Enamel Deproteinization using Papacarie and 10% Papain Gel on Shear Bond Strength of Orthodontic Brackets Before and After Acid Etching

To suggest Papacarie® as a new deproteinizing agent in comparison with indigenously prepared 10% papain gel before and after acid etching that may enhance the quality of the bond between enamel surface and composite resin complex. Study design: One hundred and twenty five extracted human premolars were utilized and divided into five groups: In the group 1, enamel surface was etched and primer was applied. In group 2, treatment with papacarie® for 60 seconds followed by etching and primer application. In group 3, etching followed by treatment with papacarie® for 60 seconds and primer application. In group 4, treatment with 10% papain gel for 60 seconds followed by etching and primer application. In group 5, etching followed by treatment with 10% papain gel for 60 seconds and primer application . After bonding the brackets, the mechanical testing was performed using a Universal testing machine. The failure mode was analyzed using an adhesive remnant index. The etching patterns before and after application of papacarie® and 10% papain gel was also evaluated using SEM. The values obtained for shear bond strength were submitted to analysis of variance and Tukey test (p < 0.05). Results: It was observed that group 2 and group 4 had the highest shear bond strength and was statistically significant from other groups (p=0.001). Regarding Adhesive remnant index no statistical difference was seen between the groups (p=0.538). Conclusion: Papacarie® or 10% papain gel can be used to deproteinize the enamel surface before acid etching to enhance the bond strength of orthodontic brackets.

Enamel deproteinization, Etching, Papacarie®, Papain gel, Shear bond strength

1. Buonocore MG. A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J Dent Res 34:849-853,1955.

2. Hobson RS, Rugg-Gunn AJ, Booth TA. Acid etch patterns on the buccal surface of human permanent teeth. Arch Oral Biol 47(5):407-412,2002.

3. Hobson RS, Crotty T, Thomason JM, Jepson NJ. A quantitative study of enamel acid etch patterns on surfaces used for retention of resin bonded fixed prosthesis. Eur J Prosthodont Restor Dent 13(3):123-128,2005.

4. Du Wp, Xing Cw, Han Y, Qi R, Xu JQ, Ji Hi. Experimental investigation of shear bond strength on orthodontic bonding on dental fluorosis after air abrading surface preparation technique. Hua Xi Kou Qiang Yi Xue Za Zhi. 25(3):246-248,2007.

5. Knobloch LA, Meyer T, Kerby RE, Johnston W. Microleakage and bond strength of sealent to primary enamel comparing air abrasion and acid etch technique. Pediatr Dent 27(6):463-469,2005.

6. Insua AM, Dominguez LS, Rivera FG, Santana Penin UA. Differences in bonding to acid-etched or Er:YAG Laser- treated enamel and dentin surface. J Prosthet Dent 84(3):280-287,2000.

7. Silverstone LM, Saxton CA, Dogon IL, Fejerskov O. Variation in the pattern of acid etching of human dental enamel examined by scanning electron microscopy. Caries Res 9:373-387,1975.

8. Gwinnett AJ. Structure and composition of enamel. Operative dentistry supplement 5:10-17,1992.

9. Van Meerbeek B, Inouse S, Perdigao J, Lambrechts P, Vanherle G. Enamel and Dentin adhesion. Fundamentals of Operative Dentistry. A Contemporary approach. Chicago: Quintessence 178-235,2001.

10. Justus R, Cubero T, Ondarza R, Morales F. A new technique with sodium hypochlorite to increase bracket shear bond strength of Fluoride releasing resin modified glass ionomer cements: comparing shear bond strength of two adhesive syatems with enamel surface deproteinization before etching. Semin Orthod 16:66-75,2010.

11. Pithon MM, Ferraz de Souza, DD oliveria et al. Effect of 10% papain gel on enamel deproteinization before bonding procedure. Angle Orthod 82(3):541-545,2012.

12. Bussadori SK, Castro LC, Galvao AC. Papain gel: A new chemomechanical caries removal agent. J Clin Pediatr Dent 30:115-119,2005.

13. Espinosa R, Valencia R, Uribe M, Ceja I, Cruz J, Saadia M. Enamel deproteinization and its effect on acid etching: An in vitro study. J Clin Pediatr Dent 33(1):13-20,2008.

14. Grandhi RK, Combe EC, Speidel TM. Shear bond strength of stainless steel orthodontic brackets with a moisture-insensitive primer. Am J Orthod Dentofacial Orthop 119:251-5,2001.

15. International Organization for standardization. ISO/ Technical specifications 11405: Dental Materials- Testing of adhesion to tooth structure. (E);1-16,2003.

16. Artun J, Bergland S. Clinical trials with crystal growth conditioning as an alternative to acid etch enamel pretreatment. Am J Orthod Dentofacial Orthop 85:333-340,1984.

17. Newmann GV. Epoxy adhesives for orthodontic attachments: progress report. Am J Orthod 51:901-912,1965.

18. Hannig C, Hannig M, Attin T. Enzymes in the acquired enamel pellicle. Eur J Oral Sci 113:2–13,2005.

19. Saroglu I, Aras S, Oztas D. Effect of deproteinization on composite bond strength in hypocalcified amelogenesis imperfecta. Oral Diseases 12:305-308,2006.

20. Aras S, Kucukesmen C, Kucukesmen HC, Saoglu IS. Deproteinization treatment on bond strengths of primary, mature and immature permanent tooth enamel. J Clin Pediatr 37(3):275-279,2013.

21. O’Brien KD, Wattas DC, Read MJF. Residual debris and bond strength—is there a relationship? Am J Orthod Dentofacial Orthop 94:222–230,1988.

22. Harleen N, Ramakrishna Y, Munshi AK. Enamel Deproteinization before acid etching and its effect on the Shear Bond Strength – An in vitro Study. J Clin Pediatr Dent 36(1):19-24,2011.

23. Espinosa R, Valencia R, Uribe M, Ceja I, Cruz J, Saadia M. Resin Replica in enamel deproteinization and its effect on acid etching. J Clin Pediatr Dent 35(1):47-52,2010.

24. Bhoomika A, Ramakrishna Y, Baliga MS, Munshi AK. Enamel deproteinization before acid etching – A Scanning electron microscopic observation. J Clin Pediatr Dent 35(2):169-172,2010.