Comparison Of Indirect Bonding Methods of Orthodontic Brackets Performed With Conventional And Fully Digital Workflows In Terms Of Microleakage And Shear Bond Strength Parameters: A Randomized Controlled In Vitro Study

Comparison Of Indirect Bonding Methods of Orthodontic Brackets Performed With Conventional And Fully Digital Workflows In Terms Of Microleakage And Shear Bond Strength Parameters: A Randomized Controlled In Vitro Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison Of Indirect Bonding Methods of Orthodontic Brackets Performed With Conventional And Fully Digital Workflows In Terms Of Microleakage And Shear Bond Strength Parameters: A Randomized Controlled In Vitro Study Selahattin Cem Unsal, Muhsin Cifter This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8617257/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Accurate bracket placement is an essential step for achieving predictable orthodontic treatment outcomes. Digital workflows using intraoral scanning, virtual bracket positioning, and 3D-printed transfer trays can enhance bonding accuracy and adhesive effectiveness. However, few studies have simultaneously evaluated microleakage, shear bond strength, and adhesive remnant patterns across direct, traditional indirect, and fully digital indirect bonding methods. The present study aims to address this issue by conducting a controlled in-vitro comparison of these three methods. Methods A total of 102 extracted human premolars were randomly allocated to three groups: direct bonding (C), traditional indirect bonding (TIDB), and fully digital indirect bonding (DIDB)(n = 34). Each group was divided into subgroups for microleakage analysis (n = 17) and shear bond strength/Adhesive Remnant Index (ARI) evaluation (n = 17). Microleakage was assessed with 0.5 basic fuchsin dye and quantified by direct measurement of dye penetration beneath bracket bases under stereomicroscopy. Shear bond strength (SBS) was measured using a universal testing machine at a crosshead speed of 1 mm/min. ARI scores were recorded after debonding. Statistical analyses were conducted using IBM SPSS V23 and JAMOVI V2.3.21 software. Results Microleakage analysis showed significant differences among the groups concerning maximum dye penetration values (p < 0.001). The control group showed significantly less microleakage than the TIDB group; however, the differences between the control and DIDB groups were not statistically significant. Additionally, gingival regions exhibited significantly higher microleakage than occlusal regions (p < 0.001). In SBS testing control group showed significantly higher values (p = 0.004)). Specifically, the control group showed significantly higher SBS than the TIDB group, while no significant differences were observed between the C and DIDB groups. ARI score distributions did not show significant variation across the groups (p = 0.110). Finally, no significant correlations were observed among SBS, ARI, or maximum dye penetration values across groups (p > 0.05). Conclusions In this study fully digital indirect bonding method showed better marginal sealing and more consistent adhesive behavior compared to traditional indirect bonding, while maintaining shear bond strength similar to that of direct bonding. Digital workflows appear to reduce laboratory-related variables, improve precision, and provide safer adhesive bonding results. Indirect bonding digital orthodontics 3D printing microleakage shear bond strength ARI Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 28 Feb, 2026 Reviewers agreed at journal 19 Feb, 2026 Reviews received at journal 19 Feb, 2026 Reviewers agreed at journal 19 Feb, 2026 Reviewers invited by journal 19 Feb, 2026 Editor invited by journal 27 Jan, 2026 Editor assigned by journal 23 Jan, 2026 Submission checks completed at journal 23 Jan, 2026 First submitted to journal 16 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8617257","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":575489527,"identity":"db96b40d-fdc8-42d7-b709-48310e69c3af","order_by":0,"name":"Selahattin Cem Unsal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYLCCB0DMxt4AJA0siNSSAMR8PAdAWiRI0CInASIZiNBicLv94YeEGptoNsnnVzf8KJBg4G/vTsCv5c4ZY4mEY2m5bdI5ZTd7gA6TOHN2A34tN3IYJBIbDoO0pN3gAWoxkMglpCX98Y/Ehv+5bZJn0m7+IU5LghnQlgO5bRLsx24TZYvkjRwzi4RjybltPDlst2UMJHgI+oUP6LAbH2rscue3H392880fGzn+9l78WpAAjwGYJFY5CLA/IEX1KBgFo2AUjCAAAIbZSUOg+S5dAAAAAElFTkSuQmCC","orcid":"","institution":"Istanbul University","correspondingAuthor":true,"prefix":"","firstName":"Selahattin","middleName":"Cem","lastName":"Unsal","suffix":""},{"id":575489528,"identity":"783ebfa0-d3b4-4061-bd46-955e454652c9","order_by":1,"name":"Muhsin Cifter","email":"","orcid":"","institution":"Istanbul University","correspondingAuthor":false,"prefix":"","firstName":"Muhsin","middleName":"","lastName":"Cifter","suffix":""}],"badges":[],"createdAt":"2026-01-16 11:01:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8617257/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8617257/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":100561314,"identity":"39d8e0fa-e666-427f-8d8c-15b1985ed75f","added_by":"auto","created_at":"2026-01-19 08:43:59","extension":"json","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":5725,"visible":true,"origin":"","legend":"","description":"","filename":"13f6cf94d9214d7e8d2ab74cc3ddcedb.json","url":"https://assets-eu.researchsquare.com/files/rs-8617257/v1/fcefc525b5147814d3f123d9.json"},{"id":100594735,"identity":"3e8d3444-f533-4eaa-8fc8-85cc2612e850","added_by":"auto","created_at":"2026-01-19 13:44:35","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1060933,"visible":true,"origin":"","legend":"","description":"","filename":"MANUSCRIPT1.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8617257/v1_covered_24fff203-b515-461e-b61c-353b860f043a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison Of Indirect Bonding Methods of Orthodontic Brackets Performed With Conventional And Fully Digital Workflows In Terms Of Microleakage And Shear Bond Strength Parameters: A Randomized Controlled In Vitro Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Indirect bonding, digital orthodontics, 3D printing, microleakage, shear bond strength, ARI","lastPublishedDoi":"10.21203/rs.3.rs-8617257/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8617257/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccurate bracket placement is an essential step for achieving predictable orthodontic treatment outcomes. Digital workflows using intraoral scanning, virtual bracket positioning, and 3D-printed transfer trays can enhance bonding accuracy and adhesive effectiveness. However, few studies have simultaneously evaluated microleakage, shear bond strength, and adhesive remnant patterns across direct, traditional indirect, and fully digital indirect bonding methods. The present study aims to address this issue by conducting a controlled in-vitro comparison of these three methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 102 extracted human premolars were randomly allocated to three groups: direct bonding (C), traditional indirect bonding (TIDB), and fully digital indirect bonding (DIDB)(n = 34). Each group was divided into subgroups for microleakage analysis (n = 17) and shear bond strength/Adhesive Remnant Index (ARI) evaluation (n = 17). Microleakage was assessed with 0.5 basic fuchsin dye and quantified by direct measurement of dye penetration beneath bracket bases under stereomicroscopy. Shear bond strength (SBS) was measured using a universal testing machine at a crosshead speed of 1 mm/min. ARI scores were recorded after debonding. Statistical analyses were conducted using IBM SPSS V23 and JAMOVI V2.3.21 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMicroleakage analysis showed significant differences among the groups concerning maximum dye penetration values (p \u0026lt; 0.001). The control group showed significantly less microleakage than the TIDB group; however, the differences between the control and DIDB groups were not statistically significant. Additionally, gingival regions exhibited significantly higher microleakage than occlusal regions (p \u0026lt; 0.001). In SBS testing control group showed significantly higher values (p = 0.004)). Specifically, the control group showed significantly higher SBS than the TIDB group, while no significant differences were observed between the C and DIDB groups. ARI score distributions did not show significant variation across the groups (p = 0.110). Finally, no significant correlations were observed among SBS, ARI, or maximum dye penetration values across groups (p \u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study fully digital indirect bonding method showed better marginal sealing and more consistent adhesive behavior compared to traditional indirect bonding, while maintaining shear bond strength similar to that of direct bonding. Digital workflows appear to reduce laboratory-related variables, improve precision, and provide safer adhesive bonding results.\u003c/p\u003e","manuscriptTitle":"Comparison Of Indirect Bonding Methods of Orthodontic Brackets Performed With Conventional And Fully Digital Workflows In Terms Of Microleakage And Shear Bond Strength Parameters: A Randomized Controlled In Vitro Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 08:28:38","doi":"10.21203/rs.3.rs-8617257/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-03-01T02:54:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92342086805745383058910961633974469188","date":"2026-02-19T14:44:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T11:58:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"220019317982549154231198891899683268333","date":"2026-02-19T11:25:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-19T09:15:56+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-27T06:54:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-23T09:58:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-23T09:53:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-01-16T08:58:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cb4df968-7254-4bee-ae2d-69d399b62fc8","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-19T09:23:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 08:28:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8617257","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8617257","identity":"rs-8617257","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}