[Downloaded free from http://www.saudijos.org on Monday, December 26, 2016, IP: 139.193.93.

17]

Saudi Journal of Oral Sciences

ORIGINAL ARTICLE

Evaluation of bond strength of splinting

materials to the teeth using three adhesive
systems-an in vitro study
Tina Puthen Purayil, Arumugam Chakravarthy1, Kishore Ginjupalli2, Nidambur Vasudeva Ballal
Departments of Conserva ve Den stry and Endodon cs and 2Dental Materials, Manipal College of Dental Sciences, Manipal
University, Manipal, Karnataka, 1Department of Conserva ve Den stry and Endodon cs, Sri Ramachandra Dental College,
Chennai, India

Abstract
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-Orthodon c wire bonded with CA,
Group II-Orthodon c wire bonded with flowable composite Group III-Orthodon c wire bonded with Ver se flow, Group IV-
Ribbond bonded with CA, Group V-Ribbond bonded with flowable composite and Group VI-Ribbond bonded with Ver se flow.
The adhesive force in newtons to debond the splin ng material was measured in tension using universal tes ng machine. The
force at which the splint system failed was noted. The data obtained were sta s cally analyzed using one-way ANOVA and
significant dierences were subjected to Tukeys post-hoc test at a confidence interval of 0.05.
Results: Bond strength with the orthodon c wire groups was significantly less compared with Ribbond groups p < 0.05. Among
the adhesives, CA demonstrated lower bond strength value as compared to Ver se 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.

Key words: Adhesives, bond strength, splin ng

Introduc on
Dental splin ng is a widely accepted treatment op on
in the event of trauma c 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.[1] There are many ways to stabilize trauma zed
teeth, viz wire splin ng, which generally involves the use
of conven onal orthodon c wire, which is held onto the
teeth with the help of dental composite. Alterna vely
acrylic cap splints, acid etched splints, porcelain veneers,
trans-alveolar sutures and fiber reinforced composite
splint have also been tried.[2,3] In general, dental splints
require a quick se ng material without any need for
special prepara on of the tooth structure.

Access this article online

In this regard, cyanoacrylate (CA) ester adhesives have
Quick Response Code:
been used for splin ng of replanted teeth.[4] The main
Website: advantage of this material is that it dries quickly and
www.saudijos.org
Address for correspondence:
Dr. Tina Puthen Purayil, Department of Conservative Dentistry
DOI: and Endodontics, Manipal College of Dental Sciences,
10.4103/1658-6816.160774 Manipal University, Manipal - 576 104, Karnataka, India.
E-mail: tina_p_p@yahoo.com

S J Oral Sci Vol 2 No 2 94 Jul-Dec 2015

[Downloaded free from http://www.saudijos.org on Monday, December 26, 2016, IP: 139.193.93.17]
Purayil, et al.: Bond strength of splinting materials
could easily facilitate the procedure in the dental clinic.
Though CA adhesives have already been inves gated for
bone repair, protec on of hypersensi ve teeth, their use
for dental splin ng is not widely reported.[5] 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
derma s and ur caria.[6]
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 esthe c
material, and allows easy passage of the light to cure
adhesive materials used for splin ng through it in clinical
situa ons. Its clinical applica on include periodontal
splin ng,[7] direct bonding of endodon c posts and cores,
fabrica on of a fixed par al denture with a composite
resin pontic or a natural tooth pontic, [8] trauma
stabiliza on[9] and orthodon c fixed lingual retainers.[10]
Some of the splin ng materials such as orthodon c
wire, fiber reinforced composite (Ribbond) are a ached
to the teeth with the help of dental composites. Such
a procedure involves mul ple steps such as etching,
priming and applica on of adhesive, which is me-
consuming. Innova ve 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[11] or inferior
performance[12] compared with the etch-and-rinse
approach.
Evalua on of these recently introduced materials for
splin ng has not been widely reported. Hence, the
aim of the present study was to evaluate in vitro the
bond strength of two splin ng materials (orthodon c
wire and ribbond) to the tooth structure using CA ester,
Ver se flow and conven onal flowable composite as
adhesives.
Materials and Methods
Prepara on 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 un l the experiment. Ethical clearance
S J Oral Sci Vol 2 No 2
was obtained from ins tu on 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 contac ng each
other. The acrylic blocks with embedded teeth were
then randomly divided into 6 groups (n = 10) based on
splin ng techniques.
Group I: Orthodon c wire bonded with CA (W-C).
Group II: Orthodontic wire bonded with flowable
composite (W-F).
Group III: Orthodon c wire bonded with Ver se 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 Ver se flow (R-V).
Splin ng techniques
The splin ng with CA ester (Fevi kwik, Pidilite industries
limited, India) was carried out in a dry field at room
temperature. The 21 gauge orthodon c 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 orthodon c wire or ribbond and was allowed
to set at room temperature for 24 h before tes ng the
bond strength.
Specimens of Group III and VI were prepared by placing
the splin ng material (orthodon c wire or ribbond)
on the labial surface of the crown, followed by the
applica on of Ver se flow. Later the composite was
light cured for 20 s using a light emi ng diode (LED)
light curing unit (Bluephase, Ivoclar, Vivadent). Further
the specimens in these groups were placed at room
temperature for 24 h before tes ng the bond strength.
In Group II and Group V, the middle third of the labial
surface of the teeth were ini ally 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 fi h
genera on 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 orthodon c
wire (Group II) or ribbond (Group V) were placed on
the crown surface and photopolymerizable flowable
composite resin (Filtex Z350 XT, flowable restora ve
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). Representa ve figure
95 Jul-Dec 2015
[Downloaded free from http://www.saudijos.org on Monday, December 26, 2016, IP: 139.193.93.17]
Purayil, et al.: Bond strength of splinting materials
of splinted teeth using orthodon c wire and Ribbond
are shown in Figures 1and 2.
Measurement of bond strength
24 h a er the splin ng and bonding process, the acrylic
molds were transferred onto the lower plate of universal
testing machine (Instron 3366, UK) equipped with
computer control, data acquisi on and data analysis
so ware (Bluehill so ware 2.18.713). The acrylic molds
were immobilized using a specially designed jig. The
upper por on of the universal tes ng machine was
used to apply tensile stress on the splin ng materials.
For this, a hook made of 0.9 inch orthodon c wire
was fixed onto the tensile jig of the universal tes ng
machine. The hook was then a ached to the splin ng
material between the teeth involved and the tes ng was
carried out at a crosshead speed of 0.5 mm/min un l
the complete debonding of the splint from the teeth
occurred. The maximum load applied during the tes ng
was automa cally noted and was reported in Newtons.
Figure 1: Splin ng of teeth using orthodon c wire
Figure 3: Flowchart of the methodology
S J Oral Sci Vol 2 No 2
Flowchart of the methodology has been presented in
Figure 3. The data obtained were sta s cally analyzed
using one-way ANOVA and significant dierences were
subjected to Tukeys post-hoc test at a confidence
interval of 0.05.
Results
Bond strength of dierent splin ng materials to enamel
for various groups is shown in Figure 4.
The results indicated that, the bond strength with the
orthodon c 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 orthodon c wire as splin ng
material (Group I, II and III) (p > 0.05). However, in Groups
IV, V and VI, which used ribbond for splin ng, the bond
Figure 2: Splin ng of teeth using ribbond
Figure 4: Bond strength of dierent splin ng materials to enamel for various
groups. *Indicates the groups with significantly higher debonding force values
compared to W-F group
96 Jul-Dec 2015
[Downloaded free from http://www.saudijos.org on Monday, December 26, 2016, IP: 139.193.93.17]
Purayil, et al.: Bond strength of splinting materials
strengths were found to be significantly less with CAs
as compared to Ver se flow and flowable composites
(p < 0.05).There was no sta s cally significant dierence
in the bond strengths between the flowable composite
and Ver se flow (p > 0.05).
Discussion
Many techniques can be used for the stabilization
and fixa on of dentoalveolar injuries. Though several
of these techniques have been used in prac ce for
many years, new techniques are being introduced as
a result of the development of new dental restora ve
materials.[13]
Modern tooth splinting should be easy to apply,
inexpensive, and easy to remove without damaging the
dental hard ssue. Splints should not trauma ze the
teeth or surrounding ssues and should not interfere
with the occlusion, dental hygiene, or endodontic
treatment if necessary. Minimally, they should help
to restore the original anatomical tooth posi on and
ensure adequate fixa on over the en re immobiliza on
period, achieving rigidity or flexibility, according to the
type of trauma.[14]
Many of the splin ng techniques previously advocated
were me-consuming and also they contributed to the
injury of the so and hard suppor ng ssues.[13]
Ribbond has shown to have an acceptable strength when
used as a splin ng material. In the present study, ribbond
Groups (Group IV, V, VI) showed be er bond strength
than orthodon c wire groups. This may be a ributed to
the infiltra on of the adhesive materials into the ribbond
leading to be er bond strength.
The adhesives used in our study were CA ester, Ver se
flow and conven onal 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 polymeriza on reac on within 15-60 s.[5]
These adhesives may be a feasible op on for making a
rapid, simple and ecient conten on of replanted teeth
in situa ons where the rou nely 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.[15]
Ver se flow (self-adhering flowable composite) and
the conven onal flowable composite (Filtex Z350 XT)
showed comparable bond strengths. Ver se flow is
suggested to bond to the tooth structure in two ways:
S J Oral Sci Vol 2 No 2
Primarily through the chemical bond between the
phosphate func onal 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 interpenetra ng network formed between
the polymerized monomers of self-adhering flowable
composite and collagen fibers of den n. Giache 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.[16]
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 limita ons of this study, it can be concluded
that splin ng of teeth with orthodon c wire resulted
in a significantly lower bond strengths compared to
ribbond. Among the adhesives CAs showed significantly
lower bond strengths compared to Ver se flow and
conventional flowable composite. However, further
studies involving several self-adhering flowable
composites are to be undertaken to confirm their
superiority over conven onal flowable composites for
splin ng.
References
1. Oikarinen K. Func onal fixa on for trauma cally luxated teeth. Endod
Dent Traumatol 1987;3:224-8.
2. Oikarinen K. Tooth splin ng: A review of the literature and considera on
of the versa lity of a wire-composite splint. Endod Dent Traumatol
1990;6:237-50.
3. Croll TP. Bonded composite resin/ligature wire splint for stabiliza on of
trauma cally displaced teeth. Quintessence Int 1991;22:17-21.
4. Negri MR, Panzarini SR, Poi WR, Sonoda CK, Manfrin TM, Vendrame dos
Santos CL. Use of a cyanoacrylate ester adhesive for splin ng of replanted
teeth. Dent Traumatol 2008;24:695-7.
5. Herod EL. Cyanoacrylates in den stry: A review of the literature. J Can Dent
Assoc 1990;56:331-4.
6. Hensten-Pe ersen A, Jacobsen N. Perceived side eects of biomaterials in
prosthe c den stry. J Prosthet Dent 1991;65:138-44.
7. Strassler HE, Serio FG. Stabiliza on of the natural den on in
periodontal cases using adhesive restora ve materials. Periodontal
Insights 1997;4:4-10.
8. Meiers JC, Freilich MA. Chairside prefabricated fiber-reinforced resin
composite fixed par al dentures. Quintessence Int 2001;32:99-104.
9. Strassler HE. Aesthe c management of trauma zed anterior teeth. Dent
Clin North Am 1995;39:353-66.
10. Bearn DR. Bonded orthodon c retainers: A review. Am J Orthod Dentofacial
Orthop 1995;108:207-13.
97 Jul-Dec 2015
[Downloaded free from http://www.saudijos.org on Monday, December 26, 2016, IP: 139.193.93.17]

Purayil, et al.: Bond strength of splinting materials

11. Bi er K, Meyer-Lueckel H, Priehn K, Kanjuparambil JP, Neumann K,
Kielbassa AM. Eects of lu ng agent and thermocycling on bond strengths
to root canal den ne. Int Endod J 2006;39:809-18.
12. Goracci C, Sadek FT, Fabianelli A, Tay FR, Ferrari M. Evalua on of
the adhesion of fiber posts to intraradicular den n. Oper Dent
2005;30:627-35.
13. Peterson LJ. Principles of Oral and Maxillofacial Surgery. Vol. 1.
Philadelphia: W.B. Saunders; 1997. p. 381-406.
14. von Arx T, Filippi A, Buser D. Splin ng of trauma zed teeth with a new
device: TTS (Titanium Trauma Splint). Dent Traumatol 2001;17:180-4.
15. Manfrin TM, Poi WR, de Mendona 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.
16. Giache L, Scaminaci Russo D, Baldini M, Ber ni 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.
Cite this ar cle as: Purayil TP, Chakravarthy A, Ginjupalli K, Ballal NV.
Evalua on of bond strength of splin ng materials to the teeth using
three adhesive systems - an in vitro study. Saudi J Oral Sci 2015;2:94-8.
Source of Support: Nil, Conflicts of Interest: None declared.

S J Oral Sci Vol 2 No 2 98 Jul-Dec 2015