Consequently, orthodontists may encounter difficulties in achieving an optimal adhesion force on ceramic surfaces that is not only effective but also harmless, that is, an adhesion force that is resistant to orthodontic and masticatory forces while also retaining the function and aesthetics that are provided by this type of restoration after bracket debonding. This is evident in the clinical practice as well with some studies having reported bracket adhesion failure rates on ceramic surfaces of around 9.8% after two years. Nonetheless, these types of restorations can reveal themselves quite complex for orthodontists, since achieving a reasonable bond strength on ceramic surfaces is challenging due to the presence of a glaze layer that hinders the adhesion process. The most used ceramic used in dental practices are feldsphatic, lithium and zirconia. In this age group, there is a high likelihood that an orthodontist will encounter complex restorative treatments using ceramic structures due to their numerous advantages, namely biocompatibility, excellent aesthetics, reduced bacterial plaque accumulation, low thermal expansion, resistance to abrasion or fracture along with colour stability. This can be attributed not only to evergrowing aesthetic concerns but also to the expeditious evolution of orthodontic techniques. As of 2015, according to the American Association of Orthodontics, the demand within this age group has doubled over a four year period and this number is set to increase further in the future. In recent years there has been an increase in demand for orthodontic treatment within the adult population.
Conclusions: The most effective technique for bonding brackets on ceramic is dependent on the type of ceramic.
HF and HF plus laser achieved significantly highest bond strength scores in felsdphatic porcelain, while laser was the best treatment in lithium disilicate ceramics. The use of hydrofluoric acid (HF), silane and laser afforded the overall best results. The risk of bias was considered medium to high in most studies. Sevety one articles were chosen for quality analysis. Results: A total of 655 articles searched in various databases were initially scrutinized. The methodological quality was evaluated using the guidelines for reporting of preclinical studies on dental materials by Faggion Jr. In vitro and ex vivo studies were included. The research was carried out in PubMed, Web of Science, Embase and Cochrane Library databases. Methods: This systematic review followed the PRISMA guidelines and the PICO methodology was used, with the question “What is the most effective technique for bonding brackets on ceramic crowns or veneers?”. This systematic review aims to compare the available surface treatments to ceramics and determine the one that allows to obtain the best bond strength. The current state of the art regarding the most effective method to achieve an appropriate bond strength of brackets on ceramic surfaces isn’t consensual.
Background: There has been an increase in demand for orthodontic treatment within the adult population, who likely receive restorative treatments using ceramic structures.