Systematic review
In-vitro orthodontic bond strength testing: A systematic review and meta-analysis

https://doi.org/10.1016/j.ajodo.2009.12.021Get rights and content

Introduction

The aims of this study were to systematically review the available literature regarding in-vitro orthodontic shear bond strength testing and to analyze the influence of test conditions on bond strength.

Methods

Our data sources were Embase and Medline. Relevant studies were selected based on predefined criteria. Study test conditions that might influence in-vitro bond strength were independently assessed by 2 observers. Studies reporting a minimum number of test conditions were included for meta-analysis by using a multilevel model with 3 levels, with author as the highest level, study as the second level, and specimens in the study as the lowest level. The primary outcome measure was bond strength.

Results

We identified 121 relevant studies, of which 24 were included in the meta-analysis. Methodologic drawbacks of the excluded studies were generally related to inadequate reporting of test conditions and specimen storage. The meta-analysis demonstrated that 3 experimental conditions significantly affect in-vitro bond strength testing. Although water storage decreased bond strength on average by 10.7 MPa, each second of photopolymerization time and each millimeter per minute of greater crosshead speed increased bond strength by 0.077 and 1.3 MPa, respectively.

Conclusions

Many studies on in-vitro orthodontic bond strength fail to report test conditions that could significantly affect their outcomes.

Section snippets

Material and methods

Relevant studies were identified in a literature search and subsequently selected on the basis of inclusion criteria. Studies fulfilling the inclusion criteria were assessed for reporting test conditions that could influence the results of in-vitro bond strength testing. The studies reporting a minimal number of test conditions were included for meta-analysis.

To identify studies related to in-vitro bond strength, a search was performed in the databases of Medline (1967 to December 2007) and

Results

The searches of Medline and Embase yielded 918 publications. After the first assessment, 166 studies were judged to be relevant for this systematic review. We found no additional studies by checking the references of the included studies and relevant review articles. After we used the specified criteria, 121 of the 166 studies regarding bond strength testing were included for detailed assessment of the experimental conditions (Fig). Interobserver agreement (Cohen kappa) for reporting the 27

Discussion

There was great diversity in the experimental conditions of studies reporting bond strength testing in orthodontics. The results from the meta-analysis in this systematic review indicate that the experimental conditions of water storage, photopolymerization time, and crosshead speed significantly influenced the results of in-vitro bond strength testing.

As previously shown in 2 other reviews evaluating orthodontic bond strength studies, there is still great diversity in test protocols and

Conclusions

In this systematic review and meta-analysis, a summary of factors is given that can affect the in-vitro bond strength of orthodontic brackets. Experimental conditions that significantly influence in-vitro bond strength are water storage of the bonded specimens, photopolymerization time, and crosshead speed. Based on the results from this systematic review, we concluded that many studies did not properly report test conditions that could have significantly affected the outcomes. Because of

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