Quantitative Volumetric Enamel Loss after Orthodontic Debracketing/Debonding and Clean-Up Procedures: A Systematic Review

Paolone, Gaetano; Mandurino, Mauro; Baldani, Sofia; Paolone, Maria Giacinta; Goracci, Cecilia; Scolavino, Salvatore; Gherlone, Enrico; Cantatore, Giuseppe; Gastaldi, Giorgio

doi:10.3390/app13095369

Cited by 7 publications

(5 citation statements)

References 37 publications

(96 reference statements)

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“…Potential damages include cracking, roughness, wear, overheating of the teeth, damage to the pulp, and altered tooth color. Proper removal techniques are vital to maintaining a good aesthetic appearance and surface brightness [ 21 – 27 ]. No technique has been proven to thoroughly and efficiently remove residual adhesives without causing at least minor damage to the enamel [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of enamel surface integrity after orthodontic bracket debonding: comparison of three different system

Ghaleb,

Al-Worafi,

Thawaba

et al. 2024

BMC Oral Health

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Objective This study aimed to evaluate enamel surface integrity and time consumed during residual cement removal after bracket debonding using different adhesive removal burs with and without a dental loupe. Material and Methods Sixty human-extracted premolars were collected, cleaned, mounted, and prepared for orthodontic bracket bonding. Teeth were randomly divided into three main groups (n = 20) based on the adhesive removal method: tungsten carbide system (TC), sof-lex discs system (SD), and diamond system (DB) groups. Then, each group was subdivided into two subgroups (naked eye and magnifying loupe subgroups). The brackets were bonded and then debonded after 24 h, and the Adhesive Remnant Index (ARI) was assessed. The adhesive remnants were removed by different systems, and the final polishing was performed by Silicone OneGloss. The enamel surface roughness was evaluated before bracketing (T0), after residual cement removal (T1), and finally after polishing (T2) using surface Mitutoyo SJ-210 profilometry and Scanning Electron Microscopy (SEM) to determine the Enamel Damage Index (EDI) score. The time consumed for adhesive removal was recorded in seconds. Results The Kruskal Wallis test showed a statistically significant difference in roughness values at T1 compared to T2 between subgroups (p < 0.001). When comparing EDI at T1 and T2, the Kruskal–Wallis H-test showed statistically significant differences in all subgroups. The pairwise comparisons revealed that EDI scores showed a statistically significant difference at T1 and T2 between DB vs. TC and SD (p = 0.015) but not between TC vs. SD (p = 1.000), indicating the highest roughness value observed in the DB group. The time for cement removal was significantly shorter in the magnifying loupe group than in the naked eye group and was shortest with the TC group, whereas the time was the longest with the DB group (p < 0.05). Conclusion All three systems were clinically satisfactory for residual orthodontic adhesive removal. However, TC system produced the lowest enamel roughness, while the DB system created the greatest. The polishing step created smoother surfaces regardless of the systems used for resin removal.

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Section: Discussionmentioning

confidence: 99%

Evaluation of enamel surface integrity after orthodontic bracket debonding: comparison of three different system

Ghaleb,

Al-Worafi,

Thawaba

et al. 2024

BMC Oral Health

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“…In orthodontic treatments that use fixed appliances or clear aligners, the brackets or attachments are bonded to enamel and when the orthodontic treatment is over, a major challenge is the removal of those attachments and adhesive resin from enamel surface with less damage to the enamel surface as possible. The removal of superficial enamel might make the enamel less resistant to the organic acids in the oral environment, which can increase the risk of demineralization [ 22 ]. Many techniques were introduced over the years to remove the adhesive remnants after bracket debonding with less surface roughness and less enamel damage.…”

Section: Discussionmentioning

confidence: 99%

“…This is an abrasive material can be used for contouring, shaping, polishing, and finishing a composite restorations, porcelain, glass ionomer cement, abutment teeth, and enamel surfaces [ 21 ]. Many tungsten carbide burs and white stone burs have been designed for removing adhesive resin after bracket debonding, but their effect on enamel is still controversial [ 22 ]. Zirconia bur is composed of Yttrium oxide partially stabilized tetragonal zirconia [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of enamel roughness after orthodontic debonding and clean-up procedures using zirconia, tungsten carbide, and white stone burs: an in vitro study

et al. 2023

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Background The main goal of orthodontic debonding is to restore the enamel surface as closely as possible to its pretreatment condition without iatrogenic damage. This study aimed to compare the effects of different adhesive removal burs; zirconia burs, tungsten carbide burs, and white stone burs on enamel surface roughness. Materials and methods Total sample of 72 extracted premolars was randomly divided into three equal groups (n = 24) depending on the method of adhesive removal: zirconia burs (ZB); tungsten carbide burs (TC); and white stones (WS). The metal brackets were bonded using Transbond XT orthodontic adhesive (3 M Unitek, Monrovia, CA, USA) and debonded after 24 h using a debonding plier, then the ARI was assessed. The adhesive remnants were removed using the different burs and Final polishing was performed using Sof-lex discs and spirals. Thirteen samples from each group were evaluated using a Mitutoyo SJ-210 profilometer to determine average surface roughness (Ra) and three samples from each group were examined under Scanning Electron Microscopy (SEM) to determine EDI score. The evaluations were performed at three time points; before bonding (T0), after adhesive removal (T1) and after polishing (T2) and the time consumed for adhesive removal by burs was recorded in seconds. The data were analyzed statistically by ANOVA, Tukey’s test and Kruskal–Wallis H-test. Results Kruskal–Wallis H-test showed no statistically significant difference of ARI in all studied groups (p = 0.845) and two-way mixed ANOVA revealed that all burs significantly increased surface roughness at T1 compared to T0 (p < 0.001) in all groups with the lowest Ra values were observed in the ZB group, followed by the TC group, and WS group. The fastest procedure was performed with WS, followed by ZB, then TC bur (p < 0.001). After polishing (T2), Ra values showed no significant difference in ZB group (P = 0.428) and TC group (P = 1.000) as compared to T0, while it was significant in WS group (p < 0.001). Conclusion zirconia bur was comparable to tungsten carbide bur and can be considered as alternative to white stone which caused severe enamel damage. The polishing step created smoother surface regardless of the bur used for resin removal.

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“…Although most studies in this field are based on qualitative indices [6][7][8], in recent years quantitative studies have also been carried out to an attempt to ascertain the volumetric loss of enamel [13] in order to produce evidence as to which may be the best technique, although there is considerable controversy in the literature and no standardized protocol has been established to date [14][15][16] Few studies have addressed this issue, and the published results are very heterogeneous, with the use of different methodological approaches that make it difficult to establish comparisons [9,14,[17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Study on the Influence of the Buccal Surface Convexity of the Tooth upon Enamel Loss after Bracket Removal

Pallarés-Serrano,

Pallarés-Serrano

et al. 2024

Materials

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Polishing after the removal of brackets is the final step in orthodontic treatment. It is simple to perform, though some studies have reported that polishing causes damage to the enamel surface. An in vitro study was made of the influence of the buccal surface convexity of the tooth upon possible enamel loss when the remaining resin and adhesive are removed after bracket decementing using two different polishing modes: a tungsten carbide bur at low and high speeds. The convexity of the buccal surface was quantified in 30 incisors and 30 premolars. A stereoscopic microscope was used to obtain photographs of the profile of the crown, and Image J software was used to calculate convexity by dividing the length of a line from the cementoenamel junction to the incisal margin by another line from the mentioned junction to the maximum convexity of the buccal surface. Brackets were cemented on all the teeth and were decemented 24 h later. In both groups, the residual composite was removed with a tungsten carbide bur at a low speed in one-half of the teeth and at a high speed in the other half. The buccal surface of each tooth was then photographed again, and the convexity was calculated and compared against the baseline value. The difference between the two values were taken to represent the enamel loss. The convexity of the premolars was significantly greater than that of the incisors, but this did not result in greater enamel loss when the same polishing mode was used. However, the tungsten carbide bur at a high speed proved more aggressive, causing significantly greater enamel loss than when used at a low speed.

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Quantitative Volumetric Enamel Loss after Orthodontic Debracketing/Debonding and Clean-Up Procedures: A Systematic Review

Cited by 7 publications

References 37 publications

Evaluation of enamel surface integrity after orthodontic bracket debonding: comparison of three different system

Evaluation of enamel surface integrity after orthodontic bracket debonding: comparison of three different system

Evaluation of enamel roughness after orthodontic debonding and clean-up procedures using zirconia, tungsten carbide, and white stone burs: an in vitro study

In Vitro Study on the Influence of the Buccal Surface Convexity of the Tooth upon Enamel Loss after Bracket Removal

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