The effects of composite resin types and debonding pliers on the amount of adhesive remnants and enamel damages: a stereomicroscopic evaluation

Revelation of microcracks as tooth structural element by X-ray tomography and machine learning

Although teeth microcracks (MCs) have long been considered more of an aesthetic problem, their exact role in the structure of a tooth and impact on its functionality is still unknown. The aim of this study was to reveal the possibilities of an X-ray micro-computed tomography ([Formula: see text]CT) in combination with convolutional neural network (CNN) assisted voxel classification and volume segmentation for three-dimensional (3D) qualitative analysis of tooth microstructure and verify this approach with four extracted human premolars. Samples were scanned using a [Formula: see text]CT instrument (Xradia 520 Versa; ZEISS) and segmented with CNN to identify enamel, dentin, and cracks. A new CNN image segmentation model was trained based on "Multiclass semantic segmentation using DeepLabV3+" example and was implemented with "TensorFlow". The technique which was used allowed 3D characterization of all MCs of a tooth, regardless of the volume of the tooth in which they begin and extend, and the evaluation of the arrangement of cracks and their structural features. The proposed method revealed an intricate star-shaped network of MCs covering most of the inner tooth, and the main crack planes in all samples were arranged radially in two almost perpendicular directions, suggesting that the cracks could be considered as a planar structure.

The Retention Effect of Resin-Based Desensitizing Agents on Hypersensitivity-A Randomized Controlled Trial

Recently, the development of dental materials has increased the availability of various hyperesthesia desensitizers. However, there are no studies on the duration of retreatment in terms of adherence rates. Thus, the adhesion rates of resin-based desensitizers were investigated. We used a conventional desensitizer and a recently developed desensitizer containing calcium salt of 4-methacryloxyethyl trimellitic acid (C-MET) and 10-methacryloyloxydecyl dihydrogen calcium phosphate (MDCP). These colored agents were applied to the surfaces of premolars and molars, and the area was measured from weekly oral photographs. Areas were statistically analyzed and mean values were calculated using 95% confidence intervals. A p-value of <0.05 was considered statistically significant. These rates were significantly higher on the buccal side of the maxilla and lower on the lingual side of the maxilla. In addition, the desensitizer containing C-MET and MDCP displayed significantly higher adhesion rates. It is suggested that this will require monthly follow-ups and reevaluation because both agents cause less than 10% adherence and there is almost no sealing effect after 4 weeks. In addition, the significantly higher adhesion rate of the desensitizer containing C-MET and MDCP indicated that the novel monomer contributed to the improvement in the adhesion ability.

Three-dimensional non-destructive visualization of teeth enamel microcracks using X-ray micro-computed tomography

Although the topic of tooth fractures has been extensively analyzed in the dental literature, there is still insufficient information about the potential effect of enamel microcracks (EMCs) on the underlying tooth structures. For a precise examination of the extent of the damage to the tooth structure in the area of EMCs, it is necessary to carry out their volumetric [(three-dimensional (3D)] evaluation. The aim of this study was to validate an X-ray micro-computed tomography ([Formula: see text]CT) as a technique suitable for 3D non-destructive visualization and qualitative analysis of teeth EMCs of different severity. Extracted human maxillary premolars were examined using a [Formula: see text]CT instrument ZEISS Xradia 520 Versa. In order to separate crack, dentin, and enamel volumes a Deep Learning (DL) algorithm, part of the Dragonfly's segmentation toolkit, was utilized. For segmentation needs we implemented Dragonfly's pre-built UNet neural network. The scanning technique which was used made it possible to recognize and detect not only EMCs that are visible on the outer surface but also those that are buried deep inside the tooth. The 3D visualization, combined with DL assisted segmentation, enabled the evaluation of the dynamics of an EMC and precise examination of its position with respect to the dentin-enamel junction.

Evaluation of Enamel Roughness in Vitro After Orthodontic Bracket Debonding Using Different Methods of Residual Adhesive Removal

Objective

The aim of the present study was to compare different techniques for resin remnant removal (RRR) after orthodontic bracket debonding and to evaluate alterations on the dental enamel caused by these methods. The null hypothesis tested was that there is no difference between RRR techniques in relationship the changes caused on the dental enamel.

Methods

A total of 75 bovine mandibular permanent incisors were used in the study. Brackets were bonded and debonded in each tooth in two experimental regions. Five RRR techniques were used in the experimental groups (n=15): Group 1-diamond bur (6-bladed), Group 2-diamond bur (12-bladed), Group 3-diamond bur (30-bladed), Group 4-aluminum oxide sandblasting (AOS), and Group 5-Er:YAG laser. Enamel surface was evaluated using profilometry, and surface roughness analysis was performed at three time intervals: before bracket bonding, after RRR techniques, and after final polishing. Qualitative analyses of the enamel surfaces were performed using scanning electron microscopy.

Results

Multiblade burs showed the best results, and the 30-bladed bur created a less irregular enamel surface. AOS caused greater enamel wear, and Er:YAG laser caused more surface irregularity.

Conclusion

The null hypothesis was rejected. The multiblade burs were the least harmful than the other techniques. Enamel surface roughness after using the 30-blade bur was similar to the original enamel. These results indicate that the type of bur tested (30-bladed) can be indicated to remove resin remnants after bracket debonding.

Impact of Fluorosis on the Tensile Bond Strength of Metal Brackets and the Prevalence of Enamel Microcracks

The objective of this in vitro study was to determine the effects of dental fluorosis on the tensile bond strength of metal brackets bonded to human teeth and to evaluate the changes in the tooth enamel surface after debonding. The study sample consisted of 68 recently extracted human upper premolars, which were divided into 2 groups: the fluorosis group (34 fluorosed teeth) and the control group (34 healthy teeth). Identical premolar metal brackets were bonded on the buccal surfaces of the teeth. Both groups were submitted to a tension test using a universal testing machine. The number and length of the enamel microcracks in the buccal surface of each tooth were determined before bracket bonding and after debonding using a stereomicroscope. The percentage adhesive remnant index (PARI) was calculated after debonding. The results showed that the tensile bond strength (TBS) of brackets bonded to fluorosed teeth was 21.08% lower than that of brackets bonded to healthy teeth (p < 0.0001). The length of the enamel microcracks on fluorosed teeth increased by 47.4% after debonding, whereas the control group showed an increase of only 12.6%. The PARI showed lower values for fluorosed teeth in comparison to the control group (p = 0.047). In conclusion, dental fluorosis has a negative impact on tensile bond strength and the length of microcracks formed after bracket debonding.

Variations in enamel damage after debonding of two different bracket base designs: An in vitro study

Background. Bracket base design is a factor influencing shear bond strength. High shear bond strength leads to enamel crack formation during debonding. The aim of this study was to compare enamel damage variations, including the number and length of enamel cracks after debonding of two different base designs. Methods. Eighty-eight extracted human premolars were randomly divided into2 groups (n=44). The teeth in each group were bonded by two types of brackets with different base designs: 80-gauge mesh design versus anchor pylon design with pylons for adhesive retention. The number and length of enamel cracks before bonding and after debonding were evaluated under an optical stereomicroscope ×40 in both groups. Mann-Whitney U test was used to compare the number of cracks between the two groups. ANCOVA was used for comparison of crack lengths after and before debonding in each group and between the two groups. Results. There was a significant increase in enamel crack length and numbers in each group after debonding. There was no significant difference in enamel crack numbers after debonding between the two groups, whereas the length of enamel cracks was significantly greater in anchor pylon base design after debonding. Conclusion. Bracket bases with pylon design for adhesive retention caused more iatrogenic debonding damage to enamel surface.

Comparison of two different debonding techniques in orthodontic treatment

Aim

The purpose of this research is to investigate whether and how the adhesive bond failure site varied in relation to the material used for the orthodontic bonding and debonding technique applied.

Materials and methods

Two different methods of orthodontic debonding were included in our survey; cutters for orthodontics and debonding plier. Three different materials for the adhesion of the bracket: composite light curing, self-curing composite and glass ionomer cement. The remaining amount of adhesive on the tooth surface is an important parameter that gives information on how the location of the posting site varied during the debonding. 60 dental elements, maxillary and mandibular, previously extracted for orthodontic reasons, as well as periodontal, were included in our research. We investigated a possible significant correlation between different variables (debonding technique and materials for membership) and the ARI index.

Conclusions

The use of orthodontic cutters or debonding pliers does not affect the adhesive bond failure site and both techniques have a tendency to leave a significant amount of adhesive on the surface enamel. In the resin-reinforced glass ionomer cements, detachment occurs at the interface enamel-adhesive and this pattern of detachment increases the risk of the enamel damage during debonding. In both types of composite resins (photopolymerizable or self-curing), the detachment occurs at the interface bracketing adhesive. In this case the amount of remaining adhesive material on the tooth must be removed with further methods, which in addition, increase the risk of iatrogenic injury as well as the working hours.

Shear bond strength and debonding characteristics of a new premixed self-etching with a reference total-etch adhesive

Background

To determine the shear bond strength and adhesive remnant index of a new premixed self-etching primer and adhesive (Tectosan, BonaDent, Germany) for orthodontic appliances in comparison to a reference total-etch system Transbond XT.

Methods

Bovine incisors were embedded in resin and randomly divided into two groups of 16 samples each. Brackets (Discovery, Dentaurum, Germany) were bonded in group 1 (total-etch-system, Transbond XT) and in group 2 (self-etch-system, Tectosan) with curing light for 40 s. Shear bonding strengths were measured after 24 h of storage in distilled water at 37 °C with a Zwicki 1120 testing machine (Zwick Roell, Germany). A force was applied on the bracket base at the wings in occluso-gingival direction. Then the adhesive remnant index (ARI) was determined.

Results

No statistical differences on SBS were found for both bonding agents (p = 0.63). ARI scores however differed statistically significantly (p = 0.035): in the total-etch group more adhesive remained on the teeth, whereas in the self-etch group more adhesive remained on the brackets. There were no visible enamel damages in both groups.

Conclusions

No differences in the shear bond strength were found between both bonding agents. In our study the self-etch-system shifted the adhesive remnant index from more adhesive on the teeth to more adhesive on the bracket - as other already published self-etch systems did - with the new benefit of not increased enamel damages. Tectosan might therefore be a promising alternative to adhesive systems.

Evaluation of enamel damages following orthodontic bracket debonding in fluorosed teeth bonded with adhesion promoter

Objective:

To evaluate shear bond strength (SBS) of the orthodontic brackets bonded to fluorosed and nonfluorosed teeth using Light Bond with and without adhesion promoters and compare their enamel damages following debonding.

Materials and Methods:

In this study, 30 fluorosed (Thylstrup and Fejerskov Index = 4–5) and 30 nonfluorosed teeth were randomly distributed between two subgroups according to the bonding materials: Group 1, fluorosed teeth bonded with Light Bond; Group 2, fluorosed teeth bonded with adhesion promoters and Light Bond; Group 3, nonfluorosed teeth bonded with Light Bond; Group 4, nonfluorosed bonded with adhesion promoters and Light Bond. After bonding, the SBS of the brackets was tested with a universal testing machine. Stereomicroscopic evaluation was performed by unbiased stereology in all teeth to determine the amount of adhesive remnants and the number and length of enamel cracks before bonding and after debonding. The data were analyzed using two-way analysis of variance, Kruskal–Wallis, Wilcoxon Signed Rank, and Mann–Whitney test.

Results:

While fluorosis reduced the SBS of orthodontic bracket (P = 0.017), Enhance Locus Ceruleus LC significantly increased the SBS of the orthodontic bracket in fluorosed and nonfluorosed teeth (P = 0.039). Significant increasing in the number and length of enamel crack after debonding was found in all four groups. There were no significant differences in the length of enamel crack increased after debonding among four groups (P = 0.768) while increasing in the number of enamel cracks after debonding was significantly different among the four groups (P = 0.023). Teeth in Group 2 showed the highest enamel damages among four groups following debonding.

Conclusion:

Adhesion promoters could improve the bond strength of orthodontic brackets, but conservative debonding methods for decreasing enamel damages would be necessary.

Epidemiological survey of different clinical techniques of orthodontic bracket debonding and enamel polishing

Objectives:

To conduct an epidemiological survey of the orthodontic debonding techniques in Italy, and describe the most commonly used methods to remove the brackets and adhesive from the tooth surfaces.

Materials and Methods:

A survey consisting of 6 questions about bracket debonding methods and instruments used was emailed to 1000 orthodontists, who were members of the Italian Orthodontics Society (SIDO. Clinicians were characterized by different sex, age, origin, and professional experience.

Results:

Overall, 267 surveys were returned, representing a response rate of 26.7% of the participants interviewed. The 0.2% of the orthodontists responded, via email, confirming that they were not interested, while 3% of the questionnaires were sent back not completed. The 70.1% of the clinicians interviewed did not return any response. Overall, 64% of SIDO members (orthodontists) did not detect any enamel damage after debonding. The brackets used most frequently (89.14%) in clinical practice were the metal ones. The most commonly used pliers for bracket removal were cutters (37.08%) and bracket removal pliers (34.83%). For adhesive removal, low speed tungsten carbide burs under irrigation were the most widely utilized method for adhesive removal (40.08%), followed by high speed carbide burs (14.19%), and diamond burs (14.19%). The most frequently used instruments for polishing after debonding were rubber cups (36.70%) and abrasive discs (21.35%). The 31.21% of the orthodontists found esthetic enamel changes before bonding versus after debonding.

Conclusions:

This survey showed the high variability of different methods for bracket debonding, adhesive removal, and tooth polishing. The collected answers indicate that most orthodontists have developed their own armamentarium of debonding and polishing, basing their method on trials and errors.