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BackgroundThe aim of this clinical investigation was to compare the level of discomfort reported by patients during the removal of orthodontic metallic brackets performed with four different debonding instruments.MethodsThe sample examined in this split-mouth study comprised a total of 70 patients (840 teeth). Four different methods of bracket removal were used: lift-off debonding instrument (LODI), straight cutter plier (SC), how plier (HP), and bracket removal plier (BRP). Prior to debonding with all experimental methods, the archwire was removed. Before appliance removal, each patient was instructed about the study objectives. It was explained that at the end of debonding in each quadrant, it would be necessary to assess the discomfort of the procedure using a visual analog scale (VAS). This scale was composed of a millimeter ruler scoring from 0 to 10, in which 0 = a lot of pain, 5 = moderate pain, and 10 = painless. The level of significance was predetermined at 5 % (p = 0.05), and the data were analyzed using the BioEstat 5.0 software (BioEstat, Belém, Brazil).ResultsThe pain scores with SC were significantly higher than in all other methods. There were no significant differences between HP and BRP pain scores, and the LODI group showed the lowest pain scores. Statistically, significant differences were observed in the ARI between the four debonding methods.LimitationsThe biggest limitation of this study is that each tooth was not assessed individually.ConclusionsPatients reported lower levels of pain and discomfort when metallic brackets were removed with the LODI. The use of a straight cutter plier caused the highest pain and discomfort scores during debonding.

Cleft lip and palate patients commonly present maxillary constriction, particularly in the anterior region. The aim of this case report was to describe an alternative clinical approach that used a smaller Hyrax screw unconventionally positioned to achieve greater anterior than posterior expansion in patients with complete unilateral cleft lip and palate. The idea presented here is to take advantage of a reduced dimension screw to position it anteriorly. When only anterior expansion was needed (patient 1), the appliance was soldered to the first premolar bands and associated to a transpalatal arch cemented to the first molars. However, when overall expansion was required (patient 2), the screw was positioned anteriorly, but soldered to the first molar bands. Intercanine, premolar, and first molar widths were measured on dental casts with a digital caliper. Pre-expansion and postexpansion radiographs and tomographies were also evaluated. A significant anterior expansion and no intermolar width increase were registered in the first patient. Although patient 2 also presented a greater anterior than posterior expansion, a noteworthy expansion occurred at the molar region. The alternative approach to expand the maxilla in cleft patients reported here caused greater anterior than posterior expansion when the Mini-Hyrax was associated to a transpalatal arch, and its reduced dimension also minimized discomfort and facilitated hygiene.