|Year : 2020 | Volume
| Issue : 2 | Page : 56-60
Comparison of the enamel surface characteristics after orthodontic debonding with and without microabrasion: An in vitro study
Luiza Rauber Missel1, Everton Ribeiro Dos Santos1, Darlene Ribeiro Dos Santos Gerzson2, Marina Lucia Cumerlato3, Alexandre Da Silveira Gerzson4
1 School of Dentistry, Lutheran University of Brazil, Canoas, Brazil
2 Private Practice, Oral and Maxillofacial Surgery and Implantology, Caxias do Sul, Rio Grande do Sul, Brazil
3 School of Dentistry, Serra Gaúcha College, Caxias do Sul, Rio Grande do Sul, Brazil
4 Private Practice, Orthodontics, Porto Alegre, RS, Brazil
|Date of Submission||28-Feb-2020|
|Date of Acceptance||01-Jun-2020|
|Date of Web Publication||21-Aug-2020|
Dr. Alexandre Da Silveira Gerzson
Rua Dona Laura 87-506 90430-091, Porto Alegre - RS
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: To visually compare, using microscope, two different techniques for removing adhesive remnants after orthodontic bracket debonding. Methods: Twenty healthy third molars were used. One molar did not undergo any procedures and served as a control. After bracket bonding and immersion of the teeth in saline solution for 12 days, the attachments were debonded. One of the molars was not stripped of the attachments, while the others (n=18) were randomly divided into two groups according to the adhesive removal technique: Group 1, use of a high-speed 18-blade bur and a fine-grain sandpaper disc; and Group 2, use of a high-speed 18-blade bur, a fine-grain sandpaper disc, and enamel microabrasion. Tooth fragments were collected for inspection under a field emission scanning electron microscope for a qualitative analysis of the adhesive remnants. Results: A substantial amount of adhesive residue remained on the enamel surface of the molars in Group 1. The procedures performed in Group 2 were more effective in removing the adhesive remnants but resulted in greater enamel wear and ledge formation. Conclusion: The combined use of a multiblade bur and the microabrasion technique was the most effective method of removing adhesive remnants and returning the enamel to its pre-treatment appearance.
Keywords: Dental debonding, dental enamel, enamel microabrasion, microscopy, orthodontic brackets
|How to cite this article:|
Missel LR, Santos ER, Gerzson DR, Cumerlato ML, Gerzson AD. Comparison of the enamel surface characteristics after orthodontic debonding with and without microabrasion: An in vitro study. J Interdiscip Dentistry 2020;10:56-60
|How to cite this URL:|
Missel LR, Santos ER, Gerzson DR, Cumerlato ML, Gerzson AD. Comparison of the enamel surface characteristics after orthodontic debonding with and without microabrasion: An in vitro study. J Interdiscip Dentistry [serial online] 2020 [cited 2020 Sep 22];10:56-60. Available from: http://www.jidonline.com/text.asp?2020/10/2/56/292923
| Clinical Relevance to Interdisciplinary Dentistry|| |
The attempt to establish a protocol for the removal of the remaining resin after orthodontic treatment and with minimally invasive dentistry as its guide, whose main aspect is to avoid unnecessary wear of the healthy dental structure, through the microabrasion technique, we seek to respoonder this questioning. This technique, in addition to eliminating resinous residue, also provides an extreme surface smoothness, avoiding the accumulation of biofilm and returning the optical aspects of the dental structure.
| Introduction|| |
Orthodontic treatment is extremely popular in the modern society. Bonding of attachments to enamel is based on acid etching, resulting in microporosity that allows microretention of resin infiltrating into the enamel. After orthodontic treatment, brackets should be adequately removed to prevent enamel damage. This process involves removing the adhesive resin while maintaining an ideal enamel surface layer both in structure and in appearance and minimizing dental plaque and discoloration. After debonding, surface roughness interacts with light reflections on the tooth surface, giving it an unnatural appearance.
The main current challenge lies in adequately removing the adhesive resin from the tooth structure after orthodontic treatment while restoring the enamel surface as closely as possible to its original state.,, Studies have shown that all removal methods result in changes to the enamel surface,,, and that enamel roughness is significantly influenced by the chosen adhesive removal technique.
Studies have demonstrated the efficacy of several methods, both single- and multiple-step systems, for removing residual adhesive. Of these, low-speed and high-speed tungsten carbide drill burs are preferred by most professionals today. These burs are quick and effective in removing adhesive residue., However, by removing a layer of enamel, they can cause surface excavation and create relatively large holes that remain visible even after polishing.
The microabrasion technique removes stains and irregularities from the superficial enamel layers and promotes the formation of a highly polished, densely compacted, mineralized layer structure.,,In vitro studies have shown that enamel wear is insignificant if compared to the thickness of the remaining enamel, which allows the microabrasion technique to be classified as a conservative procedure.,,
There are no studies in the literature on the use of microabrasion to remove adhesive remnants after orthodontic treatment. Considering that microabrasion is a conservative approach that removes a small amount of enamel and provides adequate polishing, the aim of the present study was to qualitatively compare, using field emission scanning electron microscopy (FESEM), the effects of two different adhesive removal techniques on dental surface after bracket debonding and to determine which method is the most effective.
| Materials and Methods|| |
The study was approved by the Research Ethics Committee of Universidade Luterana do Brasil in Canoas, Brazil (registration no. 61866816.0.0000.5349, approval no. 1.871.765).
Twenty healthy third molars, free of fractures or enamel cracks, were obtained from the Human Tooth Bank of Universidade Luterana do Brasil in Torres, Brazil. All teeth were previously immersed in a self-curing acrylic resin base (Jet, Clássico; São Paulo, Brazil). Prophylaxis was performed with fine powdered pumice (Rutenium; Rio de Janeiro, Brazil) and a Robinson brush (American Burrs; Palhoça, Brazil). Bracket bonding was carried out in the same order in all groups. The buccal surfaces were conditioned with 37% phosphoric acid for 15 s (Atack Tec, Caithec; São José dos Pinhais, Brazil), then rinsed for 30 s, and air dried with a triple syringe for 10 s. The Adper Single Bond 2 (3M; Campinas, Brazil) adhesive was applied and rubbed onto the previously conditioned surface using a disposable applicator, followed by air jet and light curing (Optilight LD Max, Gnatus; Ribeirão Preto, Brazil) for 20 s. Metal brackets (10.30.201, Morelli; Sorocaba, Brazil) were then bonded using Orthocem cement (FGM, Palhoça; Brazil) and positioned with an orthodontic bracket holder, being pressed against the teeth with the tip of the holder. Excess cement was removed with a dental explorer, and the resin was light cured for 20 s on the mesial and distal margins of the brackets. The teeth were then immersed in saline solution for 12 days. One tooth did not undergo any procedures and served as a healthy control for the treated enamel surfaces.
After bracket bonding and immersion of the teeth in saline solution, the attachments were debonded. The adhesive was not removed from one of the specimens to serve as a control for the amount of adhesive resin bonded to the enamel surface. The remaining teeth (n = 18) were then randomly divided into two groups (n = 9) according to the method used for adhesive removal. In group 1, an 18-speed high-speed drill (FG218, Angelus Prima Dental; Londrina, Brazil) and a polishing disc (Diamond Pro, FGM; Palhoça, Brazil), followed by polishing with diamond paste (Diamond Excel, FGM; Palhoça, Brazil) with a felt disc (Diamond Flex, FGM; Palhoça, Brazil). Group 2 underwent the same procedure, followed by enamel microabrasion (Whiteness RM, FGM; Palhoça, Brazil) and polishing.
The brackets were debonded using bracket-removing pliers (number 121; Golgran, São Caetano do Sul, Brazil), which were positioned on the mesial and distal surfaces of the bracket without touching the enamel surface. Adhesive remnants were then removed according to the methods assigned to each group [Table 1].
For the microscopic analysis, tooth fragments were obtained by sectioning the specimens with double-sided diamond discs (American Burrs; Porto Alegre, Brazil) under water cooling [Figure 1]. The samples were coated with a gold–palladium alloy and analyzed under a field emission scanning electron microscope (Inspect F50 FEI model, available at Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil) at × 125, ×1000, and × 2000 magnifications. Qualitative analysis consisted in the visual comparison of the two groups for the presence or absence of adhesive remnants on the deep enamel layers. The specimens were also compared with the healthy control and with the tooth surface where adhesive remnants remained untouched.
|Figure 1: Tooth fragments obtained for scanning electron microscope analysis. (a) Longitudinal section on the mesiodistal plane. (b) Longitudinal section on the buccolingual plane. (c) Section on the cervical region of the buccal surface, perpendicular to the long axis of the tooth. (d) Fragment obtained from the tooth|
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| Results|| |
Neither method was able to completely remove the adhesive remnants after bracket debonding. However, the procedure involving microabrasion was found to be more effective in removing the resin.
The analysis of Group 1 specimens showed that the use of a high-speed 18-blade bur followed by polishing still allowed a considerable amount of adhesive resin to remain on the enamel surface, although remnants were clinically imperceptible. A visual FESEM analysis of the samples showed milder tooth wear in Group 1 than in Group 2 and no ledge formation [Figure 2]a. However, adhesive removal in Group 1 was not as satisfactory as the one obtained in Group 2 with the combined use of a multiblade bur and the microabrasion technique. At the microscopic level, tooth surface in Group 1 showed scratches and roughness [Figure 2]b, indicating that a layer of resin was still attached to the structure.
|Figure 2: Photomicrographic appearance of Group 1 specimens. (a) Tooth surface after the use of a multiblade bur, with resin remnants. (b) Scratched surface resulting from the adhesive removal technique used, and the presence of resin remnants both on tooth surface and inside the enamel layer|
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Group 2 specimens showed visibly greater enamel wear and ledge formation between the bracket bonding area and the enamel surface [Figure 3]a. However, increased wear led to an almost complete removal of the adhesive remnants. Microabrasion removed the aprismatic enamel layer and exposed the mostly clean enamel rod heads, although a small amount of adhesive particles could still be observed on the surface [Figure 3]b. Enamel surface also had less irregularities and greater smoothness. Clinically, the microabrasion technique resulted in greater gloss and smoothness compared to the drill-only technique.
|Figure 3: Photomicrographic appearance of Group 2 specimens. (a) Ledge formation on the area treated with microabrasion. (b) Prismatic enamel layer among resin islands|
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| Discussion|| |
The presence of adhesive remnants on tooth enamel following orthodontic treatment may promote plaque buildup, facilitate staining and discoloration, and interfere with light reflections on the tooth surface, resulting in an unhealthy-looking enamel. While careful bonding and debonding are essential, many studies have shown that all adhesive remnant removal methods alter the tooth enamel surface,,,,, and that enamel smoothness is significantly influenced by the selected removal technique. This is consistent with our findings, which show that, although no technique was able to completely remove the resin, adding a microabrasion step resulted in greater adhesive removal and a more polished surface.
The use of multiblade tungsten carbide burs is a quick way to remove resin,,, and is currently the method of choice among dental professionals. The main drawback is that, by removing a layer of enamel, multiblade burs cause surface roughness, requiring further polishing. The high-speed 18-blade bur used in the present study was unable to completely remove resin remnants. Some authors recommend the use of high-speed 12-blade carbide burs, because, due to fewer blades, they provide greater surface wear and may, therefore, be more effective than 18-blade burs in removing adhesive remnants, although this might result in greater roughness on the enamel surface. Meanwhile, others recommend the use of high-speed 30-blade burs, which cause less enamel damage,, due to the larger number of blades and decreased cutting power. However, the aforementioned studies, despite providing significant results for surface roughness by profilometer analysis, have not assessed the amount of resin remaining on the teeth. Our findings lead us to believe that adhesive removal with a 30-blade bur may provide a less satisfactory outcome compared to an 18-blade bur due to lower cutting power.
The analysis of FESEM images showed that the technique combining the use of a multiblade bur and microabrasion removed the aprismatic enamel layer, exposing the prisms to the surface. This is in agreement with studies conducted by the developers of the microabrasion technique, who concluded that the chemical action of hydrochloric acid associated with an abrasive substance causes the removal of the outermost layer of enamel. In the present study, after microabrasion, the tooth surface was compacted and polished, as observed in previous studies,,,,, demonstrating that the technique confers smoothness and gloss to the enamel surface. According to studies on the effects of microabrasion, highly polished and mineralized surfaces are beneficial because their smoothness makes them less prone to colonization by Streptococcus mutans.,, Microabrasion, although did not completely remove adhesive remnants, was more efficient in the present study despite the greater wear to tooth structure. This effect, however, was insignificant considering the thickness of the remaining enamel. As previously stated by other authors, this technique can, therefore, be considered a conservative approach.,,,
Microabrasion outcomes are influenced by the abrasion technique, by the size, shape, and hardness of abrasive instruments, by application times, by rotation speed of the contra-angle handpiece, and by the amount of pressure used when applying the product to the tooth surface.,, Ledge formation in our study might have been related to the way the procedure was performed. It is the responsibility of the dental professional to carefully and properly carry out the adhesive removal procedure in order to prevent damage to the tooth structure.
The microabrasion technique is well established as an effective way to remove fluorosis stains and other types of stains and defects from the enamel structure., Although this study suggests that microabrasion may aid in the removal of adhesive remnants, we cannot state that the indication for microabrasion should include the removal of resin remnants after orthodontic bracket debonding. Further studies are needed to better understand the applications of microabrasion in this setting.
| Conclusion|| |
Both methods used for the removal of adhesive remnants caused changes to the enamel surface topography. However, the combined use of the microabrasion technique and a multiblade bur was more effective in removing the resin and returning the enamel to its pretreatment appearance.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Janiszewska-Olszowska J, Szatkiewicz T, Tomkowski R, Tandecka K, Grocholewicz K. Effect of orthodontic debonding and adhesive removal on the enamel – Current knowledge and future perspectives – A systematic review. Med Sci Monit 2014;20:1991-2001.
Ulusoy C. Comparison of finishing and polishing systems for residual resin removal after debonding. J Appl Oral Sci 2009;17:209-15.
Joo HJ, Lee YK, Lee DY, Kim YJ, Lim YK. Influence of orthodontic adhesives and clean-up procedures on the stain susceptibility of enamel after debonding. Angle Orthod 2011;81:334-40.
Eliades T, Kakaboura A, Eliades G, Bradley TG. Comparison of enamel colour changes associated with orthodontic bonding using two different adhesives. Eur J Orthod 2001;23:85-90.
Cardoso LA, Valdrighi HC, Filho MV, Correr AB. Effect of adhesive remnant removal on enamel topography after bracket debonding. Dental Press J Orthod 2014;19:105-12.
Campbell PM. Enamel surfaces after orthodontic bracket debonding. Angle Orthod 1995;65:103-10.
Albuquerque GD, Filho MV, Lucato AS, Boeck EM, Degan V, Kuramae M. Evaluation of enamel roughness after ceramic bracket debonding and clean-up with different methods. Braz J Oral Sci 2010;9:81-4.
Zarrinnia K, Eid NM, Kehoe MJ. The effect of different debonding techniques on the enamel surface: Anin vitro
qualitative study. Am J Orthod Dentofacial Orthop 1995;108:284-93.
Eliades T, Gioka C, Eliades G, Makou M. Enamel surface roughness following debonding using two resin grinding methods. Eur J Orthod 2004;26:333-8.
Vidor MM, Felix RP, Marchioro EM, Hahn L. Enamel surface evaluation after bracket debonding and different resin removal methods. Dental Press J Orthod 2015;20:61-7.
da Fonseca DM, Pinheiro FH, de Medeiros SF. Suggestion of a simple and efficient protocol for removing brackets orthodontic. R Dental Press Estét 2004;1:112-9.
Gwinnett AJ, Gorelick L. Microscopic evaluation of enamel after debonding: Clinical application. Am J Orthod 1977;71:651-65.
Zuanon AC, Azevedo ER, Lima LM, Santos-Pinto LA. Wear surface of dental enamel after in vitro
microabrasion. Rev Odontol UNESP 2010;39:207-11.
Matos AB, Turbino ML, Matson E. Effect of enamel microabrasion: Electron microscopy study of scan. Rev Odontol Univ São Paulo 1998;12:105-11.
Segura A, Donly KJ, Wefel JS. The effects of microabrasion on demineralization inhibition of enamel surfaces. Quintessence Int 1997;28:463-6.
Hermes SR. Dental enamel microabrasion for treatment of fluorosis. Rev Gaúcha Odontol 2013;61:427-33.
Mendes RF, Mondelli J, Freitas CA. Quantity evaluation wear of dental enamel subjected to microabrasion. Rev FOB 1999;7:35-40.
Train TE, McWhorter AG, Seale NS, Wilson CF, Guo IY. Examination of esthetic improvement and surface alteration following microabrasion in fluorotic human incisors in vivo
. Pediatr Dent 1996;18:353-62.
Zachrisson BU, Arthun J. Enamel surface appearance after various debonding techniques. Am J Orthod 1979;75:121-7.
Retief DH, Denys FR. Finishing of enamel surfaces after debonding of orthodontic attachments. Angle Orthod 1979;49:1-0.
Croll TP, Cavanaugh RR. Enamel color modification by controlled hydrochloric acid-pumice abrasion. I. technique and examples. Quintessence Int 1986;17:81-7.
Croll TP. Enamel microabrasion: The technique. Quintessence Int 1989;20:395-400.
Lynch CD, McConnell RJ. The use of microabrasion to remove discolored enamel: A clinical report. J Prosthet Dent 2003;90:417-9.
Hosein I, Sherriff M, Ireland AJ. Enamel loss during bonding, debonding, and cleanup with use of a self-etching primer. Am J Orthod Dentofacial Orthop 2004;126:717-24.
Croll TP, Cavanaugh RR. Enamel color modification by controlled hydrochloric acid-pumice abrasion. II. Further examples. Quintessence Int 1986;17:157-64.
Donly KJ, O'Neill M, Croll TP. Enamel microabrasion: A microscopic evaluation of the “abrasion effect”. Quintessence Int 1992;23:175-9.
De Marchi R, De Marchi LM, Terada RS, Terada HH. Comparison between two resin removal methods after bracket take-off. Dental Press J Orthod 2012;17:130-6.
Gomes MJ, Pereira AC, Queiroz CD, Cury JA, Tabchoury CP, Meneghim MD. Influence of enamel microabrasion on the development of artificial caries: pilot study in vitro
. UFES Rev Odontol 2005;7:39-47.
Queiroz VA, Martins GC, Zander-Grande C, Gomes JC, Campanha NH, Jorge JH. Report of two techniques of enamel microabrasion for stain removal: Discussion of clinical cases. Rev Odontol UNESP 2010;39:369-72.
[Figure 1], [Figure 2], [Figure 3]