Abstract
Background: 37% phosphoric acid (PA) is the traditional enamel etching technique prior to bracket adhesion, yet it has been implicated in numerous enamel injuries. The purpose of the current study was to create a calcium phosphate (CaP) etching paste in a simplified capsule formula that can underpin clinically adequate bracket bond strength without jeopardizing the integrity of enamel upon the debracketing procedure. Materials and Methods: micro-sized hydroxyapatite (HA) powder was mixed with 40% PA solution to prepare experimental acidic CaP paste. Sixty human premolars were assigned into two groups of 30 each. Enamel conditioning was accomplished using 37% PA-gel for control group and CaP paste for experimental group. Each group was further divided into two subgroups regarding the water storage (WS) period (24 h and 30 days). Shear bond strength (SBS) test conducted with examination of debonded surfaces for adhesive remnants and enamel damage using a digital microscope. Results: CaP paste produced significantly lower SBS values than PA (p < 0.01), yet sufficient for clinical use. PA etching caused often cracked enamel surfaces with excessive retention of adhesive remnants (mainly ARI scores 2 and 3). Contrarily, enamel treated with the experimental CaP paste exhibited smooth, unblemished surfaces mostly clean of adhesives residues (scores 0 and 1). Conclusion: a newly developed CaP paste in a capsule formula fosters clinically adequate bracket adhesion with a sustained bonding performance, allows a harmless bracket removal with minimal or no adhesive residues on debonded surfaces; thus, it can be introduced as a suitable alternative to PA.