|Year : 2014 | Volume
| Issue : 2 | Page : 105-107
Methods for removal of resin remaining after debonding of orthodontic brackets: A literature review
Mateus Rodrigues Tonetto1, Fausto Frizzera2, Thiago Soares Porto2, Keren Cristina Fagundes Jordão2, Marcelo Ferrarezi de Andrade2, Reidson Stanley Soares dos Santos3, Rufino Jose Klug3, Matheus Coelho Bandeca3
1 Department of Dentistry, University of Cuiabá, Cuiabá, Brazil
2 Department of Restorative Dentistry, University of São Paulo State, Araraquara, Brazil
3 Department of Post-Graduate in Dentistry, CEUMA University, São Luis, Brazil
|Date of Web Publication||5-Jun-2014|
Matheus Coelho Bandeca
Department of Post-Graduate in Dentistry, CEUMA University, São Luis
Source of Support: None, Conflict of Interest: None
The removal of resin debris and/or resin cement from the enamel surface without causing iatrogenic is the main objective when removing the orthodontic brackets. Some factors such as the time required for removal, damage to the tooth structure, are essential factors for the clinician at the time of removal. Various techniques are used for the removal of orthodontic brackets after the treatment; it is known that the use of clinical procedures such as the use of diamond burs and some pliers removers can damage the structure of the enamel, often depending on the bond strength that should be taken into consideration at the time of removal. This literature review aims to gather the most relevant studies that can clarify the clinical technique, which may be more suitable for removal of the brackets.
Keywords: Adhesion, brackets, orthodontic
|How to cite this article:|
Tonetto MR, Frizzera F, Porto TS, Jordão KF, de Andrade MF, dos Santos RS, Klug RJ, Bandeca MC. Methods for removal of resin remaining after debonding of orthodontic brackets: A literature review. J Dent Res Rev 2014;1:105-7
|How to cite this URL:|
Tonetto MR, Frizzera F, Porto TS, Jordão KF, de Andrade MF, dos Santos RS, Klug RJ, Bandeca MC. Methods for removal of resin remaining after debonding of orthodontic brackets: A literature review. J Dent Res Rev [serial online] 2014 [cited 2019 May 24];1:105-7. Available from: http://www.jdrr.org/text.asp?2014/1/2/105/133960
| Introduction|| |
Acid etching of the enamel was proposed by Buonocore in 1955  enabling the bonding of orthodontic brackets with composite resins. However, depending on the concentration of etching time, type of adhesive system, resin cement, and restorative material the union between dental enamel and base material can be larger than the union of the base material with the brackets. 
The removal of orthodontic brackets aims to separate not only the base of the bracket from the tooth as well as any remaining resin to restore the same condition prior to orthodontic treatment. However, this is not always possible and may lead to mechanical removal of the enamel, endangering healthy dental structure and providing irreversible damage to the enamel. This damage can be reduced depending on the technique used for bracket removal. Among these pliers for mechanical removal, different diamond burs of high and low speed, abrasive discs, rubber tips, ultrasonic units and air abrasion techniques are among the most commonly used techniques. [3-5]
In front of the great diversity of materials for bonding brackets and methods for its removal, it is difficult to establish a clinical effectively technique that causes less damage to the enamel structure. Thus, this study aimed to review the most used techniques to remove the remaining material after debonding of orthodontic brackets.
| Literature Review|| |
The amount of lost enamel and residual cementing agent after bracket removal has been widely discussed in the literature. Several factors such as resin cement used, tools for removal are listed in assessing the amount of enamel lost. 
Different techniques have been used to remove residual adhesive after debonding of brackets. The methods should return the enamel to its form with the least possible damage to its surface. The literature procedures for removal ranges from remover with pliers band, different types of drills in low and high speed tips, soflex discs, ultrasonic applications and laser. [6-9]
In 1979, Zachrisson and Arthun  evaluated by stereomicroscopy and scanning electron microscopy, the quality of the enamel surface after debonding of brackets. Thin diamond burs, coarse strips, medium and fine sandpaper, green rubber tip and tungsten carbide drill were tested and assigned to observable qualitative scores that ranged from 0 to 4 according to the index surface system: 0 = Perfect surface, 1 = satisfactory, 2 = surface acceptable, 3 = imperfect surface, 4 = unacceptable surface. Thus, among the tested techniques the most appropriate results were obtained with tungsten burs at low speed, producing the best standard with less enamel loss and superior accessibility into anatomical grooves as other areas.
A study using enamel reference steel markers was performed to determine the enamel loss resulting from each step in the placement and removal of the bonded orthodontic attachments. The remaining material was removed with rotary instruments. In this context higher enamel loss was observed when used at high speed with the 7902 drill and green rubber tip, while at low speed with drill 7111 less enamel was damaged. 
In order to compare tungsten burs, Hong and Lew  evaluated four other methods of enamel remaining index by scanning electron microscopy analysis. After bracket debonding, the samples of each group were finished by different methods: Ormco remover pliers, tungsten drill Komet at low speed, ultra high speed diamond drills, tungsten drill at high speed, white stone finish. Statistical analysis demonstrated no significant difference in inter-observer variability in the two assessment. It was stated that no isolated method was considered ideal for removal of the remaining composite.
In 2001, Radlanski  proposed a new drill with a rounded tip eight-strip tungsten with a funnel shape. In general, the cutting capacity was reduced enamel, while the drill is maintained sufficiently sharp. For testing the prototype, the remaining composite was removed after initial removal with conventional tungsten carbide drills and prototypes gradually modified of new finishing bur. The resulting enamel surfaces were examined by scanning electron microscopy; the samples were treated with a polishing paste and evaluated again. Conventional burs not only removed the remaining resin, but also the enamel structure. The developed prototype was demonstrated by morphological evaluation to be less aggressive in removing the residual resin after bracket debonding.
In order to evaluate the surface roughness of the enamel using two methods of removing resin, Eliades et al.,  2004, submitted the enamel surface to profilometry, registering four roughness parameters (Ra, Rq, Rt, and Rz). Removal of the remaining specimens was performed with tungsten carbide drill eight-strip and diamond drill ultrathin, both at high speed and duration of each protocol for removal was also recorded. Regarding the roughness of the enamel there was no significant difference between the two methods. The resin removal with a diamond bur was obtained in approximately half the time in comparison with the tungsten drill with eight blades. Regardless of the protocol used for removing the resin, there is an irreversible effect on enamel texture.
In 2013, Ahrari et al.  evaluated the enamel roughness after removing the resin with different tips and erbium: Yttrium-aluminum-garnet (Er: YAG) laser. The buccal enamel surfaces were initially submitted to analysis of profilometry according to four parameters of surface roughness (Ra, Rq, Rt and Rz). After detachment of the brackets, the remaining resin was removed with tungsten carbide burs in low and high speed, ultrafine diamond bur and Er: YAG laser (250 mJ, pulse time, 4 Hz) and the roughness parameters were measured. Buccal surfaces were polished and the profilometry was performed for the third time. Application of ultrafine diamond drill or Er: YAG laser caused irreversible damage to the enamel surface of teeth. These methods may not be suitable for removing resin remnants after debonding of orthodontic brackets.
| Discussion|| |
Despite the extensive published researches, there is no consensus on which technique is more effective to eliminate the remaining resin after orthodontic bracket removal. One of the methods used to analyze the enamel after bracket removal is by electron microscopy and photomicrographs to visualize the enamel roughness and morphology. [3, 5, 14-16] To quantify the damage to the enamel indexes were developed to evaluate the enamel surface by scores, as the adhesive remnant index or surface roughness index.
Since the 70's it was suggested that the removal of the composite remnants after debonding of orthodontic accessory with 30 strip tungsten drills provided less injury to the enamel. [3,5] Even with the different types of burs, for safer resin removal with minimal damage to the enamel it should be done with tungsten carbide drills in low speed. [10, 12, 17-19] When comparing multilaminate 8-30 blades, it can be observed that 30 blades provided better results. This can be explained by the greater number of blades shortened the distance between blades, generating a more refined and smooth enamel surface. [3,19]
When the consumed time of the technique is evaluated it can be observed that the procedure takes a longer time to be performed at low speed. This time should not be the factor of choice for the method employed since preserving the original appearance of the enamel surface is recquired. [13,20]
Methods such as Er: YAG laser provides a larger surface roughness of the enamel structure in comparison with rotatory instruments. The same can also be observed when ultrafine diamond bur is used, which does not return to its original enamel integrity, indicating irreversible damage. 
One of the problems that can be noticed in studies where the methods are evaluated for removing resin material is the lack of standardization of the amount of material present in the enamel surface when the bracket is removed. [20-22] This factor may influence the results obtained on the most appropriate method for removal of the resin remnant. Thus, studies with better design in order to reach the final consensus must be achieved.
| Conclusion|| |
Rotary instruments that have the ability to remove residual resin cement bonded to the enamel surface without providing excessive damage to the tooth structure should be preferred. The use of diamond burs to eliminate the remaining resin after bracket removal could remove excessive enamel. Multilaminated tungsten burs shows efficient removal of resin without damaging the enamel.
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