Diode laser debonding of ceramic brackets

Efficacy of Lasers in Debonding Ceramic Brackets: Exploring the Rationale and Methods

The development of ceramic brackets in orthodontics three decades ago emerged as a response to the increasing patient demand for less visible orthodontic appliances. While these brackets provide superior aesthetics, they are characterized by lower fracture toughness and higher bond strength in contrast to metal brackets. These properties present challenges during the debonding step, including the risk of enamel micro-fractures and cracks. Historically, various strategies have been developed to address challenges associated with debonding, reduce patient discomfort, and ensure that the bond failure site is confined to the bracket-adhesive interface. This included the use of specially designed debonding pliers, electrothermal debonding, ultrasonic technique, and chemical agents. Recently, there has been a shift towards utilizing different types of laser irradiation for this purpose. The burgeoning strategy, however, requires diligent scientific scrutiny to establish a standardized protocol with particular laser parameters and ultimately achieve the goal of enhancing the patient experience by reducing discomfort. This article offers a narrative review of laser-aided debonding of ceramic brackets, aimed at comparing different laser types, presenting their benefits and downsides, validating the efficiency of each method, and summarizing the published literature on this subject. It also provides insights for orthodontists on reducing patient discomfort that usually accompanies debonding ceramic brackets by delving into the science behind the use of lasers for this purpose.

Effectiveness of Two Intensity Levels of Diode Laser in Debonding Metallic Brackets Regarding Enamel Surface Integrity and Pulpal Temperature: An Ex-Vivo Study

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.

The influence of pulse duration and exposure time of Er,Cr:YSGG laser on lithium disilicate laminate debonding, an in vitro study

Problem statement

Grinding restorations, such as veneers, with rotary instruments, is the conventional removal approach. It may be accompanied by micro-fractures that affect the adjacent healthy dental structures. Differentiation of the veneer from the dental structure, as well as the resin cement, is not a highly selective procedure when rotary instruments are used. Moreover, the rotary instruments may lead to scratches and overheating of the enamel. Patient discomfort is another disadvantage, due to the noise of the drill.

Purpose

The purpose of this in vitro study was to examine the effectiveness of a 2790 nm Er,Cr:YSGG laser to debond lithium disilicate laminate, utilizing two distinct pulse durations and various exposure times. The shear bond strength, intrapulpal temperature, and adhesive remaining index were evaluated.

Methods and materials

This study included three groups of 75 extracted permanent mandibular incisors: G1, G2 (laser-treated groups were classified according to the pulse duration) and C (control group). Twenty five samples were regarded for each group. Both test groups were irradiated with a 3 W output power of Er,Cr:YSGG laser, for a variety of time intervals (20 s, 30 s, 40 s, 50 s, and 60 s). Five samples were tested for each time interval. During irradiation, the temperature in the pulp chamber was monitored using a K-type thermocouple connected to a digital multilogger thermometer that was introduced into the prepared sample pulp chamber. Subsequently, the shear bond strength was measured for G1 and G2, in addition to the control group (no irradiation). The adhesive remaining index was examined microscopically. The area was measured and analysed, and then, transformed into scores for comparisons. Finally, One untreated sample and two other samples of the highest power value from laser-treated groups were examined for their surface morphology by scanning electron microscope (SEM).

Results

The debonding protocols were safe relative to the intrapulpal protocol. The temperature rise after an exposure time of 50 s and 60 s was significantly different from an exposure time of 20 s, 30 s, and 40 s, in both groups (p < 0.05). Both G1 and G2 significantly outperformed the control group in shear bond strength. There was no significant difference between G1 and G2 at any of the tested exposure times (p > 0.05). Nevertheless, the 60 s exposure time showed the lowest shear bond strength.

Conclusion

Regarding intralpulpal temperature, both modes can be safely used to remove laminate veneers. In sum, an exposure time of 50 s and a pulse duration of 60 μs demonstrated superior results for SBS, adhesive remaining index, and temperature values.

Clinical implication

Lithium disilicate laminate veneers may be removed quickly, safely, and comfortably. Laser-assisted debonding of porcelain laminate veneer is recommended and does not cause any damage to the veneer or enamel surface.

Assessment of chemical, ultrasonic, diode laser, and Er:YAG laser application on debonding of ceramic brackets

Background

Risk of enamel damage that often accompanies ceramic brackets debonding raises the demand of finding an optimal method for debonding of them without adverse effects. Different techniques were proposed in an attempt to facilitate their debonding. Comparison of these techniques is crucial. The aim of this study was to evaluate and compare different techniques for debonding of ceramic brackets in terms of shear bond strength and adhesive remnant index.

Materials and methods

A total of 100 extracted premolars were randomly allocated into 5 groups. Ceramic brackets were then bonded to teeth using light cure composite resin. Among test groups; group I: served as control, group II: chemical aided debonding via peppermint oil, group III: ultrasonic aided debonding, group IV: diode laser aided debonding, and group V: Er:YAG laser aided debonding. Brackets were shear tested using universal testing machine followed by ARI assessment and evaluation of enamel microstructure was performed using scanning electron microscopy.

Results

A significantly lower shear bond strength was found in ultrasonic, diode, and Er:YAG laser groups. However, no significant difference was found in the chemical group. A significantly higher adhesive remnant index was found solely in Er:YAG laser group with minimal enamel microstructure alterations.

Conclusions

Er:YAG laser is a promising tool in debonding ceramic brackets. Ultrasonic and diode laser significantly reduced shear bond strength. Yet, adhesive remnant index in both groups revealed no difference. Chemical aided debonding had little effect and hence, it cannot be recommended without further development.

The Effect of Erbium-Doped Yttrium Aluminum Garnet Laser in Debonding of Orthodontic Brackets: A Systematic Review of the Literature

Objective: The purpose of this review is to systematically assess the existing literature and summarize the evidence regarding the effect of erbium-doped yttrium aluminum garnet (Er:YAG) laser on enamel surface roughness and pulp health compared with the conventional orthodontic debonding techniques. Materials and methods: Following the preferred reporting items for systematic reviews (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement, the electronic database, PubMed, Scopus, Web of Science, Google scholar, and Saudi Digital Library were searched for relevant published records. Data were collected following specific keywords: "debonding" "Er:YAG laser" etc. In vitro studies, and clinical randomized- and nonrandomized-controlled studies limited to the English language and published in peer-reviewed journals were included. Results: A total of 564 articles were identified as relevant to the topic. Duplicates were excluded resulting in 382 articles, out of which 374 articles were discarded upon screening titles and abstracts. The remaining eight articles were read to their entirety and included in the current qualitative review after fulfilling the eligibility criteria. In all the included studies, a total of 480 sound posterior teeth were used to evaluate the effect of Er:YAG laser on debonding of orthodontic brackets from the enamel surface. Conclusions: Er:YAG laser debonding has demonstrated a reduced risk of enamel damage (fracture or cracks) but resulted in increased enamel surface roughness and was time-consuming for adhesive removal procedures compared with the conventional debonding methods. Further, within the applied laser settings, Er:YAG lasers have found to exhibit low thermal exhaustion in relation to the pulp. The laser source with a wavelength of 2940 nm has been used with different setting ranges (power of 2.5-5 W, energy 125-600 mJ, frequency 4-30 Hz, and pulse duration 50-350 μsec) for debonding of orthodontic brackets.

Effects of Diode and Nd:YAG Laser Irradiation on Friction Forces Between Two Types of Ceramic Brackets and Rhodium-Coated Archwires

Introduction: Ceramic brackets have gained increasing popularity among dental clinicians and orthodontic patients but friction is a major concern when using them. This study sought to assess the effects of diode and Nd:YAG (neodymium-doped yttrium aluminum garnet) laser irradiation on friction forces between two types of ceramic brackets and rhodium-coated esthetic archwires. Methods: Thirty polycrystalline and 30 poly-sapphire brackets were divided into 6 groups (n=10) as follows: (I) control polycrystalline brackets (no laser irradiation), (II) polycrystalline brackets subjected to diode laser irradiation, (III) polycrystalline brackets subjected to Nd:YAG laser irradiation, (IV) control poly-sapphire brackets (no laser irradiation), (V) poly-sapphire brackets subjected to diode laser irradiation, and (VI) poly-sapphire brackets subjected to Nd:YAG laser irradiation. The bracket slots were laser-irradiated on a custom-made table. Sixty 5-cm pieces of rhodium-coated archwires were used for the friction test in a universal testing machine at a speed of 10 mm/min. Ten brackets from the six groups underwent scanning electron microscopy (SEM), X-ray diffraction (XRD) and energy-dispersive X-ray spectroscopy (EDX). Results: The frictional resistance value of polycrystalline brackets was significantly higher than that of poly-sapphire brackets, irrespective of laser type (P <0.05). Irradiation of diode and Nd:YAG lasers, compared with the control group, had no significant effect on friction, irrespective of bracket type (P >0.05). Conclusion: It appears that diode and Nd:YAG laser irradiation cannot significantly decrease the friction. Future studies are warranted on different laser types with variable exposure.

Er,Cr:YSGG Laser in the Debonding of Feldspathic Porcelain Veneers: An In Vitro Study of Two Different Fluences

Background: New applications in laser technology in aesthetic restorative dentistry merit further research. This study compares the debonding strength and failure mode of feldspathic ceramic veneers using either Er,Cr:YSGG (erbium,chromium:ytrrium-scandium-gallium-garnet) laser at two levels of fluency or no laser (control group). Methods: An in vitro comparative study was carried out using bovine teeth that were randomly distributed into 3 groups of 21 specimens each: (a) experimental group 1 (EG1): irradiated with Er,Cr:YSGG (Waterlase iPlus®; Biolase, Irvine) at an energy density per pulse of 4 J/cm2, using a handpiece (Turbo; Biolase) with a sapphire tip (MX7) and applying the beam perpendicular to the specimen at a distance of 4 mm for 60 sec; (b) experimental group 2 (EG2): irradiated as in EG1, but at 2.7 J/cm2; and (c) control group (CG): debonding without laser irradiation. Results: The stress required for veneer debonding was 8.19 MPa in CG, 0.91 MPa in EG1, and 0.48 MPa in EG2. The difference between the control and both experimental groups was statistically significant (p < 0.001). The percentages of adhesive failure were 40%, 61.9%, and 96%, respectively. Conclusions: Using the Er,Cr:YSGG laser at 4 or 2.7 J/cm2 requires significantly less force to debond ceramic veneers. The percentage of adhesive failures in the two experimental protocols was higher than in the control group. Application of the Er,Cr:YSGG laser using the parameters in this study may be useful in removing feldspathic ceramic veneers, avoiding damaging them and protecting the enamel.

Morphological, optical, and elemental analysis of dental enamel after debonding laminate veneer with Er,Cr:YSGG laser: A pilot study

Laminate veneer removal is becoming a routine procedure at the dental clinic and the use of laser can facilitate its removal. This work aimed to evaluate the morphological, elemental, and optical changes in the remaining enamel after veneer removal using Er,Cr:YSGG laser. Forty-four enamel slabs were prepared and randomly distributed into nine experimental groups, for bonding using lithium disilicate laminates with three different luting agents (Variolink Veneer, RelyX U200, and RelyX Veneer). Then each agent was debonded using Er,Cr:YSGG laser (2.78 μm) using two different protocols:3.5 W, 48.14 J/cm² , 20 Hz non-contact and 3.0 W, 48.14 J/cm² , 20 Hz non-contact. The morphological, optical, and elemental analysis of enamel was performed before cementation and after laser debonding, using scanning electron microscopy (SEM), optical coherence tomography (OCT), and energy-dispersive X-ray spectroscopy (EDS). The level of statistical significance adopted was 5%. The EDS analysis of enamel after debonding revealed a significant increase in silane and carbon, as well as a decrease in calcium and phosphate contents. Analysis showed the presence of residual cement in most experimental groups but the morphological analysis showed alteration of the enamel's prisms only in the groups that used RelyX Veneer and Variolink Veneer cements. There was no evidence of deleterious morphological changes resulting from irradiation. However, an increase in the optical attenuation coefficient by the OCT was observed due to the presence of the remaining cement. It can be concluded that the Er,Cr:YSGG laser, in the mean powers used, is efficient for veneer removal without causing deleterious effects for the enamel.

Effects of 445-nm Diode Laser-Assisted Debonding of Metallic Brackets on Shear Bond Strength and Enamel Surface Morphology

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.

Effect of Er:YAG and Er,Cr:YSGG Lasers on Ceramic Bracket Debonding from Composite Blocks

Objectives:

This study aimed to assess the effect of erbium-doped yttrium aluminum garnet (Er:YAG) and erbium, chromium: yttrium, scandium, gallium, garnet (Er,Cr:YSGG) lasers on the shear bond strength (SBS) of ceramic brackets debonding from the surface of composite blocks.

Materials and Methods:

Thirty-six composite blocks were fabricated using Filtek Z250 light-cure composite. Block surfaces were etched with 37% phosphoric acid for 30 seconds and then rinsed with water for 20 seconds and dried. Maxillary right central incisor ceramic orthodontic brackets were bonded to the surfaces of composite blocks using Transbond XT adhesive and were cured for 40 seconds. Twelve samples were irradiated with Er:YAG laser, while 12 samples were irradiated with Er,Cr:YSGG laser, and the brackets were then debonded using a universal testing machine. Twelve samples served as controls (debonding using the universal testing machine without using a laser). The adhesive remnant index (ARI) score and bracket or composite cracks were evaluated under a stereomicroscope. One-way analysis of variance (ANOVA) was used for the comparison of the three groups. Kruskal-Wallis test was used to compare the ARI scores.

Results:

The mean SBS was 17.01±5.22 MPa with Er:YAG laser, 18.03±6.46 MPa with Er,Cr:YSGG laser, and 16.61±6.73 MPa in the control group; the difference of the three groups was not significant (P=0.835). The difference in the ARI scores and enamel and composite cracks was not significant either (P>0.05).

Conclusion:

This study did not show any reduction in the bond strength of ceramic bracket to composite blocks after Er:YAG and Er,Cr:YSGG laser irradiation.

Evaluation of the Shear Bond Strength and Adhesive Remnant Index in Debonding of Stainless Steel Brackets Assisted with Nd:YAG Laser Irradiation

Objectives:

The purpose was to compare shear bond strength (SBS), pulp temperature, and adhesive remnant index (ARI) in debonding of stainless steel brackets from enamel surface using neodymium-doped yttrium aluminum garnet (Nd:YAG) laser versus the conventional debonding method.

Materials and Methods:

Forty-eight extracted premolars were bonded to stainless steel brackets. The samples were divided into three experimental groups and one control group. In the first three groups, Nd:YAG laser was used for debonding with the power of 1, 1.5, and 2 W, respectively, for 10 seconds. The SBS and ARI of the samples were assessed. Pulp temperature was recorded before and after irradiation. Two samples from each group were used for determining enamel morphology after debonding using scanning electron microscopy (SEM).

Results:

The mean SBS in the groups was 33.05, 28.69, 24.37, and 31.53 MPa, respectively, with no statistically significant differences (P=0.205). Significant differences in post-irradiation temperature were noted among the lased groups (P=0.000). Debonding mainly occurred at the adhesive-enamel interface in the 1-W laser and control groups and at the bracket-adhesive interface in the 1.5-W and 2-W laser groups. Enamel structure was amorphous and irregular following laser irradiation.

Conclusion:

Based on the results of this study, the use of Nd:YAG laser could not significantly affect the SBS. Therefore, this laser would not be suitable for debonding of metal brackets. The use of a 2-W laser could significantly raise the pulpal temperature. Nd:YAG laser renders a more heterogeneous enamel morphology compared to conventional debonding methods.

Evaluation of rebonding strengths of leucite and lithium disilicate veneers debonded with an Er:YAG laser

Resin cements create a high bond between the tooth and ceramic surfaces, thus making it impossible to remove the restoration in one piece. The aims of this study were to evaluate (i) the efficiency of an Er:YAG laser for debonding, and (ii) the changes in the rebonding strength values of all-ceramic veneers, which were removed after laser application. A tooth reduction of 120 extracted human maxillary central incisors was made to provide two different bonding surfaces (60 enamel and 60 dentin). Sixty leucite and 60 lithium disilicate discs (1-mm thickness, 5-mm diameter) were cemented to prepared surfaces with a dual-cure resin cement. Each group was divided into two subgroups (n = 15): control and laser-irradiated. Er:YAG laser (2940 nm) was applied for 9 s at 3 W power (10 Hz, 300 mJ) with 100 μs pulse duration. Shear bond strength (SBS) test was made with a universal testing machine. After the tested laser-irradiated specimens had been rebonded, the SBS test was performed again and rebonding strengths were measured. The statistical evaluations were performed by using repeated measures one-way ANOVA and post hoc Bonferroni tests (p < 0.05). Significant differences were found between the control and laser-irradiated groups (p < 0.001). While the required SBS values for control groups were between 30.04 and 24.66 MPa, the values for laser-irradiated groups were between 6.60 and 4.09 MPa. There was no significant difference between the control and rebonded groups. Er:YAG laser-irradiation is an effective method for removing all-ceramic restorations without affecting the rebonding strength.

Different modes of diode laser irradiation: effects on enamel surface and intrapulpal temperature at debonding

Background

laser aided debonding of ceramic brackets has been proved to be effective in reducing enamel surface damages, though the optimal parameters of laser to be chose is in question. The aim of this study was to investigate the six different regimens of diode laser irradiation on enamel surface characteristics and intrapulpal temperature changes while debonding.

Materials and methods

90 polycrystalline brackets were bonded to 90 intact extracted premolars. At debonding, teeth were divided into 6 groups (n = 15) and were subjected to the following regimen of diode laser irradiation; G1 = 2 W, continuous wave, G2 = 2.5 W, continuous wave, G3 = 3 W, continuous wave, G4 = 2 W, pulsed mode, G5 = 2.5 W, pulsed mode, G6 = 3 W, pulsed mode. After debonding, the adhesive remnant index, the lengths and frequency of enamel cracks were compared among the groups. 5 teeth out of 15 were randomly selected from each group to assess the intrapulpal temperature changes.

Results

The number of enamel cracks increased significantly in all the specimens after debonding. Enamel crack length increased significantly in all the study groups except G3 and G6. The increase in intrapulpal temperature was significantly below the benchmark of 5.5 C for all the specimens. Significant difference was observed in adhesive remnant index scores among the groups and more than half of the teeth showed a score of 2.

Conclusion

Diode-laser irradiation in pulsed mode or continuous wave at given outputs (2, 2.5, 3 W) were not statistically different in regard to producing enamel surface damages or increasing intrapulpal temperature.

Efficiency of Er:YAG laser in debonding of porcelain laminate veneers by contact and non-contact laser application modes (in vitro study)

OBJECTIVE

To determine the efficiency of debonding porcelain laminate veneers (PLV) by using several laser parameters and two different application modes of Er:YAG laser [contact (CM) and non-contact (NCM)], by verification of the consumed PLV debonding time and the changes in dental pulp temperature.

MATERIALS AND METHODS

Forty extracted non-carious human maxillary premolars were prepared for receiving PLV. Sixteen of them were divided into two groups, each of them comprised eight samples based on the application mode; group A with NCM, and group B with CM. Veneers of both groups were debonded by the same laser parameters (360 mJ, 15 Hz) during loading of a 15 N force on specially fabricated veneer cervical margins. The primary results showed that the NCM was more efficient, thus, additional groups (C, D, and E) of the same mode and number of samples were tested with different laser parameters of energy and frequency; group C (400 mJ, 10 Hz), group D (270 mJ, 15 Hz), group E (300 mJ, 10 Hz). The failure mode was determined and classified for the debonded samples of all groups.

RESULTS

All veneers were debonded and samples of the NCM group had considerably lower debonding time (12.6 seconds) than the CM samples (96.3 seconds), however, higher changes of temperature in NCM (4.2°C) than in CM were observed (2.9°C). The failure mode of samples was either type 1 or 3.

CONCLUSION

Er:YAG laser is an effective tool in debonding PLVs. The NCM application mode was more efficient in reducing debonding time than CM application mode but with a higher change in pulp temperature.

CLINICAL SIGNIFICANCE

Investigating the efficacy of Er:YAG laser as a non-invasive particle technique for debonding of failed or malpositioned of porcelain laminated veneers.

Intrapulpal Temperature Increases Caused by 445-nm Diode Laser-Assisted Debonding of Self-Ligating Ceramic Brackets During Simulated Pulpal Fluid Circulation

OBJECTIVE

This study investigated temperature increases in dental pulp resulting from laser-assisted debonding of ceramic brackets using a 445-nm diode laser.

MATERIALS AND METHODS

Eighteen ceramic brackets were bonded in standardized manner to 18 caries-free human third molars. Pulpal fluid circulation was simulated by pumping distilled water at 37°C through the pulp chamber. The brackets were irradiated with a 445-nm diode laser. Temperatures were measured using a thermal camera at points P1 (center of the pulp) and P2 (in the hard dental tissue) at the baseline (T0), at the start and end of laser application (T1 and T2), and the maximum during the sequence (T_max).

RESULTS

Significant differences in the temperatures measured at P1 and P2 were observed among T0, T1, T2, and T_max. Significant increases in temperature were noted at points P1 and P2, between T1 and T2, T1 and T_max, and T2 and T_max. The maximum P2 values were significantly higher than at P1. The maximum temperature increase measured in the pulp was 2.23°C, lower than the critical threshold of 5.5°C.

CONCLUSIONS

On the basis of the laser settings used, there is no risk to the vitality of dental pulp during laser-assisted debonding of ceramic brackets with a 445-nm diode laser.

445-nm diode laser-assisted debonding of self-ligating ceramic brackets

Objectives:

This study determined the influence of irradiation on aesthetic ceramic brackets with a novel 445-nm diode laser prior to debonding on the bracket failure mode.

Materials and methods:

Thirty ceramic brackets (In-Ovation® C, GAC) were standard-bonded to the oral and buccal planed and polished enamel surfaces of 15 caries-free human 3

Results:

In the laser group, the ARI-score was statistically significantly reduced (p<0.05) at 10-fold and 20-fold magnifications compared to the conventional group, while enamel fractures were not found at any magnification in either group at T1. Enamel fractures and grinding marks were increasingly found in the conventional group by SEM at T2.

Conclusion:

Irradiation with the novel diode laser prior to debonding of ceramic brackets significantly changes bonding failure in terms of less remaining adhesive. This is of clinical importance as the risk of enamel fractures and chair time can be reduced.

Effects of 445-nm Diode Laser-Assisted Debonding of Self-Ligating Ceramic Brackets on Shear Bond Strength

OBJECTIVE

The aim of this study was to measure the effect of irradiation with a novel 445-nm diode laser on the shear bond strength (SBS) of ceramic brackets before debonding.

MATERIALS AND METHODS

Thirty ceramic brackets (In-Ovation^® C, GAC) were bonded in standard manner to the planed and polished buccal enamel surfaces of 30 caries-free human third molars. Each tooth was randomly allocated to the laser or control group, with 15 samples per group. The brackets in the laser group were irradiated with the diode laser (SIROLaser Blue^®; Sirona) on three sides of the bracket bases for 5 sec each (lateral-coronal-lateral, a total of 15 sec) immediately before debonding. SBS values were measured for the laser group and control group. To assess the adhesive remnant index (ARI) and the degree of enamel fractures, micrographs of the enamel surface were taken with 10-fold magnification after debonding.

RESULTS

The SBS values were significantly lower statistically in the laser group in comparison with the control group (p < 0.05). The ARI scores were also significantly lower statistically in the laser group in comparison with the control group (p < 0.05). No bracket fractures or enamel fractures occurred in either group after debonding.

CONCLUSIONS

Irradiation of ceramic brackets with the novel diode laser before debonding significantly reduces the SBS values. This is of clinical importance, as it means that the risk of damage to the teeth, bracket fractures, and the overall treatment time can be reduced.

Intrapulpal Temperature Increase During Er:YAG Laser-Aided Debonding of Ceramic Brackets

OBJECTIVE

The purpose of this study was to evaluate the temperature changes in the pulp chamber while using a newly introduced application of Er:YAG laser to debond ceramic brackets in a study model with a pulpal circulation with and without thermocycled samples.

BACKGROUND DATA

An esthetic alternative to stainless steel brackets, ceramic brackets have been proposed. However, because of their low fracture resistance and high bond strengths, ceramic brackets can cause a problem when they are being removed using conventional techniques.

MATERIALS AND METHODS

Experimental Groups A and B were established for samples with or without thermocycling. The same 20 maxillary central incisor and 20 premolar teeth were used in both groups. Pulpal blood microcirculation was simulated using an apparatus described in a previous study. Monocrystalline brackets were bonded by using Transbond XT. In Group A, brackets were debonded using the Er:YAG laser (600 mJ, 2 Hz, long pulse, and no air or water spray) after being stored in distilled water for 24 h. In Group B, brackets were debonded using the same laser system as that used in Group A after being stored in distilled water for 24 h and then thermocycled for a total of 5000 cycles between 5°C and 55°C. The laser irradiation duration and intrapulpal temperature changes were measured.

RESULTS

In Group B, the intrapulpal temperature increase of the central incisors was significantly higher than that of the premolar teeth. In the central incisor and premolar teeth groups, there were no statistically significant difference between Groups A and B (p > 0.05). A positive correlation was found between laser irradiation duration and temperature increase (p < 0.01).

CONCLUSIONS

The use of Er:YAG laser is an effective method for debonding the monocrystalline ceramic brackets. This method can be used safely under the consideration of intrapulpal temperature changes.

Debonding of ceramic brackets by Er:YAG laser

Purpose:

The objective of the present study is to evaluate the effects of Er:YAG laser debonding of ceramic brackets on the bond strength and the amount of adhesive resin remnant.

Materials and Methods:

Twenty human mandibular incisors were randomly divided into two groups of 10 and polycrystalline ceramic brackets (Transcend series 6000, 3M Unitek, Monrovia, CA, USA) were bonded on enamel surfaces. Group 1 was the control group in which no laser application was performed prior to the shear bond strength (SBS) testing. In Group 2, Er:YAG was applied in 3W power for 6 seconds using the scanning method. The brackets were tested for SBS with an Instron universal testing machine and results were expressed in megapascals (MPa). The amount of adhesive remnant was evaluated with Adhesive Remnant Index (ARI). One-way analysis of variance and Tukey’s post-hoc tests were used for statistical analysis.

Results:

Mean ± standard deviation of SBS values in the control group was 13.42 ±1.23 MPa and 8.47 ±0.71 MPa in the Er:YAG group and this difference was statistically significant (p<0.05). The evaluation of ARI scores demonstrated more adhesive was left on the enamel surface with Er:YAG group.

Conclusion:

3W power Er:YAG laser application with the scanning method to polycrystalline ceramic brackets demonstrated lower bond strengths and higher ARI scores during the debonding procedure.

Immediate and Delayed Effects of Diode Laser on Debonding of Ceramic Brackets: An in vitro Study

AIM

The aim of the study is to evaluate the immediate and delayed effects of diode laser on debonding of ceramic brackets.

MATERIALS AND METHODS

A total of 60 human extracted premolar teeth were randomly assigned to three different treatment groups. All teeth were bonded with adhesive precoated (APC) ceramic brackets (3M Unitek). A total of 20 teeth were debonded without lasing (group 1), 20 immediately after lasing (group 2), and 20 1 hour after lasing (group 3). For the lasing groups (groups 2 and 3), access cavity was prepared on the occlusal surface to a 2 mm diameter. A transbond plus self-etching primer (3M Unitek, Monrovia, CA, USA) and APC PLUS clarity advanced brackets (3M, Unitek, Monrovia, CA, USA) were used. The shear bond strength (SBS) and adhesive remnant index (ARI) were measured. The internal pulpal wall temperature was noted for the laser groups.

RESULTS

The mean SBS was 15.4, 11.57, and 11.79 MPa for groups 1 to 3 respectively. Post hoc test showed significant difference (p < 0.001) between the control group and the lased groups. For groups 2 and 3, the rise in temperature was at an average of 1.4 and 1.3°C respectively.

CONCLUSION

The SBS of APC brackets decreased by 33.3% on application of diode laser without increasing the internal pulp chamber wall temperature significantly. Shear bond strength remains more or less the same whether debonding is done immediately after lasing or 1 hour after lasing. Diode lasers increased the ARI scores and thus decreased the risk of enamel fracture.

Laser-Aided Ceramic Bracket Debonding: A Comprehensive Review

Different techniques have been introduced for the removal of ceramic brackets. Since the early 1990s, lasers have been used experimentally for debonding ceramic brackets. The goal of this study is to give a comprehensive literature review on laser-aided ceramic bracket debonding. PubMed and Google Scholar databases were used to identify dental articles with the following combination of key words: Ceramic brackets, Debonding, and Laser. Sixteen English articles from 2004 to 2015 were selected. The selected studies were categorized according to the variables investigated including the intrapulpal temperature, shear bond strength, debonding time, enamel damage and bracket failure. Most articles reported decreased shear bond strength and debonding time following laser irradiation without any critical and irritating increase in pulpal temperature. There were no reports of bracket failure or enamel damage. Laser irradiation is an efficient way to reduce shear bond strength of ceramic bracket and debonding time. This technique is a safe way for removing ceramic bracket with minimal impact on intrapulpal temperature and enamel surface and it reduces ceramic bracket failure.

Using an Er,Cr:YSGG laser to remove lithium disilicate restorations: A pilot study

STATEMENT OF PROBLEM

The use of lasers is growing widely in dentistry. Despite its clinical implications, most information and clinical data related to the removal of ceramic restorations with the aid of a laser is either anecdotal or in the form of clinical reports.

PURPOSE

The purpose of this in vitro study was to establish a parameter on the removal of lithium disilicate crowns with a laser and conduct an in vitro trial of crown removal based on the wattage and time of application.

MATERIAL AND METHODS

Twenty extracted molars were prepared to accommodate a lithium disilicate disk specimen, which was cemented with resin cement. An erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser was applied at different wattages (3, 3.5, 4, and 5 W) to determine the optimal wattage for the removal of the lithium disilicate specimens. Once the optimal wattage was established, 25 extracted teeth were mounted in stone, then prepared to receive milled lithium disilicate computer-aided design/computer-aided manufacturing complete coverage crowns. The crowns were cemented with a dual-polymerizing resin cement. The groups comprised 3.5 and 4 W output with 30-, 60-, and 90-second application time (n=5), and 5 crowns were removed using traditional handpiece and electric handpiece with coarse grit diamond rotary instruments. The results and time required to remove the crown were recorded. The chi-square test was performed to assess any significant differences in removing the crown with the laser according to wattage or time of application (α=.05).

RESULTS

Laser application at 3.5 and 4 W was best for removing crowns conservatively. Eight crowns (40%) of 20 specimens were successfully removed at the first attempt. The majority of the crowns came off during the second attempt. The chi-square test revealed no significant difference between the combination of wattage and time of application (P= .92). The mean time to remove the lithium disilicate crown with a diamond rotary instrument was 6 minutes, and removal required 1.8 instruments on the average.

CONCLUSIONS

An Er,Cr:YSGG laser can safely remove lithium disilicate crowns with the settings used this study.

The effect of transmitted Er:YAG laser energy through a dental ceramic on different types of resin cements

BACKGROUND AND OBJECTIVE

The laser debonding procedure of adhesively luted all-ceramic restorations is based on the ablation of resin cement due to the transmitted laser energy through the ceramic. The purpose of this study was to determine the effect of Er:YAG laser irradiation transmitted through a dental ceramic on five different resin cements.

MATERIALS AND METHODS

Five different resin cements were evaluated in this study: G-Cem LinkAce, Multilink Automix, Variolink II, Panavia F, and Rely X Unicem U100. Disc shaped resin cement specimens (n = 10) were fabricated for each group. A ceramic disc was placed between the resin cement discs and the tip of the handpiece of Er:YAG laser device. The resin cement discs were irradiated through the ceramic and the volume of the resin cement discs were measured using a micro-CT system before and after Er:YAG laser irradiation. The volume loss of the resin cement discs was calculated and analyzed with one-way ANOVA and Tukey-HSD tests.

RESULTS

The highest volume loss was determined in G-Cem (1.1 ± 0.6 mm³ ) and Multilink (1.3 ± 0.1 mm³ ) (P < 0.05) groups, and the lowest volume loss was determined in Rely X (0.3 ± 0.07 mm³ ), Variolink (0.4 ± 0.2 mm³ ), and Panavia (0.6 ± 0.2 mm³ ) groups (P < 0.05). All resin cements were affected by the laser irradiation resulting in the volume loss of the cement; however, there are significant differences among different resin cements.

CONCLUSIONS

All the resin cements tested in this study were effected by the Er:YAG laser irradiation and there were significant differences among the resin cements with regard to ablation volume. Lasers Surg. Med. 47:602-607, 2015. © 2015 Wiley Periodicals, Inc.

Effects of Diode Laser Debonding of Ceramic Brackets on Enamel Surface and Pulpal Temperature

AIM

Debonding of ceramic brackets due to their high bond strength and low fracture toughness is one of the most challenging complications of orthodontic clinicians. Application of lasers might be effective in the debonding of ceramic brackets as they reduce bond strength of resins and, therefore, can eliminate the risk of enamel damage. However, the thermal effects of laser radiation on dental tissue can cause undesirable results. The aim of this study is to evaluate the enamel surface characteristics and pulpal temperature changes of teeth after debonding of ceramic brackets with or without laser light.

MATERIALS AND METHODS

Thirty polycrystalline brackets were bonded to 30 intact extracted premolars, and later debonded conventionally or through a diode laser (2.5 W, 980 nm). The laser was applied for 10 seconds with sweeping movement. After debonding, the adhesive remnant index (ARI), the lengths and frequency of enamel cracks were compared among the groups. The increase in intrapulpal temperature was also measured. The collected data were analyzed by Chi-squared test and paired t-test using Statistical Package for Social Sciences (SPSS) software.

RESULTS

There was no case of enamel fracture in none of the groups. Laser debonding caused a significant decrease in the frequency and lengths of enamel cracks, compared to conventional debonding. In laser debonding group, the increase in intrapulpal temperature (1.46°C) was significantly below the benchmark of 5.5°C for all the specimens. No significant difference was observed in ARI scores among the groups.

CONCLUSION

Laser-assisted debonding of ceramic brackets could reduce the risk of enamel damage, without causing thermal damage to the pulp. However, some increases in the length and frequency of enamel cracks should be expected with all debonding methods.

CO2 laser as auxiliary in the debonding of ceramic brackets

This study evaluated the temperature in the bonding composite and in the pulp chamber, the shear bond strength after the irradiation of CO2 lasers, and the Adhesive Remnant Index (ARI) after debonding of ceramic bracket. A hundred and five premolars were used: 30 to evaluate the temperature and 75 to test the resistance to shear and the ARI. To assess the temperature, different irradiation times (3 and 5 s), pulse duration (0.001 and 0.003 s), and output power (5, 8, and 10 W) were tested (total of 12 groups). During all the irradiation, specimens were immersed in thermal bath water at 37 °C. In the test and ARI evaluation, premolars were divided into five groups (n = 15) and were submitted to the following regimens of CO2 laser irradiation: I (5 W, pulse duration = 0.01 s, application time = 3 s), II (5 W, 0.03 s, 3 s), III (8 W, 0.01 s, 3 s), and IV (1 0 W, 0.01 s, 3 s). Group C (control) was not subjected to irradiation. ARI was measured after debonding of the bracket. Following irradiation of the lasers, the pulpal temperature was not higher than 5.5 °C in four of the study groups. Results were submitted to the ANOVA and Duncan's test. CO2 laser irradiation regimen IV was one in which the strength of debonding is 7.33 MPa. Therefore, CO2 laser may aid removal of ceramic brackets; it decreased the bond strength without increasing the excessive temperature excessively.

Lasers in orthodontics

Many types of dental lasers are currently available that can be efficiently used for soft and hard tissue applications in the field of orthodontics. For achieving the desired effects in the target tissue, knowledge of laser characteristics such as power, wavelength and timing, is necessary. Laser therapy is advantageous because it often avoids bleeding, can be pain free, is non-invasive and is relatively quick. The high cost is its primary disadvantage. It is very important to take the necessary precautions to prevent possible tissue damage when using laser dental systems. Here, we reviewed the main types and characteristics of laser systems used in dental practice and discuss the applications of lasers in orthodontics, harmful effects and laser system safety.

A Comparison of Shear Bond Strengths of Metal and Ceramic Brackets using Conventional Acid Etching Technique and Er:YAG Laser Etching

Background and aims. The aim of this study was to compare shear bond strength (SBS) of metal and ceramic brackets bonded to enamel using acid versus Er:YAG laser etching.

Materials and methods. Eighty premolars were divided into 4 groups: AM (acid etching/ metal brackets), AC (acid etching/ ceramic brackets), LM (laser etching/ metal brackets) and LC (laser etching/ ceramic brackets). Enamel condition-ing was done using acid in AC and AM and Er:YAG laser in LC and LM. Brackets were debonded with a Dartec machine and the SBSs were determined. Adhesive remnant index was evaluated under a stereomicroscope. Two additional teeth were conditioned with acid and laser for scanning electron microscopy examination. Comparisons of SBS value were done by ANOVA test.

Results. statistical analyses showed that SBSs of acid groups were significantly higher than that of laser groups, but dif-ferences between SBS values of AC/ AM and LC/LM were not significant. SEM examination revealed different etching pattern.

Conclusion. Low power Er:YAG laser etching offers clinically acceptable SBS which besides its other superiorities to acid etching can be an appropriate alternative for bonding of ceramic brackets.

Transmission of Er:YAG laser through different dental ceramics

OBJECTIVE

The aim of this study was to determine the erbium-doped yttrium aluminum garnet (Er:YAG) laser transmission ratio through different dental ceramics with different thicknesses.

BACKGROUND DATA

Laser debonding procedure of adhesively luted all-ceramic restorations is based on the transmission of laser energy through the ceramic and the ablation of resin cement, because of the transmitted laser energy.

METHODS

Five different dental ceramics were evaluated in this study: sintered zirconium-oxide core ceramic, monolithic zirconium-oxide ceramic, feldspathic ceramic, leucite-reinforced glass ceramic, and lithium disilicate-reinforced glass ceramic. Two ceramic discs with different thicknesses (0.5 and 1 mm) were fabricated for each group. Ceramic discs were placed between the sensor membrane of the laser power meter and the tip of the contact handpiece of an Er:YAG laser device with the aid of a custom- made acrylic holder. The transmission ratio of Er:YAG laser energy (500 mJ, 2 Hz, 1 W, 1000 μs) through different ceramic discs was measured with the power meter. Ten measurements were made for each group and the results were analyzed with two way analysis of variance (ANOVA) and Tukey honestly significant difference (HSD) tests.

RESULTS

The highest transmission ratio was determined for lithium disilicate-reinforced ceramic with 0.5 mm thickness (88%) and the lowest was determined for feldspathic ceramic with 1 mm thickness (44%). The differences among the different ceramics and between the different thicknesses were significant (p<0.05).

CONCLUSIONS

Ceramic type and thickness should be taken into consideration to adjust the laser irradiation parameters during laser debonding of adhesively luted all-ceramic restorations.

A comparative study of shear bond strength between metal and ceramic brackets and artificially aged composite restorations using different surface treatments

This in vitro study evaluated the shear bond strength (SBS) between ceramic brackets (CBs) and resin composite restorations (RCRs) prepared using different surface treatments. The findings were also compared with a similar study that used stainless steel brackets (SSBs). Forty-five premolars were restored with a nano-hybrid composite resin (Tetric EvoCeram) and randomly assigned to three surface treatment groups: group 1, 5 per cent hydrofluoric acid (HF); group 2, air abrasion (50 μm alumina particles); and group 3, diamond bur. Specimens were bonded with CBs (Fascination) and exposed to thermo-cycling (500 cycles). The shear force at a crosshead speed of 1 mm/minute was transmitted to brackets. The adhesive remnant index (ARIs) scores were recorded after bracket failure. The analysis of SBS variance (P < 0.01) and chi-square test of ARIs scores (P < 0.01) revealed significant differences among three groups tested. The SBS in group 3 (mean: 26.34 ± 4.76 MPa) and group 2 (mean: 26.68 ± 5.93 MPa) was significantly higher than group 1 (mean: 16.25 ± 5.42 MPa). The SBS was significantly higher in CBs (mean: 23.09 ± 7.19 MPa) compared to SSBs (mean: 15.56 ± 5.13 MPa). High ARIs (100 per cent) occurred in SSBs treated with a diamond bur, whereas CBs primarily failed at the resin-adhesive interface (P < 0.01). In two-thirds of the specimens (SSBs or CBs), no adhesive was left on the restoration after HF conditioning. The ARIs profile of CBs and SSBs that received surface treatments with air abrasion were similar (P > 0.05) and bond failure occurred mainly in adhesive-bracket base and resin-adhesive interfaces. The diamond bur surface treatment is recommended as a safe and cost-effective method of bonding CBs to RCRs.