The inappropriateness of conventional orthodontic bond strength assessment protocols

The purpose of this article is to examine the soundness of conventional orthodontic bonding assessment methods. A classification of bond strength studies is proposed with the testing environment (in vivo, in vitro, and ex vivo), loading mode (shear, tensile, and torsion), and bonding substrate (enamel, restorative, and prosthetic materials) serving as discriminating variables. Inconsistencies throughout the various stages of research protocols are analysed. These include the following: tooth selection, storage, and preparation; bonding; testing; and data analysis with regard to the clinical applicability of the reported information, as well as the scientific integrity of the testing procedure. Contradictory models may partially account for the considerable variability noted for reported bond strength values of different orthodontic bonding systems. Such discrepancies may also explain the conflicting evidence reported on the failure characteristics of the components of the bonding system in different trials examining the efficacy of nominally identical materials. A novel approach to study the fatigue life of materials is proposed to understand the processes occurring prior to bond failure. Mock research data manipulation is also utilized to illustrate the correct statistical treatment of findings, and recommendations for future research are made to ensure scientific soundness and clinical applicability of data.