The effect of various adhesives, enamel etching, and base treatment on the failure frequency of customized lingual brackets: a randomized clinical trial

Objectives: The aim of this paper was to compare failure differences in precious metal customized lingual brackets bonded with three adhesive systems. Also, differences in failure of non-precious metal brackets with and without a silicatized base layer bonded with the same adhesive, as well as the influence of enamel etching prior to using a self-etching dual cure resin were explored. Materials/methods: Five different groups were defined in a semi-randomized approach. Group 1 (IME): Maxcem Elite with 378 Incognito brackets and etched teeth, Group 2 (IMNE): Maxcem Elite with 193 Incognito brackets on non-etched teeth, Group 3 (INE): Nexus+Excite with 385 Incognito brackets, Group 4 (IRE): Relyx with 162 Incognito brackets, Group 5 (HRME) and Group 6 (HNRME): Maxcem Elite with 182 Harmony brackets with silicatized and non-slicatized bases respectively. Bracket failures were recorded over a 12-month period. Results: The number of failures during the observation period was small in the various adhesives types of groups, as well as in HRME and HNRME groups, and the comparisons among those groups were non-significant (P > 0.05). A statistically significant difference (P < 0.05) was found between the IME and IMNE groups. Conclusions: 1. During the first year of treatment customized lingual brackets failure frequencies (rates) are not different for the three adhesive materials tested. 2. Eliminating the etching stage when using self-etch/self-adhesive adhesives, may lead to a dramatic increase in the failure rates. 3. Silicoating of stainless steel customized lingual brackets does not seem to influence the failure of the bonds.