Background This study aimed to develop remineralizing calcium-phosphate (CaP) etchant pastes for enamel conditioning before bracket bonding and evaluate the bonding performance, failure pattern, and enamel surface integrity post bracket debonding in comparison with the conventional phosphoric acid (PA) etchant gel. Material and Methods Micro-sized monocalcium phosphate monohydrate and hydroxyapatite (micro- and nano-sized) powders were mixed with various phosphoric and nitric acid concentrations to develop eight acidic CaP pastes. Ninety extracted human premolars were randomly assigned into eight experimental and one control group (n=10). The developed pastes and control (commercial 37% PA-gel) were applied onto the enamel using the etch-and-rinse protocol before bonding metal brackets. Shear bond strength and adhesive remnant index (ARI) scores were evaluated after 24 hours water storage (24 h) and post 5000 thermocycling (TC). Field emission scanning electron microscopy (FE-SEM) was used to evaluate enamel damage after bracket debonding. Results The developed CaP pastes, excepting MNA1 and MPA1, resulted in significantly lower SBS values and ARI scores than 37% PA gel. Etching with 37% PA yielded roughened, cracked enamel surfaces with excessive retention of adhesive residue. In contrast, enamel treatment with the experimental pastes exhibited smooth, unblemished surfaces, with obvious CaP re-precipitation induced by mHPA2 and nHPA2 pastes and to a lesser extent by MPA2 paste. Conclusions Three newly developed CaP etchant pastes (MPA2, mHPA2, and nHPA2) can be promising alternative enamel conditioners that outperform conventional PA by generating adequate bracket bond strengths besides precipitating CaP crystals on the enamel. Moreover, these pastes maintained unblemished enamel surfaces with no or minimal adhesive residue after bracket removal.
