized controlled clinical study.


METHODS
Twenty-five consecutive patients (15 females and 10 males) were selected and treated with fixed appliances in a university postgraduate orthodontic clinic. All teeth, but the molars, were bonded with twin stainless steel brackets (n = 429) using a split-mouth technique and random allocation of the two adhesives.


METHODS
Bond failure rates during a period of 9 months were estimated for each adhesive system and the corresponding bracket survival curves were plotted using the Kaplan-Meier product-limit estimate. Bracket survival distributions with respect to adhesive material, tooth location, investigator, and bond failure interface were then compared by means of a log-rank test. Bond failure interface was determined using the Adhesive Remnant Index (ARI).


RESULTS
The water-activated bonding material recorded a significantly higher bond failure (22.4%) than the composite resin (5.1%). There were also statistically significant differences in bracket survival distributions between the two adhesives (log-rank test: p < 0.001). Premolars exhibited higher bond failure rates than incisors and canines (p < 0001). The predominant mode of failure was within the bonding material.


CONCLUSIONS
Further investigations focused on the improvement of the physical and mechanical properties of the water-activated bonding system are needed to make it a reliable alternative adhesive for the direct bonding of orthodontic brackets.
Karamouzos
A
A
Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, GR-54006 Thessaloniki, Greece.
Mavropoulos
A
A
Athanasiou
A E
AE
Kolokithas
G
G
D000269:Adhesives / Q000737:chemistry*; D001641:Bicuspid; D003188:Composite Resins / Q000737:chemistry; D003481:Cuspid; D003487:Cyanoacrylates / Q000737:chemistry; D001840:Dental Bonding; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007180:Incisor; D016014:Linear Models; D008297:Male; D016382:Orthodontic Appliance Design; D016910:Orthodontic Brackets; D019279:Resin Cements / Q000737:chemistry*; D013193:Stainless Steel / Q000737:chemistry; D013223:Statistics as Topic; D013314:Stress, Mechanical; D013499:Surface Properties; D016019:Survival Analysis; D014867:Water / Q000737:chemistry
D000269:Adhesives; D003188:Composite Resins; D003487:Cyanoacrylates; D019279:Resin Cements; C449140:Smartbond; C045637:System 1 plus; D014867:Water; D013193:Stainless Steel; C029054:ethyl 2-cyanoacrylate