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 Table of Contents  
Year : 2017  |  Volume : 8  |  Issue : 3  |  Page : 91-95

An audit of bonding failure among orthodontic patients in a tertiary hospital in South-South Nigeria

1 Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
2 Department of Child Dental Health, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Date of Web Publication14-Jun-2017

Correspondence Address:
Elfleda Angelina Aikins
Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba, Port Harcourt, Rivers State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijor.ijor_17_17

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Introduction: The adhesion of brackets to the teeth throughout the period of orthodontic treatment is essential for achieving a timely and satisfactory treatment outcome. Bonding failure is therefore not desirable.
Objective: To assess the prevalence of bonding failure among orthodontic patients at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
Materials and Methods: Data were compiled from the files of all patients being managed with fixed orthodontic therapy at the orthodontic unit of a teaching hospital from August 2013 to December 2016.
Results: A total of 42 patients comprising 26 (61.9%) females and 16 (38.1%) males with a mean age of 14.7 ± 7.8 years who were undergoing treatment were included in the study. Thirty-one patients (73.8%) experienced bracket failure. Male patients (81.2%) experienced this more than female patients (69.2%). Brackets bonded on the second premolars (46.8%) had the highest while maxillary anterior teeth (13%) had the least failure. Brackets on mandibular teeth had a higher failure rate (66.2%). There was a progressive decrease in bracket loss with age of the patient and duration of treatment.
Conclusions: Bracket loss among patients treated at the hospital was found to be higher among males and younger patients. Brackets placed on mandibular premolars had the highest failure rate.

Keywords: Audit, bonding failure, brackets, Nigeria, orthodontic patients

How to cite this article:
Aikins EA, Ututu C. An audit of bonding failure among orthodontic patients in a tertiary hospital in South-South Nigeria. Int J Orthod Rehabil 2017;8:91-5

How to cite this URL:
Aikins EA, Ututu C. An audit of bonding failure among orthodontic patients in a tertiary hospital in South-South Nigeria. Int J Orthod Rehabil [serial online] 2017 [cited 2023 Mar 25];8:91-5. Available from: https://www.orthodrehab.org/text.asp?2017/8/3/91/208064

  Introduction Top

A pleasing smile as well as a functional occlusion are usually the incentives for most patients that undergo orthodontic treatment.[1],[2] Malocclusion is defined by the World Health Organization as a “handicapping dento-facial anomaly which causes disfigurement, or impedes function and requiring treatment if the disfigurement or functional defect is likely to be or constitutes an obstacle to the patient's physical or emotional well-being.”[3] Such malocclusion can be managed effectively by the orthodontist and results in the correction and improvement of dentofacial esthetics, function as well as speech.[2] Orthodontic management increases the quality of life of the individual and is known to aid in the prevention and cessation of bullying in schools as some types of malocclusion are the reasons for such negative behavioral patterns.[2],[4]

The management of malocclusion by an orthodontist involves the use of various appliances which may be removable, fixed, or functional in nature. Fixed orthodontic appliances comprise bonded attachments, arch wires, and auxiliaries.[5],[6] Brackets and buccal tubes are bonded to the teeth with orthodontic adhesive and arch wires are passed through the slots of these attachments and ligated, thus applying controlled forces which results in the alignment of irregular teeth.[5]

To achieve a satisfactory result, the long-term adhesion of brackets to the teeth with composite resin which may be chemical (self-cure), light, or dual cure by microretention is absolutely essential.[7],[8],[9],[10],[11]

Bonding failure increases chairside time, compromises treatment time/results, and may cause damage to enamel.[7],[12],[13],[14],[15],[16],[17] It is therefore imperative that these failures be reduced to the barest minimum. There are various reasons that are adduced to failure among which are operator factors including bonding technique, patients' cooperation and compliance with dietary and oral hygiene instructions, type of etchant used and its duration of application, adhesive used, bracket properties, and ligation forces.[6],[7],[12],[13],[14],[15],[18],[19],[20],[21],[22],[23] In particular, failure to achieve a dry field during bonding due to a lack of appropriate technology [7],[12],[13],[14] as well as a reduced level of self-motivation of the patients resulting in a lack of compliance with dietary instructions have been described as contributory factors.[6],[20]

The teaching and practice of orthodontics at the hospital is very young. Thus, the purpose of this study was to assess the prevalence of bonding failure of brackets among orthodontic patients over a period of 40 months. This study will provide important information that will help not only to audit but also to enhance the orthodontic practice in the hospital.

  Materials and Methods Top

This was a retrospective study carried out on all patients managed with fixed orthodontic appliances at the orthodontic unit of the teaching hospital between August 2013 and December 2016. Ethical approval for this study was obtained from the Ethical and Research Committee of the hospital before retrieving the case notes of the patients. Age, sex, teeth bonded, dates of start and completion of treatment (if applicable), and bracket loss of each patient were extracted from the patients' folders and recorded in structured paper forms.

Analysis of data collected was performed using IBM Statistical Package for Social Sciences for Windows Version 20.0 (IBM Corp., Armonk, NY). The results were presented using frequencies, percentages, and proportions for categorical variables and means and standard deviations for continuous variables. Chi-square was used to test association between variables. Significance was determined at 95% confidence interval and statistical significance set at P < 0.05.

  Results Top

In all, there were 42 patients comprising 26 (61.9%) females and 16 (38.1%) males with an age range of 7–35 years and mean age of 14.7 ± 7.8 years as shown in [Table 1]. Thirty-five (83.3%) patients had maxillary and mandibular fixed orthodontic appliances, two (4.8%) had maxillary fixed appliances only, while five (11.9%) had partially fixed appliances consisting of two bands and four brackets on the maxillary and/or mandibular incisors (2 by 4).
Table 1: Sociodemographic characteristics of patients

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[Table 2] shows the relationship between bracket failure, gender and age. Thirty-one (73.8%) patients consisting of 18 females (69.2%) and 13 males (81.3%) experienced bracket failure. Eleven patients (26.2%), eight females (30.8%) and three males (18.7%), did not experience bracket breakage. The 10-year-old patients had the highest (51.6%) while 24 years and above had the least failure (22.6%).
Table 2: Cross tabulation of bracket loss with age and gender of patients

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Out of a total of 905 brackets bonded, 154 debonded over 24 visits of the patients. A bond failure rate of 17.0% was observed.

[Table 3] indicates the distribution of failed brackets on individual teeth. Second premolars had a higher loss of 72 (46.8%). The mandibular left second premolars had the greatest loss of 24 (15.6%). The maxillary anterior teeth had the least bracket loss of 20 (13%). Bracket loss was higher in the mandible than the maxilla: 102 (66.2%) and 52 (33.8%), respectively, and on the left side 79 (51.3%) than the right side 75 (48.7%) of the jaws.
Table 3: Distribution of bracket failure on teeth of patients

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[Table 4] indicates the number of patients that had failed brackets per appointment. During the first and second appointments, the maxillary right second premolars recorded the highest bracket loss of 7 (14.3%). In subsequent visits, the mandibular second premolars had the greatest bracket loss of 30 (49.2%). There was a progressive decrease in bracket loss with age and as treatment progressed.
Table 4: Failed brackets of patients per appointment

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  Discussion Top

Efficient bracket bonding and minimal failure rates are essential in orthodontic treatment.[7],[12],[13] In the literature, bonding failure rate varies from 1.57% to 55.6%.[5],[12],[24],[25],[26],[27],[28],[29] The frequency varies with age, gender, the particular tooth, side and location of the arch, and skeletal class.[6] The bonding failure rate in this study was 17.0%, which is lower than similar study conducted in South-West Nigeria.[5] This result may be due to the fact that we have fewer patients and resident doctors in orthodontics in our hospital. Bond failure occurring at the early period of treatment may be due to the initial adaptation period and/or lack of experience of the young orthodontist.[15],[20],[24],[29]

The premolars were found to have the greatest bond failure. This is in agreement with other studies which showed that posterior teeth experience more bonding failure than the anterior teeth.[5],[20],[24],[25],[26],[27],[28],[29],[30],[31] This has been said to be due to poor moisture control, greater masticatory forces, and number of prismless enamel which may affect microretention of the brackets.[20],[24],[29]

In our study, there was a higher loss of brackets bonded on the mandible than the maxilla. This may be due to failure to achieve a dry field during bonding [6] as well as masticatory forces.[24],[29] This observation is in agreement with a study carried out among orthodontic patients in a similar setting [5] but contrasts with other studies carried out in other parts of the world [6],[32] which demonstrate a greater failure rate in the maxilla while other authors report no significant difference between loss in the maxilla and mandible.[12],[14],[20],[24],[33]

Masticatory habits of patients indicate the side of the jaw, they habitually use most as well as the level of masticatory forces applied. Among our patients, the left side of the jaws had a higher bonding failure rate than the right which may be adduced to such habits.[12],[24],[34] However, differences were seen in other studies with the right side experiencing higher bond failure.[12],[24],[34] Masticatory forces which are influenced by diets are known to vary with facial type and culture.[24],[29],[35] In our culture, majority of our food is hard and coarse; thus, patients are advised to embark on a soft diet for the duration of the treatment. Many of them do not adhere to dietary counsel which may have contributed to the bonding failure of their brackets.

It has also been suggested by some researchers that patient's socioeconomic status, gender, class of malocclusion, the mechanics used during treatment, and the number of times bracket is handled may also influence the bond failure.[6],[24],[30],[34] The differences in the sequences of arch wire used by different orthodontists may also be a reason for bond failure.[27]

The relationship between bracket loss and gender is variable. In the present study, a higher proportion of male patients experienced bracket loss than females. Females are generally more careful than males, and the fact that females tend to apply lighter masticatory forces [36] could explain this finding. Furthermore, our finding is in agreement with some studies carried out in a similar environment [5],[30] but in contrast to others which demonstrated greater bond failure in females [6],[15],[37] while other researchers did not find any significant difference between males and females.[20],[26]

Our younger patients demonstrated a higher bracket failure than older patients which is in agreement with studies carried out in Nigeria and Pakistan [5],[6],[15] but in contrast with a very recent American study which showed no significant difference in bond failure with patients' age.[26] This finding may be attributed to increased self-consciousness and self-motivation in adults while undergoing orthodontic treatment when compared to adolescents.[6],[15] This may also explain the progressive decrease in bracket loss with age and as treatment progressed that was seen in our study and was corroborated in these studies.[5],[30]

Satisfactory orthodontic treatment is hinged on the retention of brackets on the teeth for as long as the treatment is ongoing.[12] Therefore, patients need to understand the importance of complying with instructions, and the orthodontist is also required to ensure that the bonding of brackets is carried out with adequate skill and expertise.

  Conclusions Top

Bracket loss among patients treated at the University of Port Harcourt Teaching Hospital was found to be higher among males and younger patients. Brackets placed on mandibular premolars had the highest failure rate. We therefore recommend that special attention be paid when bonding brackets to premolar teeth. Also that males and younger patients should be adequately motivated by the orthodontist before treatment commences.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Bora N, Baruah N. Debonding in orthodontics: A review. Univ J Dent Sci 2015;1:77-81.  Back to cited text no. 1
Preoteasa CT, Ionescu E, Preoteasa E. Risks and complications associated with orthodontic treatment. In: Bourgui F, editor. Orthodontics – Basic Aspects and Clinical Considerations. Croatia: InTech Europe; 2012. p. 403-29. Available from: http://www.intechopen.com. [Last accessed on 2017 Feb 13].  Back to cited text no. 2
World Health Organisation. Oral Health Survey: Basic Methods 3rd Edition. Geneva: Oral Health Unit; 1987.  Back to cited text no. 3
Sanu OO, Isiekwe MC. Management of malocclusions: Report of two cases treated using Begg Technique at the Lagos University Teaching Hospital, Lagos, Nigeria. Nig Q J Hosp Med 2004;14:39-44.  Back to cited text no. 4
Moninuola AE, Costa OO, Isiekwe MC. A review of orthodontic bond failure using a chemical cure adhesive. Odontostomatol Trop 2010;33:35-40.  Back to cited text no. 5
Rasool G, Raza HA, Afzal F, Ijaz W, Shah SS. Frequency of bracket breakage and bond failure in patients, undergoing fixed orthodontic treatment at Khyber College of Dentistry, Peshawar. Pak Oral Dent J 2013;33:299-302.  Back to cited text no. 6
Grubisa HS, Heo G, Raboud D, Glover KE, Major PW. An evaluation and comparison of orthodontic bracket bond strengths achieved with self-etching primer. Am J Orthod Dentofacial Orthop 2004;126:213-9.  Back to cited text no. 7
Mandall NA, Millett DT, Mattick CR, Hickman J, Worthington HV, Macfarlane TV. Orthodontic adhesives: A systematic review. J Orthod 2002;29:205-10.  Back to cited text no. 8
Klocke A, Korbmacher HM, Huck LG, Ghosh J, Kahl-Nieke B. Plasma arc curing of ceramic brackets: An evaluation of shear bond strength and debonding characteristics. Am J Orthod Dentofacial Orthop 2003;124:309-15.  Back to cited text no. 9
Retief DH, Busscher HJ, de Boer P, Jongebloed WL, Arends J. A laboratory evaluation of three etching solutions. Dent Mater 1986;2:202-6.  Back to cited text no. 10
Oztürk B, Malkoç S, Koyutürk AE, Catalbas B, Ozer F. Influence of different tooth types on the bond strength of two orthodontic adhesive systems. Eur J Orthod 2008;30:407-12.  Back to cited text no. 11
Romano FL, Valério RA, Gomes-Silva JM, Ferreira JT, Faria G, Borsatto MC. Clinical evaluation of the failure rate of metallic brackets bonded with orthodontic composites. Braz Dent J 2012;23:399-402.  Back to cited text no. 12
Bishara SE, Laffoon JF, Vonwald L, Warren JJ. The effect of repeated bonding on the shear bond strength of different orthodontic adhesives. Am J Orthod Dentofacial Orthop 2002;121:521-5.  Back to cited text no. 13
Ozer M, Bayram M, Dincyurek C, Tokalak F. Clinical bond failure rates of adhesive precoated self-ligating brackets using a self-etching primer. Angle Orthod 2014;84:155-60.  Back to cited text no. 14
Sukhia HR, Sukhia RH, Mahar A. Bracket de-bonding and breakage prevalence in orthodontic patients. Pak Oral Dent J 2011;31:73-7.  Back to cited text no. 15
Vicente A, Bravo LA, Romero M, Ortíz AJ, Canteras M. Bond strength of brackets bonded with an adhesion promoter. Br Dent J 2004;196:482-5.  Back to cited text no. 16
Karan S, Kircelli BH, Tasdelen B. Enamel surface roughness after debonding. Angle Orthod 2010;80:1081-8.  Back to cited text no. 17
Millett DT, Gordon PH. A 5-year clinical review of bond failure with a no-mix adhesive (Right on). Eur J Orthod 1994;16:203-11.  Back to cited text no. 18
Hitmi L, Muller C, Mujajic M, Attal JP. An 18-month clinical study of bond failures with resin-modified glass ionomer cement in orthodontic practice. Am J Orthod Dentofacial Orthop 2001;120:406-15.  Back to cited text no. 19
Bherwani A, Fida M, Azam I. Bond failure with a no-mix adhesive system. Angle Orthod 2008;78:545-8.  Back to cited text no. 20
Murray SD, Hobson RS. Comparison of in vivo and in vitro shear bond strength. Am J Orthod Dentofacial Orthop 2003;123:2-9.  Back to cited text no. 21
Hobson RS, McCabe JF, Rugg-Gunn AJ. The relationship between acid-etch patterns and bond survival in vivo. Am J Orthod Dentofacial Orthop 2002;121:502-9.  Back to cited text no. 22
Arici S, Minors C. The force levels required to mechanically debond ceramic brackets: An in vitro comparative study. Eur J Orthod 2000;22:327-34.  Back to cited text no. 23
Dominguez GC, Tortamano A, Lopes LV, Catharino PC, Morea C. A comparative clinical study of the failure rate of orthodontic brackets bonded with two adhesive systems: Conventional and self-etching primer (SEP). Dental Press J Orthod 2013;18:55-60.  Back to cited text no. 24
Le PT, Weinstein M, Borislow AJ, Braitman LE. Bond failure and decalcification: A comparison of a cyanoacrylate and a composite resin bonding system in vivo. Am J Orthod Dentofacial Orthop 2003;123:624-7.  Back to cited text no. 25
Roelofs T, Merkens N, Roelofs J, Bronkhorst E, Breuning H. A retrospective survey of the causes of bracket- and tube-bonding failures. Angle Orthod 2017;87:111-7.  Back to cited text no. 26
Fleming PS, Johal A, Pandis N. Self-etch primers and conventional acid-etch technique for orthodontic bonding: A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2012;142:83-94.  Back to cited text no. 27
Cal-Neto JP, Quintão CA, Almeida MA, Miguel JA. Bond failure rates with a self-etching primer: A randomized controlled trial. Am J Orthod Dentofacial Orthop 2009;135:782-6.  Back to cited text no. 28
Elekdag-Turk S, Cakmak F, Isci D, Turk T. 12-month self-ligating bracket failure rate with a self-etching primer. Angle Orthod 2008;78:1095-100.  Back to cited text no. 29
Murfitt PG, Quick AN, Swain MV, Herbison GP. A randomised clinical trial to investigate bond failure rates using a self-etching primer. Eur J Orthod 2006;28:444-9.  Back to cited text no. 30
Linklater RA, Gordon PH. Bond failure patterns in vivo. Am J Orthod Dentofacial Orthop 2003;123:534-9.  Back to cited text no. 31
Manning N, Chadwick SM, Plunkett D, Macfarlane TV. A randomized clinical trial comparing 'one-step' and 'two-step' orthodontic bonding systems. J Orthod 2006;33:276-83.  Back to cited text no. 32
Marquezan M, Lau T, Rodrigues C, Sant'Anna E, Ruellas A, Marquezan M, et al. Shear bond strengths of orthodontic brackets with a new LED cluster curing light. J Orthod 2010;37:37-42.  Back to cited text no. 33
Pandis N, Polychronopoulou A, Eliades T. Failure rate of self-ligating and edgewise brackets bonded with conventional acid etching and a self-etching primer: A prospective in vivo study. Angle Orthod 2006;76:119-22.  Back to cited text no. 34
Reis A, dos Santos JE, Loguercio AD, de Oliveira Bauer JR. Eighteen-month bracket survival rate: Conventional versus self-etch adhesive. Eur J Orthod 2008;30:94-9.  Back to cited text no. 35
Adolfsson U, Larsson E, Ogaard B. Bond failure of a no-mix adhesive during orthodontic treatment. Am J Orthod Dentofacial Orthop 2002;122:277-81.  Back to cited text no. 36
Liu Z, McGrath C, Hägg U. Changes in oral health-related quality of life during fixed orthodontic appliance therapy: An 18-month prospective longitudinal study. Am J Orthod Dentofacial Orthop 2011;139:214-9.  Back to cited text no. 37


  [Table 1], [Table 2], [Table 3], [Table 4]

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