Bärbel Kahl-Nieke

Treatment and postretention changes in dental arch width dimensions—a long-term evaluation of influencing cofactors

The aim of the present long-term follow-up study of orthodontically treated patients was to analyze postretention changes in arch width dimension and to isolate factors that may serve as predictors of long-term prognosis. Pretreatment, end-of-treatment, and postretention (at least 10 years) models of 226 cases with different malocclusions were used to measure intercanine and intermolar width, arch length, sum of the mesiodistal dimension of the incisors, irregularity index, crowding, molar and canine relationship, overjet, and overbite. To assess the influence of initial and end-of-treatment alignment, kind of treatment (extraction versus nonextraction) and the amount of expansion in postretention stability, the sample was divided into different subgroups. The findings indicate that postretention arch width relapse occurred more frequently in the upper intermolar (25.8%) and lower intercanine region (23.9%) than in the lower intermolar (19.0%) and upper intercanine (13.8%) region. Pretreatment and posttreatment alignment as well as the kind of treatment and the amount of expansion were found to be influencing factors. The study concludes by proposing a reassessment of the definition of stability. The influence of the pretreatment anomaly, kind of treatment, amount of expansion, and posttreatment alignment on long-term stability should be recognized. Patients should be apprised of treatment limitations before treatments.

Value of two cone-beam computed tomography systems from an orthodontic point of view.

Aim:Since its introduction in dental radiology in 1998, cone-beam computed tomography (CBCT) has found increasing acceptance in clinical routine. The aim of this study was thus to evaluate this imaging modality from an orthodontic point of view. Materials and Methods:Two systems formed the basis of this investigation: the NewTom 9000 (NewTom Germany AG, Marburg, Germany), in use at the University Medical Center Hamburg-Eppendorf since October 2002, and the mobile Arcadis Orbic 3D system (Siemens Medical Solutions, Erlangen, Germany), which was introduced in February 2005. Two independent examiners evaluated a total of 68 NewTom and 15 Arcadis Orbic 3D images involving orthodontic indications. The images were categorized according to their indications and diagnostic value assessed according to a predefined and quantifiable protocol. Information obtained from the CBCT was also compared to that gleaned from conventional radiographs.Results:The indication for the NewTom images in cleft patients as well as for all Arcadis Orbic 3D images was considered justified. The osseous morphology of the cleft and position of osteosynthetic screws and plates were particularly well visualized. CBCT implementation in cases of tooth impaction or for assessing third molars was considered justified, although its value was judged differently by the two examiners. CBCT did not provide more information than conventional imaging regarding cartilaginous joint structures.Conclusions:In complex orthodontic cases in which 3D imaging is mandatory, CBCT is the method of choice. Furthermore, in cleft patients and those undergoing combined orthodontic and maxillofacial therapy, CBCT proved advantageous, providing more information than conventional images.ZusammenfassungFragestellung:Seit der Einführung der digitalen Volumentomographie (DVT) in die zahnärztliche Röntgendiagnostik im Jahr 1998 etablierte sich diese neue Modalität zunehmend in den klinischen Alltag. Ziel dieser Studie war daher, retrospektiv die mit kieferorthopädischer Fragestellung angefertigten DVT-Aufnahmen zu evaluieren.Material und Methodik:Seit Oktober 2002 wird das NewTom 9000 (NewTom Deutschland AG, Marburg) und seit Februar 2005 das mobile Arcadis Orbic 3D System (Siemens Medical Solutions, Erlangen, Deutschland) im Universitätsklinikum Hamburg-Eppendorf eingesetzt. Aus dem DVT-Pool der Poliklinik für Röntgendiagnostik analysierten zwei Untersucher unabhängig voneinander retrospektiv alle mit kieferorthopädischer Fragestellung angefertigten Aufnahmen: Insgesamt wurden 68 NewTom- und 15 Arcadis-Orbic-3D-Aufnahmen hinsichtlich der unterschiedlichen Indikationsstellungen gruppiert und die diagnostische Wertigkeit anhand indikationsspezifischer Kriterien mit Hilfe einer Bewertungsskala quantifiziert. Des Weiteren wurde die DVT-Indikation anhand des Informationsgewinns gegenüber herkömmlichen radiologischen Verfahren beurteilt.Ergebnisse:Alle NewTom-Aufnahmen von Patienten mit Lippen- Kiefer-Gaumen-Spalten sowie alle Arcadis-Orbic-3D-Aufnahmen wurden als indiziert eingestuft. Die Knochenverhältnisse in der Spalte sowie die Positionierung der Platten und Schrauben konnten besonders gut beurteilt werden. Die Anfertigung einer DVT-Aufnahme bei retinierten bzw. verlagerten Zähnen sowie zur Lagebeurteilung der dritten Molaren wurde mehrheitlich befürwortet. Allerdings war die Einschätzung vom Untersucher abhängig. Bei Fragestellungen zu knorpeligen Gelenkstrukturen brachte die DVT-Aufnahme keinen zusätzlichen Informationsgewinn.Schlussfolgerungen:Die DVT stellt bei komplexen kieferorthopädischen Fragestellungen, die eine dreidimensionale Bildgebung erfordern, die Methode der Wahl dar. Insbesondere bei Patienten mit Lippen-Kiefer-Gaumen-Spalten und kombiniert kieferorthopädisch-kieferchirurgisch behandelten Patienten weisen die DVT-Aufnahmen deutliche Vorzüge gegenüber der konventionellen Diagnostik auf.

Correlations between Anomalies of the Dentition and Pathologies of the Locomotor System—a Literature Review

Abstract.From anatomic and functional aspects the stomatognathic system and the upper cervical spine are closely interlinked. Together with complex neuromuscular relationships, this gives rise to an important field of cooperation between orthodontics and orthopedics. The literature appeals for close interdisciplinary cooperation for patients with syndromes and for those with torticollis and scoliosis. Since orthopedic points of contact are obvious in these special cases, orthopedic aspects are now being taken increasingly into account in farther-reaching studies.With the rising popularity of manual medicine, these aspects are being recognized from the orthopedic point of view too in terms of functional correlations and are being increasingly debated at international congresses and in the literature. Although relevant publications were initially confined to studies of moderate scientific interest or case reports, potential correlations have undergone scientific investigation in recent interdisciplinary studies.Despite the many clinical studies, no unequivocal recommendation can be given for basic conditions under which an orthopedist is bound to be consulted on patients with orthodontic findings.This literature review is aimed at providing an introduction to this still hotly debated issue.Zusammenfassung.Kausystem und obere Halswirbelsäule sind anatomisch und funktionell eng miteinander verbunden. Daraus ergibt sich unter Berücksichtigung komplexer neuromuskulärer Zusammenhänge ein wichtiges Feld der Zusammenarbeit zwischen der Kieferorthopädie und Orthopädie. Eine enge kooperative Zusammenarbeit wird in der Fachliteratur bei Patienten mit Syndromen wie auch bei Patienten mit Skoliose und Tortikollis gewünscht. Da bei diesen Auffälligkeiten orthopädische Berührungspunkte offensichtlich sind, werden orthopädische Aspekte nun auch innerhalb kieferorthopädischer Patientenkollektive in weiterführenden Studien zunehmend berücksichtigt.Mit wachsender Verbreitung der manuellen Medizin werden diese Ansätze auch aus orthopädischer Sicht unter Berücksichtigung funktioneller Zusammenhänge erkannt und auf Kongressen und in Fachzeitschriften zunehmend erörtert. Existierten zu dieser Thematik zunächst wissenschaftlich nur gering valide Studien oder Kasuistiken, so werden in aktuellen interdisziplinären Studien mögliche Zusammenhänge wissenschaftlich hinterfragt.Trotz zahlreicher klinischer Studien kann zurzeit noch keine eindeutige Empfehlung für Rahmenbedingungen einer obligaten Konsultation eines Orthopäden bei kieferorthopädischen Patienten gegeben werden.In diesen immer noch kontrovers diskutierten Themenkomplex soll die vorliegende Übersicht einführen.From anatomic and functional aspects the stomatognathic system and the upper cervical spine are closely interlinked. Together with complex neuromuscular relationships, this gives rise to an important field of cooperation between orthodontics and orthopedics. The literature appeals for close interdisciplinary cooperation for patients with syndromes and for those with torticollis and scoliosis. Since orthopedic points of contact are obvious in these special cases, orthopedic aspects are now being taken increasingly into account in farther-reaching studies. With the rising popularity of manual medicine, these aspects are being recognized from the orthopedic point of view too in terms of functional correlations and are being increasingly debated at international congresses and in the literature. Although relevant publications were initially confined to studies of moderate scientific interest or case reports, potential correlations have undergone scientific investigation in recent interdisciplinary studies. Despite the many clinical studies, no unequivocal recommendation can be given for basic conditions under which an orthopedist is bound to be consulted on patients with orthodontic findings. This literature review is aimed at providing an introduction to this still hotly debated issue.

Age-dependent three-dimensional microcomputed tomography analysis of the human midpalatal suture.

Aim:The success of rapid maxillary expansion is hard to predict in patients from the age of 20. There are as yet no reliable parameters enabling us to define success or failure a priori. The aim of this study was thus to use micro-CT techniques to quantify suture morphology three-dimensionally, and investigate its relation to age.Material and Methods:The morphology of the midpalatal suture was evaluated by documenting 28 human-palate specimens from individuals aged 14–71 using computed tomography. The software AMIRA 3.00 was used for 3D (three-dimensional) reconstruction of the datasets. Sutural morphology was quantified and examined for age-dependent morphological characteristics with the software Image Tool 3.00. To that end, the specimens were assigned to three age groups (< 25 years, 25 years to < 30 years, ≥ 30 years) and the following parameters were considered: obliteration index in the frontal plane, and suture length, linear sutural distance, and interdigitation index in the horizontal plane, as well as bone density (BV/TV [%]) in the sagittal plane.Results:Significant differences between age groups were only found for bone density in sagittal dimension. The middle-aged group exhibited the highest bone density (53.2%). In comparison to that group, bone density was significantly lower in the youngest and the oldest age groups. The mean obliteration index exhibited substantial inter-individual variation, was generally low, and did not correlate with chronological age. The extent of interdigitation was independent of age.Conclusions:The necessity for surgical weakening can neither be explained by sutural interdigitation increasing with age nor by a higher obliteration index. Sutural bone density (hence the fracture resistance increasing with age) seems to be the parameter limiting conservative RME.ZusammenfassungZielsetzung:Bei Patienten älter als 20 Jahre ist es schwierig, den Erfolg einer konservativen GNE vorherzusagen. Bisher existieren keine verlässlichen Parameter, mit Hilfe derer a priori der Erfolg bzw. Misserfolg definiert werden kann. Daher war das Ziel der Studie, mit Hilfe der neuwertigen Mikro-CT-Technik dreidimensional die Morphologie der Sutur zu quantifizieren und in Abhängigkeit zum Alter zu setzen.Material und Methodik:Zur Evaluation der Morphologie der Sutura palatina mediana wurden 28 humane Gaumenpräparate von Individuen im Alter von 14 bis 71 Jahren computertomographisch dargestellt. Mit der Software AMIRA 3.00 wurden die Datensätze dreidimensional rekonstruiert. Die suturale Morphologie wurde mit Hilfe des Programms Image Tool 3.00 quantifiziert und auf altersspezifische morphologische Charakteristika untersucht. Dazu wurden die Präparate in drei Altersgruppen eingeteilt (< 25 Jahre, 25 Jahre bis < 30 Jahre, ≥ 30 Jahre) und folgende Parameter berücksichtigt: in der Frontalebene der Obliterationsindex, in der Horizontalebene die suturale Länge, die suturale Streckendistanz sowie der sich daraus ergebende Interdigitationsindex und in der Sagittalebene die Knochendichte (BV/TV [%]).Ergebnisse:Signifikante Unterschiede zwischen den Altersgruppen wurden nur hinsichtlich der Knochendichte in der Sagittalen registriert. Die höchste Knochendichte mit 53,2% zeigte die mittlere Altersgruppe. Die Knochendichten in der jüngeren und älteren Altersgruppe waren hierzu signifikant reduziert. Die mittleren Obliterationsindices waren bei großer interindividueller Variabilität generell gering und unabhängig vom chronologischen Alter. Die Intensität der Interdigitationen war altersunabhängig.Schlussfolgerungen:Die Notwendigkeit einer chirurgischen Schwächung kann weder mit einer zunehmenden suturalen Interdigitation noch mit einem erhöhten Obliterationsindex erklärt werden. Die altersabhängig zunehmende suturale Knochendichte mit konsekutiv steigender Frakturresistenz scheint der mechanisch limitierende Faktor einer konservativen GNE zu sein.

Bond strength with custom base indirect bonding techniques.

Different types of adhesives for indirect bonding techniques have been introduced recently. But there is limited information regarding bond strength with these new materials. In this in vitro investigation, stainless steel brackets were bonded to 100 permanent bovine incisors using the Thomas technique, the modified Thomas technique, and light-cured direct bonding for a control group. The following five groups of 20 teeth each were formed: (1) modified Thomas technique with thermally cured base composite (Therma Cure) and chemically cured sealant (Maximum Cure), (2) Thomas technique with thermally cured base composite (Therma Cure) and chemically cured sealant (Custom I Q), (3) Thomas technique with light-cured base composite (Transbond XT) and chemically cured sealant (Sondhi Rapid Set), (4) modified Thomas technique with chemically cured base adhesive (Phase II) and chemically cured sealant (Maximum Cure), and (5) control group directly bonded with light-cured adhesive (Transbond XT). Mean bond strengths in groups 3, 4, and 5 were 14.99 +/- 2.85, 15.41 +/- 3.21, and 13.88 +/- 2.33 MPa, respectively, and these groups were not significantly different from each other. Groups 1 (mean bond strength 7.28 +/- 4.88 MPa) and 2 (mean bond strength 7.07 +/- 4.11 MPa) showed significantly lower bond strengths than groups 3, 4, and 5 and a higher probability of bond failure. Both the original (group 2) and the modified (group 1) Thomas technique were able to achieve bond strengths comparable to the light-cured direct bonded control group.

Trends in trabecular architecture and bone mineral density distribution in 152 individuals aged 30–90 years

The strength of trabecular bone depends on its microarchitecture and its tissue level properties. However, the interrelation between these two determinants of bone quality and their relation to age remain to be clarified. Iliac crest bone cores (n=152) from individuals aged 30-90 years were analyzed by quantitative backscattered electron imaging. Univariate and multivariate analyses were conducted to determine whether epidemiological parameters (age, sex or BMI), structural histomorphometrical variables (BV/TV, Tb.Th, Tb.N and Tb.Sp) and osteoid-related indices (OV/BV, OS/BS or O.Th) predict the degree of bone mineralization. While sex and BMI were not associated with bone mineralization, age was positively correlated with the most frequently occurring calcium concentrations (Ca peak), the percentage of highly mineralized bone areas (Ca high) and, in the case of adjusted covariates, also the mean calcium content (Ca mean). Bone volume fraction and trabecular thickness were both negatively correlated with Ca mean. However, trabecular thickness was additionally associated with Ca peak, Ca high as well as the amount of low mineralized bone (Ca low) and was the only structural parameter predicting bone mineralization independent of age. Furthermore, our analyses demonstrated that osteoid variables - within a normal range (<2% OV/BV) - were significantly associated with all mineralization parameters and represent the only predictor for the mineralization heterogeneity (Ca width). Taken together, we showed that elevated trabecular bone mineralization correlates with aging and bone loss. However, these associations are attributable to trabecular thinning that comes along with high bone mineralization due to the loss of low mineralized bone surfaces. Therefore, we demonstrated that the degree of areally resolved bone mineral is primarily associated with the amount of physiological osteoid present and the thickness of mineralized bone in trabeculae.

Osteopetrosis, osteopetrorickets and hypophosphatemic rickets differentially affect dentin and enamel mineralization

Osteopetrosis (OP) is an inherited disorder of defective bone resorption, which can be accompanied by impaired skeletal mineralization, a phenotype termed osteopetrorickets (OPR). Since individuals with dysfunctional osteoclasts often develop osteomyelitis of the jaw, we have analyzed, if dentin and enamel mineralization are differentially affected in OP and OPR. Therefore, we have applied non-decalcified histology and quantitative backscattered electron imaging (qBEI) to compare the dental phenotypes of Src(-/-), oc/oc and Hyp(-/0) mice, which serve as models for OP, OPR and hypophosphatemic rickets, respectively. While both, Src(-/-) and oc/oc mice, were characterized by defects of molar root formation, only oc/oc mice displayed a severe defect of dentin mineralization, similar to Hyp(-/0) mice. Most importantly, while enamel thickness was not affected in either mouse model, the calcium content within the enamel phase was significantly reduced in oc/oc, but not in Src(-/-) or Hyp(-/0) mice. Taken together, these data demonstrate that dentin and enamel mineralization are differentially affected in Src(-/-) and oc/oc mice. Moreover, since defects of dental mineralization may trigger premature tooth decay and thereby osteomyelitis of the jaw, they further underscore the importance of discriminating between OP and OPR in the respective individuals.

The Displaced Maxillary Canine—a Retrospective Study

Objective:The re-alignment of retained maxillary canines was studied in relation to the degree of displacement in panoramic radiographs, mesiodistal root deviations, length of treatment and side-effects. The aim was then to determine whether the decision between surgical removal and orthodontic re-alignment can be made on the basis of panoramic radiographs alone.Materials and Methods:Forty-seven panoramic radiographs with 59 displaced canines were used to determine their distance and inclination to the occlusal plane (similar to the method described by Dausch-Neumann [8]), the position of the crown tip, and the frequency of mesiodistal root deviations. The length of active treatment was recorded and analyzed statistically in relation to the degree of displacement and incidence of root deviation. Finally, pre- and post-therapeutic panoramic radiographs were compared to determine the incidence of root resorptions and marginal bone defects.Results:The mean values for the angle of inclination and the distance of the maxillary canines from the occlusal plane were 57.4° (± 14.3°) and 10.5 mm (± 3.8 mm), respectively. In 21 canines, the crown tips projected most frequently between the central and lateral incisors. Twelve canines presented root deviations. Treatment lasted an average of 1.9 years (± 0.7 years). No correlation was found between the treatment time and the canine’s distance from the occlusal plane (r = 0.03), its angle of inclination (r = 0.06), position of the crown tip (r = 0.12), or root deviation (r = −0.07). Root resorptions were found in nine canines (15.3%) and marginal bone defects in 24 canines (40.7%).Conclusion:Fifty-nine retained maxillary canines, some showing extreme displacement, were re-aligned in an average of 1.9 years. There was no correlation between the degree of canine displacement in the panoramic radiographs or the incidence of mesiodistal root deviations and active treatment time. For this reason, the indication to remove displaced maxillary canines should not be taken from panoramic radiographs alone.ZusammenfassungFragestellung:Die Einordnung retinierter oberer Eckzähne wurde in Hinblick auf Verlagerungsgrad in Orthopantomogrammen, mesiodistalen Wurzelkrümmungen, Behandlungsdauer und Nebenwirkungen untersucht. Abschließend sollte überprüft werden, ob die Entscheidung chirurgische Entfernung oder kieferorthopädische Einordnung ausschließlich anhand von Orthopantomogrammen getroffen werden kann.Material und Methodik:Aus 47 Orthopantomogrammen mit 59 verlagerten Eckzähnen wurden Abstand und Neigung zur Okklusionsebene (analog der Methode von Dausch-Neumann [8]), Lage der Kronenspitze und Häufigkeit von mesiodistalen Wurzelkrümmungen ermittelt. Die Dauer der aktiven Behandlung wurde erfasst und in Bezug zum Verlagerungsgrad und zur Wurzelkrümmung statistisch ausgewertet. Abschließend wurden prä- und posttherapeutische Orthopantomogramme zur Ermittlung der Inzidenz von Wurzelresorptionen und marginalen Knochendefekten verglichen.Ergebnisse:Die Durchschnittswerte bezüglich des Neigungswinkels und des Abstandes der oberen Canini zur Okklusionsebene betrugen 57,4° (± 14,3°) und 10,5 mm (± 3,8 mm). Bei 21 Eckzähnen projizierten sich die Kronenspitzen am häufigsten zwischen dem mittleren und seitlichen Inzisivus. Zwölf Eckzähne wiesen Wurzelkrümmungen auf. Die Behandlung dauerte im Durchschnitt 1,9 Jahre (± 0,7 Jahre). Es konnte keine Korrelation der Behandlungszeit zum Abstand zur Okklusionsebene (r = 0,03), zum Neigungswinkel (r = 0,06), zur Lage der Kronenspitze (r = 0,12) und zur Wurzelkrümmung (r = −0,07) gefunden werden. Wurzelresorptionen wurden bei neun Canini (15,3%) und marginale Knochendefekte bei 24 Canini (40,7%) festgestellt.Schlussfolgerung:59 retinierte obere Eckzähne konnten auch bei teilweise extremer Verlagerung im Durchschnitt in 1,9 Jahren eingeordnet werden. Es bestand weder eine Korrelation zwischen dem Verlagerungsgrad des Eckzahnes in den Orthopantomogrammen noch der Inzidenz von mesiodistalen Wurzelkrümmungen zur aktiven Behandlungszeit. Auch deswegen sollte die Indikation zur Entfernung von verlagerten oberen Eckzähnen nicht nur anhand von Orthopantomogrammen gestellt werden.

Orofacial Development in Children with Down’s Syndrome 12 Years after Early Intervention with a Stimulating Plate

Abstract.Background:Orofacial regulation therapy for children with Down’s syndrome was introduced to Europe in Munich in 1978. Since then, many clinical studies have provided scientific evidence that this therapeutic approach enhances the orofacial function and facial appearance of children with trisomy 21. Only few long-term results have been published to date.Patients and Results:In the present study, 20 children with trisomy 21 were examined more than 12 years after starting treatment in infancy with a Castillo Morales stimulating plate. The follow-up examination showed that the improved orofacial appearance resulting from the early treatment had remained stable in most cases. Although the mechanical stimulus of the stimulating plate was absent during the follow-up period, some patients revealed a lip and tongue posture superior to that recorded at baseline.Conclusion:According to the results of the present study, the orofacial status in early childhood is decisive for the subsequent development of the orofacial region and the long-term stability of the achieved improvements: Children with a pronounced orofacial dysfunction showed a greater stimulation-plate-induced improvement than those with initially moderate orofacial findings. This observation was confirmed by the findings of the 12-year follow-up: Children with Down’s syndrome and initially slight orofacial impairment displayed only slight improvements or unchanged findings.Zusammenfassung.Hintergrund:Die orofaziale Regulationstherapie bei Kindern mit Down-Syndrom wurde 1978 in München erstmals in Europa präsentiert. Seitdem konnten zahlreiche wissenschaftliche Studien den Nachweis erbringen, dass mithilfe dieser Behandlung die orofaziale Funktion und der Gesichtsausdruck bei Kindern mit Trisomie 21 verbessert werden kann. Aussagen über die Langzeitstabilität liegen in der Literatur nur begrenzt vor.Patienten und Ergebnisse:In der vorliegenden Studie konnten 20 Kinder mit Trisomie 21, die im Säuglingsalter mit einer Stimulationsplatte nach Castillo Morales behandelt wurden, mehr als 12 Jahre nach Therapiebeginn nachuntersucht werden. Die im Rahmen der frühen Behandlung bereits verbesserte orofaziale Erscheinung und Funktion war zum Zeitpunkt der Nachuntersuchung bei den meisten Patienten stabil. Einige Patienten zeigten eine gegenüber dem Ausgangsbefund verbesserte Lippen- und Zungenhaltung, obwohl der mechanische Reiz der Stimulationsplatte im Nachuntersuchungszeitraum fehlte.Schlussfolgerung:Hinsichtlich der weiteren Entwicklung der orofazialen Region bzw. Langzeitstabilität der erzielten Verbesserungen ist gemäß den Ergebnissen der vorliegenden Studie der Ausgangsbefund im Kindesalter entscheidend: Im Vergleich zu Kindern mit anfangs moderater Ausprägung wiesen Patienten mit ausgeprägter orofazialer Dysfunktion eine größere Verbesserung durch die Stimulationsplatte auf. Diese Beobachtung konnte durch die nach zwölf Jahren durchgeführte Diagnostik bekräftigt werden. Kinder mit Down-Syndrom bei initial geringer orofazialer Beeinträchtigung zeigten nur geringfügige Verbesserungen oder unveränderte Befunde.

Fluoride-releasing Adhesive and Antimicrobial Self-etching Primer Effects on Shear Bond Strength of Orthodontic Brackets

OBJECTIVE To determine whether the combination of a new antimicrobial primer and a fluoride-releasing adhesive will affect the shear bond strength (SBS) and the bracket/adhesive failure mode. MATERIALS AND METHODS A total of 120 extracted human teeth were randomly divided into three groups of 40 specimens each (20 incisors, 20 premolars). Transbond XT was used in group 1, a fluoride-releasing adhesive (Kurasper F) was used in group 2, and a new antimicrobial self-etching primer (Clearfil Protect Bond) was applied in combination with Kurasper F in group 3. A universal testing machine was used to determine the SBS, and the adhesive remaining after debonding was assessed. RESULTS No enamel fractures were detected in any of the specimens. SBS values for incisors and premolars were 11.40 +/- 4.65 MPa and 10.37 +/- 3.36 MPa in group 1, 14.50 +/- 4.22 MPa and 13.06 +/- 5.13 MPa in group 2, and 14.79 +/- 4.10 MPa and 14.60 +/- 3.55 MPa in group 3. Statistically significant difference (P = .001) was found in the premolars in group 3 revealing the highest mean SBS. Significantly lower adhesive remnant index (ARI) values (median ARI value of 1) were detected in group 3 when compared with groups 1 and 2. CONCLUSIONS Considering the acceptable bond strength and the mode of failure, the combination of the new antimicrobial primer with the fluoride-releasing adhesive is recommended for clinical use.