Thermal image analysis of electrothermal debonding of ceramic brackets: an in vitro study.

This study used modern thermal imaging techniques to investigate the temperature rise induced at the pulpal well during thermal debonding of ceramic brackets. Ceramic brackets were debonded from vertically sectioned premolar teeth using an electrothermal debonding unit. Ten teeth were debonded at the end of a single 3-second heating cycle. For a further group of 10 teeth, the bracket and heating element were left in contact with the tooth during the 3-second heating cycle and the 6-second cooling cycle. The average pulpal wall temperature increase for the teeth debonded at the end of the 3-second heating cycle was 16.8 degrees C. When the heating element and bracket remained in contact with the tooth during the 6-second cooling cycle an average temperature increase of 45.6 degrees C was recorded.     

Electrothermal debonding of ceramic brackets: an ex vivo study.

Abstract

The shear forces necessary to remove ceramic brackets from human premolar teeth using mechanical and electrothermal debonding techniques were compared and the post-debond enamel characteristics were evaluated. The temperature rise in the pulp cavity during electrothermal debonding was recorded. The samples were tested sequentially on a shear jig attached to an Instron Universal Testing Machine. The results indicate that removal of ceramic brackets with an electrothermal debonder requires less force than with a mechanical debonding technique. Furthermore, the associated pulp temperature rise appears to be within currently established biologically acceptable limits. However, the indices that are commonly used to define the condition of the enamel surface following debond may not be applicable to electrothermal debonding.     

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.     

Comparisons of different debonding techniques for ceramic brackets: an in vitro study. Part I. Background and methods

Techniques for removing metal orthodontic attachments are, for the most part, not as effective with ceramic brackets because the properties of ceramic brackets differ greatly from those of the conventional metal orthodontic brackets. Currently available ceramic brackets are composed of aluminum oxide crystals in either a polycrystalline or monocrystalline form that has a low fracture toughness compared with that of stainless steel. Metal brackets will deform 20% under stress before fracturing, whereas ceramic brackets will deform less than 1% before failing. The purpose of this study was (1) to evaluate the debonding characteristics of three different types of ceramic brackets when removed by techniques recommended by the manufacturers; (2) to evaluate and compare the conventional, ultrasonic, and electrothermal bracket-removal techniques, and (3) to evaluate and compare the mean enamel loss from removal by high-speed bur, by slow-speed bur, and by the ultrasonic method. In the first phase of the investigation, 140 teeth (70 maxillary central incisors and 70 third molars) were bonded with one of three types of ceramic brackets. Three different debonding methods were tested--(1) the conventional method recommended by the manufacturer (either pliers or wrench), (2) an ultrasonic method that employed specially designed tips, and (3) an electrothermal method involving an apparatus that transmits heat to the bracket. In each of the test groups, five variables were evaluated during and after bracket removal: (1) the incidence of bracket failure, (2) the amount of adhesive remaining after bracket removal, (3) the site of bond failure, (4) the debonding time for each technique, and (5) enamel damage resulting from bracket removal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laser-aided debonding of orthodontic ceramic brackets.

The removal of ceramic brackets from the enamel surface by means of laser heating was investigated with the use of CO2 and YAG lasers. The two bracket types investigated were polycrystalline alumina and monocrystalline alumina. The average torque force necessary to break the adhesive between the polycrystalline ceramic brackets and the tooth was lowered by a factor of 25 when the brackets were illuminated with a CO2 laser beam of 14 watts for 2 seconds. All polycrystalline brackets debonded with the CO2 laser resulted in a complete bracket detachment without bracket failure. The average torque force needed to debond monocrystalline brackets was lowered by a factor of 5.2 when illuminated with a laser setting of 7 watts. Monocrystalline brackets cracked along the bracket slot in 2 of 10 cases. Debracketing without laser heating resulted in a slightly higher incidence of bracket failure (12 of 50). Nevertheless, no visible damage to the enamel surface was observed. Advantages of the laser-aided bracket-removal techniques include the following: The heat produced is localized and controlled; the debracketing tool is essentially "cold"; and the method can be used for removal of various types of ceramic brackets, regardless of their design.     

Comparisons of different debonding techniques for ceramic brackets: an in vitro study. Part II. Findings and clinical implications

A series of tests of three different debonding techniques applied to three different types of ceramic brackets revealed the following: (1) The incidence of bracket failure during debonding was significantly greater with conventional debonding recommended by the manufacturer (10-35%), as compared with the incidence associated with either the ultrasonic or the electrothermal methods (0%). (2) Bond failure at the bracket-adhesive interface occurred with significantly greater frequency for the Starfire brackets when debonding was performed with the electrothermal instrument and with significantly less frequency when the debonding pliers were used. Combination bond failures, in which part of the adhesive stayed on the enamel and part stayed on the bracket, occurred with significantly greater frequency when Transcend and Starfire brackets were debonded with debonding wrenches than when other methods were used. Combination-bond failures occurred with significantly less frequency when the brackets were removed with ultrasonic tips or with the electrothermal instrument. (3) The debonding times for the ultrasonic method were significantly greater than the times for either the conventional or the electrothermal methods. There were no significant differences among the debonding times for the three bracket types. There were no significant differences in the debonding times between the electrothermal method (means = 3.0 seconds) and the conventional bracket-removal method (means = 1.0 seconds). (4) Enamel loss as a result of adhesive removal was not significantly different among the three adhesive-removal techniques tested. Post-treatment roughness of the enamel surface was greater for the high-speed adhesive-removal technique than for either the low-speed or ultrasonic adhesive-removal methods.     

Plasma arc curing of ceramic brackets: an evaluation of shear bond strength and debonding characteristics.

The aim of this in vitro investigation was to evaluate bond strength and debonding characteristics when a xenon plasma arc curing light is used to bond polycrystalline and monocrystalline ceramic brackets. Brackets were bonded to 240 extracted bovine mandibular incisors with a composite adhesive. Curing intervals of 1, 3, and 6 seconds were chosen for curing with the plasma arc light, and the control group was cured at 10 seconds per bracket with a conventional halogen light. Debonding was performed on a universal testing machine and according to the bracket manufacturers' recommendations. Both the polycrystalline and the monocrystalline brackets consistently debonded at the bracket-adhesive interface, regardless of debonding method, curing interval, or curing light. No enamel fractures were observed after debonding. Bracket fractures were rare and did not affect debonding. Bond strength was significantly higher for the monocrystalline brackets (P <.0001): mean shear bond strength ranged between 9.68 +/- 2.17 MPa (plasma arc curing light, 1 sec curing interval) and 10.73 +/- 3.22 MPa (halogen light, 10 sec curing interval) for the polycrystalline brackets and between 19.85 +/- 2.97 MPa (plasma arc curing light, 1 sec curing interval) and 22.94 +/- 3.20 MPa (plasma arc curing light, 3 sec curing interval) for the monocrystalline brackets. Significant differences were also found for the curing methods used (P =.047). A curing interval of 3 seconds with the plasma arc curing light is recommended for both polycrystalline and monocrystalline ceramic brackets.     

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.     

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.     

机械法去除国产陶瓷托槽安全性的研究

目的使用去托槽钳去除两种底板设计的国产多晶体氧化铝陶瓷托槽,评价对牙齿安全性的影响。方法选择离体上、下颌各15颗双尖牙,随机分为3组。实验组为国产沟槽底板（3条横沟）和网格底板（3×3网格）陶瓷托槽,对照组为临床常用多晶体氧化铝陶瓷托槽（Crystaline IV）。使用37%液体磷酸和京津釉质粘接剂分别粘接上述3种托槽,在0.9%生理盐水中室温保存24h。使用去托槽钳及WDW3050型微机控制电子万能试验机龈向施加剪切力,检测去除强度、粘接剂残留指数（ARI）及托槽断裂个数,并以立体显微镜评价釉质表面损伤情况。结果国产沟槽底板、网格底板陶瓷托槽及Crystaline IV的去除强度分别为18.49±4.00MPa、17.89±4.13MPa和17.62±4.51MPa,三者间无显著性差异。主要去除部位均在粘接剂内部,托槽断裂个数分别为7个、7个和6个。各有一颗使用国产沟槽底板陶瓷托槽和Crystaline IV的牙齿在立体显微镜下发现明显的釉质缺损。结论对于唇面呈弧形的牙体,使用去托槽钳龈向施加剪切力去除国产多晶体氧化铝陶瓷托槽时,去除强度大,易发生托槽断裂,且可能并发釉质剥脱,并不是理想方法。     

Safety evaluation of debonding domestic ceramic brackets with bracket-removal plier in vitro

目的 使用去托槽钳去除两种底板设计的国产多晶体氧化铝陶瓷托槽,评价对牙齿安全性的影响.方法 选择离体上、下颌各15颗双尖牙,随机分为3组.实验组为国产沟槽底板(3条横沟)和网格底板(3×3网格)陶瓷托槽,对照组为临床常用多晶体氧化铝陶瓷托槽(Crystaline IV).使用37%液体磷酸和京津釉质粘接剂分别粘接上述3种托槽,在0.9%生理盐水中室温保存24h.使用去托槽钳及WDW3050型微机控制电子万能试验机龈向施加剪切力,检测去除强度、粘接剂残留指数(ARI)及托槽断裂个数,并以立体显微镜评价釉质表面损伤情况.结果 国产沟槽底板、网格底板陶瓷托槽及Crystaline IV的去除强度分别为18.49±4.00MPa、17.89±4.13MPa和17.62±4.51MPa,三者间无显著性差异.主要去除部位均在粘接剂内部,托槽断裂个数分别为7个、7个和6个.各有一颗使用国产沟槽底板陶瓷托槽和Crystaline IV的牙齿在立体显微镜下发现明显的釉质缺损.结论 对于唇面呈弧形的牙体,使用去托槽钳龈向施加剪切力去除国产多晶体氧化铝陶瓷托槽时,去除强度大,易发生托槽断裂,且可能并发釉质剥脱,并不是理想方法.     

Laboratory evaluations on thermal debonding of ceramic brackets.

The purpose of this laboratory study was to define the working parameters and physiological safety and efficacy of the Dentaurum Ceramic Debonding Unit. Extracted mandibular incisors were utilized because of their low thermal mass and low heat sensitivity. The teeth were embedded in plastic and placed on a turning force measuring apparatus. An electrothermal element was placed in the pulp chamber (filled with a conducting paste). The thermoelement temperature was registered on y-t recorder as was the turning momentum required to remove the ceramic brackets with the Dentaurum Ceramic Debonding Unit. Ceramic brackets from GAC (Allure III), Unitek (Transcend) and Dentaurum (Fascination) using one and two component adhesives (Monolok, Concise), were tested. Scanning electron microscopic views taken after debonding showed predictable (and favorable) adhesive failure at the bracket base/resin interface. No enamel damage was demonstrated. All brackets were removable under three seconds with a clinically reproducible turning force of 85-100 Nmm allowing for intrapulpal temperature increases under the 5 degrees C biocompatible threshold. The Dentaurum Ceramic Debonding Unit provided a safe, reliable, efficient modality of removing ceramic brackets while maintaining a physiologically acceptable rise in pulpal temperature without damage to tooth enamel or pulpal tissue.     

Bond strengths of five different ceramic brackets: an in vitro study

The purpose of this investigation was to compare the bond strengths to enamel obtained in shear/peel and tensile/peel modes of testing using five different ceramic brackets and two different light-cured composites. The site of failure was also examined. Shear/peel bond strength was significantly affected by adhesive type, with Heliosit having higher mean bond strengths than Prismafil. Bond strength was significantly affected by bracket type; the highest mean bond strength in both tests being attained using Transcend with Heliosit. All brackets resisted shear/peel forces better than tensile/peel forces. High bond strengths are associated with an increased incidence of bracket and enamel fractures with Transcend and Starfire.     

Bond strength of disinfected metal and ceramic brackets: an in vitro study

The aim of this in vitro investigation was to test whether disinfecting with Chlorhexamed fluid had an influence on the shear bond strength of metal and ceramic orthodontic brackets. Metal and ceramic brackets were fixed by the composite adhesives Transbond XT (light curing) and Concise (chemical curing) to 224 bovine permanent mandibular incisors. Bovine teeth were divided into eight groups of 28 each as group 1: metal bracket/Transbond XT, group 2: disinfected metal bracket/Transbond XT, group 3: metal bracket/Concise, group 4: disinfected metal bracket/Concise, group 5: ceramic bracket/Transbond XT, group 6: disinfected ceramic bracket/Transbond XT, group 7: ceramic bracket/Concise, and group 8: disinfected ceramic bracket/Concise. Adhesive bonding was done according to the manufacturers' instructions. As shown by group comparison (Kruskal-Wallis test, univariate analysis of variance, P < .001), the disinfection of metal brackets had no statistically relevant influence on shear bond strength (P = .454). However, disinfecting ceramic brackets with either adhesive led to a significant reduction in shear bond strength compared with the untreated ceramic bracket group (P < .001). The Fisher's exact test of the Adhesive Remnant Index (ARI) scores showed a significant difference within the metal group bonded with different adhesives (P = .0003). The ARI scores 1 and 2 were not reached by the ceramic bracket groups. The disinfection of the ceramic brackets is a suitable procedure for clinical use because the measured shear bond strength values were higher than 6-8 MPa required in orthodontics.     

Clinical evaluations on thermal versus mechanical debonding of ceramic brackets.

Removal of ceramic orthodontic brackets, utilizing orthodontic pliers, has resulted in significant patient discomfort, enamel trauma and bracket shattering. The purpose of this clinical study was to compare the safety and efficacy of standard orthodontic mechanical debonding with a new Dentaurum thermal debonding device. Fifteen healthy patients with maxillary or mandibular premolars scheduled for extraction completed this study. One week after bracket placement, removal was accomplished by mechanical pliers or a thermal debonding device. Both procedures were performed on each patient in random order. Efficacy was monitored using scanning electron microscopy (SEM) on impressions made before and at selected times after debonding. Extracted teeth were subjected to histological evaluation to check potential injury to the pulp. Comfort levels were determined by questionnaires. Data was analyzed by Chi square. No irritation or overt changes were reported or observed. Significant differences (p less than 0.05) favoring the thermal devices were determined from the questionnaire on comfort during the removal process. Evaluation of SEM surfaces found significantly less (p less than 0.05) changes produced with the thermal debonding device, compared to mechanical removal. No histological evidence of pulpal injury related to product treatments were determined. The Dentaurum thermal debonding device was judged less traumatic by patients and produced minimal enamel surface changes compared to a mechanical debonding plier.     

The force levels required to mechanically debond ceramic brackets: an in vitro comparative study

The in vitro force levels generated by four differing methods of mechanical debonding techniques for ceramic brackets, using debonding pliers, were measured. The forces generated using wide (method W) and narrow blades (method N) were compared with those generated using a diagonally opposite corner application of the wide blades (method C) and incisal-gingival application of a pair of pointed blades (method P). Chemically retained ceramic brackets (Transcend) were bonded to bovine teeth using a filled, two-paste, chemically cured composite (Concise). After 24 hours storage at 37 degrees C in water, each specimen was subjected to one of the four mechanical debonding methods in a custom-built jig, simulating the clinical application of conventional debonding pliers. A one-way ANOVA with a Tukey's honestly significant difference test revealed statistically significant differences in debonding strengths between the four methods at the 0.05 level of significance. The mean debonding strength generated by method C was 40 and 25 per cent lower than that for methods W and N, respectively. Scoring of the adhesive remnant index (ARI) revealed that the predominant bond failure site was at the bracket/adhesive interface for all groups. Macroscopically, no enamel damage or bracket fractures were observed.     

Bonding characteristics of a self-etching primer and precoated brackets: an in vitro study

Little is known about the performance of Transbond Plus Self-Etching Primer (TPSEP), especially when used with Adhesive Precoated Brackets (APC 1 and APC 2). The aim of this study was to compare the shear bond and rebond strengths and failure sites of APC 1 and APC 2 with a non-coated bracket system [Victory Series (V)] using Transbond XT light-cured adhesive and TPSEP or 37 percent phosphoric acid as the conditioner. The results demonstrated that on dry testing of 120 brackets when applying an occluso-gingival load to produce a shear force at the bracket-tooth interface, there was no statistically significant difference in the shear bond strength (SBS) of APC 1 (68.4 N), APC 2 (74.9 N), and V brackets (75.4 N, control group). There was also no significant difference in bond failure sites of the APC 1 and APC 2 when compared with the non-coated bracket system using Transbond XT light-cured adhesive and TPSEP, with bond failure for all groups occurring mainly at the adhesive-enamel interface. There was a significant difference in the SBS of the V brackets when using TPSEP and 37 percent phosphoric acid as the conditioners. The latter was lower (60.6 N) and the bond failure site changed from the enamel-adhesive interface to the bracket-adhesive interface. The shear rebond strengths of all bracket types were statistically significantly lower (P < 0.05) than their initial SBS (APC 1, APC 2, and V: 35.9, 36.7, and 34.1 N, respectively) and the locus of bond failure altered from the adhesive-enamel interface to the bracket-adhesive interface. A clinical trial using TPSEP as a conditioner would be useful as the time taken to remove the adhesive from the enamel surface may be reduced following debond.