Effects of femtosecond laser and other surface treatments on the bond strength of metallic and ceramic orthodontic brackets to zirconia

Femtosecond laser has been proposed as a method for conditioning zirconia surfaces to boost bond strength. However, metallic or ceramic bracket bonding to femtosecond laser-treated zirconia surfaces has not been tested. This study compared the effects of four conditioning techniques, including femtosecond laser irradiation, on shear bond strength (SBS) of metallic and ceramic brackets to zirconia.Three hundred zirconia plates were divided into five groups: 1) control (C); 2) sandblasting (APA); 3) silica coating and silane (SC); 4) femtosecond laser (FS); 5) sandblasting followed by femtosecond laser (APA+SC). A thermal imaging camera measured temperature changes in the zirconia during irradiation. Each group was divided into 2 subgroups (metallic vs ceramic brackets). SBS was evaluated using a universal testing machine. The adhesive remnant index (ARI) was registered and surfaces were observed under SEM. Surface treatment and bracket type significantly affected the bracket-zirconia bond strength. SBS was significantly higher (p<0.001) for ceramic brackets in all groups (APA+FS > APA > FS > SC > control) than metallic brackets (APA+FS > FS > SC > APA > control). For metallic brackets, groups SC (5.99 ± 1.86 MPa), FS (6.72 ± 2.30 MPa) and APA+FS (7.22 ± 2.73 MPa) reported significantly higher bond strengths than other groups (p < 0.05). For ceramic brackets, the highest bond strength values were obtained in groups APA (25.01 ± 4.45 MPa), FS (23.18 ± 6.51 MPa) and APA+FS (29.22 ± 8.20 MPa).Femtosecond laser enhances bond strength of ceramic and metallic brackets to zirconia. Ceramic brackets provide significantly stronger adhesion than metallic brackets regardless of the surface treatment method.