Clinical Oral Investigations

, Volume 16, Issue 1, pp 1–14 | Cite as

Retention of orthodontic brackets bonded with resin-modified GIC versus composite resin adhesives—a quantitative systematic review of clinical trials

  • Steffen MickenautschEmail author
  • Veerasamy Yengopal
  • Avijit Banerjee


The aim of this systematic review was to establish whether the clinical debonding (failure) rates of orthodontic brackets bonded either with resin-modified glass ionomer (RM-GIC) or with composite resin adhesive are the same. Five databases were searched for articles up to 18 November 2010. Inclusion criteria were titles/abstracts relevant to the review question and two or more arm clinical trial. Exclusion criteria were the following: no computable data recorded and subjects of both groups not followed up in the same way. From the accepted trials, datasets were analysed concerning clinical precision and internal validity. Eleven trials were accepted. From these, 15 dichotomous datasets were extracted. Relative risk with 95% confidence interval of nine datasets showed no statistically significant differences in outcome between the treatment and control group after 6 months–1.32 years. Five showed a statistically significant difference (p < 0.05), favouring resin composite bonding after 12 and 18 months. One favoured RM-GIC after 10 months. Meta-analysis found no difference in the failure rate between the two treatment groups after 12 months (RR, 1.11; 95% CI, 0.87–1.42; p = 0.40) and found in favour of composite resin adhesive after >14 months (RR, 2.25; 95% CI, 1.60–3.17; p < 0.00001). All trials had poor internal validity due to selection and detection/performance bias risk. The current evidence suggests no difference between the types of materials after 12 months but favours composite resin adhesives after a >14-month period. However, its risk of selection and detection/performance bias are high, and all results need to be regarded with caution. Further high quality randomised control trials addressing this topic are needed. The clinical relevance of this study is that RM-GIC may have the same clinical debonding (failure) rate as composite resin adhesives after 1 year when used for bonding of orthodontic brackets.


Resin-modified glass ionomer cement Composite resin Orthodontic treatment Systematic review Orthodontic brackets 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Barry GR (1995) A clinical investigation of the effects of pumice prophylaxis on band and bond failure. Br J Orthod 22:245–248PubMedGoogle Scholar
  2. 2.
    Bearn DR, Aird JC, McCabe JF (1995) Ex vivo bond strength of adhesive precoated metallic and ceramic brackets. Br J Orthod 22:233–236PubMedGoogle Scholar
  3. 3.
    Bin Abdullah MS, Rock WP (1996) The effect of etch time and debond interval upon the shear bond strength of metallic orthodontic brackets. Br J Orthod 23:121–124PubMedGoogle Scholar
  4. 4.
    Ozer M, Arici S (2005) Sandblasted metal brackets bonded with resin-modified glass ionomer cement in vivo. Angle Orthod 75:406–409PubMedGoogle Scholar
  5. 5.
    Banerjee A, Paolinelis G, Socker M, Watson TF, McDonald F (2008) An in-vitro investigation of the effectiveness of bioactive glass air-abrasion in the selective removal of orthodontic resin adhesive. Eur J Oral Sci 116:488–492PubMedCrossRefGoogle Scholar
  6. 6.
    Hallgren A, Oliveby A, Twetman S (1993) Flouride concentration in plaque adjacent to orthodontic bracket appliances retained with glass ionomer cement. Caries Res 27:51–54PubMedCrossRefGoogle Scholar
  7. 7.
    Millett DT, McCabe JF, Bennett TG, Carter NE, Gordon PH (1995) The effect of sandblasting on the retention of first molar orthodontic bands cemented with glass ionomer cement. Br J Orthod 22:161–169PubMedGoogle Scholar
  8. 8.
    Millett DT, McCabe JF (1996) Orthodontic bonding with glass ionomer cement-a review. Eur J Orthod 18:385–399PubMedCrossRefGoogle Scholar
  9. 9.
    Silverman E, Cohen M, Demke RS, Silverman M, Linwood NJ (1995) A new light-cured glass ionomer cement that bond brackets to teeth without etching in the presence of saliva. Am J Orthod Dentofacial Orthop 108:231–236PubMedCrossRefGoogle Scholar
  10. 10.
    Miguel JAM, Almeida MA, Chevitarese O (1995) Clinical comparison between a glass ionomer cement and a composite for direct bonding of orthodontic brackets. Am J Orthod Dentofacial Orthop 107:484–487PubMedCrossRefGoogle Scholar
  11. 11.
    Foley T, Aggarwal M, Hatibovic-Kofman S (2002) A comparison of in vitro enamel demineralisation potential of three orthodontic cements. Am J Orthod Dentofacial Orthop 121:576–580CrossRefGoogle Scholar
  12. 12.
    Millett DT, Glenny AM, Mattick CR, Hickman J, Mandall NA (2007) Adhesives for fixed orthodontic bands. Cochrane Database Syst Rev 2:CD004485PubMedGoogle Scholar
  13. 13.
    Berger VW (2005) Selection bias and covariate imbalances in randomised clinical trials. Wiley, ChichesterCrossRefGoogle Scholar
  14. 14.
    Berger VW, Alperson SY (2009) A general framework for the evaluation of clinical trial quality. Rev Recent Clin Trials 4:79–88PubMedCrossRefGoogle Scholar
  15. 15.
    Bax L, Yu LM, Ikeda N, Tsuruta H, Moons KGM (2006) Development and validation of MIX: comprehensive free software for meta-analysis of causal research data. BMC Med Res Methodol 6:50PubMedCrossRefGoogle Scholar
  16. 16.
    Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–634PubMedCrossRefGoogle Scholar
  17. 17.
    Thompson SG (1994) Why sources of heterogeneity in meta-analysis should be investigated. BMJ 309:1351–1355PubMedCrossRefGoogle Scholar
  18. 18.
    Summers A, Kao E, Gilmore J, Gunel E, Ngan P (2004) Comparison of bond strength between a conventional resin adhesive and a resin-modified glass ionomer adhesive: an in vitro and in vivo study. Am J Orthod Dentofacial Orthop 126:200–206PubMedCrossRefGoogle Scholar
  19. 19.
    Choo SC, Ireland AJ, Sherriff M (2001) An in vivo investigation into the use of resin-modified glass poly(alkenote) cements as orthodontic bonding agents. Eur J Orthod 23:403–409PubMedCrossRefGoogle Scholar
  20. 20.
    Gaworski M, Weinstein M, Borislow AJ, Braitman LE (1999) Decalcification and bond failure: a comparison of a glass ionomer and a composite resin bonding system in vivo. Am J Orthod Dentofacial Orthop 116:518–521PubMedCrossRefGoogle Scholar
  21. 21.
    Fowler PV (1998) A twelve-month clinical trial comparing the bracket failure rates of light-cured resin-modified glass-ionomer adhesive and acid-etch chemical-cured composite. Aust Orthod J 15:186–190PubMedGoogle Scholar
  22. 22.
    Fricker JP (1998) A new self-curing resin-modified glass-ionomer cement for the direct bonding of orthodontic brackets in vivo. Am J Orthod Dentofacial Orthop 113:384–386PubMedGoogle Scholar
  23. 23.
    Wright AB, Lee RT, Lynch E, Young KA (1996) Clinical and microbiologic evaluation of a resin modified glass ionomer cement for orthodontic bonding. Am J Orthod Dentofacial Orthop 110:469–475PubMedCrossRefGoogle Scholar
  24. 24.
    Fricker JP (1994) A 12-month clinical evaluation of a light-activated glass polyalkenoate (ionomer) cement for the direct bonding of orthodontic brackets. Am J Orthod Dentofacial Orthop 105:502–505PubMedCrossRefGoogle Scholar
  25. 25.
    Oliveira SR, Rosenbach G, Brunhard IH, Almeida MA, Chevitarese O (2004) A clinical study of glass ionomer cement. Eur J Orthod 26:185–189PubMedCrossRefGoogle Scholar
  26. 26.
    Shammaa I, Ngan P, Kim H, Kao E, Gladwin M, Gunel E, Brown C (1999) Comparison of bracket debonding force between two conventional resin adhesives and a resin-reinforced glass ionomer cement: an in vitro and in vivo study. Angle Orthod 69:463–469PubMedGoogle Scholar
  27. 27.
    Hegarty DJ, Macfarlane TV (2002) In vivo bracket retention comparison of a resin-modified glass ionomer cement and a resin-based bracket adhesive system after a year. Am J Orthod Dentofacial Orthop 121:496–501PubMedCrossRefGoogle Scholar
  28. 28.
    Ireland AJ, Sherriff M (2002) The effect of pumicing on the in vivo use of resin modified glass poly(alkenoate) cement and a conventional no-mix composite for bonding orthodontic brackets. J Orthod 29:217–220PubMedCrossRefGoogle Scholar
  29. 29.
    Cacciafesta V, Bosch C, Melsen B (1998) Clinical comparison between a resin-reinforced self-cured glass ionomer cement and a composite resin for direct bonding of orthodontic brackets. Part 1: wetting with water. Clin Orthod Res 1:29–36PubMedGoogle Scholar
  30. 30.
    Cacciafesta V, Bosch C, Melsen B (1999) Clinical comparison between a resin-reinforced self-cured glass ionomer cement and a composite resin for direct bonding of orthodontic brackets. Part 2: Bonding on dry enamel and on enamel soaked with saliva. Clin Orthod Res 2:186–193PubMedGoogle Scholar
  31. 31.
    The Cochrane Collaboration (2006) Cochrane handbook for systematic reviews of interventions 4.2.6. The Cochrane Collaboration, Oxford, pp. 97–99Google Scholar
  32. 32.
    Bax L, Ikeda N, Fukui N, Yaju Y, Tsuruta H, Moons KG (2009) More than numbers: the power of graphs in meta-analysis. Am J Epidemiol 169:249–255PubMedCrossRefGoogle Scholar
  33. 33.
    Chalmers TC, Matta RJ, Smith H Jr, Kunzler AM (1977) Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction. N Engl J Med 297:1091–1096PubMedCrossRefGoogle Scholar
  34. 34.
    Egger M, Jüni P, Bartlett C, Holenstein F, Sterne J (2003) How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess 7:1–76PubMedGoogle Scholar
  35. 35.
    Ahovuo-Saloranta A, Hiiri A, Nordblad A, Mäkelä M, Worthington HV (2008) Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 4:CD001830PubMedGoogle Scholar
  36. 36.
    Mickenautsch S (2010) Systematic reviews, systematic error and the acquisition of clinical knowledge. BMC Med Res Methodol 10:53PubMedCrossRefGoogle Scholar
  37. 37.
    Schulz KF, Altman DG, Moher D, CONSORT Group (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 8:18PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Steffen Mickenautsch
    • 1
    Email author
  • Veerasamy Yengopal
    • 1
  • Avijit Banerjee
    • 2
  1. 1.Division of Public Oral Health, Faculty of Health ScienceUniversity of the WitwatersrandJohannesburgSouth Africa
  2. 2.Unit of Conservative Dentistry, King’s College London Dental Institute, KCLGuy’s Dental HospitalLondonUK

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