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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 1  |  Page : 18-25

Effect of laser application on microtensile bond strength of an orthodontic adhesive to water-aged composite


1 Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey
2 Department of Orthodontics, Faculty of Dentistry, Kocaeli University, İzmit, Turkey
3 Department of Paediatric Dentistry, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey

Date of Submission17-Jun-2019
Date of Acceptance30-Aug-2019
Date of Web Publication10-Jan-2020

Correspondence Address:
Dr. F M Korkmaz
Karadeniz Technical University, Faculty of Dentistry, Kanuni Kampus 61080 Trabzon
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_318_19

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   Abstract 


Aim: This study evaluated the microtensile bond strength (MTBS) of an orthodontic adhesive to water-aged composite surfaces using different surface treatments. Subjects and Methods: Twelve composite blocks (10 mm × 10 mm × 5 mm) were fabricated and randomly divided into two groups. Half of the specimens were stored in distilled water for 1 day, and the other specimens were stored for 30 days. The specimens were randomly assigned to six groups according to surface treatments (n = 15): Group 1, control (no treatment); Group 2, phosphoric acid; Group 3, diamond bur; Group 4, diamond bur + phosphoric acid; Group 5, laser; and Group 6, laser + phosphoric acid. One coat of orthodontic adhesive was bonded to one surface of composite blocks, and a microhybrid composite resin was bonded to the surfaces via a Teflon mold. Bond strength was evaluated using an MTBS test. Surface topography was evaluated using scanning electron microscopy (SEM) analysis. The data were analyzed using one-way analysis of variance, Tamhane post-hoc test, and independent sample t-tests (P < 0.05). Results: Bond strength values tended to decrease in all groups (with the exception of Group 2) after storage in water for 30 days (P < 0.05). Laser and diamond bur application (with or without phosphoric acid) enhanced the bond strength. Conclusions: An Er,Cr:YSGG laser application may be a feasible alternative to diamond bur for enhancing the bond strength of orthodontic adhesive to composite resin.

Keywords: Composite, laser, microtensile bond strength, orthodontic adhesive


How to cite this article:
Korkmaz F M, Ozel M B, Tuzuner T, Baygin O. Effect of laser application on microtensile bond strength of an orthodontic adhesive to water-aged composite. Niger J Clin Pract 2020;23:18-25

How to cite this URL:
Korkmaz F M, Ozel M B, Tuzuner T, Baygin O. Effect of laser application on microtensile bond strength of an orthodontic adhesive to water-aged composite. Niger J Clin Pract [serial online] 2020 [cited 2020 Jan 18];23:18-25. Available from: http://www.njcponline.com/text.asp?2020/23/1/18/275621




   Introduction Top


Successful bonding of orthodontic attachments to tooth surfaces is a critical step for fixed orthodontic treatments.[1],[2],[3],[4] The failure of orthodontic attachment may lead to loss of obtained tooth movement, which prolongs treatment time and patient discomfort.[1],[5] The teeth of adolescent patients who need orthodontic treatment are restored with composite materials by clinicians at a high ratio because of it produces esthetic results and minimum wear.[6] Although durable bonding of the orthodontic brackets to enamel surfaces is successfully achieved, the achievement of a durable bond between the orthodontic attachments and composite resin has been a subject of considerable interest for orthodontists.[4],[7] The presence of composite restorations causes difficulties in achieving adequate bond strength.[8] In these cases, saliva-contaminated, polished, laboratory processed, or aged composite resin may lead to bonding failures.[2],[7] The potential bond strength problems related to water-aged composites were documented using chemical degradation and the remaining nonreactive methacrylate group characteristics.[9],[10],[11],[12] Various surface pretreatment modalities are used to increase the bond strength values of aged composite resins.[2],[4],[13],[14] A common failure pattern is described as reduced bond strength values of composite resin to an aged composite restoration.[4],[7],[10],[12] Several methods, including sandblasting, sodium bicarbonate particle abrasion, or roughening the surfaces with tungsten carbide or diamond burs, were used as solutions for bond strength problems.[4],[6],[15] Other chemical agents, such as phosphoric acid, hydrofluoric acid, or the application of silane coupling agents, were introduced as alternative methods.[8],[12],[14] The results obtained from these procedures were not consistent. Previous studies suggested that the diamond bur surface treatment method was a safe and effective method for achieving high bond strength between orthodontic brackets and composite resin.[4],[6] Phosphoric acid with different etching times was used to change the composite resin surface to improve the bond strength of orthodontic brackets to composite resin in previous studies.[2],[6],[14],[15],[16]

Since the development of the ruby laser by Maiman in 1960, advances in laser technology have resulted in technology that quickly had many uses in dentistry for different purposes.[17] Laser devices are used as a surface treatment method to alter the surface of the tooth or dental materials and improve bond strength.[2],[13],[16],[17] Laser application creates micro- and nanoroughness on the material surface.[17] Different types of lasers are successfully used to modify the tooth surface before bracket bonding.[17],[18] A previous study showed that laser application improved the bond strength of brackets to a porcelain surface.[18] Dehghani et al.[16] reported that Er:YAG laser application increased the bond strength of orthodontic attachment to fiber-reinforced composites. Some authors used a CO2 laser to enhance the bond strength between orthodontic brackets and temporary crowns.[19] Er:YAG (3W) laser application was previously recommended for improving the bond strength of metal brackets to aged composite resin.[2] An Er, Cr:YSGG laser was used recently as a surface-conditioning method for dental material surfaces to improve the bond strength.[20] However, the efficiency of the Er, Cr:YSGG laser on the bond strength between composite resin and orthodontic adhesive was not evaluated. Studies on bond strength of orthodontic brackets to tooth and restored surfaces mostly relied on shear bond strength testing.[4],[5],[6],[8],[15],[17] However, the micromechanical properties of bonding phenomena between aged composites and orthodontic bonding agents was not thoroughly investigated. Therefore, this study evaluated the effects of Er, Cr:YSGG laser application on the microtensile bond strength (MTBS) of an orthodontic adhesive to water-aged composite. The null hypotheses investigated in this study were that different surface treatments would not generate any differences in bond strength values, and water aging would not decrease MTBS.


   Subjects and Methods Top


Specimen preparation

The manufacturers and compositions of the materials used in this study are presented in [Table 1]. The study involved a total of 12 composite blocks made of microhybrid composite resin (Gradia Direct Anterior, Shade A2, GC Co., Tokyo, Japan). The blocks were prepared with the aid of a Teflon mold of 5.0-mm depth and 10-mm width. Once the mold was filled with composite on a glass slab to ensure a smooth, glossy surface, it was incrementally polymerized for 40 s according to the manufacturer's recommendation using a light curing unit (Elipar S10, 3M ESPE, St. Paul, MN, USA). The last increment was covered with a Mylar strip to obtain a flat surface and aid in the removal of excess material. Specimens were wet-ground using 600- and 1200-grit silicon carbide papers (Carbimet Paper Discs; Buehlar, Lake Bluff, Ill, USA) and ultrasonically cleaned in distilled water for 5 min. All specimens were stored in distilled water for 24 h at 37°C, and half of the specimens were stored for 30 days in distilled water. All specimens were randomly distributed into six experimental groups after storing according to the following surface preparation techniques:
Table 1: Materials used in this study

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Group 1: (control), (no treatment).

Group 2: (phosphoric acid), etched with 37% phosphoric acid for 2 min (Scotchbond, 3M ESPE, St. Paul, MN, USA).

Group 3: (diamond bur), ground using a diamond bur with a 151-μm grain size (KG Sorensen 1052, Barueri, SP, Brazil) in a high-speed dental handpiece from two directions perpendicular to each other, with water cooling under constant manual pressure for ten seconds. The burs were replaced after the grinding of every fifth specimen.

Group 4: (diamond bur + phosphoric acid), specimens were roughened with a diamond bur as described in Group 3, and the surfaces of the specimens were subjected to the application of 37% phosphoric acid for 60 s.

Group 5 (laser): Laser etching procedures were performed using an Er, Cr:YSGG laser system (Waterlase MD; Biolase Technology, San Clemente, CA, USA) operating at a wavelength of 2,780 nm. Irradiation was performed for 15 s under the following conditions: pulse duration of 140–200 μs, repetition rates of 20 Hz, and output power of 2 W (100 mJ/Pulse). Air and water spray levels were set at 85% air and 85% water. Laser energy was delivered through a beam spot, 600 μm diameter, in noncontact mode at a 1-mm distance, in accordance with the manufacturer's instructions for etching. The specimen and stabilization jig were moved slowly in a circular motion at a distance of ~1 mm from the cylinder fiber tip for 15 s.

Group 6 (laser + phosphoric acid): After the laser application described in Group 5, the specimens were etched with 37% phosphoric acid for 60 s.

Following surface preparation, the specimens were rinsed for 15 s and air-dried. A light-cured orthodontic adhesive (Transbond XTTM, 3M-Unitek, St. Paul, MN, USA) was applied to the treated composite surfaces and light-cured for 10 s, according to the manufacturer's instructions. After the bonding procedure, the specimen was positioned in the Teflon mold, which was filled with the microhybrid composite resin (Gradia Direct Anterior, Shade A3, GC Co), and polymerized as described earlier. The composite shade was A3 to allow differentiation between two composite blocks. The same clinician performed all bonding procedures.

Microtensile bonding test

After the bonding procedure, 12 composite blocks were sectioned using a double-faced diamond disk mounted in a sectioning machine (Isomet 1000, Buehler, Lake Bluff, IL, USA) at low speed under water cooling. Fifteen beams of 1.0 ± 0.2 mm2 cross-sectional area were obtained from the central portion of the slab, and peripheral beams were discarded. Each specimen was measured using a digital caliper to the nearest 0.01 mm (Mitutoyo, Tokyo, Japan) and subjected to MTBS testing (n = 15). The beams were fixed to a microtensile device coupled to a universal testing machine (Micro Tensile Tester T-61010K Bisco, CA, USA) with cyanoacrylate adhesive (Super Bonder gel-Loctite, Sao Paulo, SP, Brazil). The test was performed at a crosshead speed of 0.5 mm/min. To express the bond strength in megapascals (MPa), the load upon failure was recorded in Newton (N) and divided by the bond area (mm2).

Scanning Electron Microscopy (SEM) analysis

Surface microtopography was evaluated after surface preparation of the specimens using scanning electron microscopy (SEM; EVO L10, Carl Zeiss, Oberkochen, Germany) under 500 × magnification.

Statistical analysis

Statistical analyses were performed using a statistical software program (SPSS for Windows 17.0; Chicago, IL, USA). Intergroup differences at each storage time period were detected using one-way analysis of variance and Tamhane post-hoc tests. The independent sample t-test was used to detect intragroup differences between 1 and 30 days (for individual group) for each surface treatment protocol. The significance level was adjusted to P < 0.05.


   Results Top


The mean values of MTBS and the standard deviations of each surface treatment process according to the storage periods are presented in [Table 2] and [Table 3].
Table 2: Mean shear bond strength values (MPa) and standard deviation (SD) obtained in the tested groups, and inter-group comparisons of the surface treatment protocols for each storage time period

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Table 3: Mean shear bond strength values (MPa) and standard deviation (SD) obtained in the tested groups, and intra-group comparisons for the individual surface treatment protocols between the 1-30 days

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The highest values at day 1 were detected in Group 4. Intergroup comparisons revealed that Group 4 demonstrated significantly higher bond strength values than Group 1 and Group 2 (P < 0.05). However, Group 4 exhibited statistically insignificant higher values compared with Groups 6, 3, and 5 (P > 0.05). Group 2 demonstrated the lowest bond strength value. Groups 6, 3, and 5 exhibited significantly higher MTBS values when compared with Groups 1 and 2 (P < 0.05).

The highest values at day 30 were detected in the Group 3. The MTBS of Groups 3 and 4 indicated statistically significant higher values when compared with Groups 5, 2, 6, and 1 (P < 0.05), but the difference between Groups 3 and 4 was not significant (P > 0.05). It was found in this study that control group had the lowest bond strength value after 30-day storage period. The MTBS values of control group at day 30 were significantly lower than first day (P < 0.05). Group 5 exhibited higher, but statistically insignificant, MTBS values than Groups 2, 6, and 1. Intragroup comparisons revealed that MTBS values tended to decrease in all groups (with the exception of Group 2) after storage in water for 30 days (P < 0.05). No significant differences were found between 1 and 30 storage days (P > 0.05) for Group 2.

Representative SEM images of the composite surfaces treated with various surface preparation techniques are presented in [Figure 1]. The untreated control group revealed a smooth surface topography [Figure 1]a. The surfaces of the diamond bur specimens showed parallel, deep scratches that followed the direction of the bur propagation [Figure 1]b, and the phosphoric acid group samples demonstrated a homogenously etched surface with very small pits [Figure 1]c. The surfaces of the laser-irradiated specimens (Groups 5 and 6) revealed deep craters in a honeycomb pattern and noticeable asperities and cracks [Figure 1]d.
Figure 1: Representative SEM micrographs at 500 × magnification of the composite surfaces after various surface treatments: (a) no treatment; (b) phosphoric acid; (c) diamond bur; (d) diamond bur + phosphoric acid; (e) Er,Cr:YSGG laser; (f) Er,Cr:YSGG laser + phosphoric acid

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   Discussion Top


This study investigated the effects of different surface treatment methods on the MTBS of an orthodontic adhesive to aged composite. The results of this study showed that all surface treatment methods improved MTBS, except phosphoric acid etching application alone. Moreover, water aging reduced the bond strength of orthodontic adhesive to composite resin, except for the acid-etching application alone. Therefore, the results of this study require the rejection of both null hypotheses tested in this study.

This study determined the bond strengths of orthodontic adhesive to water-aged composite resins after different surface treatments using MTBS. Previous studies evaluated the bonding strength of orthodontic brackets to tooth surfaces, and surfaces generally, using shear bond strength testing.[4],[5],[6],[8],[15],[17] The shear test is not considered a suitable method to analyze aged composite–composite bond strength values because it causes a nonuniform distribution of stresses at the adhesive area.[12] However; the micromechanical properties of bonding phenomena between aged composites and orthodontic bonding agents were not investigated using the MTBS test. Some authors declare that tensile testing was a more representative measurement to evaluate the strength at the interface, because it provides more uniform and homogeneous stress distribution during loading.[9],[21] All failures in the MTBS test occurred within the adhesive interface, because the bonding interface of the specimens has very small dimensions.[9] Sano et al.[22] demonstrated that the small adhesive interface used in the microtensile test contained fewer defects than larger specimens, such as the specimens used in shear tests. Fewer defects would reduce the variation.[22] This technique has great potential for estimating the bond strength of the tooth and restorative materials.[10],[21],[22] Nevertheless, further studies should be performed carefully because the tensile strength test is very susceptible.[21] The results are greatly affected by small changes in the specimen structure and stress distribution during loading.[9],[21] In this study, MTBS test was used in order to evaluate the bond strength between orthodontic adhesives and water-aged composite resin. It is known that the MTBS test identifies bond strength with small bonded interfaces where fractures are primarily observes at the adhesive interface.[12] This study presents a pioneering methodological alternative for orthodontic bonding studies because it is the first study to incorporate MTBS testing in orthodontic adhesives.

Durable bonds between orthodontic attachments and tooth surfaces after different surface preparations were reported previously.[3],[17] However, there were difficulties in achieving durable bonding of an orthodontic attachment to the surface of porcelain, temporary crowns, and composite resins.[4],[5],[6],[8],[15],[23] Several techniques were suggested to increase bond strength to composite resin.[4],[6],[14],[15] Improvements in micromechanical interlocking increased the bond strength of composite resin.[4] The use of phosphoric acid before orthodontic adhesive application alone did not improve the bond strength compared with no surface treatment in this study. Phosphoric acid is ineffective in ensuring mechanical interlocking on resin composites to improve the bond strength.[14],[24] Traditionally, 37% orthophosphoric acid is used for conditioning the enamel surface because it dissolves the inorganic component of the enamel prism. However, phosphoric acid does not change the composite surface topography, but it cleans the composite surface from saliva or other agents.[4],[6],[9] Therefore, phosphoric acid is ineffective for dissolving organic components, and this inability creates microretention sites on the surface of the composite resin.[4],[6],[25] The inefficiency of phosphoric acid application for roughening the surface of resin composites on SEM images was demonstrated previously,[14],[15],[24],[25] and these results are consistent with our study. Some previous studies demonstrated that phosphoric acid application produced similar results with no surface treatment, and some authors cautioned against the use of phosphoric acid alone for composite resin repairs.[6],[24],[25] Etching the composite with acid may decrease bond strength depending on the material type and etching time.[15] This study applied phosphoric acid for 2 minutes to a microhybrid composite in the etching alone group. This protocol may totally remove filler particles from the composite resin surface, which could adversely affect the bond strength depending on the material type.

Previous studies reported that diamond bur application was an effective method for improving the bond strength of composite resin.[4],[6],[13],[14],[23],[26] The results of the present study revealed that diamond bur application (with or without phosphoric acid) produced high strength values, which is consistent with previous studies.[4],[6],[13],[14],[27] Bishara et al.[23] demonstrated that carbide bur abrasion of a composite surface produced the highest bond strength values for metal brackets to composite resin. Diamond bur application may create streaks and microretentive surface characteristics in a linear pattern, which increases the micromechanical interlocking that is detected under SEM.[27] Bonstein et al.[26] showed that surface treatment with diamond bur application was the most effective method for repairing aged composite resin. In contrast, some studies reported that diamond bur application did not produce adequate and durable bond strength.[15],[28] This difference between results may be attributed to the type of composite resin and adhesive system used in the studies, which affect the bond strength.[15],[24],[29],[30] The regularity of surface roughness after diamond bur application may be affected by the hand pressure applied, and bond strength may change depending on residual debris during surface preparation.[15] Therefore, diamond bur application ensures a less predictable outcome compared with other techniques.[28] Notably, the higher surface roughness obtained from diamond bur application may lead to increased plaque accumulation and a higher risk of caries development.[31]

Many investigators reported the ability of the dental lasers to alter the surface of dental materials.[2],[13],[16],[17] Different types of dental lasers create appropriate surfaces for the bonding of dental materials to composite resins.[19],[20],[27],[32] Dehghani et al.[16] used Er: YAG laser and reported higher bond strength of orthodontic attachment to a fiber-reinforced composite (FRC) covered with a layer of flowable composite. The results of our study demonstrated that Er, Cr:YSGG laser application (with or without acid etching) with an output power of 2 W provided significantly higher bond strength values of orthodontic adhesive to composite resin than no surface treatment, which is consistent with previous studies. SEM images showed that laser application produced a microretentive surface without formation of a smear layer,[13],[32] and a smear layer may deteriorate the bonding of materials.[13],[33] The microretentive morphology enhanced the surface area, which modified the distribution of stress at the interface of the materials and increased surface area to eventually improve repair bond strength.[32] The results of this study are consistent with the finding of Oskoee et al.,[27] who demonstrated that Er, Cr:YSGG laser surface treatment produced higher bond strength values compared with no surface treatment. In contrast, Cho et al.[34] found no significant difference between the shear bond strength between Er, Cr:YSGG laser application with an output power of 4 W and the control group, and these authors reported that the laser-irradiated specimens exhibited the most irregular surfaces with cracks under SEM examination. Previous studies revealed that the parameters of the laser affect bond strength values.[2],[29],[35] Mirzaie et al.[35] reported that an Er, Cr:YSGG laser with an output power of 3 W produced higher bond strength than 2 W and 4 W. Sobouti et al.[2] investigated the effects of Er: YAG laser application (2 W or 3 W) and bur abrasion followed by phosphoric acid etching, hydrofluoric acid etching, and sandblasting on the bond strengths of metal brackets to composite resin. The authors reported that 3 W laser application was the most effective surface treatment modality for bonding to an aged composite.[2]

This study demonstrated that the MTBS values of diamond bur application alone were almost similar to Er, Cr:YSGG laser application in the bond strength of orthodontic adhesive to a microhybrid composite resin. This result is consistent with Bektas et al.[13] who did not find any significant differences between laser- and bur-treated groups. In contrast to our study, Oskoee et al.[27] and Kimyai et al.[33] demonstrated that surface treatment of silorane-based composite resin with an Er, Cr:YSGG laser produced significantly higher bond strengths than diamond bur. The reason of this result may be the type of composite resin used. The composition and structure of the composite resin affect the micromorphological characteristics, penetration depth, and ablation rate of the laser beam, and affect bond strength.[13],[15],[29]

The present study found that diamond bur application followed by phosphoric acid etching produced significantly higher bond strength values than the two laser groups. In contrast, Sobouti et al.[2] showed that Er: YAG laser application produced higher bond strengths than diamond bur abrading followed by phosphoric acid etching. This difference may be attributed the type of laser used in the present study. Oskoee et al.[29] reported that different types of lasers create micromorphological features after ablating depending on the laser parameters. Differences in the ablation patterns and types of surface irregularities of the laser-applied specimens may be the reason for the different results between our study and Oskoee et al.'s[29] study.

Mechanical and chemical degradation of composite restorations may occur after aging in a humid oral environment.[9],[10],[11] Aging in water makes the composite more flexible because the water is absorbed into the resin matrix.[9],[10],[11] Hydrolytic degradation occurs during water absorption, which results in a leaching of the components, degradation and swelling of the cross-linked matrix, hydrolysis of the filler matrix, and an eventual increase in internal porosity.[9],[10],[11] These mechanisms may cause some alterations on the surface of restorative materials that influence the bond strength of the composite resin.[9],[10],[11],[36] Artificial aging methods allow for the assessment of degradation of materials over short or more prolonged times.[25] Therefore, aging conditions of the restoration should be considered and included in the planning of the study design.[9] Various methods are used to simulate the aging of a resin composite, such as thermocycling, storage of the dry material at 37°C in acids, and immersion in water, artificial saliva, or hot water.[10],[25] This study stored half of the composite cylinders in water for 30 days to simulate aging conditions and compared these samples with nonaged specimens, similar to a previous study.[36]

The results of this study revealed that aging of the composite decreased the MTBS values in all groups, except Group 2 (P < 0.05). This result is consistent with previous studies,[13],[37] which support a negative effect of thermocycling on the bond strength of composite resins. This effect may result from the increased water absorption and solubility of the hydrophilic adhesive layer. Alqarni et al.[36] reported that the microshear bond strength of composite repair was affected by water aging depending on the material type and appropriate adhesive application. Contrary to our findings, da Costa et al.[38] reported that 6 months of water storage did not reduced the bond strength of composite resin, but only early signs of degradation were detected. Bektas et al.[13] reported that 5,000 and 10,000 thermocycling significantly influenced the repair bond strength of composite resin, by 1,000 thermocycling had no significant effect on the repair of composite resins. These differences suggest that aging methods affect the composite repair bond strength.[9],[10],[11],[13],[36] This study found no significant differences between 1 and 30 storage days (P > 0.05) in the phosphoric acid etched group. This result may have occurred because of the inability of phosphoric acid to create microretention sites on the surface of the composite resin,[25] and the initial bond strength value of phosphoric acid-etched specimens were lower compared with the other groups.

The limitations of this study were the use of one type of aging method under a short aging period (specimens immersed in water for 30 days), and only one output parameter of the Er, Cr:YSGG laser system was used. Further studies are required to evaluate the bond strength of orthodontic adhesives to aged composite resins using the Er, Cr:YSGG laser with different output parameters after long-term aging conditions.


   Conclusions Top


Within the limitations of this study, the following conclusions were drawn:

  • MTBS values of orthodontic adhesive to composite resin tended to decrease in all groups after storage in distilled water for 30 days, except phosphoric acid application alone.
  • Phosphoric acid application to the composite resin surface alone did not produce adequate bond strength.
  • Composite surface preparation using a diamond bur prior to orthodontic adhesive enhanced MTBS.
  • Surface treatment with an Er, Cr:YSGG laser (with or without phosphoric acid etching) produced similar results to diamond bur application (with or without phosphoric acid etching). Therefore, Er, Cr:YSGG laser application may be a recommended alternative for enhancing the bond strength of orthodontic attachments to composite restoration surfaces.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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  [Table 1], [Table 2], [Table 3]



 

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