Orthodontic bracket removal using conventional and ultrasonic debonding techniques, enamel loss, and time requirements (original) (raw)
Related papers
The effects of bracket removal on enamel
Australian orthodontic journal, 2008
Enamel cracks, which may develop during debonding orthodontic brackets, may jeopardise the integrity of the enamel and detract from the appearance of the teeth. To compare the adhesive remnant scores (ARI), the number, lengths and directions of enamel cracks before bonding and after debonding metal orthodontic brackets with three different methods. Metal brackets were bonded with a self-curing orthodontic adhesive to the buccal surfaces of 75 recently extracted upper and lower premolars. The teeth were randomly divided into three groups, and the brackets removed either with a side-cutter, a single-blade bracket remover or a two-blade bracket remover. The number, directions and lengths of the enamel cracks before bonding and after debonding were compared. The number of 'pronounced' cracks (i.e. cracks that could be identified with the naked eye) and the ARI scores in each group were also compared. After debonding, the number of enamel cracks and pronounced cracks, and the len...
Journal of Orthodontic Science, 2015
Objectives: To conduct an epidemiological survey of the orthodontic debonding techniques in Italy, and describe the most commonly used methods to remove the brackets and adhesive from the tooth surfaces. Materials and Methods: A survey consisting of 6 questions about bracket debonding methods and instruments used was emailed to 1000 orthodontists, who were members of the Italian Orthodontics Society (SIDO. Clinicians were characterized by different sex, age, origin, and professional experience. Results: Overall, 267 surveys were returned, representing a response rate of 26.7% of the participants interviewed. The 0.2% of the orthodontists responded, via email, confirming that they were not interested, while 3% of the questionnaires were sent back not completed. The 70.1% of the clinicians interviewed did not return any response. Overall, 64% of SIDO members (orthodontists) did not detect any enamel damage after debonding. The brackets used most frequently (89.14%) in clinical practice were the metal ones. The most commonly used pliers for bracket removal were cutters (37.08%) and bracket removal pliers (34.83%). For adhesive removal, low speed tungsten carbide burs under irrigation were the most widely utilized method for adhesive removal (40.08%), followed by high speed carbide burs (14.19%), and diamond burs (14.19%). The most frequently used instruments for polishing after debonding were rubber cups (36.70%) and abrasive discs (21.35%). The 31.21% of the orthodontists found esthetic enamel changes before bonding versus after debonding. Conclusions: This survey showed the high variability of different methods for bracket debonding, adhesive removal, and tooth polishing. The collected answers indicate that most orthodontists have developed their own armamentarium of debonding and polishing, basing their method on trials and errors.
Efficiency of different protocols for enamel clean-up after bracket debonding: an in vitro study
Objective: This study aimed to assess the efficiency of six protocols for cleaning-up tooth enamel after bracket debonding. Methods: A total of 60 premolars were divided into six groups, according to the tools used for clean-up: 12-blade bur at low speed (G12L), 12-blade bur at high speed (G12H), 30-blade bur at low speed (G30L), DU10CO ORTHO polisher (GDU), Renew System (GR) and Diagloss polisher (GD). Mean roughness (Ra) and mean roughness depth (Rz) of enamel surface were analyzed with a profilometer. Paired t-test was used to assess Ra and Rz before and after enamel clean-up. ANOVA/Tukey tests were used for intergroup comparison. The duration of removal procedures was recorded. The association between time and variation in enamel roughness (∆Ra, ∆Rz) were evaluated by Pearson's correlation test. Enamel topography was assessed by scanning electron microscopy (SEM). Results: In Groups G12L and G12H, original enamel roughness did not change significantly. In Groups G30L, GDU, GR and GD, a smoother surface (p < 0.05) was found after clean-up. In Groups G30L and GD, the protocols used were more time-consuming than those used in the other groups. Negative and moderate correlation was observed between time and (∆Ra, ∆Rz); Ra and (∆Ra, ∆Rz); Rz (r = -0.445, r = -0.475, p < 0.01). Conclusion: All enamel clean-up protocols were efficient because they did not result in increased surface roughness. The longer the time spent performing the protocol, the lower the surface roughness.
Medical science monitor : international medical journal of experimental and clinical research, 2014
After orthodontic treatment, brackets are debonded and residual adhesive is removed, causing iatrogenic enamel damage. The aim of this study was to review the methods of orthodontic adhesive removal, find clear evidence, and provide a rationale for this procedure. A literature search was performed in PubMed, Dentistry and Oral Sciences, Scopus, Cochrane, Google, and Google Scholar using keywords: orthodontic adhesive removal, orthodontic debonding, orthodontic clean-up. Studies concerning human enamel roughness or loss from debonding and adhesive removal were considered. Forty-four full-text articles were analyzed and 3 were rejected after detailed reading; finally 41 papers were included. Fifteen qualitative studies, 13 studies based on indices of enamel surface, and 13 quantitative studies were found. No meta-analysis could be performed due to a lack of homogenous quantitative evidence. The most popular tools were tungsten carbide burs, which were faster and more effective than So...
Loss of Surface Enamel after Bracket Debonding: An in-vivo and ex-vivo Evaluation.
Introduction: The objective of this study was to evaluate the surface enamel after bracket debonding and residual resin removal. Methods: Thirty patients (female, 20; male, 10; mean age, 18.4 years) who completed orthodontic treatment with fixed appliances (Twin Brackets, 3M Unitek, Monrovia, Calif) (n 5 525) were included. The amounts of adhesive left on the tooth surfaces and the bracket bases were evaluated with the adhesive remnant index (ARI). ARI tooth (n 5 498) was assessed on digital photographs by 2 operators. After resin removal and polishing, epoxy replicas were made from the maxillary anterior teeth (n 5 62), and enamel surfaces were scored again with the enamel surface index. Elemental analysis was performed on the debonded bracket bases by using energy dispersive x-ray spectrometry mean area scanning analysis. The percentages of calcium and silicon were summed up to 100%. Tooth damage was estimated based on the incidence of calcium from enamel in relation to silicon from adhesive (Ca%) and the correlation between the ARI bracket and Ca%. Results and Conclusions: While ARI tooth results showed score 3 as the most frequent (41%) (P \0.05), followed by scores 0, 1, and 2 (28.7%, 17.9%, and 12.4%, respectively), ARI bracket results showed score 0 more often (40.6%) than the other scores (P \0.05). Maxillary anterior teeth had significantly more scores of 3 (49%) than the other groups of teeth (10%-25%) (chi-square; P \0.001). There were no enamel surface index scores of 0, 3, or 4. No correlation between the enamel surface index and ARI tooth scores was found (Spearman rho 5 0.014, P 5 0.91). The incidence of Ca% from the scanned brackets showed significant differences between the maxillary and mandibular teeth (14% 6 8.7% and 11.2% 6 6.5%, respectively; P \0.05), especially for the canines and second premolars (Kruskal-Wallis test, P \0.01). With more remnants on the bracket base, the Ca% was higher (Jonckheere Terpstra test, P\0.05). Iatrogenic damage to the enamel surface after bracket debonding was inevitable. Whether elemental loss from enamel has clinical significance is yet to be determined in a long-term clinical follow-up of the studied patient population. (Am J Orthod Dentofacial Orthop 2010;138:387.e1-387.e9)
American Journal of Orthodontics and Dentofacial Orthopedics, 2007
Introduction: The purpose of this study was to evaluate 3-dimensionally the changes on tooth surfaces after debonding orthodontic brackets and after removing residual adhesive and finishing. Methods: Sixty premolars were randomly divided into 2 groups, and brackets were bonded according to the manufacturers' instructions. Two types of orthodontic adhesives were used: resin-modified glass ionomer cement (group 1) and resin-coated adhesive precoated brackets (group 2). The brackets were debonded on a testing machine at a cross-head speed of 1 mm per minute. Models were made of each tooth before bonding, after debonding, and after removal of residual adhesive. The models were scanned with a 3-dimensional laser scanning machine, and the scanned images were analyzed by using modified analytical software. Results: The Mann-Whitney test showed significant differences in adhesive thickness and enamel loss between the 2 groups (P Ͻ.001). The mean (Ϯ SD) thickness for group 1 was 31.2 m (Ϯ 26.5 m), and the mean (Ϯ SD) thickness for group 2 was 102.7 m (Ϯ 79.71 m). The means (Ϯ SD) for enamel losses after cleaning and finishing the enamel surfaces were 22.8 m (Ϯ 17.67 m) for group 1 and 50.5 m (Ϯ 31.27 m) for group 2. Conclusions: Adhesive thickness and enamel loss due to orthodontic procedures can successfully be measured in vitro by using 3-dimensional laser scanning technology.
Feasibility of Different Methods after Debonding of Orthodontic Brackets: An In Vivo Study
2019
Aim: This study aims to evaluate and compare the discomfort levels during debonding using different three methods and adhesive remnant index (ARI) scores compared. Materials and Methods: Sample comprised 50 female patients from single clinic of an average age of 24 years and 5 months. Three methods used were lift-off debonding instrument (LODI), straight cutter, and Howe plier. At the end of debonding in each quadrant, discomfort levels were assessed using visual analog scale (VAS). Remaining adhesive on enamel surface was studied with the help of ARI. Results: Pain scores were significantly higher for SC method. LODI group showed least discomfort. ARI showed significantly different results with three methods used. Conclusion: Patients showed least discomfort when LODI method was used.
Effect of adhesive remnant removal on enamel topography after bracket debonding
Dental Press Journal of Orthodontics
Introduction: At orthodontic treatment completion, knowledge about the effects of adhesive remnant removal on enamel is paramount. Objective: This study aimed at assessing the effect of different adhesive remnant removal methods on enamel topography (ESI) and surface roughness (Ra) after bracket debonding and polishing. Methods: A total of 50 human premolars were selected and divided into five groups according to the method used for adhesive remnant removal: high speed tungsten carbide bur (TCB), Sof-Lex discs (SL), adhesive removing plier (PL), ultrasound (US) and Fiberglass burs (FB). Metal brackets were bonded with Transbond XT, stored at 37 o C for 24 hours before debonding with adhesive removing plier. Subsequently, removal methods were carried out followed by polishing with pumice paste. Qualitative and quantitative analyses were conducted with pre-bonding, post-debonding and post-polishing analyses. Results were submitted to statistical analysis with F test (ANOVA) and Tukey's (Ra) as well as with Kruskal-Wallis and Bonferroni tests (ESI) (P < 0.05). Results: US Ra and ESI were significantly greater than TCB, SL, PL and FB. Polishing minimized Ra and ESI in the SL and FB groups. Conclusion: Adhesive remnant removal with SL and FB associated with polishing are recommended due to causing little damage to the enamel.
Effects of Different Stain Removal Protocols on Bonding Orthodontic Brackets to Enamel
The Journal of Contemporary Dental Practice
Aim: To evaluate the effect of different stain removal protocols with or without topical fluoride application on the bond strength of orthodontic brackets to enamel. Materials and methods: Eighty extracted premolars were randomly assigned into four groups according to the stain removal protocol. The stain removal protocols were (1) using rubber cup with prophylaxis paste in (G1, n = 20), (2) air-abrasion with prophy-jet polishing system (G2, n = 20), (3) micro-abrasion with opalusture polishing paste (G3, n = 20), and (4) macroabrasion with ultrafine diamond finishing tips (G4, n = 20). Ten teeth in each group (SG1, n = 10) had no topical fluoride treatment after stain removal protocol, while the rest (SG2, n = 10) were subjected to topical fluoride application. After bonding the orthodontic brackets, all specimens were thermocycled before testing their bracket-enamel bond strength. The debonded bracket and enamel surfaces of each specimen were also assessed to determine the adhesive remnant index (ARI) for each subgroup. Results: Specimens in G2, G3, and G4 recorded lower shear bond strength as compared with G1 (p < 0.05). For all groups, specimens in SG2 demonstrated lower bond strength than their counterpart in SG1 (p < 0.05). No significant differences were detected between the ARIs of different subgroups (p > 0.05). Conclusion: Bonding orthodontic brackets is affected by the protocol of removing enamel stains. The use of the rubber cup
International Journal of Dental Materials
Brackets are generally debonded and remaining adhesive is removed at the end of the orthodontic treatment. There are different methods for adhesive removal of which few methods have a chance of damaging enamel and roughen the tooth surface which can lead to plaque accumulation, discolouration, and aesthetic problems. Enamel polishing after debonding is one strategy to decrease such consequences. Severalenamel cleaning and polishing methods include Sof-Lex discs, TC burs, ultrasonic tools, hand instruments,rubbers, composite burs, Arkansas stones, green stones, diamond burs, steel burs and lasers. Each method has some advantages and some lacunae. To be precise soflex discs and TC burs have less damage on enamel than other methods, i.e., Arkansas stone and greenstone. This article is a review of available different enamel cleaning and polishing methods after debonding, their advantages and disadvantages.