Self-etching primers: is prophylactic pumicing necessary? A randomized clinical trial

Abstract

The purpose of this clinical trial was to determine whether pumice prophylaxis is required before the use of a self-etching primer (SEP). A total of 30 patients undergoing treatment with full upper and lower fixed appliances were recruited into this randomized cross-mouth controlled trial. In all cases, stainless steel orthodontic brackets were bonded using Transbondtrade mark XT adhesive after pretreatment of the enamel surface using a new SEP. Diagonally opposite quadrants of the mouth were randomly assigned to have the enamel either pumiced or not pumiced before the use of a SEP. Bond failures, along with the adhesive remnant index (ARI) scores, were recorded at 6 and 12 months into treatment. The data were subsequently analyzed in terms of odds ratio and associated 95% confidence interval. Because of the very high bond failure rates of 55.5% for the no-pumice group and 33.2% for the pumice group, patient recruitment ceased at only 14 patients. Although the bond failure rates were unacceptably high in both groups, pumicing was found to have a clinically and statistically significant effect on reducing clinical bond failure rates. The ARI scores in all cases were 0, indicating that no adhesive remained on the enamel surface at bond failure. The significance of this trial is that pumicing before the use of an SEP is to be recommended, although the SEP used in this study cannot be recommended for clinical use.