Heat generated by grinding during removal of ceramic brackets

The Effect of Water Coolant and Bur Type on Pulp Temperature When Removing Tooth Structure and Restorative Dental Materials

OBJECTIVE

The aim was to compare intrapulp temperature (IPT) changes when flat-fissure diamond burs and pear-shaped tungsten carbide burs were used to cut tooth structure, amalgam, and composite resin with and without water coolant.

METHODS

Thermocouples were inserted into the pulp chamber of extracted intact mandibular molars. The thermocouples were connected to an electronic thermometer that detects temperature every second to an accuracy of 0.1°C. IPT changes were recorded while using a high-speed handpiece during MOD cavity preparations (n=40), composite resin removal (n=40), and amalgam removal (n=40). A two-way ANOVA was used for each procedure to test for the effect of bur (pear-shaped tungsten carbide vs flat-fissured diamond) and water coolant (on vs off), with significant main effects (α=0.05) further analyzed using Tukey's multiple comparison test.

RESULTS

During MOD cavity preparation, water coolant reduced changes in IPT (0.03±0.27°C) compared to no water coolant (1.27±0.29°C) when tungsten carbide burs were used (p<0.05) but not when diamond burs were used. During composite resin removal, tungsten carbide burs had less changes in IPT (0.55±0.18°C) compared to diamond burs (1.66±0.50°C) with no water coolant (p<0.05). Water coolant also reduced changes in IPT (0.09±0.14°C) compared to no water coolant (1.66±0.50°C) when diamond burs were used (p<0.01). Water coolant did not significantly affect IPT when tungsten carbide burs were used. During amalgam removal, tungsten carbide burs had lower changes in IPT (0.56±0.15°C) compared to diamond burs (1.88±0.43°C) with no water coolant (p<0.05). Water coolant also significantly reduced changes in IPT (0.71±0.2°C) compared to no water coolant (1.88±0.43°C) when diamond burs were used (p<0.05) but not when tungsten carbide burs were used.

CONCLUSIONS

Water coolant reduced IPT changes when drilling tooth structure with tungsten carbide burs, but not when removing amalgam or composite. Conversely, water coolant reduced IPT changes when drilling with flat fissure diamond burs to remove amalgam and composite, but not when removing tooth structure. When amalgam and composite were removed without water coolant, the tungsten carbide burs resulted in lower IPT changes than when flat fissure diamond burs were used in the same way.

Comparative Study of Transmission of 2940 nm Wavelength in Six Different Aesthetic Orthodontic Brackets

Background: Previous studies have confirmed the superiority of using erbium lasers (2940, 2780 nm) over other lasers in the debonding of ceramic brackets due to their safety and effectiveness. The most important factor in the debonding of aesthetic brackets is the transmission of the erbium laser through the aesthetic bracket to the adhesive resin. Objective: To identify the transmission of the 2940 nm wavelength through different types of aesthetic brackets. Materials and methods: A total of 60 aesthetic brackets were divided into six equal groups (10 monocrystalline sapphire brackets—Radiance, AO; 10 monocrystalline sapphire brackets—Absolute, Star Dentech; 10 polycrystalline brackets—20/40, AO; 10 polycrystalline brackets—3M Unitek Gemini Clear Ceramic; 10 silicon brackets—Silkon Plus, AO; 10 composite brackets—Orthoflex, OrthoTech). The aesthetic brackets were mounted in a Fourier transform infrared spectrophotometer (FTIR IRPrestige-21, SHIMADZU) following the typical spectroscopy lab procedure for such samples. The transmission ratio for the 2940 nm wavelength was obtained using IRsolution software. The mean transmission values of the tested groups were compared using a one-way analysis of variance (ANOVA) test followed by a Bonferroni test (post-hoc test). Results: The highest transmission ratio was observed for the Radiance sapphire brackets (64.75%) and the lowest was observed for the 3M polycrystalline brackets (40.48%). The differences among the Aesthetic brackets were significant (p < 0.05). Conclusions: The thick polycrystalline and composite brackets have the lowest transmissibility, whereas the monocrystalline sapphire brackets have the highest transmissibility for the 2940 nm wavelength, meaning that there is a higher possibility of debonding them with a hard tissue laser through thermal ablation.

Comparison of Different Energy Levels of Er:YAG Laser Regarding Intrapulpal Temperature Change During Safe Ceramic Bracket Removal

OBJECTIVE

This study was done to compare the intrapulpal temperature change generated by different energy levels of Er:YAG laser used during debonding of ceramic brackets and find the most suitable level for clinical use.

MATERIAL AND METHODS

Eighty polycrystalline alumina brackets were bonded on bovine incisor teeth, which were randomly divided into 4 groups of 20. One group was assigned as control. In the study groups, after laser exposure with 2, 4, or 6 Watt energy levels, brackets were debonded using an Instron Universal Testing machine. Adhesive remnant index (ARI) scores were recorded to evaluate the site of debonding. To assess intrapulpal thermal increase, 60 human premolar teeth that were prepared in the same way, at the same energy levels, by a thermocouple were used.

RESULTS

When the debonding forces, intrapulpal temperature increases, and ARI of the groups were examined, statistically significant difference was observed between the groups. Mean temperature increases of 0.67°C ± 0.12°C, 1.25°C ± 0.16°C, and 2.36°C ± 0.23°C were recorded for the 2, 4, and 6 Watt laser groups. The mean shear bond strength was 21.35 ± 3.43 megapascals (MPa) for the control group, whereas they were 8.79 ± 2.47, 3.28 ± 0.73, and 2.46 ± 0.54 MPa for the 2, 4, and 6 Watt laser groups, respectively.

CONCLUSIONS

Four watts is the most efficient and safe energy level to be used, utilizing Er:YAG laser with water cooling spray for 6 sec by scanning method during debonding of polycrystalline alumina brackets without any carbonization effects and detrimental temperature changes at debond sites.

Shear bond strength of two 2-step etch-and-rinse adhesives when bonding ceramic brackets to bovine enamel

AIM

The present study assessed a fracture analysis and compared the shear bond strength (SBS) of two 2-step etch-and-rinse (E&R) adhesives when bonding ceramic orthodontic brackets to bovine enamel.

MATERIALS AND METHODS

Thirty healthy bovine mandibular incisors were selected and were equally and randomly assigned to 2 experimental groups. Ceramic brackets (FLI Signature Clear^®, RMO) were bonded onto bovine enamel using an adhesive system. In group 1 (n=15), the conventional E&R adhesive (OrthoSolo^®+Enlight^®, Ormco) was used, and in group 2 (n=15), the new E&R adhesive limited to ceramic bracket bonding (FLI ceramic adhesive^®: FLI sealant resin^®+FLI adhesive paste^®, RMO) was used. In order to obtain appropriate enamel surfaces, the vestibular surfaces of mandibular bovine incisors were flat ground. After bonding, all the samples were stored in distilled water at room temperature for 21 days and subsequently tested for SBS, using the Instron^® universal testing machine. The Adhesive Remnant Index (ARI) scores were evaluated. Failure modes were assessed using optical microscopy at magnification ×40. A statistic data analysis was performed using the Mann-Whitney U-test (P<0.05).

RESULTS

The test showed a significant difference (P=0.00155) between the two groups for the SBS values. Group 1 had significantly higher SBS values (9.79 to 20.83MPa) than group 2 (8.45 to 13.94MPa). Analysis of the ARI scores revealed that most of the failures occurred at the enamel/adhesive interface. A statistically significant difference was found for the ARI scores between the two groups (P=0.00996). Only two fractured brackets, which remained bonded onto the bovine enamel, were reported. Both occurred in group 1.

CONCLUSION

When bonded to ceramic brackets, FLI ceramic adhesive^® (RMO) was demonstrated to be very predictable and safe for clinical application in enamel bonding, whereas the results obtained with the conventional adhesive system (OrthoSolo^®+Enlight^®, Ormco) were less reproducible and revealed slightly excessive shear bond strength values.

Heat Generation on Implant Surface During Abutment Preparation at Different Elapsed Time Intervals

PURPOSE

The purpose of this study was to evaluate heat generation at the implant surface caused by abutment preparation using a diamond bur in a high-speed dental turbine in vitro at 2 different water-coolant temperatures.

MATERIALS AND METHODS

Thirty-two titanium-alloy abutments were connected to a titanium-alloy implant embedded in an acrylic resin placed within a water bath at a controlled temperature of 37°C. The specimens were equally distributed into 2 groups (16 each). Group 1: the temperature was maintained at 20 ± 1°C; and group 2: the temperature was maintained at 32 ± 1°C. Each abutment was prepared in the axial plane for 1 minute and in the occlusal plane for 1 minute. The temperature of the heat generated from abutment preparation was recorded and measured at 3 distinct time intervals.

RESULTS

Water-coolant temperature (20°C vs 32°C) had a statistically significant effect on the implant's temperature change during preparation of the abutment (P < 0.0001).

CONCLUSION

The use of water-coolant temperature of 20 ± 1°C during preparation of the implant abutment decreased the temperature recorded at the implant surface to 34.46°C, whereas the coolant temperature of 32 ± 1°C increased the implant surface temperature to 40.94°C.

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.

Current Products and Practice

Due to an increasing demand for superior aesthetics during fixed appliance treatment, the use of aesthetic brackets has grown in popularity over recent years. Although often requested by patients, aesthetic brackets are not without their disadvantages. This article presents the currently available plastic and ceramic brackets and discusses the potential problems associated with each. Recent advances, introduced by manufacturers in an attempt to overcome their clinical disadvantages, are described.

Does ultra-pulse CO(2) laser reduce the risk of enamel damage during debonding of ceramic brackets?

This study seeks to evaluate the enamel surface characteristics of teeth after debonding of ceramic brackets with or without laser light. Eighty premolars were bonded with either of the chemically retained or the mechanically retained ceramic brackets and later debonded conventionally or through a CO(2) laser (188 W, 400 Hz). The laser was applied for 5 s with scanning movement. After debonding, the adhesive remnant index (ARI), the incidence of bracket and enamel fracture, and the lengths, frequency, and directions of enamel cracks were compared among the groups. The increase in intrapulpal temperature was measured in ten extra specimens. The data were analyzed with SPSS software. There was one case of enamel fracture in the chemical retention/conventional debonding group. When brackets were removed with pliers, incidences of bracket fracture were 45% for the chemical retention, and 15% for the mechanical retention brackets. No case of enamel or bracket fracture was seen in the laser-debonded teeth. A significant difference was observed in ARI scores among the groups. Laser debonding caused a significant decrease in the frequency of enamel cracks, compared to conventional debonding. The increase in intrapulpal temperatures was below the benchmark of 5.5 °C for all the specimens. Laser-assisted debonding of ceramic brackets could reduce the risk of enamel damage and bracket fracture, and produce the more desirable ARI scores without causing thermal damage to the pulp. However, some augmentations in the length and frequency of enamel cracks should be expected with all debonding methods.

Influence of various polishing methods on pulp temperature : an in vitro study

OBJECTIVE

After orthodontic debonding, adhesive removal can lead to rises in pulp temperature, causing histological changes or pulp necrosis. The objective of this study was to measure increases in pulp temperature during adhesive removal using different instruments and various cooling procedures.

MATERIALS AND METHODS

A thermoelement was introduced into the pulp chamber of 10 human incisors. The teeth were immersed in a 36°C water bath up to the cementoenamel junction. Two carbide burs, one polishing disk and two rubber points were used for polishing. All measurements were taken over a 10 s period by a single investigator, under slight pressure and with constant motion. Three cooling procedures were examined: no cooling, air cooling and water cooling. Pulp temperatures were measured before polishing and after 10 s of polishing.

RESULTS

Without cooling, the two rubber points revealed clinically relevant temperature increases of 6.1°C and 12.4°C. Cooling with air and with water reduced pulp temperature in conjunction with all polishing methods. Air cooling was most efficient, except in combination with the polishing disk.

CONCLUSION

Under these study conditions, carbide burs and polishing disks can be used safely and without risk to the pulp, even without cooling. On the other hand, rubber points cause a marked increase in pulp temperature when used without cooling.

Histopathologic evaluation of pulpal tissue response to various adhesive cleanup techniques

INTRODUCTION

The aim of this prospective in-vivo study was to investigate the possible effects of temperature changes from various adhesive cleanup procedures on pulpal tissue.

METHODS

The materials, consisting of 40 sound maxillary and mandibular premolars to be extracted during orthodontic treatment, were randomly assigned to 4 groups, with 1 group as the control. The teeth in the 3 study groups were etched; brackets were bonded and then debonded. The remaining adhesive was removed with a tungsten carbide bur by using a high-speed hand piece. The teeth in the control group were not etched and bonded. In group 1, the residual adhesive was removed with water cooling, and the teeth were extracted 24 hours later. In group 2, the residual adhesive was removed without water cooling, and the teeth were extracted 24 hours later. In group 3, the residual adhesive was removed without water cooling, and the teeth were extracted 20 days later. The teeth were prepared for histologic examination, and the number of vessels, vessel areas and perimeters, extravasation of red blood cells, vascular congestion, and inflammatory cell infiltration were evaluated to determine pulpal tissue changes.

RESULTS

According to the findings from histologic and immunohistochemical evaluations, the coronal pulps of the teeth in groups 1 and 3 were almost similar to the control teeth, but some distinct pathologic changes were observed in group 2.

CONCLUSIONS

Adhesive removal without water cooling caused some vascular and pulpal tissue alterations, but these were tolerated by the pulpal tissues, so the changes were reversible.

Nd: YAG laser for debonding ceramic orthodontic brackets

INTRODUCTION

The purpose of this study was to develop an effective method for debonding ceramic orthodontic brackets with a high-peak power Nd:YAG laser.

METHODS

Two types of ceramic brackets (single crystal and polycrystalline) were bonded to mandibular bovine teeth with 2 types of bonding resins (4-META/MMA and Bis-GMA). The laser was applied to 2 points on each bracket, each with a 1-pulse-per-second shot. Bond strength and thermal effects of the laser on the dentin surface were assessed at 3 laser energy levels: 1.0, 2.0, and 3.0 joules (J). Shear tests were performed on the irradiated test group and on a nonirradiated control group. ANOVA was used to determine significant differences.

RESULTS

The shear test (P < .05) showed that every specimen in the 2.0-J and 3.0-J groups underwent a significant decrease in bonding strength compared with the nonirradiated group. However, the 1.0-J group did not exhibit any such difference. In the 2 former groups, laser irradiation alone was sufficient to debond some specimens. No significant difference was found between bonding resins. The maximum temperature rise measured on the pulpal walls at the lasing points was 5.1 degrees C.

CONCLUSIONS

The application of a high-peak power Nd:YAG laser at 2.0 J or more is effective for debonding ceramic brackets.

Clinical comparison of an adhesive precoated vs. an uncoated ceramic bracket system

OBJECTIVES

To clinically evaluate the bond characteristics of the adhesive precoated ceramic (APC) Clarity bracket and compare it with the uncoated Clarity bracket used with Transbond XT bonding system. Design - A randomized clinical trial. SETTINGS AND SAMPLE POPULATION: Department of Orthodontics, Katholieke Universiteit Leuven. Twenty patients requiring bonded fixed orthodontic appliance from central incisor to second bicuspid.

EXPERIMENTAL VARIABLE

APC Clarity brackets were bonded in the first and fourth quadrant of group 1 and in the second and third quadrant of group 2. Uncoated Clarity brackets were bonded with Transbond XT in the second and third quadrant of group 1 and in the first and fourth quadrant of group 2.

OUTCOME MEASURE

During orthodontic treatment, bracket failures were registered. At debonding, the tooth surfaces were intraorally scored according to the Adhesive Remnant Index.

RESULTS

During treatment one tie wing fractured in the APC group and no bond failures occurred. At debonding, no significant differences between the APC and Transbond XT could be shown in any of the quadrants.

CONCLUSION

The two groups performed identically.

Laser debonding of ceramic brackets: a comprehensive review

Since the invention of the ruby laser in the early 1960s, tremendous advances have been made in optic laser technology. Orthodontists have found various uses for lasers, including the debonding of ceramic brackets. Laser energy degrades the adhesive resin used to bond brackets. Consequently, lower forces can be used than when mechanical debonding is performed, reducing the risk of enamel damage. However, the heat produced by some lasers can damage the tooth pulp. Selecting the appropriate laser, resin, and bracket combination can minimize risks and make debonding more efficient. The purpose of this article is to give the clinician an up-to-date, comprehensive literature review about the clinical characteristics of debonding ceramic brackets with lasers.

The effect of different bonding and debonding techniques on debonding ceramic orthodontic brackets

Previous studies have indicated that different bonding and debonding techniques affect the removal or detachment of polycrystalline ceramic brackets that use a mechanical mechanism of bonding to resin. The delamination type debonding forces have been shown to be more effective, compared with twisting and tensile type forces. Further, polycrystalline brackets bonded by the indirect techniques debond leaving minimal filled resin on the tooth surface and hence cleanup and enamel damage are minimized. The purpose of this research was to compare the effects of three bonding and debonding techniques on debonding two types of ceramic brackets, using different modes of bonding. The monocrystalline bracket used the chemical and the polycrystalline bracket used the mechanical mechanisms for bonding respectively. Brackets were bonded to 180 freshly extracted bovine teeth, divided into two groups of 90 each, based on the bracket employed, i.e., monocrystalline and polycrystalline brackets. These brackets were bonded with the direct and two different indirect bonding methods: the conventional indirect method (modified Thomas) and the indirect technique that used a thermally cured resin. Each bonding group was further divided into three groups of 10, based on the type of debonding technique used, i.e., lift off, delamination, and twisting. The variables evaluated were bracket failure and remnant adhesive on debonding. The data were subjected to an analysis of variance to determine existence of significant differences, followed by multiple comparisons of means. Bracket failure or fracture was significantly affected, based on the bonding technique and the debonding technique for the monocrystalline at p < 0.0001 and the polycrystalline ceramic brackets at p < 0.001 and p < 0.05, respectively. Remnant adhesive was significantly affected by bonding and debonding techniques for the polycrystalline brackets at p < 0.0001. Remnant adhesive was significantly (p < 0.01) affected by the bonding technique for the monocrystalline brackets. The delamination debonding technique combined with the thermal-cured indirect bonding technique was shown to be a safe combination for debonding both types of ceramic brackets. Therefore both bonding and debonding techniques significantly affect bracket failure or fracture and remnant adhesive of ceramic orthodontic brackets during the debonding procedure.

Clinical characteristics and properties of ceramic brackets: A comprehensive review

The aim of this article is to provide the clinician with an up-to-date comprehensive literature review concerning the clinical characteristics and properties of ceramic brackets. The article critically presents and discusses the various aspects of ceramic brackets with regard to the types, physical properties, bond strength, frictional resistance, base surface characteristics, debonding techniques and enamel fracture risks, enamel abrasion and wear, bracket fracture, and bracket recycling. The article contains also guidelines and criteria concerning the specific applications and use of ceramic brackets.

In vitro comparison of debonding force and intrapulpal temperature changes during ceramic orthodontic bracket removal using a carbon dioxide laser

The aim of this study was to develop a method to reduce the fracture of ceramic orthodontics brackets during debonding procedures. Lasers have been used to thermally soften the bonding resin, which reduces the tensile debonding force. Thermal effects of lasers may create adverse effects to the dental pulp. Previous studies have shown that no pulpal injury occurs when the maximum intrapulpal temperature rise stayed below 2 degrees C. This study investigated the effect of lasing time on intrapulpal temperature increase and tensile debonding force with a 18 watt carbon dioxide laser. Ceramic brackets were bonded to mandibular deciduous bovine teeth and human mandibular first premolars with a photoactivated bonding resin. Modified debonding pliers was used to accurately position the laser beam onto the ceramic bracket. Lasing time required to keep the maximum intrapulpal temperature rise below 2 degrees C was determined by the use of thermocouples inserted into the pulp chambers of the specimens. A tensile debonding force was applied on the control group without lasing and the experimental group was debonded after applying a predetermined lasing time with a carbon dioxide laser. It was found that there was a significance difference (P < 0.05) in tensile debonding force between the control group and the experimental group. It is feasible to use a laser for the debonding of ceramic brackets while keeping the intrapulpal temperature rise below the threshold of pulpal damage.

Surface preparation for orthodontic bonding to porcelain

This study evaluated the effect of various porcelain surface treatments on the tensile strength of orthodontic brackets bonded to a feldspathic metal ceramic porcelain. The porcelain was fused to flat gold alloy tabs and divided into six groups that were subjected to sandblasting, silane application, intermediate resin, or etchants (9.6% hydrofluoric acid or 4% APF gels). Two brackets were bonded onto each porcelain/metal tab (n=60) with Bis-GMA resin (Concise, 3M Corp., St. Paul, Minn.) or 4-META resin (MCP-bond, Sun Medical Co. Ltd., Tokyo, Japan). The samples were stored in 37 degrees C water, thermocycled 1000 times from 5 degrees C to 55 degrees C and tested in tension. Alignment and uniform loading during testing were secured by engaging a hook in a circular ring soldered onto the bracket slot before bonding. Similar control brackets (n=12) were bonded with Concise to extracted caries-free mandibular incisors. Bond failure sites were classified according to a modified Adhesive Remnant Index (ARI) system. Silane application to the sandblasted porcelain surface significantly increased the bond strengths according to analysis of variance and Duncan's multiple range test. The quality of the bonds was further enhanced by the addition of the intermediate resin. Etching the porcelain with 9.6% hydrofluoric acid provided similar bond strengths, but the 4% APF gel was less effective. The MCP-bond was not significantly better than Concise in bond strength to sandblasted porcelain. Several difficulties associated with the clinical interpretation of laboratory data on bonding to dental porcelains are discussed, and clinical trials are necessary for final evidence of efficacy.

Interlayer formation and its effect on debonding polycrystalline alumina orthodontic brackets

During the debonding of ceramic orthodontic brackets, there is a risk of causing fractures, cracks, or flaking of enamel or of the bracket itself. Preliminary work on the resin-enamel interface under bonded brackets with the indirect (modified Thomas) or the thermal-cured indirect bonding techniques revealed an interlayer of unfilled resin formed between the filled resin and the enamel surface. The direct bonding technique, on the other hand, showed no such layer. This study was designed to determine the effect of the interlayer on conventional debonding techniques for polycrystalline ceramic orthodontic brackets. Variables examined were bracket failure or fracture (BF), amount of remnant adhesive (ARI), and enamel damage. Brackets were bonded to 90 fresh bovine teeth. These were divided into three groups of 30 each, based on three methods of bonding, i.e., direct, indirect (modified Thomas), and an indirect technique that used a thermal-cured resin. Each bonding group was further divided into three groups of 10 each, based on the type of debonding technique used, i.e., lift off, delamination, and twisting. Brackets bonded by the indirect (modified Thomas, BF mean = 0.27, ARI mean = 0.93) and the indirect technique that used a thermal-cured resin (BF mean = 0.03, ARI mean = 0.43) resulted in an overall significantly lower failure (p < 0.01) and ARI score on debonding (p < 0.0001) compared with those bonded by the direct technique (BF mean = 1.03, ARI mean = 1.97). Specimens evaluated under the stereomicroscope revealed that the brackets bonded with the indirect techniques debonded at the filled-unfilled resin interface or within the interlayer of unfilled resin.(ABSTRACT TRUNCATED AT 250 WORDS)

Methods of debonding ceramic brackets

The problem of debonding ceramic brackets is still one which concerns the orthodontist. It is advisable to use the manufacturers recommended method of debonding each particular type of bracket. The risks of using such brackets need to be carefully assessed against the benefits. Risks can be minimized by carefully assessing the patient and the dentition, avoiding heavily restored teeth with pre-existing enamel cracks. It would seem wise to obtain an informed consent from the patient having out-lined the potential problems.