Assessment of enamel damage after removal of ceramic brackets

doi:10.1016/j.ajodo.2006.08.022

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 134, Issue 4, October 2008, Pages 548-555

https://doi.org/10.1016/j.ajodo.2006.08.022 Get rights and content

Introduction: Since the introduction of ceramic brackets, research has been performed to evaluate enamel damage caused during their removal. One problem in comparing treated and control groups is the absence of assurance that the surfaces were undamaged before the brackets were bonded and debonded, or that superficial treatment applied to the enamel could hinder damage detection. The aim of this in-vitro study was to evaluate enamel injuries during debonding of 3 types of ceramic brackets. Methods: Forty-five premolars, extracted for orthodontic purposes, were divided into 3 groups of 15. The enamel surfaces were photographed with a magnifying loupe (60 times) in an optical stereomicroscope (Stemi 2000-C, Zeiss, Oberkochen, Germany) with a digital camera. A different type of backet was bonded and debonded in each group: mechanical retention, mechanical retention with a polymer base, and chemical retention. After debonding, the surfaces were again photographed. The photographs were evaluated for quality of enamel surface according to a predetermined scale. The results were tested by method error and the chi-square test. Results: The damage evaluation comparing the same surface before bonding and after debonding showed no significant statistical difference between the mechanical retention group and the polymer base retention group. There was a significant statistical difference (P <0.05) for the chemical adhesion ceramic bracket group. Conclusions: The difference between the enamel surfaces before bonding and after debonding brackets with chemical retention was statistically significant; bonding and debonding these brackets resulted in enamel damage.

Section snippets

Material and methods

We used 45 labial surfaces of dental enamel obtained from 45 premolars extracted for orthodontic reasons from the tooth bank of the Dental School of Fluminense Federal University in Brazil. All applicable bioethical standards were observed during the procedures.

The teeth were cleaned and dipped in 1% thymol and stored at 5°C. All teeth had intact labial surfaces with no carious lesions. The roots were cut, and the crowns molded with self-curing resin with polyvinyl chloride cylinders three

Results

Verification of the reproducibility rate between the 2 evaluations by the same evaluator a week apart yielded a kappa index of 0.85, pointing to excellent concordance.

The results for the ARI are shown in Table I. The evaluations before bracket bonding and debonding for the 3 groups focused on enamel damage. Damage was assessed after adhesive removal, and the results are given in Table II.

According to the chi-square nonparametric statistical test at a 5% probability level (Table II), no

Discussion

Enamel damage caused during the removal of ceramic brackets has been the subject of concern to many researchers and has prompted a number of studies. Some of these evaluated bonding factors, such as the etching time on the enamel surface and the type of adhesive used.2, 4, 7, 13, 14, 15, 16, 17, 18, 19 Others assessed the different types of bracket base retentions.2, 4, 7, 8, 16, 17, 20, 21, 22, 23, 24, 25, 26, 27, 28 Because of concern about the removal method, several studies evaluated which

Conclusions

In line with the methodology adopted and the results from this study, the following conclusions can be drawn.

1
Removal of mechanical retention brackets according to the manufacturer's instructions is easy, quick. and safe.
2
Most polymer base ceramic brackets popped off during removal with an orthodontic wire cutter. Orthodontists should therefore debond this type of bracket with the archwires secured in the bracket slots.
3
Compared with the other groups, the removal of chemical retention brackets

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The influence of age and orthodontic debonding on the prevalence and severity of enamel craze lines
2023, Journal of the American Dental Association
Craze lines may cause esthetic concerns, especially when noted on the incisors. Various light sources with additional recording apparatus have been proposed to visualize craze lines, but a standardized clinical protocol is yet to be determined. This study aimed to validate the application of near-infrared imaging (NIRI) from intraoral scans to evaluate craze lines and to determine the influence of age and orthodontic debonding on their prevalence and severity.
The NIRI of maxillary central incisors from a full-mouth intraoral scan and photographs from an orthodontic clinic (N = 284) were collected. The prevalence of craze lines and influence of age and orthodontic debonding history on severity were evaluated.
Craze lines were detected reliably as white lines distinguishable from dark enamel using the NIRI from intraoral scans. The craze line prevalence was 50.7%, which was significantly higher in patients 20 years or older than in patients younger than 20 years (P < .001), with more frequent severe craze lines for those 40 years or older than in patients younger than 30 years (P < .05). Prevalence or severity was similar between patients with and without an orthodontic debonding history regardless of the type of appliance.
The prevalence of craze lines in the maxillary central incisor was 50.7%, with a higher prevalence in adults than in adolescents. Orthodontic debonding did not affect the severity of craze lines.
Craze lines were reliably detected and documented by means of applying NIRI from intraoral scans. Intraoral scanning can provide new clinical information on enamel surface characteristics.
In vivo examination of enamel microcracks after orthodontic debonding: Is there a need for detailed analysis?
2021, American Journal of Orthodontics and Dentofacial Orthopedics
Our aim was to assess changes in the number of enamel microcracks (EMCs) after removing metal brackets in teeth with and without visible EMCs before the bonding procedure.
Before bonding, 13 patients having teeth with visible EMCs and 13 subjects whose teeth were free of EMCs were included in the study. All patients were asked to complete a questionnaire with a detailed medical history at the beginning of treatment and after removing metal brackets. The number of teeth with visible EMCs and the number of premolars without EMCs were recorded for each subject twice, that is, before bonding and after debonding, together with the tooth sensitivity assessments elicited by compressed air and cold testing.
The number of visible EMCs in premolars increased after removing metal brackets. EMCs were recorded in at least 25.0% of all evaluated teeth for the patients having teeth with and without visible EMCs at the beginning of treatment. However, the changes in the number of visible EMCs were not significantly different (P = 0.619) between the groups. For the subjects with visible EMCs, tooth sensitivity caused by cold was registered nearly 3 times more often after removing brackets compared with the patients without EMCs prior bonding.
Formation of EMCs was noticed after debonding. Changes in the number appeared to be similar for the subjects with and without visible EMCs before bonding. Higher incidence of EMCs was associated with more frequent tooth sensitivity perceptions after removing brackets.
Quantitative analysis of enamel on debonded orthodontic brackets
2017, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
The amount of enamel on the metal bracket adhesive was small, with only 2% of the brackets having more than 5% of their bracket area covered in enamel. The literature indicates that removal of ceramic brackets is more commonly associated with enamel fractures, cracks, and tearouts.3,15,16 To reduce this damage, mechanically retained ceramic brackets were introduced13; their use compared with chemically retained brackets with nearly half the incidence of cracks.3
Iatrogenic damage to the tooth surface in the form of enamel tearouts can occur during removal of fixed orthodontic appliances. The aim of this study was to assess debonded metal and ceramic brackets attached with a variety of bonding materials to determine how frequently this type of damage occurs.
Eighty-one patients close to finishing fixed orthodontic treatment were recruited. They had metal brackets bonded with composite resin and a 2-step etch-and-bond technique or ceramic brackets bonded with composite resin and a 2-step etch-and- bond technique, and composite resin with a self-etching primer or resin-modified glass ionomer cement. Debonded brackets were examined by backscattered scanning electron microscopy with energy dispersive x-ray spectroscopy to determine the presence and area of enamel on the base pad.
Of the 486 brackets collected, 26.1% exhibited enamel on the bonding material on the bracket base pad. The incidences of enamel tearouts for each group were metal brackets, 13.3%; ceramic brackets, 30.2%; composite resin with self-etching primer, 38.2%; and resin-modified glass ionomer cement, 21.2%. The percentage of the bracket base pad covered in enamel was highly variable, ranging from 0% to 46.1%.
Enamel damage regularly occurred during the debonding process with the degree of damage being highly variable. Damage occurred more frequently when ceramic brackets were used (31.9%) compared with metal brackets (13.3%). Removal of ceramic brackets bonded with resin-modified glass ionomer cement resulted in less damage compared with the resin bonding systems.
Evaluation of enamel surface roughness after orthodontic bracket debonding with atomic force microscopy
2017, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
The controversy among these studies may be attributed to the different enamel surface assessment methods. Dental loupes have proven to be practical, user-friendly, and efficient for evaluating enamel surfaces.26 Their use has been shown to affect the quality of debonding and often causes less enamel damage and leaves fewer resin remnants.
Achieving a smooth enamel surface after orthodontic bracket debonding is imperative. In this study, we sought to compare the enamel surface roughness values after orthodontic bracket debonding and resin removal using a white stone bur, a tungsten carbide bur, and a tungsten carbide bur under loupe magnification.
Thirty sound premolars were randomly divided into 3 groups, and their buccal surfaces were subjected to atomic force microscopy to measure initial surface roughness. Brackets were bonded to the buccal surfaces and debonded after 24 hours. Resin remnants were removed using a white stone bur, a tungsten carbide bur, or a tungsten carbide bur under loupe magnification. The teeth were then subjected to atomic force microscopy again. The time required for composite removal was calculated. Data were analyzed using repeated-measures analysis of variance, 1-way analysis of variance, and the Tukey test.
Resin removal increased the enamel surface roughness compared with the initial values (P <0.001); however, no significant differences were noted among the 3 groups in this respect after resin removal. The mean times required for smoothing by the tungsten carbide bur and the tungsten carbide bur with a dental loupe were similar (P >0.05): significantly lower than the time with the white stone bur (both, P <0.001).
The tungsten carbide bur is still recommended for composite removal.
A Novel Method Using Confocal Laser Scanning Microscopy for Three-Dimensional Analysis of Human Dental Enamel Subjected to Ceramic Bracket Debonding
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Original articleAssessment of enamel damage after removal of ceramic brackets

Section snippets

Material and methods

Results

Discussion

Conclusions

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Original article
Assessment of enamel damage after removal of ceramic brackets