|Year : 2015 | Volume
| Issue : 2 | Page : 94-98
Evaluation of bond strength of splinting materials to the teeth using three adhesive systems-an in vitro study
Tina Puthen Purayil1, Arumugam Chakravarthy2, Kishore Ginjupalli3, Nidambur Vasudeva Ballal1
1 Department of Conservative Dentistry and Endodontics, Manipal University, Manipal, Karnataka, India
2 Department of Conservative Dentistry and Endodontics, Sri Ramachandra Dental College, Chennai, India
3 Department of Dental Materials, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
|Date of Web Publication||14-Jul-2015|
Tina Puthen Purayil
Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Manipal - 576 104, Karnataka
Source of Support: None, Conflict of Interest: None
Aim: To evaluate the bond strength of two splinting materials (orthodontic wire and ribbond) to the tooth structure using cyanoacrylate (CA) ester, self-adhering flowable composite (Vertise flow) and conventional flowable composite as adhesives.
Materials and Methods: A total of 120 human central incisors free of any carious lesions were selected for the study. To obtain the specimens, 120 human central incisors were embedded in the blocks of rapid polymerizing self-cure acrylic resin with two teeth each. The specimens were divided into six groups with ten specimens each. Group I-Orthodontic wire bonded with CA, Group II-Orthodontic wire bonded with flowable composite Group III-Orthodontic wire bonded with Vertise flow, Group IV-Ribbond bonded with CA, Group V-Ribbond bonded with flowable composite and Group VI-Ribbond bonded with Vertise flow. The adhesive force in newtons to debond the splinting material was measured in tension using universal testing machine. The force at which the splint system failed was noted. The data obtained were statistically analyzed using one-way ANOVA and significant differences were subjected to Tukey's post-hoc test at a confidence interval of 0.05.
Results: Bond strength with the orthodontic wire groups was significantly less compared with Ribbond groups p < 0.05. Among the adhesives, CA demonstrated lower bond strength value as compared to Vertise flow and flowable composite p < 0.05.
Conclusion: Orthodontic wire groups demonstrated significantly lower bond strength compared to ribbond groups. Among the adhesives CAs showed significantly lower bond strength compared to Vertise flow and conventional flowable composite.
Keywords: Adhesives, bond strength, splinting
|How to cite this article:|
Purayil TP, Chakravarthy A, Ginjupalli K, Ballal NV. Evaluation of bond strength of splinting materials to the teeth using three adhesive systems-an in vitro study. Saudi J Oral Sci 2015;2:94-8
|How to cite this URL:|
Purayil TP, Chakravarthy A, Ginjupalli K, Ballal NV. Evaluation of bond strength of splinting materials to the teeth using three adhesive systems-an in vitro study. Saudi J Oral Sci [serial online] 2015 [cited 2020 Sep 22];2:94-8. Available from: http://www.saudijos.org/text.asp?2015/2/2/94/160774
| Introduction|| |
Dental splinting is a widely accepted treatment option in the event of traumatic injuries to stabilize subluxated, luxated, avulsed and root fractured teeth. The course of healing of the severed periodontal ligament will determine the treatment outcome of these injured teeth.  There are many ways to stabilize traumatized teeth, viz wire splinting, which generally involves the use of conventional orthodontic wire, which is held onto the teeth with the help of dental composite. Alternatively acrylic cap splints, acid etched splints, porcelain veneers, trans-alveolar sutures and fiber reinforced composite splint have also been tried. , In general, dental splints require a quick setting material without any need for special preparation of the tooth structure.
In this regard, cyanoacrylate (CA) ester adhesives have been used for splinting of replanted teeth.  The main advantage of this material is that it dries quickly and could easily facilitate the procedure in the dental clinic. Though CA adhesives have already been investigated for bone repair, protection of hypersensitive teeth, their use for dental splinting is not widely reported.  Although, there is no evidence to prove that CA is carcinogenic to humans, it can be toxic leading to neurological and respiratory problems, and may also cause contact dermatitis and urticaria. 
Ribbond (Ribbond Inc.Seattle, WA) is basically a reinforced ribbon which is made from ultrahigh molecular weight polyethylene fiber having an ultrahigh modulus. Its translucency makes it an excellent esthetic material, and allows easy passage of the light to cure adhesive materials used for splinting through it in clinical situations. Its clinical application include periodontal splinting,  direct bonding of endodontic posts and cores, fabrication of a fixed partial denture with a composite resin pontic or a natural tooth pontic,  trauma stabilization  and orthodontic fixed lingual retainers. 
Some of the splinting materials such as orthodontic wire, fiber reinforced composite (Ribbond) are attached to the teeth with the help of dental composites. Such a procedure involves multiple steps such as etching, priming and application of adhesive, which is time-consuming. Innovative resin based materials combining the property of self-adhesion and flowability have been developed (Vertise Flow, Kerr, and Orange, CA, USA). These self-adhering materials are claimed to eliminate the need of etching, rinsing, priming and bonding application steps, thus simplifying the splinting procedure. The existing literature on the clinical performance of self-adhering flowable composites provide superior performance  or inferior performance  compared with the etch-and-rinse approach.
Evaluation of these recently introduced materials for splinting has not been widely reported. Hence, the aim of the present study was to evaluate in vitro the bond strength of two splinting materials (orthodontic wire and ribbond) to the tooth structure using CA ester, Vertise flow and conventional flowable composite as adhesives.
| Materials and Methods|| |
Preparation of specimens
A total of 120 human central incisors free of any carious lesions (extracted for periodontal reasons) were selected for the study. Teeth were cleaned and stored in 0.2% sodium azide until the experiment. Ethical clearance was obtained from institution review board. The enamel surfaces of the selected teeth were polished using pumice slurry for 2 min. The polished teeth were then embedded into a self-cure acrylic resin loaded into aluminum molds exposing the crown surface. In a single acrylic block, two incisors were placed contacting each other. The acrylic blocks with embedded teeth were then randomly divided into 6 groups (n = 10) based on splinting techniques.
Group I: Orthodontic wire bonded with CA (W-C).
Group II: Orthodontic wire bonded with flowable composite (W-F).
Group III: Orthodontic wire bonded with Vertise flow (W-V).
Group IV: Ribbond bonded with CA (R-C).
Group V: Ribbond bonded with flowable composite (R-F).
Group VI: Ribbond bonded with Vertise flow (R-V).
The splinting with CA ester (Fevi kwik, Pidilite industries limited, India) was carried out in a dry field at room temperature. The 21 gauge orthodontic wire (Remanium, Dentaurum, Germany) or ribbond splint material (Group I and Group IV) were cut to the designated length (15 mm) and placed on the middle third of the labial surface of crown following which CA ester was placed on the orthodontic wire or ribbond and was allowed to set at room temperature for 24 h before testing the bond strength.
Specimens of Group III and VI were prepared by placing the splinting material (orthodontic wire or ribbond) on the labial surface of the crown, followed by the application of Vertise flow. Later the composite was light cured for 20 s using a light emitting diode (LED) light curing unit (Bluephase, Ivoclar, Vivadent). Further the specimens in these groups were placed at room temperature for 24 h before testing the bond strength.
In Group II and Group V, the middle third of the labial surface of the teeth were initially acid etched using 37% phosphoric acid gel (Eco-Etch, Ivoclar Vivadent, Asia) for 20 s, rinsed with water for 20 s and air dried. A fifth generation bonding agent (Adper Single Bond 2, 3M ESPE, USA) was then applied on to the etched surface of the teeth and light cured for 20 s using a LED light curing unit (Bluephase, Ivoclar, Vivadent).Further orthodontic wire (Group II) or ribbond (Group V) were placed on the crown surface and photopolymerizable flowable composite resin (Filtex Z350 XT, flowable restorative A2 shade; 3M ESPE, USA) was applied. The flowable composite was light cured for 20 s using a LED light curing unit (Bluephase, Ivoclar, Vivadent). Representative figure of splinted teeth using orthodontic wire and Ribbond are shown in [Figure 1] and [Figure 2].
Measurement of bond strength
24 h after the splinting and bonding process, the acrylic molds were transferred onto the lower plate of universal testing machine (Instron 3366, UK) equipped with computer control, data acquisition and data analysis software (Bluehill software 2.18.713). The acrylic molds were immobilized using a specially designed jig. The upper portion of the universal testing machine was used to apply tensile stress on the splinting materials. For this, a hook made of 0.9 inch orthodontic wire was fixed onto the tensile jig of the universal testing machine. The hook was then attached to the splinting material between the teeth involved and the testing was carried out at a crosshead speed of 0.5 mm/min until the complete debonding of the splint from the teeth occurred. The maximum load applied during the testing was automatically noted and was reported in Newtons. Flowchart of the methodology has been presented in [Figure 3]. The data obtained were statistically analyzed using one-way ANOVA and significant differences were subjected to Tukey's post-hoc test at a confidence interval of 0.05.
| Results|| |
Bond strength of different splinting materials to enamel for various groups is shown in [Figure 4].
|Figure 4: Bond strength of diff erent splinting materials to enamel for various groups. *Indicates the groups with significantly higher debonding force values compared to W-F group|
Click here to view
The results indicated that, the bond strength with the orthodontic wire groups was significantly less when compared to the bond strength obtained with ribbond splint groups (p < 0.05). There was no significant difference in the bond strength among the various adhesives when used with orthodontic wire as splinting material (Group I, II and III) (p > 0.05). However, in Groups IV, V and VI, which used ribbond for splinting, the bond strengths were found to be significantly less with CAs as compared to Vertise flow and flowable composites (p < 0.05).There was no statistically significant difference in the bond strengths between the flowable composite and Vertise flow (p > 0.05).
| Discussion|| |
Many techniques can be used for the stabilization and fixation of dentoalveolar injuries. Though several of these techniques have been used in practice for many years, new techniques are being introduced as a result of the development of new dental restorative materials. 
Modern tooth splinting should be easy to apply, inexpensive, and easy to remove without damaging the dental hard tissue. Splints should not traumatize the teeth or surrounding tissues and should not interfere with the occlusion, dental hygiene, or endodontic treatment if necessary. Minimally, they should help to restore the original anatomical tooth position and ensure adequate fixation over the entire immobilization period, achieving rigidity or flexibility, according to the type of trauma. 
Many of the splinting techniques previously advocated were time-consuming and also they contributed to the injury of the soft and hard supporting tissues. 
Ribbond has shown to have an acceptable strength when used as a splinting material. In the present study, ribbond Groups (Group IV, V, VI) showed better bond strength than orthodontic wire groups. This may be attributed to the infiltration of the adhesive materials into the ribbond leading to better bond strength.
The adhesives used in our study were CA ester, Vertise flow and conventional flowable composite. CAs are liquid monomers with water-like viscosity and appearance. On contact with water or any kind of protein, CAs undergo an exothermic polymerization reaction within 15-60 s.  These adhesives may be a feasible option for making a rapid, simple and efficient contention of replanted teeth in situations where the routinely used materials are not readily available. However in this study CA ester showed lower bond strength. These results are in accordance with the results reported by Manfrin et al. 
Vertise flow (self-adhering flowable composite) and the conventional flowable composite (Filtex Z350 XT) showed comparable bond strengths. Vertise flow is suggested to bond to the tooth structure in two ways : Primarily through the chemical bond between the phosphate functional groups of a glycerol phosphate dimethacrylate monomer and calcium ions of the tooth and secondarily, through a micro-mechanical bond as a result of an interpenetrating network formed between the polymerized monomers of self-adhering flowable composite and collagen fibers of dentin. Giachett et al. have shown the interfacial strength between light curing self-adhering resin composite and root canal walls is equivalent to the interfacial strength between dual-curing cement and root canal walls. 
The self-adhering material represents an attractive approach to the clinicians. However, long-term success is not yet validated, as these materials have only been recently introduced into the market. Although in the present study Vertise flow yielded favorable results, long-term in vitro and in vivo studies are warranted.
| Conclusion|| |
Within the limitations of this study, it can be concluded that splinting of teeth with orthodontic wire resulted in a significantly lower bond strengths compared to ribbond. Among the adhesives CAs showed significantly lower bond strengths compared to Vertise flow and conventional flowable composite. However, further studies involving several self-adhering flowable composites are to be undertaken to confirm their superiority over conventional flowable composites for splinting.
| References|| |
Oikarinen K. Functional fixation for traumatically luxated teeth. Endod Dent Traumatol 1987;3:224-8.
Oikarinen K. Tooth splinting: A review of the literature and consideration of the versatility of a wire-composite splint. Endod Dent Traumatol 1990;6:237-50.
Croll TP. Bonded composite resin/ligature wire splint for stabilization of traumatically displaced teeth. Quintessence Int 1991;22:17-21.
Negri MR, Panzarini SR, Poi WR, Sonoda CK, Manfrin TM, Vendrame dos Santos CL. Use of a cyanoacrylate ester adhesive for splinting of replanted teeth. Dent Traumatol 2008;24:695-7.
Herod EL. Cyanoacrylates in dentistry: A review of the literature. J Can Dent Assoc 1990;56:331-4.
Hensten-Pettersen A, Jacobsen N. Perceived side effects of biomaterials in prosthetic dentistry. J Prosthet Dent 1991;65:138-44.
Strassler HE, Serio FG. Stabilization of the natural dentition in periodontal cases using adhesive restorative materials. Periodontal Insights 1997;4:4-10.
Meiers JC, Freilich MA. Chairside prefabricated fiber-reinforced resin composite fixed partial dentures. Quintessence Int 2001;32:99-104.
Strassler HE. Aesthetic management of traumatized anterior teeth. Dent Clin North Am 1995;39:353-66.
Bearn DR. Bonded orthodontic retainers: A review. Am J Orthod Dentofacial Orthop 1995;108:207-13.
Bitter K, Meyer-Lueckel H, Priehn K, Kanjuparambil JP, Neumann K, Kielbassa AM. Effects of luting agent and thermocycling on bond strengths to root canal dentine. Int Endod J 2006;39:809-18.
Goracci C, Sadek FT, Fabianelli A, Tay FR, Ferrari M. Evaluation of the adhesion of fiber posts to intraradicular dentin. Oper Dent 2005;30:627-35.
Peterson LJ. Principles of Oral and Maxillofacial Surgery. Vol. 1. Philadelphia: W.B. Saunders; 1997. p. 381-406.
von Arx T, Filippi A, Buser D. Splinting of traumatized teeth with a new device: TTS (Titanium Trauma Splint). Dent Traumatol 2001;17:180-4.
Manfrin TM, Poi WR, de Mendonça MR, Cardoso LC, Massa Sundefeld ML, Sonoda CK, et al.
Analysis in vitro
of direct bonding system with cyanoacrylate ester and orthodontic wires. Dent Traumatol 2009;25:229-32.
Giachetti L, Scaminaci Russo D, Baldini M, Bertini F, Steier L, Ferrari M. Push-out strength of translucent fibre posts cemented using a dual-curing technique or a light-curing self-adhering material. Int Endod J 2012;45:249-56.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]