title: Impulse debracketing compared to conventional debonding.
abstract: OBJECTIVE
  To evaluate impulse debonding compared to three conventional methods for bracket removal in relation to the damage caused to the enamel surface.
  
  
  METHODS
  Ninety-six osteotomed third molars were randomly assigned to two study groups (n = 48) for bracket bonding with either a composite adhesive system (CAS) or a glass-ionomeric cement (GIC). These two groups were then each randomly divided into four subgroups (n = 12) according to the method of debonding using (1) bracket removal pliers, (2) a side-cutter, (3) a lift-off debracketing instrument, or (4) an air pressure pulse device. Following debonding and corresponding postprocessing with either a finishing bur (CAS) or ultrasound (GIC), the enamel surfaces were assessed for damage, adhesive residues, and the need for postprocessing using scanning electron microscopy and the Adhesive Remnant Index, and the surfaces were compared in terms of mode of removal and type of adhesive using Fisher's exact test (alpha = 5%).
  
  
  RESULTS
  No significant differences were found between the two different types of adhesives (CAS, GIC) in terms of the amount of damage to the enamel. Portions of enamel damage were found for impulse debonding/0%<bracket removal pliers/4%<lift-off debracketing instrument/17%<side-cutter/21%. The highest Adhesive Remnant Index grades were seen for impulse debonding. GIC residues after postprocessing using ultrasound were seen in 79%, compared to 48% after rotational postprocessing of CAS residues.
  
  
  CONCLUSIONS
  Impulse debonding provides a good alternative to conventional debonding methods, as the adhesion is usually separated at the bracket-adhesive interface, thereby avoiding enamel damage, independent of the adhesive used.
authors.affiliation: Department of Orthodontics and Dentofacial Orthopedics, Georg-August-University, Göttingen, Germany. r.veberiene@gmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Knösel
authors.forename: Simone
authors.initials: S
authors.lastname: Mattysek
authors.forename: Klaus
authors.initials: K
authors.lastname: Jung
authors.forename: Reza
authors.initials: R
authors.lastname: Sadat-Khonsari
authors.forename: Dietmar
authors.initials: D
authors.lastname: Kubein-Meesenburg
authors.forename: Oskar
authors.initials: O
authors.lastname: Bauss
authors.forename: Dirk
authors.initials: D
authors.lastname: Ziebolz
mesh_terms: D000399:Air Pressure; D017005:Dental Debonding / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D003743:Dental Enamel / Q000293:injuries* / Q000648:ultrastructure; D005899:Glass Ionomer Cements; D006801:Humans; D016910:Orthodontic Brackets; D019279:Resin Cements
chemical_list: D005899:Glass Ionomer Cements; D019279:Resin Cements