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Industry Insights: The EtchFree Evolution by Zachary Burkett, Ismail Turker, and Sam Alauddin

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Categories: Orthodontics;
Industry Insights: The EtchFree Evolution

Introducing the next generation of bonding, inspired by nature

by Zachary Burkett, Ismail Turker, and Sam Alauddin

The field of orthodontics has evolved significantly since the earliest braces were applied to the first patients’ teeth. But there remains one aspect of orthodontic technology that is long overdue for innovation: bonding—specifically, the etching process critical to creating a reliable, secure bond.

In 1955, the practice of using phosphoric acid for etching enamel was first introduced in orthodontic practice,1 and became widely adopted as the primary method of bonding orthodontic appliances in the 1980s.2 Since then, orthodontists have regularly relied on etch and self-etch products to prepare the surface of the tooth as the first step of the bonding procedure. Many of these products, however, can have a detrimental effect on the patient’s tooth.

Acid etchant, for example, creates microporosity and a roughened tooth surface. Etching the enamel surface enables primers and resins to seep into the tooth, forming resin tags and creating a mechanical bond. Composite adhesives and orthodontic appliances are then bonded to complete the anchorage. By demineralizing the tooth, these etching processes create morphological changes to the patient’s enamel. This results in enamel loss, allowing the tooth to become vulnerable to white spot lesions throughout the course of orthodontic treatment.3

Commonly used etching processes present challenges for the clinician as well as for patients’ enamel health. The etching process is a time-consuming one, requiring clinicians to wait for the etchant product to dissolve highly mineralized enamel. What’s more, etching requires a dry environment to reliably bond orthodontic appliances to teeth. This naturally becomes a challenge, given that the mouth is an inherently wet environment.4 Keeping the teeth dry enough for technique-sensitive etching becomes a stressful and lengthy part of the bonding process.

What if there was a way to remove the etching step entirely, with a system that enables orthodontists to decrease technique sensitivity, work confidently in a wet environment, and preserve the integrity of their patients’ enamel? To develop such a system, Ormco’s Research and Development team turned to nature and the field of biomimicry.


Bio-inspired bonding technology
Over the past few decades, material scientists have increasingly embraced the biomimicry field, also known as biomimetics, for innovate solutions to a host of product challenges.

Indeed, a wide range of human advances have taken inspiration from designs, processes, and applications found in the natural world. Think Velcro (derived from burrs), bullet trains (influenced by kingfishers), ventilation systems (borrowed from termite mounds), or swimsuits (adapted from sharks). All these innovations were inspired by time-tested evolved principles gleaned from the observable world.

Could we not apply nature’s inspiration to orthodontic bonding? In its simplest mechanical terms, orthodontic bonding is a process by which appliances are adhered to highly mineralized surfaces (patient’s teeth).

The challenge of successful bonding lies in the biologically active and highly moisture contaminated oral environment of the patient’s mouth. This environment can interfere with the chemical processes orthodontists commonly use in bonding. Adding to the challenge, clinicians must ensure that the adhesive they use is not only effective but also safely applied.

To address this challenge, Ormco R&D explored different mechanisms used by various species to selectively bond or adhere to surfaces. Our research ultimately led us to marine mussels.


Mimicking the marine mussel’s adhesive prowess
Marine mussels were of particular interest to us because they exist in physically turbulent aquatic environments that are rife with chemical and biological contaminants—much like the mouth. These creatures have adapted to their moist environment, evolving an exceptional ability to attach themselves to myriad substrates, including highly mineralized rocks. Could human invention find inspiration from their unique adaptations?

To find out, we must first understand how marine mussels achieve this remarkable adhesive quality in such challenging conditions. Their bonding ability involves a combination of chemical and mechanical actions. The marine mussel’s anatomy includes the byssus, a threadlike structure that extends from the mussel stem (Fig. 1). This byssus contains 25 to 30 different foot proteins, pre-polymerized collagens, and thread matrix proteins that form a complex bonding network.5
Industry Insights: The EtchFree Evolution
Fig. 1a: Diagram of marine mussel attachment to a substrate.
Industry Insights: The EtchFree Evolution
Fig.1b: Diagram of marine mussel attachment to a substrate.

The byssus proteins contain a high quantity of post-transitionally modified 3,4-dihydroxyphenylalanine (DOPA). A chemical group containing a catecholamine and a phenethylamine, DOPA is found in dopamine and epinephrine. It’s also widely thought to be the critical ingredient that allows mussels to adhere to a variety of substrates (wood, metal, mineral, and more) in wet environments and turbulent conditions. This durable bond, even in challenging circumstances, is further supported by a cross-linked polymer matrix that forms when seawater’s basic pH and oxidizing agent combine to create a catechol oxidation that produces quinone.6


Similarities between marine mussel bonding and orthodontic bonding
There are striking parallels between the nature of marine mussel bonding to mineralized surfaces in aquatic environments and the clinical requirements of bonding to mineralized tissues (i.e. tooth enamel) in the oral environment. In other words, the bonding of mussels to rock is analogous to the bonding of brackets to teeth.

Like sea water, saliva is generally neutral to slightly basic pH and saline, and harbors highly mineralized substrates. As such, it only seemed natural to apply the biology and chemistry behind the bonding-proficient marine mussels. The Ormco R&D team synthesized a monomer inspired from marine mussel proteins that enable these animals to adhere so effectively to substrates in wet and challenging environments, and used it as the foundation for our Ormco EtchFree Bonding system, designed to eliminate the time-consuming and often frustrating etching step, preserve the patient’s enamel, and deliver a robust bond in a wet and biologically active environment.


EtchFree technology applied to orthodontic bonding
The next evolution in orthodontic bonding, the Ormco EtchFree Bonding system, adapts the technology gleaned from nature and uses it to create a new approach to bonding. This approach removes the etching step and thus the need for phosphoric acid as the active ingredient for prepping the tooth’s surface. The system creates an effective bond by using three bonding components: EtchFree Bonding Primer, Ortho Solo bond enhancer, and EtchFree Adhesive. Let’s take a deeper look at each component and how they work together.


EtchFree Bonding Primer: Moisture tolerant and less aggressive
While typical etchants demineralize the enamel surface, EtchFree Bonding Primer uses a proprietary monomer inspired by proteins found in marine mussels to chemically prepare the tooth surface. This monomer cross-links with itself and other polymers in the system to form a matrix of co-polymers with specific adhesion properties.5

The EtchFree Bonding system requires no acid etching mechanism to create clinically successful bonds in orthodontic cases, without damaging the tooth surface. That’s because the co-polymers in the EtchFree Bonding Primer bond instantly to the calcium ions in hydroxyapatite while remaining impervious to moisture. These ionically bonded polymer groups remain active and available for following resin adhesive steps. Scanning electron microscope (SEM) images show that EtchFree Bonding Primer is less aggressive than self-etch products containing phosphoric acid (Fig. 2). This helps preserve the natural surface of the tooth and presents a superior alternative over current etch and self-etch products when it comes to enamel health.
Industry Insights: The EtchFree Evolution
Fig. 2: SEM images of teeth after application of EtchFree Bonding Primer (far right) and competitor products (middle three) when compared to virgin enamel. EtchFree Bonding Primer creates less microporosities compared to etch and self-etch competitor products, indicating more intact enamel. Images shown at 5,000x magnification.

EtchFree Adhesive
A new composite formulation from Ormco, EtchFree Adhesive is translucent while delivering a familiar feel and handling. Sharing EtchFree Bonding Primer’s patented technology, EtchFree Adhesive performs in moist environments. When paired with EtchFree Bonding Primer, EtchFree Adhesive allows clinicians to bond metal and ceramic brackets, as well as aligner attachments, in wet fields (Figs. 3 and 4).
Industry Insights: The EtchFree Evolution
Fig. 3: Bond strength performance of EtchFree Bonding system, 3M Transbond XT, and 3M Transbond MIP bonded to metal brackets in dry and wet conditions (sample size n=36 for each group). Wet conditions are defined as moisture introduced at every step of the bonding process.
Industry Insights: The EtchFree Evolution 
Fig. 4: Bond strength performance of EtchFree Bonding system, 3M Transbond XT, and 3M Transbond MIP bonded to ceramic brackets in dry and wet conditions (sample size n=36 for each group). Wet conditions are defined as moisture introduced at every step of the bonding process.


EtchFree workflow
The EtchFree Bonding system technology reduces the time and technique sensitivity required to bond orthodontic appliances (Fig. 5). A Split mouth study comparing etching and EtchFree systems was conducted on 85 patients with metal brackets. 94% of clinicians and staff members felt “very noticeable” or “somewhat noteiceable” time savings with EtchFree Bonding.
Industry Insights: The EtchFree Evolution
Fig. 5


EtchFree: The next-generation bonding system
Dental and orthodontic bonding techniques and technology have been long overdue for innovation. With the help of nature, Ormco EtchFree rethinks how we approach orthodontic bonding without the acid etching technique that has remained mostly unchanged for decades. EtchFree Bonding has been shown to significantly reduce procedure time, improve the patient experience, score high satisfaction by clinical staff, and deliver overall improvements to clinical outcomes in orthodontic applications.

EtchFree Bonding provides a chairside solution for orthodontists seeking to optimize workflow and minimize risks on bonding day.

References
1. Buonocore, M. G. (1955). A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. Journal of Dental Research, 34(6), 849–853.
2. Sofan, E., et al. (2017). Classification review of dental adhesive systems: From the IV generation to the universal type. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28736601/
3. Chapman, J. A., et al. (2010). Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances. American Journal of Orthodontics and Dentofacial Orthopedics, 138(2), 188–194.
4. Phaphe, S., Ganiger, C., Ahammed, Y., & Mane, P. (2015). In vitro study of the effect of different samples of water used for washing the etchant on bracket bond strength. Journal of Clinical and Diagnostic Research, 9(10), ZC53–ZC55.
5. Lee, B. P., Messersmith, P. B., Israelachvili, J. N., & Waite, J. H. (2011). Mussel-inspired adhesives and coatings. Annual Review of Materials Research, 41, 99–132.
6. Pinnataip, R., & Lee, B. P. (2021). Oxidation chemistry of catechol utilized in designing stimuli-responsive adhesives and antipathogenic biomaterials. ACS Omega, 6(8), 5113–5118.

Author Bios
Zachary Burkett is the senior global product manager at Ormco.

Ismail Turker is an R&D engineer at Ormco.

Sam Alauddin is the director of new product development at Ormco.
This content is sponsored by Ormco. For more information, visit ormco.com.

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