Zachrisson B U, Brobakken B O
Am J Orthod. 1978 Jul;74(1):62-78. doi: 10.1016/0002-9416(78)90046-5.
A longitudinal clinical trial was made in forty-two children to compare some commonly used techniques for orthodontic bracket bonding. A particular study design (Figs. 1 and 5) allowed blind quadrantwise comparisons in the same patient of six different variables, including direct versus indirect bonding, adhesives of the filled diacrylate resin type with small versus large filler particles, and metal brackets with mesh-backed versus perforated bases. The same person bonded all brackets within one week and performed the orthodontic treatment by a friction-free edgewise light-wire technique. Efforts were made to minimize gingival irritation by using eccentrically placed brackets on small bases, by careful trimming of excess adhesives flash around the bases, and by directing much emphasis on oral hygiene measures. The plaque situation around the brackets and along the gingival margins and the gingival condition were assessed according to the criteria of the plaque and gingival index systems by a dental hygienist at each monthly visit during a test period of 6 months. The study demonstrated that both direct and indirect bonding with the different adhesives and bracket types could give clinically satisfactory results. Still, there were statistically significant differences in plaque retention, gingival inflammation, and bond strength. The bonding adhesive with small filler particles was more hygienic than and about as strong as two adhesives with larger, coarser filler particles. The mesh-backed brackets retained less plaque and gave stronger bonds than the brackets with perforated pads. Advantages of direct bonding over the indirect procedure were that (1) the bracket bases were fitted closer to the tooth surface (which improved bond strength), (2) it was easier to work clean and to remove excess adhesive flash around the bracket bases (to help prevent gingival inflammation and decalcification and facilitate debonding), and (3) the bonding adhesive constantly filled out the entire contact surface of the brackets (thus avoiding artificial undercuts and deficiency areas which are prone to promote decalcification). A number of other clinical observations were also discussed.
对42名儿童进行了一项纵向临床试验，以比较一些常用的正畸托槽粘结技术。一种特殊的研究设计（图1和图5）允许在同一患者中对六个不同变量进行盲法象限比较，包括直接粘结与间接粘结、填充双丙烯酸酯树脂类型且填料颗粒小与大的粘合剂，以及网背式与穿孔基底的金属托槽。由同一人在一周内粘结所有托槽，并采用无摩擦直丝弓轻丝技术进行正畸治疗。通过在小基底上偏心放置托槽、仔细修剪托槽基底周围多余的粘结剂飞边以及大力强调口腔卫生措施，努力将牙龈刺激降至最低。在6个月的测试期内，每次月度就诊时，由一名口腔保健员根据菌斑和牙龈指数系统的标准评估托槽周围、沿牙龈边缘的菌斑情况以及牙龈状况。该研究表明，使用不同的粘合剂和托槽类型进行直接粘结和间接粘结均可取得临床满意的结果。然而，在菌斑滞留、牙龈炎症和粘结强度方面仍存在统计学上的显著差异。填料颗粒小的粘结粘合剂比两种填料颗粒大且粗糙的粘合剂更卫生，且粘结强度相当。网背式托槽比穿孔垫托槽保留的菌斑更少，粘结更强。直接粘结相对于间接粘结的优点在于：（1）托槽基底更贴合牙齿表面（这提高了粘结强度）；（2）更容易保持清洁并去除托槽基底周围多余的粘结剂飞边（有助于预防牙龈炎症和脱矿，并便于脱粘）；（3）粘结粘合剂不断填充托槽的整个接触面（从而避免容易促进脱矿的人为倒凹和缺陷区域）。还讨论了一些其他的临床观察结果。
