Getting braces with existing composite bonding is generally possible, but the process requires specialized techniques. Composite bonding uses a tooth-colored resin material to repair chips, close small gaps, or improve tooth shape. Braces are orthodontic appliances designed to reposition teeth over time. Combining these treatments necessitates careful planning to ensure brackets adhere securely to the non-enamel surface of the bonding.
Attaching Orthodontic Brackets to Composite Surfaces
Bonding an orthodontic bracket to a composite surface presents a different challenge than bonding to natural tooth enamel. Natural enamel is typically prepared with a 37% phosphoric acid gel, which creates microscopic pores for the adhesive resin to lock into, a process known as micromechanical retention. Composite resin, however, does not react to this standard acid etching, requiring a modified protocol to achieve acceptable bond strength.
To prepare the existing composite for bracket placement, the orthodontist must first mechanically roughen the surface. This is often accomplished by lightly abrading the area with a diamond bur or through micro-air abrasion, creating a better surface texture for adhesion. Following this roughening, specialized agents are applied to the composite material. A composite primer or a silane coupling agent promotes a chemical bond between the old composite and the new orthodontic adhesive.
The goal is to create a bond strong enough to withstand the forces of orthodontic tooth movement and chewing, but weak enough to allow for safe removal at the end of treatment. While these specialized steps create a reliable bond, the strength achieved on a composite restoration may still be less robust than a bond directly to pristine enamel. This difference requires the clinical team to be aware of the increased potential for bracket detachment throughout the treatment period.
Managing Treatment Complications with Existing Bonding
The presence of composite bonding introduces practical issues that can arise over the months or years of orthodontic treatment. The most common complication is a higher likelihood of bracket detachment, often referred to as bond failure, compared to brackets placed on natural enamel. A bracket bonded to a non-ideal surface may require re-bonding more frequently, which can slightly extend the overall treatment timeline.
When a bracket detaches from a bonded surface, it requires an immediate re-bonding appointment, where the surface is cleaned, re-roughened, and re-primed before a new bracket is placed. The composite material itself is also more prone to staining than natural enamel, particularly around the edges of the bracket where adhesive residue may be present. Over the course of treatment, dark-colored liquids or foods can cause slight discoloration in the composite material that becomes noticeable once the bracket is removed.
The already altered texture of a bonded tooth surface, combined with the presence of a bracket, can complicate routine oral hygiene. Maintaining a clean area around the bracket is difficult, and the slight porosity of the composite material can harbor plaque more readily than enamel. Patients must exercise careful cleaning techniques to prevent localized staining of the composite and to avoid developing white spots or decay around the edges of the bonding.
Post-Orthodontic Care and Composite Restoration
Once the teeth are properly aligned and the braces are ready to be removed, specific care is taken to protect the underlying composite bonding. The bracket is removed using specialized debonding pliers that apply gentle pressure to break the adhesive bond. The orthodontist must then carefully remove the remaining adhesive resin without damaging the composite material or the natural tooth structure.
The residual adhesive is meticulously scraped or ground away using a fine-grit bur, such as a tapering tungsten-carbide bur. Removing the adhesive from a composite surface requires more precision than from enamel, as the two materials are chemically similar. After the adhesive is fully removed, the area must be carefully polished to restore the smooth surface of the composite restoration.
Patients should understand that existing composite bonding may require repair, reshaping, or complete replacement after orthodontic treatment. Stress from the initial bracket placement, the sustained presence of the bracket, and the final removal process can compromise the integrity or appearance of the original bonding. This final restorative phase is often a planned part of the total treatment, ensuring the cosmetic result is perfected after the teeth are straightened.