What is the best method for debonding metallic brackets from the patient’s perspective?

Abstract

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.

The effect of using Er,Cr:YSGG laser in debonding stainless steel orthodontic brackets: an in vitro study

“…Adhesive remnants on the enamel surfaces must be removed after bracket debonding. However, methods employed for adhesive remnant removal may scratch the enamel surface or produce craters or grooves [9,10].…”

Comparison of shear bond strength to clinically simulated debonding of orthodontic brackets: An in vitro study

“…[ 1 2 3 4 5 6 7 8 9 10 11 ] Others used instruments that are not manufactured specifically for debonding such as Weingart pliers, Howe pliers, and straight wire cutters. [ 12 13 ] Multiple in vitro and some in vivo studies have assessed and compared the effect of such instruments on the debonding strength, enamel surfaces, adhesive remnants, as well as on bracket breakage,[ 4 7 10 12 13 14 15 ] with varied results.…”

“…However, many factors have been reported to affect the final debonding strength value. The force application type,[ 2 3 4 12 16 17 18 19 ] magnitude,[ 20 ] location,[ 6 16 17 19 21 22 23 ] direction,[ 1 7 19 ] and angulation[ 23 ] are some of the major factors affecting the final bond strength value. The in vivo versus in vitro environments have also shown to give different results.…”

“…The debonding pliers, which are specifically designed for debonding orthodontic brackets, are designed to produce shear/peel, compressive, or tensile forces depending on the type of pliers used, direction (occluso-gingival or mesiodistal), and location of force application (at bracket wings or bracket base). [ 1 4 5 10 12 13 14 17 ] Su et al ., compared in vitro four different methods of debonding using clinically simulated models. They found that applying a debonding force on the brackets in an occluso-gingival direction at the bracket base produced significantly lower bond strength and less adhesive remnants than applying the same force in the same direction but at the bracket wings.…”

Shear Bond Strength of Bisphenol a-Glycidyl Methacrylate Adhesive Resin After Application of Eucalyptus Oil Before Debonding Metallic Orthodontic Bracket

“…However, superior bonding forces may lead to problems during debonding at the end of orthodontic treatment. The visual analog scale, used to assess discomfort, has demonstrated moderate levels of pain (4.6-6.6, where 0=a lot of pain, 5=moderate pain, and 10=painless) when metallic brackets were removed using pliers [1]. An increase in shear bond strength leads to an increase in the risk of enamel fracture during debonding.…”