Bonding failure is a clinical issue frequently encountered in orthodontic practice. The aim of this study was to evaluate enamel pretreatment both in vitro and clinically using agents with different RDA values before brackets' bonding, to assess if RDA can affect the Shear Bond Strength (SBS), Adhesive Remnant Index (ARI) and clinical failure rate of orthodontic brackets. For the in vitro study, 220 bovine teeth were pretreated with agents with different RDA values. Subsequently, brackets were bonded. For the clinical study, 20 patients underwent bonding of 20 brackets each with a split-mouth design. Low and high RDA toothpastes were used for enamel pretreatment. SBS, ARI and failures were recorded. Higher SBS values were found for teeth pretreated with lower RDA agents; conversely, lower SBS values were found for teeth pretreated with higher RDA agents (p < 0.05). For high ARI values, RDA increased too (p > 0.05). In the clinical study, a significantly lower failure rate was reported for teeth pretreated with low RDA toothpaste (2.5% in low RDA group, 7.0% in high RDA group; p < 0.05). No significant differences were assessed comparing the two dental arches and anterior and posterior sites. Enamel pretreatment with low RDA toothpastes could increase brackets' survival rate. Further in vitro and clinical studies would be welcomed to confirm these findings.
Keywords: ARI; RDA; bonding; brackets; enamel; failure rate; orthodontics; pretreatment; shear bond strength; toothpaste.