title: Loss of surface enamel after bracket debonding: an in-vivo and ex-vivo evaluation.
abstract: BACKGROUND
  The objective of this study was to evaluate the surface enamel after bracket debonding and residual resin removal.
  
  
  METHODS
  Thirty patients (female, 20; male, 10; mean age, 18.4 years) who completed orthodontic treatment with fixed appliances (Twin Brackets, 3M Unitek, Monrovia, Calif) (n = 525) were included. The amounts of adhesive left on the tooth surfaces and the bracket bases were evaluated with the adhesive remnant index (ARI). ARI(tooth) (n = 498) was assessed on digital photographs by 2 operators. After resin removal and polishing, epoxy replicas were made from the maxillary anterior teeth (n = 62), and enamel surfaces were scored again with the enamel surface index. Elemental analysis was performed on the debonded bracket bases by using energy dispersive x-ray spectrometry mean area scanning analysis. The percentages of calcium and silicon were summed up to 100%. Tooth damage was estimated based on the incidence of calcium from enamel in relation to silicon from adhesive (Ca%) and the correlation between the ARI(bracket) and Ca%.
  
  
  CONCLUSIONS
  While ARI(tooth) results showed score 3 as the most frequent (41%) (P<0.05), followed by scores 0, 1, and 2 (28.7%, 17.9%, and 12.4%, respectively), ARI(bracket) results showed score 0 more often (40.6%) than the other scores (P<0.05). Maxillary anterior teeth had significantly more scores of 3 (49%) than the other groups of teeth (10%-25%) (chi-square; P<0.001). There were no enamel surface index scores of 0, 3, or 4. No correlation between the enamel surface index and ARI(tooth) scores was found (Spearman rho = 0.014, P = 0.91). The incidence of Ca% from the scanned brackets showed significant differences between the maxillary and mandibular teeth (14% ± 8.7% and 11.2% ± 6.5%, respectively; P <0.05), especially for the canines and second premolars (Kruskal-Wallis test, P<0.01). With more remnants on the bracket base, the Ca% was higher (Jonckheere Terpstra test, P<0.05). Iatrogenic damage to the enamel surface after bracket debonding was inevitable. Whether elemental loss from enamel has clinical significance is yet to be determined in a long-term clinical follow-up of the studied patient population.
authors.affiliation: Graduate student, Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Huib Berghauser
authors.initials: HB
authors.lastname: Pont
authors.affiliation: Professor, Dental Materials Unit, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, University of Zürich, Zürich, Switzerland. Electronic address: mutluozcan@hotmail.com.
authors.forename: Mutlu
authors.initials: M
authors.lastname: Özcan
authors.affiliation: Assistant professor, Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.
authors.forename: Bora
authors.initials: B
authors.lastname: Bagis
authors.affiliation: Professor, Department of Orthodontics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Yijin
authors.initials: Y
authors.lastname: Ren
mesh_terms: D000179:Acrylates / Q000009:adverse effects; D000293:Adolescent; D002118:Calcium / Q000032:analysis; D001840:Dental Bonding / Q000009:adverse effects*; D017005:Dental Debonding / Q000009:adverse effects; D003743:Dental Enamel / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D016910:Orthodontic Brackets / Q000009:adverse effects*; D019279:Resin Cements / Q000009:adverse effects*; D013052:Spectrometry, X-Ray Emission; D018709:Statistics, Nonparametric; D017001:Tooth Demineralization / Q000209:etiology*
chemical_list: D000179:Acrylates; D019279:Resin Cements; C477790:Transbond XT; C040415:heliobond; D002118:Calcium