ABSTRACT
A literature review on the existing information about bonding of orthodontic brackets on altered enamel surfaces, the influence of such surfaces on adhesion, and the most favorable conditions for achieving better bond strength is presented. Studies on bracket adhesion have identified the conditions that lead to morphological changes in enamel as dental fluorosis and dental bleaching. In this review, each of these conditions that alter the enamel surface and pose a major challenge to clinical orthodontists performing bracket bonding, will be analyzed. The literature provides a range of approaches for overcoming the challenges of bonding on altered enamel surfaces and will be discussed, taking into account, where possible, the type of adhesive selected. Adhesion on enamel that is fluorosed depends on the degree of severity and the bond strength on a bleached enamel surface depends largely on the concentration of the bleaching agent.