title: Effects of various debonding and adhesive clearance methods on enamel surface: an in vitro study.
abstract: BACKGROUND
  The purpose of this study was to evaluate orthodontic debonding methods by comparing the surface roughness and enamel morphology of teeth after applying two different debonding methods and three different polishing techniques.
  
  
  METHODS
  Forty eight human maxillary premolars, extracted for orthodontic reasons, were randomly divided into three groups. Brackets were bonded to teeth with RMGIC (Fuji Ortho LC, GC, Tokyo, Japan) (two groups, n = 18 each) after acid etching (30s), light cured for 40 s, exposed to thermocycling, then underwent 2 different bracket debonding methods: debonding pliers (Shinye, Hangzhou, China) or enamel chisel (Jinzhong, Shanghai, China); the third group (n = 12) comprised of untreated controls, with normal enamel surface roughness. In each debonded group, three cleanup techniques (n = 6 each) were tested, including (I) diamond bur (TC11EF, MANI, Tochigi, Japan) and One-Gloss (Midi, Shofu, Kyoto, Japan), (II) a Super-Snap disk (Shofu, Kyoto, Japan), and (III) One-Gloss polisher. The debonding methods were compared using the modified adhesive remnant index (ARI, 1-5). Cleanup efficiencies were assessed by recording operating times. Enamel surfaces were qualitatively and quantitatively evaluated with scanning electron microscopy (SEM) and surface roughness tester, respectively. Two surface roughness variables were evaluated: Ra (average roughness) and Rz (10-point height of irregularities).
  
  
  RESULTS
  The ARI scores of debonded teeth were similar with debonding pliers and enamel chisel (Chi-square = 2.19, P > 0.05). There were significant differences between mean operating time in each group (F = 52.615, P < 0.01). The diamond bur + One-Gloss took the shortest operating time (37.92 ± 3.82 s), followed by the Super-Snap disk (56.67 ± 7.52 s), and the One-Gloss polisher (63.50 ± 6.99 s). SEM appearance provided by the One-Gloss polisher was the closest to the intact enamel surface, and surface roughness (Ra: 0.082 ± 0.046 μm; Rz: 0.499 ± 0.200 μm) was closest to the original enamel (Ra: 0.073 ± 0.048 μm; Rz: 0.438 ± 0.213 μm); the next best was the Super-Snap disk (Ra: 0.141 ± 0.073 μm; Rz: 1.156 ± 0.755 μm); then, the diamond bur + One-Gloss (Ra: 0.443 ± 0.172 μm; Rz: 2.202 ± 0.791 μm).
  
  
  CONCLUSIONS
  Debonding pliers were safer than enamel chisels for removing brackets. Cleanup with One-Gloss polisher provided enamel surfaces closest to the intact enamel, but took more time, and Super-Snap disks provided acceptable enamel surfaces and efficiencies. The diamond bur was not suitable for removing adhesive remnant.
authors.affiliation: Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road, Xicheng District, Beijing, 100050, China.
authors.forename: Xiao-Chuan
authors.initials: XC
authors.lastname: Fan
authors.affiliation: Department of Orthodontics, Capital Medical University School of Stomatology, No.4 Tiantan Xili, Dongcheng District, Beijing, 100050, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Stomatology, Beijing Friendship Hospital, Capital Medical University, No.95 Yong'an Road, Xicheng District, Beijing, 100050, China. hxf1998@hotmail.com.
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Huang
mesh_terms: D000134:Acid Etching, Dental; D001641:Bicuspid / Q000648:ultrastructure; D003738:Dental Cements; D017005:Dental Debonding / Q000379:methods*; D003743:Dental Enamel / Q000648:ultrastructure*; D003762:Dental Instruments; D003775:Dental Polishing / Q000009:adverse effects / Q000379:methods*; D018130:Diamond; D006801:Humans; D066298:In Vitro Techniques; D008855:Microscopy, Electron, Scanning; D016910:Orthodontic Brackets; D011897:Random Allocation; D013499:Surface Properties
chemical_list: D003738:Dental Cements; D018130:Diamond
keywords: Adhesive clearance; Enamel damage; Orthodontic debonding; Resin modified glass ionomer cement (RMGIC); Scanning electron microscope (SEM); Surface roughness