1
|
Mousa MM, Al-Jannan HMG, Sultan K, Ajaj MA, Hajeer MY, Al-Manadili A, Ammar AM, Awawdeh M. Effectiveness of Two Intensity Levels of Diode Laser in Debonding Metallic Brackets Regarding Enamel Surface Integrity and Pulpal Temperature: An Ex-Vivo Study. Cureus 2023; 15:e41372. [PMID: 37408936 PMCID: PMC10319451 DOI: 10.7759/cureus.41372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION The traditional methods of deboning metal brackets exert excessive force, resulting in enamel scratches, fractures, and patient discomfort. The objective of this study was to evaluate the effectiveness of using two intensity levels of a diode laser for debonding metallic orthodontic brackets as an alternative to the conventional debonding method. MATERIALS AND METHODS Sixty intact, extracted human premolar teeth were used in this study, and metal orthodontic brackets were bonded to the buccal surface of these teeth. The teeth were divided into three groups for the experiment: (1) the control group, where conventional bracket debonding was performed using a debonding plier, (2) the first experimental group, where a diode laser (2.5W, 980nm) was utilized for laser debonding, and (3) the second experimental group, where a diode laser (5W, 980nm) was used for laser debonding. The laser was applied using a sweeping movement for 5 seconds. After debonding, the adhesive remnant index (ARI), the lengths, and the frequency of enamel cracks were compared among the groups. Additionally, an increase in intra-pulpal temperature was measured. RESULTS In all groups, there were no instances of enamel fractures. Laser debonding resulted in a significant reduction in both the frequency and length of newly formed enamel cracks compared to the conventional debonding method. The laser debonding group exhibited increases in intra-pulpal temperature of 2.37°C and 3.60°C in the second and third groups, respectively. These temperature increases were significantly lower than the threshold of 5.5°C. There were no significant differences observed in the ARI scores among the groups. CONCLUSION With all debonding methods, an increase in the length and frequency of enamel cracks should be anticipated. However, laser-assisted debonding of metal brackets offers the advantage of reducing the risk of enamel damage while avoiding thermal damage to the pulp.
Collapse
Affiliation(s)
- Mudar Mohammad Mousa
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR
| | - Hiba M G Al-Jannan
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR
| | - Kinda Sultan
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR
| | - Mowaffak A Ajaj
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR
| | - Mohammad Y Hajeer
- Department of Orthodontics, Faculty of Dentistry, University of Damascus, Damascus, SYR
| | - Ahmad Al-Manadili
- Department of Oral Histopathology, Damascus University, Damascus, SYR
| | - Ali Mohsen Ammar
- Department of Orthodontics, Faculty of Dentistry, Arab Private University for Science and Technology, Hama, SYR
| | - Mohammed Awawdeh
- Department of Preventive Dental Science, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| |
Collapse
|
2
|
Rodríguez-Chávez JA, Arenas-Alatorre JÁ, Flores-Ruiz HM, Aguilar-Pérez FJ, Flores-Ledesma A, Moreno-Vargas YA, Pesqueira-Melgarejo R. Correlation between dental enamel chemical composition and bracket debonding, comparing adhesive systems through a scanning electron microscope. Microsc Res Tech 2022; 85:2567-2578. [PMID: 35349203 DOI: 10.1002/jemt.24111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 02/21/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
Literature reports indicate that during bracket removal there can be enamel damage. We compare the shear bond strength (SBS) and tooth enamel loss of four adhesive systems and identify the Ca/P ratio. Then a total of 20 premolars were divided into four groups of five each. After prophylaxis, photographs were taken at 35× with a scanning electron microscope (SEM) and analyzed with X-ray spectroscopy (EDS) at 250×. Brackets were bonded with Transbond™ MIP(G1), Transbond™ PLUS SEP(G2), Enlight(G3) and Stylus®(G4) adhesives, 24 h after were debonded with a Instron universal testing machine at 1 mm/min. All the brackets were photographed with the SEM. The amount of lost enamel was measured with AutoCad. All the results were measured with a significance level p < .05. The SBS general average at debonding was 7.94 ± 2.26 MPa, meanwhile the SBS for G1, G2, G3 and G4 was 9.38 ± 1.46, 6.28 ± 0.69, 9.08 ± 2.45 and 7.04 ± 2.64 MPa respectively. 90% of the samples had no enamel loss, 10% had enamel loss. Only two samples in G1 presented an enamel loss area of 0.34mm2 and 0.80mm2 respectively. From EDS analysis, the Ca/P ratio was 1.6 ± 0.05, 1.61 ± 0.03, 1.64 ± 0.83 and 1.59 ± 0.07 for G1, G2, G3 and G4 respectively; no statistically significant differences were found. We conclude that no association was found between the Ca/P ratio and enamel damage when brackets are removed.
Collapse
Affiliation(s)
| | | | - Hugo M Flores-Ruiz
- Departamento de Ciencias Naturales y Exactas, CUValles, Universidad de Guadalajara, Ameca, Mexico
| | | | | | | | | |
Collapse
|
3
|
Rodríguez-Chávez JA, Arenas-Alatorre JÁ, Flores-Ruiz HM, Flores-Ledesma A, Aguilar-Pérez FJ. Evaluation of enamel loss by scanning electron microscopy after debonding brackets place with four different adhesives. Microsc Res Tech 2020; 84:912-920. [PMID: 33242361 DOI: 10.1002/jemt.23652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022]
Abstract
The clinically adequate shear bond strengths (SBS) should be from 2.8 to 10 MPa. The aim of this research is to observe tooth enamel loss through a scanning electron microscope (SEM) during the debonding of braces of four adhesive systems. Then, 100 premolars were used in 4 groups of 25 specimens each, for Transbond MIP (G1), Enlight (G2), Stylus (G3), and Transbond Plus SEP (G4). The research was done under the NOM ISO/TS 11405:2015. Gemini 3M were placed under the manufacturer's recommendations. The SBS test was done at 24 hr in an Instron electromechanical universal testing machine at 1 mm/1 min. Adhesive remnant index (ARI) was measured, all of the brackets where examined in the SEM. For the shear bonding strength G1 = 10.09 ± 2.73 MPa, G2 = 9.27 ± 3.99 MPa, G3 = 7.83 ± 4.46 MPa, and G4 = 6.40 ± 2.85 MPa statistically significant differences were found when comparing the four groups (p = .002). In the Tukey post hoc test, G1 versus G4 and G2 versus G4, statistically significant differences were found. For the ARI a value of 1 in 46%, followed by a value of 2 in 38%, a value of 3 in 13% and a value of 0 in 3% of the total samples, finding statistically significant differences (p < .001). In relation to the tooth enamel loss due to SBS, statistically significant differences were found (p = .326). G1 and G4 had not statistically significant differences. Even though our results concur with the appropriate clinical values, we observed tooth enamel loss with Transbond Plus SEP and Stylus.
Collapse
Affiliation(s)
- Jacqueline Adelina Rodríguez-Chávez
- Departamento de Clínicas Odontologicas Integrales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Salvador Quevedo y Zubieta 228, Guadalajara, Jalisco, 44340, Mexico
| | - Jesús Ángel Arenas-Alatorre
- Departamento de Materia Condensada, Instituto de Física, Universidad Nacional Autónoma de México, Circuito de la Investigación Científica S/N, Ciudad Universitaria, Delegación Coyoacán, Ciudad de México, 04510, Mexico
| | - Hugo M Flores-Ruiz
- Departamento de Ciencias Naturales y Exactas, Universidad de Guadalajara, CUValles Campus, Carretera Guadalajara-Ameca Km 43.5, Ameca, Jalisco, 46600, Mexico
| | - Abigailt Flores-Ledesma
- Facultad de Estomatología, Benemerita Universidad Autónoma de Puebla, 31 Poniente #1304, Colonia Volcanes, Puebla, Puebla, 72410, Mexico
| | - Fernando Javier Aguilar-Pérez
- Facultad de Odontología, Campus de Ciencias de la Salud, Universidad Autónoma de Yucatán, Calle 61-A num 492-A, Centro, Mérida, Yucatán, 97000, Mexico
| |
Collapse
|
4
|
D’Amario M, Bernardi S, Di Lauro D, Marzo G, Macchiarelli G, Capogreco M. Debonding and Clean-Up in Orthodontics: Evaluation of Different Techniques and Micro-Morphological Aspects of the Enamel Surface. Dent J (Basel) 2020; 8:E58. [PMID: 32560482 PMCID: PMC7344892 DOI: 10.3390/dj8020058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Abstract
There is currently no consensus on the best way to remove adhesive remnants from teeth following debonding. The main objective of this study is to evaluate and compare the effectiveness of four adhesive resin removal (clean-up) techniques, performed with or without the use of an operative microscope. Forty human teeth were duplicated using an epoxy resin for impregnation. Brackets were bonded to teeth and debonded from teeth. Then, the samples were randomly divided into two equal groups-the naked eye group and the magnification group-and further subdivided into four equal subgroups, in order to compare the different techniques used for the clean-up. Each subgroup was formed of five natural teeth with the respective pre- and post-bonding replicas. Macro- and micro-analysis by means of a stereomicroscope and scanning electron microscopy evaluated, qualitatively and quantitatively, the adhesive remnant index and the damage index of the enamel. Overall, the magnification improved the removal of resins compared to the naked eye (p < 0.001), and the use of magnification constantly reduced resin residual and surface damage. Enamel damage and adhesive residual from the clean-up procedures represent an ascertained risk in orthodontics. The use of a magnification system improves the quality of debonding and clean-up techniques in a significant way.
Collapse
Affiliation(s)
- Maurizio D’Amario
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.); (D.D.L.); (G.M.); (G.M.); (M.C.)
| | - Sara Bernardi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.); (D.D.L.); (G.M.); (G.M.); (M.C.)
- Microscopy Center, University of L’Aquila, 67100 L’Aquila, Italy
| | - Daniele Di Lauro
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.); (D.D.L.); (G.M.); (G.M.); (M.C.)
| | - Giuseppe Marzo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.); (D.D.L.); (G.M.); (G.M.); (M.C.)
| | - Guido Macchiarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.); (D.D.L.); (G.M.); (G.M.); (M.C.)
| | - Mario Capogreco
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.); (D.D.L.); (G.M.); (G.M.); (M.C.)
| |
Collapse
|
5
|
Zubizarreta-Macho Á, Triduo M, Alonso Pérez-Barquero J, Guinot Barona C, Albaladejo Martínez A. Novel Digital Technique to Quantify the Area and Volume of Cement Remaining and Enamel Removed after Fixed Multibracket Appliance Therapy Debonding: An In Vitro Study. J Clin Med 2020; 9:jcm9041098. [PMID: 32290554 PMCID: PMC7230799 DOI: 10.3390/jcm9041098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to construct a novel, repeatable, reproducible, and accurate measurement protocol for the area and volume of the remaining cement after removal of fixed multibracket appliances, the area and volume of remaining cement after cement removal, the area and volume of enamel removed after cement removal, and the volume of cement used to adhere fixed multibracket appliances. A total of 30 brackets were cemented and removed with over 30 extracted teeth embedded into three experimental models of epoxy resin. The models were scanned before and after bracket placement, bracket debonding, and polishing the remaining cement. The brackets were submitted to micro-computed tomography. The standard tessellation language digital files were aligned, segmented, and re-aligned using geomorphometric software. The digital measurement technique accuracy, repeatability, and reproducibility were analyzed using Gage R&R statistical analysis. The variability attributable to the area and volume measurement techniques of the total variability of the samples was 0.70% and 0.11% for repeatability, respectively, and 0.79% and 0.01% for reproducibility, respectively. The re-alignment procedure is a repeatable, reproducible, and accurate technique that can be used to measure the area and volume of the remaining cement after removal of fixed multibracket appliances, the area and volume of remaining cement after cement removal, the area and volume of enamel removed after cement removal, and the volume of cement used to adhere the fixed multibracket appliance.
Collapse
Affiliation(s)
- Álvaro Zubizarreta-Macho
- Department of Endodontics, Faculty of Health Sciences, Alfonso X El Sabio University, 28691 Madrid, Spain;
| | - Martina Triduo
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (M.T.); (A.A.M.)
| | - Jorge Alonso Pérez-Barquero
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-963864175
| | - Clara Guinot Barona
- Department of Dentistry, Faculty of Health Sciencies, University Cardenal Herrera-CEU, CEU Universities, 46115 Valencia, Spain;
| | - Alberto Albaladejo Martínez
- Department of Orthodontics, Faculty of Medicine and Dentistry, University of Salamanca, 37008 Salamanca, Spain; (M.T.); (A.A.M.)
| |
Collapse
|
6
|
Knaup T, Korbmacher-Steiner H, Braun A, Wenzler JS, Knaup I, Stein S. Effects of 445-nm Diode Laser-Assisted Debonding of Metallic Brackets on Shear Bond Strength and Enamel Surface Morphology. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:160-166. [PMID: 32195639 DOI: 10.1089/photob.2019.4704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To evaluate the effect of a 445-nm diode laser on the shear bond strength (SBS) of metallic brackets before debonding. Background: Due to the new blue laser technology, very few studies are available in this context. Methods: Seventy metallic brackets (Discovery; Dentaurum, Ispringen, Germany) were bonded to the frontal enamel surfaces of 70 caries-free bovine incisors in a standardized way. Each sample was randomly assigned to the control or laser group, with 35 samples per group. The brackets in the laser group were irradiated with the diode laser (SIROLaser Blue®; Sirona, Bensheim, Germany) on three sides of the bracket bases for 5 s each (lateral-coronal-lateral, a total of 15 s) immediately before debonding. SBS values were evaluated for the control group and laser group. Micrographs of the enamel surface were taken with 10 × magnification to assess the adhesive remnant index (ARI) and the degree of enamel fractures after debonding. Results: There were no statistically significant differences in SBS in the laser group in comparison with the control group (p > 0.05). The distribution of ARI scores was also not statistically significantly different in the laser group in comparison with the control group (p > 0.05). Three enamel fractures occurred in the control group and one in the laser group after debonding. Conclusions: Irradiation of metallic brackets with the 445-nm diode laser before debonding does not significantly reduce the SBS values and does not influence the remaining amount of adhesive on the enamel surface. The risk of enamel fractures during debonding is therefore not clinically affected.
Collapse
Affiliation(s)
- Thomas Knaup
- Department of Orthodontics, University of Marburg, Marburg, Germany
| | | | - Andreas Braun
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University of Aachen, Aachen, Germany
| | - Johannes-Simon Wenzler
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University of Aachen, Aachen, Germany
| | - Isabel Knaup
- Department of Orthodontics, University of Aachen, Aachen, Germany
| | - Steffen Stein
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, University of Aachen, Aachen, Germany
| |
Collapse
|
7
|
Evaluation of Enamel Topography after Debonding Orthodontic Ceramic Brackets by Different Er,Cr:YSGG and Er:YAG Lasers Settings. Dent J (Basel) 2020; 8:dj8010006. [PMID: 31936500 PMCID: PMC7175227 DOI: 10.3390/dj8010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/17/2022] Open
Abstract
In the last decade, the success of lasers in simplifying many dental procedures has heightened the need for research in the orthodontic field, in order to evaluate the benefits of laser-assisted ceramic brackets debonding. Conventional ceramic brackets removal delivers a high shear bond strength (SBS), which might lead to enamel damage. Nowadays, debonding ceramic brackets by Er:YAG laser seems a viable alternative technique; however, there is no data on the use of Er,Cr:YSGG in the literature. We aimed to evaluate the difference in enamel topography derived from different erbium laser settings used during debonding. One hundred and eighty bovine incisors teeth were randomly divided into fifteen experimental groups, according to different erbium laser settings using scanning methods. SBS testing was performed after debonding; stereomicroscopic and SEM analyses were done after cleaning the remaining adhesive so as to assess the incidence of enamel microcracks formation and enamel loss. There were no statistically significant differences between the proportions of teeth with normal enamel topography within the control group when compared with any of the Er:YAG groups. However, the proportion of teeth with a normal enamel topography in Er,Cr:YSGG was 4 W/20 Hz (83.3%) and in Er:YAG was 5 W/20 Hz (91.7%), which was statistically significantly higher than the control group (41.7%). The selection of erbium lasers' optimal parameters during debonding influences the enamel topography. When considering the evaluation of both microscopic and statistical analyses, irradiation by Er:YAG (120 mJ/40 Hz) displayed a significant reduction in microcracks compared with conventional debonding, even though some microstructural changes in the enamel could be noted. Er,Cr:YSGG (4 W/20 Hz) respected the enamel topography the most out of the studied groups.
Collapse
|
8
|
Hoteit M, Nammour S, Zeinoun T. Assessment of microcracks and shear bond strength after debonding orthodontic ceramic brackets on enamel priorly etched by different Er,Cr:YSGG and Er:YAG laser settings without acid application: An in vitro study. Int Orthod 2019; 17:744-757. [PMID: 31543426 DOI: 10.1016/j.ortho.2019.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND DATA Enamel microcrack formation has a high incidence after mechanical debonding of ceramic brackets. This may be due to high delivered shear bond strength values when enamel is priorly etched by phosphoric acid. It is still not well elucidated in the literature if laser etching affects enamel the same way. The aim of the research was to analyze different Er,Cr:YSGG and Er:YAG laser etching settings as an alternative to phosphoric acid, in an attempt to prevent enamel microcrack formation during laser etching and mechanical debonding, while reducing the shear bond strength to the minimal clinical acceptable value. MATERIALS AND METHODS One hundred and thirty-three teeth were randomly divided into 7 experimental groups according to their etching modalities. Settings used for enamel etching were in Er,Cr:YSGG groups: Er,Cr:YSGG (1.5Watt, W/20Hertz, Hz); Er,Cr:YSGG (1.5W/15Hz) and Er,Cr:YSGG (2W/20Hz) and settings used for enamel etching in Er:YAG groups were: Er:YAG (60 millijoules, mJ), Er:YAG (80mJ) and Er:YAG (100mJ). Group C etched with 37% phosphoric acid served as control. Microscopic analysis was performed to assess presence of enamel microcracks. Shear bond strength was evaluated after thermocycling using Weibull survival analysis. RESULTS All groups showed a reduction in additional microcracks after debonding when compared to control, but only group Er:YAG (60mJ) exhibited a statistically significant difference. Groups Er:YAG (80mJ), control and Er:YAG (100mJ) showed respectively the highest probability of survival at various stress levels followed by groups Er:YAG (60mJ); Er,Cr:YSGG (1.5W/15Hz); Er,Cr:YSGG (2W/20Hz) and Er,Cr:YSGG (1.5W/20Hz) that presented a relatively considerable risk of failure, even at low stress levels. CONCLUSIONS When considering reduction of enamel microcrack formation and clinical acceptable shear bond strength, none of the groups succeeded both. Etching by Er:YAG (60mJ) and Er,Cr:YSGG (1.5W/15Hz), showed the least overall microcrack incidence between groups, but Er:YAG (60mJ) displayed significant reduction compared to phosphoric acid. However, etching by Er:YAG (80mJ) had the most predictable results in term of shear bond strength.
Collapse
Affiliation(s)
- Marwan Hoteit
- Lebanese University, Faculty of Dental Medicine, Department of Orthodontics, Hadath, Lebanon.
| | - Samir Nammour
- University of Liege, Faculty of Medicine, Department of Dental Science, 4020 Liege, Belgium
| | - Toni Zeinoun
- Lebanese University,Faculty of Dental Medicine, Department of Oral and Maxillofacial Surgery, Lebanon
| |
Collapse
|