title: Patients' report of discomfort and pain during debonding of orthodontic brackets: a comparative study of two methods.
abstract: OBJECTIVE
  To examine the level of discomfort and pain reported by patients during debonding of orthodontic metallic brackets by comparing two of the most popular methods, since discomfort can negatively influence patients' motivation to undergo orthodontic treatment.
  
  
  METHODS
  This split-mouth designed study involved 37 patients. Two methods were used for bracket removal: a lift-off debonding instrument and a ligature-cutting plier. The level of discomfort during debonding was evaluated on a scale of 0 to 4; The Adhesive Remnant Index (ARI) was taken into consideration, as well. Comparison between the methods was statistically analyzed by using the Wilcoxon signed rank and chi-squared tests (P<.05).
  
  
  RESULTS
  Regarding the remnant adhesive, no significant difference was observed between the methods. Patients' reports of pain (score ≥2) were observed in 24.3% of teeth when the brackets were removed using a ligature-cutting plier, while there was a 12.8% report of pain when the lift-off instrument was employed (odds ratio [OR]=2.17, P<.001, χ(2)=17.7). Statistically significant lower scores for maxillary (P=.02) and mandibular central incisors (P=.02), maxillary lateral incisors (P=.02), mandibular canines (P=.00), and mandibular premolars (P=.00/.02) were reported when the lift-off instrument was employed.
  
  
  CONCLUSIONS
  For the removal of orthodontic brackets, the lift-off instrument is better accepted by patients compared to the ligature cutting pliers, given that reports of pain are about two times lower with the former. The ARI was the same for both methods.
authors.affiliation: Department of Orthodontics, São Paulo Association of Dentistry at São José dos Campos, São Paulo, Brazil.
authors.forename: Thiene Silva
authors.initials: TS
authors.lastname: Normando
authors.forename: Flávio Siqueira
authors.initials: FS
authors.lastname: Calçada
authors.forename: Weber José da Silva
authors.initials: WJ
authors.lastname: Ursi
authors.forename: David
authors.initials: D
authors.lastname: Normando
mesh_terms: D000134:Acid Etching, Dental / Q000379:methods; D000268:Adhesiveness; D000293:Adolescent; D000328:Adult; D001641:Bicuspid / Q000473:pathology; D002648:Child; D003481:Cuspid / Q000473:pathology; D003738:Dental Cements / Q000737:chemistry; D017005:Dental Debonding / Q000295:instrumentation / Q000379:methods*; D003743:Dental Enamel / Q000473:pathology; D005260:Female; D006801:Humans; D007180:Incisor / Q000473:pathology; D008297:Male; D016910:Orthodontic Brackets; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement; D019279:Resin Cements / Q000737:chemistry; D013499:Surface Properties; D055815:Young Adult
chemical_list: D003738:Dental Cements; C097531:Rely a Bond system; D019279:Resin Cements