Assessment of in vivo bond strength studies of the orthodontic bracket-adhesive system: A systematic review

The aim of this study was to systematically review the available studies measuring the bond strength of orthodontic bracket-adhesive system under different experimental conditions in vivo. Literature search was performed in four different databases: PubMed, Web of Science, Cochrane, and Scopus using the keywords – bond strength, orthodontic brackets, bracket-adhesive, and in vivo. A total of six full-text articles were selected based on the inclusion and exclusion criteria of our study after a careful assessment by the two independent reviewers. Data selection was performed by following PRISMA 2009 guidelines. Five of the selected studies were clinical trials; one study was a randomized clinical trial. From each of the selected articles, the following data were extracted – number of samples, with the type of tooth involved materials under experiment methods of measurement, the time interval between bonding and debonding orthodontic brackets, mode of force application, and the bond strength results with the overall outcome. The methodological quality assessment of each article was done by the modified Downs and Black checklist method. The qualitative analyses were done by two independent reviewers. Conflicting issues were resolved in a consensus meeting by consulting the third reviewer (MKA). Meta-analysis could not be performed due to the lack of homogenous study results. The review reached no real conclusion apart from the lack of efforts to clinically evaluate the bonding efficiency of a wide range of orthodontic bracket-adhesive systems in terms of debonding force compared to laboratory-based in vitro and ex vivo studies.