Debonding and composite remanants removal

Debanding , debonding
and removal of
orthodontic composite
remnants .
prof. dr. Maher Fouda
Faculty of Dentistry. Mansoura university
Mansoura .Egypt

The objectives of debonding
Is to Remove the attachments and all the adhesives
from the teeth.
Is to restore the surfaces of the teeth as closely as
possible to their pretreatment condition without
inducing iatrogenic damages to the enamel surfaces.

Debonding is discussed in
detail as follows;
Clinical procedure.
Enamel tear outs and cracks(fractures
lines).
Removal of the residual adhesives.
Amount of enamel lost in debonding.
Operator safety during debonding.

Clinical procedure
Removal of steel brackets;
The brackets should be individually removed to avoid
the force transfer from tooth to tooth, which may
increase risk of enamel crack formation.

With metal brackets, applying a cutting pliers to the base
of the bracket so that the bracket bends is the safest
method. This has the disadvantage of destroying the
bracket, which otherwise could be reused, but protecting
the enamel usually is a more important consideration

1. Mechanical Methods: Using pliers (bracket removing plier,
Howe plier, ligature cutter, Weingart)or wrenches.
The original method:
Place a tips of a twin-beaked pliers against
the mesial and the distal edges of the bonding
base and cut the brackets off between the tooth
and the base.

Gentler technique:
Squeeze the bracket wings
mesiodistally and
then lift the bracket off
with a peel force.
This technique is useful on
mobile, brittle
or endodontically treated
tooth.
.

The recommended technique,
 in which brackets are not deformed and is to
remove the brackets while it is still ligated
in place.
 The brackets are gripped one by one
with bracket-removing plier
and
lifted outward at a 45-degree angle. The indention
In the pliers fits into the gingival tie-wings for
a secure grasp

Lift-Off Bracket Remover
Place the wire over any bracket wing, position the instrument so that
it is over the bracket, gently squeeze the handle until the two contact
surfaces are balanced over the tooth and squeeze more until the
bracket lifts from the tooth

 This technique is quick and gentle and leave
 the brackets intact and fit for recycling.
The bond breaks in the adhesive bracket interface
and the pattern of the mesh backing is visible on
the adhesive remaining on the tooth.
This technique uses a peeling type force.
A peel force ,as in peeling an orange, creates
prepheral stress
concentrations that cause bonded metal brackets
to fail at low force values.
 .

 Attempts to remove the brackets by shearing it off
( as is done in removing the bands)can be traumatic to the patient
and damaging to the enamel
Task Bond Removing Pliers
Designed to remove excess composite bond
from the enamel surface after debonding.
The plastic tip sits on the occlusal surface, whilst
the metal tip gently removes adhesive residue.
Task Bracket Removing Pliers
Designed to remove any type of direct
bond bracket – metal, ceramic or
composite.
The blades slide behind the base of the
attachment, and when squeezed, lift it
from the tooth surface.
.

Task Bracket Remover Angled Task Bracket Remover Straight

Mesiodistally cutting off the brackets with gradual
pressure from the tips of twin-beaked pliers oriented
close to the bracket–adhesive interface is not
recommended because doing so may introduce
horizontal enamel cracks.

2. Ultrasonic method using
special tips
Ultrasonic tip can cause cohesive
bond failure within the adhesive or
bond failure occurs at enamel adhesive interference.
So bracket damage is
avoided.

it minimizes the potential for bracket failure as well as the trauma
to the enamel surface during debonding .

3-Electro-thermal Method:
Overcomes the problems of bracket failure,
enamel damage and high forces when
debonding orthodontic brackets. The electro
thermal debracketing instrument transfers
heat through the bracket, allowing bond
failure at the bracket-adhesive interface as
the heat deforms the adhesive.

Removal of ceramic brackets
Debonding of the ceramic brackets is more liable to enamel
fracture formation since they more strongly adhere to the
enamel surface and will not flex when squeezed with debonding
pliers.

Recent ceramic brackets have a mechanical lock base
and a vertical slot that will collapse the bracket by
squeezing. Debonding collapsible ceramic brackets with
the arch wire in place and ligated to hold together the
debonded bracket parts is recommended.
Ceramic brackets bond to enamel by
indentations and/or undercuts in the
base (mechanical retention)
Chemical retention of
a ceramic bracket
base.Fracture of two tie-wings.

Ceramic brackets are a particular problem for debonding because
their base cannot be distorted. They break before they bend. There
are two ways to create adhesion between a ceramic bracket and the
bonding adhesive: mechanical retention through undercuts on the
bracket base, as is done with metal brackets, or chemical bonding
between the adhesive and a treated bracket base.
The mesh design closely replicates a metal base, while the
polymer material provides a protective barrier between the
ceramic bracket and the enamel. Since the base flexes upon
debonding, the bracket removes cleanly without the need to
fracture the bracket or rely on special tools
Chemical retention
of a ceramic bracket
base

It is quite possible to create such a strong bond between the
adhesive and a chemically treated bracket base that failure
will not occur there, but then when the bracket is removed,
there is a real chance of enamel surface damage. Reports of
enamel damage on debonding began to appear soon after
ceramic brackets were introduced and have been a problem
ever since.

Enamel damage from debonding metal brackets is rare, but
there have been a number of reports of enamel fractures and
removal of chunks of enamel when ceramic brackets are
debonded . It also is easy to fracture a ceramic bracket while
attempting to remove it, and if that happens, large pieces of the
bracket must be ground away with a diamond stone in a
handpiece.

These problems arise because ceramic
brackets have little or no ability to deform—
they are either intact or broken. Shearing
stresses are applied to the bracket to remove
it, and the necessary force can become
alarmingly large

There are three approaches to these problems in
debonding ceramic brackets: 1. Modify the interface
between the bracket and the bonding resin to increase
the chance that when force is applied, the failure will
occur between the bracket
and the bonding material.

Most of the ceramic brackets now on the market have an
interface designed to make removal easier. Chemical bonds
between the bonding resin and the bracket can be too good,
and most manufacturers now have weakened them or
abandoned chemical bonding altogether.

2. Use heat to soften the bonding resin, so that the
bracket can be removed with lower force. 3. Modify
the bracket so that it breaks predictably when
debonding force is applied.

Nevertheless, the ideal solution would be to perfect the
third approach-modification of the bracket -
so that ceramic brackets can be debonded without
heating as readily as metal ones.

One advantage of a metal slot in a ceramic bracket
is that then the bracket can be engineered to fracture
in the slot area, which makes it much easier to
remove.

Electrothermal and laser instruments to heat ceramic
brackets for removal now are available. There is no
doubt that less force is needed when the bracket is
heated, and research findings indicate that there is little
patient discomfort and minimal risk of pulpal damage.

The Pauls Tool
The QuicKlear bracket is by far the easiest ceramic bracket to
remove. The Pauls Tool fits over the bracket and a simple push or
pull on the handle toward the tooth or away from the tooth will easily
debond the bracket.

The Pauls Tool disengages the bracket from the tooth. No pain!
No noise! No squinting of patient’s eyes! The bracket is removed
in one piece and during treatment, if desired the bracket can be
removed and replaced to a better position on the tooth surface

Easier and safer way for sapphire bracket de-bonding
process
• Produced the highest quality, corrosion resistant
stainless steel.
• Prevent the fracture on bracket.
• Possible to remove the bracket even with the ligation
of wire.
• Provide easier and comfortable handling for users.
• Able to use with other bracket brands
Sapphire Bracket Orthodontic De-bonding pliers Aesthetic
Transparent Clear

De-bonds like metal using “Wrench” debonding
instrument in combination with advanced mechanical
mushroom-style base
• Wrenching method: ceramic brackets are debonded
by a special tool that uses a torsional or wrenching
force at the base of the bracket

Grinding
Low-speed grinding of ceramic
brackets with no water coolant
may cause permanent damage
or necrosis of dental pulps.
Therefore water cooling of the
grinding sites is necessary.

Lasers
 also have the potential to be less traumatic and less risky for enamel
damage. This procedure first appeared to facilitate the removal of
porcelain laminate veneers, which are bonded using a very strong
resin cement. Öztoprak and colleagues demonstrated that with a new
scanning method, the Er:YAG laser is effective for reducing SBS of
ceramic brackets from high values to levels for safe removal from the
teeth in 9 seconds per bracket.


Additionally, in a recent study, Mundethu and co-
workers reported that clear brackets can be
debonded with a single pulse when irradiated with
the Er:YAG laser operating at 600 mJ, 800-μs
pulse, 1.3-mm fiber tip. With this method, 19 out of
20 brackets successfully debonded with a single
pulse

 In this method, laser energy is transferred through the ceramic and
absorbed at the composite layer where micro explosions occur, resulting
in the detachment of the bracket without any thermal damage to the
tooth.

The laser tip is brought into contact with the ceramic bracket
and initiated for
laser-aided debonding. Laser energy is transferred through the
ceramic and absorbed at the composite
layer where microexplosions occur, resulting in the detachment
of the bracket without any
thermal damage to the tooth.

Enamel Tearouts and Cracks (Fracture Lines)
Localized enamel tearouts have been reported to occur
associated with bonding and debonding metal and ceramic
brackets.

Ceramic brackets using chemical retention cause
enamel damage more often than those using
mechanical retention.

This damage probably occurs because the location of the
bond breakage is at the enamel–adhesive interface rather
than at the adhesive–bracket interface.

the sharp sound sometimes heard on the removal of
bonded orthodontic brackets with pliers is possibly
associated with the creation of enamel cracks.

Hosein et al pointed out that more surface enamel is lost
during debonding and clean-up procedures than during
bonding. Least enamel was lost during clean-up of brackets
bonded with a self-etching primer system compared to
conventional acid-etching technique.

With ceramic brackets, the risk for creating enamel
cracks is greater than for metal brackets. The lack of
ductility may generate stress in the adhesive–enamel
interface that may produce enamel cracks at
debonding.

Clinical implication
Use brackets that have mechanical retention and debonding
instruments and techniques that primarily leave all or the
majority of composite on the tooth
Avoid scraping away adhesive remnants with hand
instruments.
Another important clinical implication may be the need for a
pretreatment examination of cracks, notifying the patient and
the parents if pronounced cracks are present.

Removal of bands is accomplished by breaking the
cement attachment and then lifting the band off the
tooth, which sounds simpler than it is in some
instances. For upper molar and premolar teeth, a
band-removing instrument is placed so that first the
lingual, then the buccal surface is elevated .

Bands are largely retained by the elasticity of the
band material as it fits around the tooth. This is
augmented by the cement that seals between the
band and the tooth, but a band retained only by
cement was not fitted tightly enough.

Maxillary right
first molar, mesial
aspect. LR,
Lingual root; FC,
fifth cusp; MLC,
mesiolingual
cusp; MMR,
mesial marginal
ridge; MBC,
mesiobuccal
ridge; MCA,
mesial contact
area; CR, cervical
ridge; MBR,
mesiobuccal root

Mandibular right first
molar, mesial aspect.
MMR, Mesial marginal
ridge; MLC,
mesiolingual cusp;
MCA, mesial contact
area; CL, cervical
line; DD,
developmental
depression; CR,
cervical ridge; MBC,
mesiobuccal cusp

Cement left on the teeth after debanding can be
removed easily by scaling .

No orthodontic band cement bonds strongly to enamel
(which is why band cements cannot be used to bond
brackets). When the band is distorted by force to remove it,
the cement breaks away from the band or the tooth, and
there is almost no chance of damaging the enamel surface

Removal of composite
remnants after bracket
debonding.

It is as important to
remove a fixed
appliance safely as to
place it properly.

Acid etching removes approximately 10 µm of enamel
surface and creates a morphologically porous layer (5
µm to 50 µm deep). The low-viscosity fluid resin
contacts the surface and is attracted to the interior of
these microporosities created by capillary attraction.
Resin tags are formed into microporosities of
conditioned enamel that after adequate
polymerization, provide a resistant, long- lasting bond
by micromechanical interlocking with this tissue .
50µ= 0.05000000mm
5µ= 0.005000000mm
10µ= 0.01000000mm

penetration depth of
the etching acid into
the tissue ranging from
5 to 50 𝜇m.
5µ= 0.005000000mm 50µ= 0.05000000mm

Debonding of brackets usually leaves a residual
adhesive volume of 0.6 to 2.5 mm on the enamel
surface .

. Factors which are affecting acid etching of
enamel include: 1. Type of the acid 2. Concentration of
the acid 3. The time of etching. Etching with 10 % or 37 %
phosphoric acid produces the highest bond strengths to
enamel. The use of 10 % maleic acid for etching results in a
lower bond strength . No etching yields a very low bond
strength. No differences in bond strengths are observed
when enamel is etched with phosphoric acid ranging in
concentration from 2 % to 37 % .

Iatrogenic Effects of Etching:1-fracture
and cracking of enamel upon debonding.2. Increased
surface porosity - possible staining.3. Loss of
acquired fluoride in outer 10 µm of enamel surface.4.
Loss of enamel during etching about 10 ±20 µm of
enamel.5. Resin tags retained in enamel - possible
discoloration of resin.6. Rougher surface if over-
etched .

Duration of Etching . No differences in bond
strength are detected between 15-second and 60-
second etching with 37 % phosphoric acid;
however, shorter etching times cause less enamel
damage on debonding. Decreasing etching time
between 30 and 10 seconds does not affect bond
strength(11 Mpa) or location of failure site
Whereas etching for 0 or 5 seconds reduces bond
strength (less than 3 Mpa).

the application of a sustained force
during the bonding process affects
the adhesive layer and improves the
bond strength mainly because it
reduces fluid interference from the
underlying dentine (Chieffi et al.,
2006, 2007; Goracci et al., 2006).

When enamel etching was introduced in 1955,
the recommended time was 30 seconds for 85%
phosphoric acid. Then, at the time of its first
clinical use (the 1960s), it was extended to 60
seconds. In the 1980s, it was reduced to a 30-
second application and has remained today .
Enamel Acid Etching: C A Review
January 2007;28(1):662-669

Some authors recommend reducing the etching
time to 15 seconds when a 32% to 40%
phosphoric acid is used. Most of the
manufacturers of adhesive systems have
recommended 15 seconds because it saves time
without compromising the adhesive
performance.
January 2007;28(1):662-669

As a result, it has been suggested that the
conditioning time be reduced to 15 seconds, which is
considered adequate for creating a retentive enamel
surface with no difference in the enamel etching
pattern or decrease of the bond strengths. . In vitro
studies have demonstrated that a 15-second
conditioning time is also adequate for orthodontic
adhesive procedures. The third advantage is saving
chair time.
January 2007;28(1):662-669

A 15-second etching time is sufficient when using 32%
to 40% phosphoric acid to achieve a proper bond
strength when it is applied to instrumented enamel
surfaces or when a cavitary preparation has been
accomplished.
January 2007;28(1):662-669

Reducing times has been suggested because it presents 3
advantages. First, because acid conditioning causes superficial
tissue loss, it is desirable that minimal tooth structure be
dissolved; therefore, minimal acid-application time should be
used. The difference between 15-second and 30-second
application time of phosphoric acid on enamel dissolution is
very small. The chemical reaction of the conditioning occurs
quickly and, as mineral components are lost, the acid
potential decreases by buffering.
January 2007;28(1):662-669

AFM ANALYSIS OF ENAMEL DAMAGE DUE TO ETCHING WITH ORTHOPHOSPHORIC
ACID
. The surface of enamel after laying the
phosphoric acid was demineralized in a
5−10 μm layer, which is the area of etched
enamel. The pores about 20 μm thick are
created beneath the surface, and these
are the areas of qualitative pores, while
beneath that area there is the area of
quantitative pores, about 20 μm thick.
20 micron
0.02 mm

With improvements in the physical and mechanical properties
of resin adhesive systems, cleanup of resin remnants
after orthodontic bracket debonding has
become a clinical problem.
Pocket Dentistry
Fastest Clinical Dentistry Insight
Engine
Adhesives and Bonding in Orthodontics

The removal of adhesive remnants from tooth
surfaces is a final procedure to restore the
surface as closely as possible to its
pretreatment gloss without inducing iatrogenic
damage

If remnants are not completely removed,
tooth surfaces are likely to discolor and
entrap plaque .

Despite the introduction of new methods (e.g., Nd:YAG
laser) to remove residues of bonding resin selectively, the
most common removal techniques use a low-speed
handpiece with a tungsten-carbide bur and a high-
speed handpiece with a diamond bur. The preferred
method uses a low-speed handpiece with a round,
tungsten-carbide bur.
tungsten-carbide bur diamond bur

The bulk of the remaining adhesive may be removed
with diamond or tungsten-carbide burs
attached to a high-speed handpiece.
Because of considerable scratching,
however, these should not be used closer
to the enamel surface.

When approaching the enamel, a tungsten-carbide
bur attached to a low-speed hand piece operating at
30,000 rpm should be used. For this purpose, the
bur is moved in one direction as the resin layers are
removed. Water cooling is avoided at this stage
to improve the contrast between the adhesive and
the enamel surface.

The mechanics of high-speed rotary
instrument. A, The blue circular arrow indicates that the high-
speed diamond bur rotates in a clockwise direction when viewed
from the head of the handpiece. The green arrows indicate the
direction that the instrument should be drawn to counteract the
rotational force of the bur and achieve the most rapid abrasive
action of the bur.

B, Incisal view of the forces generated during high-speed rotary tooth
preparation. As the bur rotates in a clockwise direction, it generates a
rotational force at the tooth surface, FB(large blue arrow that represents
schematically the force of tooth structure against the bur). The operator
of the instrument must generate an opposing force, Fo (green arrow),
which will exceed the rotational force of the bur, FB, and carry the
instrument against the tooth surface where the surface will be abraded

Any recontouring considered necessary should be
completed at this stage before proceeding to polishing

The brackets were removed, and then, with the aid of a UV
light source , the cement adhering to the enamel was
removed selectively.

ORTHOCEM UV TRACE
Orthocem UV Trace contains a
fluorescent tracer, which in contact
with ultraviolet light, emits an
blue light, facilitating its removal at
end of the treatment.
• 1 syringe with 4g
• 1 acid conditioner (Condac 37 – FGM)

Orthocem UV Trace is a light-curing cement for
the bonding of orthodontic brackets made of
polycarbonate, metal and ceramic, which has a
difference to the already known Orthocem: the
inclusion of a fluorescent tracer. When it
receives UV (ultraviolet) energy originating from
specific equipment at a determined wavelength,
the cement emits a bright blue light
(fluorescent) that allows it to be distinguished
from the enamel.

UV Tracer: when UV light is applied, it enables cement
residues stuck to the enamel to be identified.
• Photo-activated curing mechanism: enables control
of the working time when placing the material.
• Balanced adhesive strength: balanced adhesion to
avoid adhesive failure measured throughout treatment
as well as facilitating removal of the bracket at the end
of treatment.

Appropriate consistency: facilitates the installation
of the brackets.
• Comprehensive application spectrum: cements
various types of brackets (polycarbonate, metal or
ceramic).
•High aesthetic quality: resistant to color
variations over time and with high translucency;
• Greater practicality: primer and bond in the same
syringe; reduction in clinical steps.
• Light curing:

Operator Safety During Debonding
Another important but often ignored issue is the
inhalation of aerosols produced during the removal of
fixed orthodontic appliances. Recent research shows that
aerosol particulates produced during enamel cleanup
might be inhaled regardless of handpiece speed or the
presence or absence of water coolant.

This aerosol may contain calcium,
phosphorus, silica, aluminum,
iron, and lanthanum.

Although the particles most likely are deposited in
the conducting airways and terminal bronchi,
some might be deposited in the terminal alveoli of
the lungs and cleared only after weeks or months.

Studies indicate that
orthodontists are exposed to high
levels of aerosol generation and
contamination during the
debonding procedure, and that
preprocedural chlorhexidine
gluconate mouthrinse appears to
be ineffective in decreasing
exposure to infectious agents.
Barrier equipment should be used
to prevent aerosol contamination.

Detailing and Polishing
After completion of adhesive removal, the enamel
surface may be further polished using various soft
disks, cups, and pastes. Some authors view this
stage as “optional,” considering the normal wear of
enamel.
The wide diversity of elastomeric or
rubberized abrasive rotary finishing
and polishing devices. Coarser
finishing and pre-polishing devices
are on the top row; polishing
devices are aligned on the lower row
of the illustration.

Synthetic and natural foam or felted polishing paste
rotary applicators provide for a more efficacious and
efficient final polishing step using loose-abrasive
polishing pastes. Synthetic and natural felt applicators
appear on the left and center of the photograph;
synthetic foam cup applicator appears on the far right

A recent technologic development in restorative
polishing involves abrasive-impregnated brushes,
which are depicted in this photograph. The three
abrasive brushes from left to right contain diamond
particles as the abrasive. The brush on the far right
contains silicon carbide

Newer rotary devices have broadened the range of
indications for finishing and polishing devices. The white,
fiber-impregnated polymer rotary burs have been suggested
and indicated for “minimally” abrasive action—that is, stain
removal and selective composite removal. The blue rotary
bur (right) is suggested for removal and cleaning of
temporary cement on tooth preparations before final
cementation

Bonded brackets must be removed, insofar as possible,
without damaging the enamel surface. This is done by
creating a fracture within the resin bonding material or
between the bracket and the resin and then removing the
residual resin from the enamel surface.

 Complete removal of all remaining adhesive is not easily achieved
because of the color similarity between present adhesives and
enamel.

The greater strength of bonding adhesives becomes a potential
problem in debonding. When a bonded bracket is removed, failure
at one of three interfaces must occur:
between the bonding material and the bracket, within the bonding
material itself, or between the bonding material
and the enamel surface.
.

enamel surface as it pulls away from it
If a strong bond to the enamel
has been achieved, which is the case with the modern
materials, failure at the enamel surface on debonding is
undesirable because the bonding material may tear the
Enamel fracture at debond

The interface between the bonding material and the
bracket is the usual and preferred site of failure when
brackets are removed. The safest way to remove metal brackets
is to distort the bracket base, which induces failure between it and
the bonding
adhesive. This damages the bracket so that it cannot be
reused.

The major reason for not recycling and reusing brackets is the
possibility of enamel damage when they
are removed without distorting the base. If brackets can be
removed without damage they can be cleaned, sterilized, and
reused without risk to the patient in exactly the same way as other
medical devices

Residual bonding resin is more difficult to remove .The best
results are btained with a 12-fluted carbide bur at moderate
speeds in a dental handpiece . This bur cuts resin readily but
has little effect on enamel.

Topical fluoride should be applied when the cleanup
procedure has been completed, however, since some
of the fluoride-rich outer enamel layer may be lost
with even the most careful approach.

Many patients may be left with incomplete
resin removal, which is not acceptable.
Abrasive wear of present bonding resins is
limited and remnants are likely to become
unesthetically discolored with time .

The removal of excess adhesive may be
accomplished by 1. Scraping with a very sharp
band or bond-removing pliers or with scaler.

As a final quality assurance check after debonding orthodontic
brackets. In this regard, following the removal of any
composite deposits using a tungsten carbide bur in a slow
hand-piece, the Mitchell's trimmer may be used to sweep up
and down the labial surface of the tooth, in order to detect any
missed adhesive remnants. This then shows up as silver grey
on the surface of any residual composite, thereby rendering
the task of the adhesive's complete removal.
Mitchell's trimmer

2. Using a suitable bur and contra –angle. -- Dome shaped
TC bur -- Ultrafine diamond bur -- White stone finishing bur.
Although the first method is fast and frequently successful
on curved teeth it is less useful on flat anterior teeth. Also, a
risk exists of creating significant scratch marks
TUNGSTEN CARBIDE
ORTHODONTIC
DEBONDING BURS
Ultrafine diamond bur
The removal of excess adhesive may be accomplished by

. Residual Adhesive Cleaning • Methods :
Use of handpiece with tungsten carbide
bur (30,000rpm) - High speed handpiece
with diamond bur - Scraping with sharp
band or bond removing pliers • Scarring of
enamel after debonding is inevitable •
Angle Orthodontist. 1995;65:103-110
Phillip M, Campbell. Enamel surfaces after orthodontic debonding
diamond bur
tungsten
carbide
bur

Tungsten carbide slow speed
adhesive removal burs were
found to be less damaging to
the enamel surface compared
with high speed tungsten
carbide burs and abrasive
discs.

Fine fluted tungsten carbide burs used
with high speed, with light brush stroke
in one direction is most fastest and
least damaging method .

Fine fluted(grooved)
tungsten carbide burs
The fewer the flutes, the more
aggressive is the cutting
tungsten carbide bur

Speeds higher than 30,000 rpm using fine
fluted(rugged)
tungsten carbide burs may be useful for bulk removal
but are not indicated closer to the enamel because of
the risk of marring(HARM) the surface.

Remnants of adhesive on enamel surface can be also
eliminated through different methods and instruments
including:
• bioactive glass air abrasion
• aluminum oxide air abrasion :Compressed air shoots
a tiny stream of aluminum oxide particles and
water, and a small vacuum sucks up the materials.

The preferred method
for the removal of
excess adhesive is to use
a suitable
dome-tapered tungsten
carbide bur
in a contra-angle hand
piece.

Clinical experience and laboratory studies indicate that
approximately
30,000 rpm is the optimum for rapid adhesive
removal without enamel damage.
Light painting movements of the bur should be used so as
not to cause deep scratches on the enamel.

Water cooling should not be used when the
last remnants are removed because water
lessens the contrast with enamel.

When all adhesive has been removed, the
tooth surface may be polished with pumice

ultrafine highspeed diamonds produce
considerable surface scratches. Slower speeds
(10,000 rpm and less) are ineffective, and the
increased jiggling vibration of the bur may be
uncomfortable to the patient.

INFLUENCE ON ENAMEL BY DIFFERENT
DEBONDING INSTRUMENTS Zachrisson and Artun
were able to compare different instruments commonly
used in debonding procedures and rank their degrees
of surface marking on young permanent teeth.

The study demonstrated that 1. diamond instruments were
unacceptable; even fine diamond burs produced coarse
scratches and gave a deeply rough appearance. 2. medium
sandpaper disks and a green rubber wheel produced
similar scratches that could not be polished away

3. fine sandpaper disks produced several marked
and some even deeper scratches and a surface
appearance largely resembling that of adult teeth.

4. plain cut and spiral fluted TC burs operated
at about 25,000 rpm were the only instruments
that provided the satisfactory surface
appearance. 5.none of the instruments tested
left the virgin tooth surface with its perikymata
intact.

The clinical implication of the study is that TC
burs produced the finest scratch pattern with
the least enamel loss and are superior in their
ability to reach difficult areas-pits, fissures,, and
along the gingival margin

Shofu tip is also used for the removal of the
residual adhesives but it was reported that The
Shofu tip at low speed or high speed promoted
the highest surface roughness on enamel
compared to debonding pliers, carbide bur at
high speed, carbide bur at low speed
A – Shofu tip;

• Some patients complain
about color change of their
teeth during and after
orthodontic treatment.
• the composite bur provided
a smoother enamel surface
than was produced by the
carbide bur.
STAINBUSTER burs (Pearson Dental Supply
Co., Sylmar, CA) gently remove cement, stains, and colored
coatings from the surface of the enamel without abrading tooth
enamel or ceramic. The burs are made up of the fiber sections
with abrasive power, which cover the entire working surface
and split up into small fragments as they act on a hard surface.

• A recent study confirms this and
states that both the orthodontic
adhesive systems and the burs used
to remove their residuals on tooth
surfaces are responsible for this
effect.

• The authors suggest using STAINBUSTER burs
(A new composite bur, reinforced by zircon-rich
glass fiber) to remove the adhesive remnants
close to the enamel surface.
Thus reducing the occurrence of bacterial
colonization and decalcification

New composite burs for cement and stains removal
gentle for enamel, ceramics, and soft tissues
. Removal of stains and coloured coatings . Cleaning of
the enamel after ultrasonic scaling . Grinding of
composite fillings . Easy removal of surplus cement .
Elimination of temporary cement
STAIN BUSTER (tseZlatneD) Stain Remover Burs

Cleanup with Super-Snap produced acceptable
results, but a number of deep scratches were left
on the enamel surfaces.

Manufacturer: Shofu Dental
Super-Snap is designed for easy, fast and safe contouring, finishing and polishing of all
microfilled and hybrid composites.
•Ultra-thin, colour coded discs indicate the grit and function to take you step-by-step to the
finest restorations you can achieve.
•Four different colour-coded and grit-sizes in both standard and mini-discs without metal
centres – giving protection against ditching or scoring-on composite or compomer restorations.
•For interproximal areas use polystrips which are matched to give the same finish as the discs.

Types: L506 (Black, Coarse Contour, Safeside Down), L508 (Dark Violet, Medium Finish,
Safeside Down), L509 (Light Violet, Medium Finish, Safeside Up),
L501 (Dark Green, Fine Polish, Double Sided), L502 (Dark Red, Extra-Fine Polish, Double
Sided)
Packing: Each kit contains 100 Standard Discs, 80 Mini Discs, 40 Polystrips, 2 Dura-White
Stones (Shapes CN1 & FL2), Composite Fine Midi-Point and 2 CA Mandrels. Each refill disc
pack contains 50 pieces

After removal of the adhesive, it should
be followed by multistep Sof-Lex disks
and pumice slurry because a negligible
amount of resin ranging from 0.11 to
0.22 mm3 is left on the tooth surface,
and the use of polishing systems with
good composite polishing properties
may leave a lustrous surface and
therefore more composite remnants as
they become invisible.

Polishing also can be done using;
One-Gloss silicone particle polishing alone produced
enamel surfaces that were closest to the intact enamel
surface, but the polishing efficiency was the lowest
between all the methods.
.

NOTE
In clinical settings, cooling procedures that use air-
water sprays are essential to ensure the prevention of
pulpal damage

 Removal of resin remnants with a tungsten carbide bur
using a high-speed handpiece without water cooling
produces temperature increases exceeding the critical
5.58°C value for pulpal health.

The removal of residual adhesive after
debonding is best performed with fine burs.

Upon debonding , the bond failure usually occurs
between the base of the bracket and the resin, leaving
excess resin on the tooth. Removing excess bonding
resin is best accomplished with a smooth 12-fluted
carbide bur, followed by pumicing. The carbide bur is
used with a gentle wiping motion to remove the resin.

Clean-up with water cooling never produces
temperature changes exceeding the critical
value. Temperature rise of 9.4°C was found
using a 6-fluted bur, followed by the 12-fluted
bur (6.5°C) and 1.2°C using a 40-fluted bur.

AMOUNT OF ENAMEL LOST IN DEBONDING 10 to 25 μm.
Pus and Way(AJO 1980) found a high-speed bur and
green rubber wheel removes approximately 20μm and a
low- speed TC bur removes around 10μm of enamel..
. B, Tooth ground by a diamond bur. Note the multiple
scratches formed by the random arrangement of abrasive
particles on the diamond bur.

Van Waes et al(1997) recently confirmed
observations of a more limited loss of enamel when TC
burs are used cautiously. They found an average
enamel loss of only 7.4 μm and concluded that minimal
enamel damage is associated with careful use of a TC
bur for removal of residual composite
Tooth cut by a carbide bur. Note the regular pattern of removal of tooth
structure, which corresponds to the regular arrangement of blades on the bur

ENAMEL TEAROUTS Redd TB(Jco1991)
suggested localized enamel tearouts have been
reported to occur associated with bonding and
debonding both metal and ceramic brackets. They
may be related to the type of filler particles in the
adhesive resin used for bonding and to the location
of bond breakage.

When comparisons were made between tooth
surface appearances after debonding metal
brackets attached with either macrofilled (10 to
30μm) or microfilled (0.2 to 0.3μm) adhesives, a
difference occurred when the resin was scrapped
off with pliers

On debonding the small fillers reinforce the
adhesive tags. The macrofillers, on the other hand,
create a more natural breakup-point in the enamel-
adhesive interface. Similarly, with unfilled resins
there is no natural breakpoint.

The clinical implications is 1. To use
brackets that have mechanical retention and
debonding instruments and techniques that
primarily leave all or the majority of composite
on the tooth. To avoid scraping away adhesive
remnants with hand instrument

ENAMEL CRACKS Zachrisson BU et al (AJO
1980) The prevalance of cracks, their distribution per
tooth, their location on the tooth surface and the type
were described; 1. Vertical cracks are common, but
great individual variation

Few horizontal and oblique cracks are observed normally. 3.
No significant difference exists between the three groups with
regard to prevalance and location of cracks. 4. The most
notable cracks are on the maxillary central incisors and
canines

The clinical implication of these findings 1. observes
several distinct enamel cracks on the patients teeth
after debonding, particularly on teeth other than
maxillary canines and central incisors 2. detects
cracks in horizontal direction, this is an indication
that the bonding or debonding technique used may
need improvement. With ceramic brackets, the risk
for creating enamel cracks is greater than for metal
brackets. The lack of ductility may generate stress
build-up in the adhesive-enamel interface that may
produce enamel cracks at debonding

 The reason for this
examination is
that patients may be overly
inspective
after appliance removal
and may detect cracks that
were present before
treatment of which they
were unaware. They may
question the orthodontist
about the cause of the
cracks.
Enamel cracks generally are not visible on
intraoral photographs. Several cracks
are clearly seen on the left central incisor with
fiberoptic transillumination (A) and are
undetectable
by routine photography (B).

Note
The prevalence of enamel cracks after
debonding has been found as high as 50%,
with vertical cracks being the most common.

Without a pretreatment
diagnosis and documentation
(most cracks are not visible on
routine intraoral slides), proving
that such cracks are indeed unrelated
to the orthodontic treatmentis almost impossible.

ADHESIVE REMNANT WEAR Adhesive has been
found on the tooth surface, even after attempts to
remove it with mechanical instruments. Because
of color resemblance to the teeth, particularly when
wet, residual adhesive may easily remain
undetected.

Brobakken and Zachrisson (AJO 1981) Abrasive
wear depends on the size, type and amount of
reinforcing fillers in the adhesive. At the time of
debonding, varying amounts of adhesive were
purposely left on the teeth assumed to be the most
exposed to tooth brushing forces. Only thin films
of residual adhesive showed any reduction in size

ADHESIVE “ is a material frequently a viscous fluid that joins two
surfaces together and solidifies and therefore is able to transfer a
load from one surface to the other.
2 basic types resins for orthodontic bonding 1- Acrylic
/ Based on Self-curing acrylics / Methylmethacrylate
monomer & ultra fine powder / form linear polymers
only / filled or unfilled forms / e.g Orthomite, Genie /
Plastic brackets 2-Diacrylate resin based on acrylic
modified Epoxy resin / Bis GMA or Bowen’s resin /
Polymerised also by cross linking into 3 dimensional
network / Cross linking – greater strength / filled or
unfilled forms / e. g Concise, Phase II .

COMPOSITES RESINS FILLERS Bis-GMA / URETHANE-
DIMETHACRYLATE TEGMA-REDUCES VISCOSITY QUARTZ
FUSED SILICA ALUMINO- SILICATES BARIUM OXIDES
Coupling agent: vinylsilane –helps the filler and polymer for
reinforcement to occur
TYPES-ACCORDING TO SIZE OF FILLER PARTICLES
CONVENTIONAL 1-50 µm MICROFILLED 0.04 µm
HYBRID CLINCAL APPLICATION: •LARGER FILLER
PARTICLES-EXTRA BOND STRENGTH. •CAREFUL
REMOVAL IS NECESSARY DUE TO ACCUMULATION OF
PLAQUE

ACID ETCHING:ACID ETCHING: REMOVAL OF SURFACE
DEBRISREMOVAL OF SURFACE DEBRIS AIDS BONDING
PORES CREATED RESIN PENETRATES CREATES TAG LIKE
EXTENSIONS MECHANICAL INTERLOCKING INCREASES
SURFACE ENERGY OF ENAMEL IMPROVES WETTING.

Gwinnett and Ceen (AJO 1978) report that small
remanants of unfilled sealant did not predispose to
plaque accumulation and did begin to wear away with
time. However, this finding can not automatically be
transferred to different types of filled adhesives, some
of which have much greater wear resistance and
accumulate plaque more readily.

Brobakken and Zachrissons( AJO 1981) findings
showed that residual filled adhesive will quickly
disappear by itself after debonding; it appears
irresponsible to leave large accumulations of
adhesives.

REVERSAL OF DECALCIFICATION White spots or
areas of demineralization are carious lesions of varying
extent. The general conclusion was that individual teeth,
banded or bonded, may exhibit significantly more white spot
formation than untreated control teeth.

In a multibonded technique Gorelick et al (AJO 1982)
found that 50% of the patients experienced an increase in
white spots. The highest incidence was in the maxillary
incisors, particularly the laterals. This obvious degree
of iatrogenic damage suggests the need for preventive
programs using fluoride associated with fixed appliance
orthodontic treatment.

Zachrisson BU (AJO 1975) suggested daily
rinsing with dilute (0.05%) sodium fluoride solution
throughout the periods of treatment and retention,
plus regular use of a fluoride dentifrice, is
recommended as a routine procedure for all
orthodontic patients.

Ogaard et al (AJO 1981) observed that
remineralization of surface softened enamel and
subsurface lesions are completely different
processes. The surface – softened lesions
remineralize faster and more completely than
subsurface lesions which remineralize extremely
slowly, probably because of lesion arrest by
widespread use of fluoride. Visible white spots that
develop during orthodontic therapy should therefore
not treated with concentrated fluoride agents
immediately after debonding because this procedure
will arrest the lesions and prevent complete repair

At present it seems advisable to recommend a period
of 2 to 3 months of good oral hygiene but without fluoride
supplementation associated with the debonding session.
This should reduce the clinical visibility of the white spots.
More fluoride may tend to precipitate calcium phosphate
onto the enamel surface and block the surface pores. This
limits remineralization to the superficial part of the lesion,
and the optical appearance of the white spot is not
reduced.

Microabrasion Done when remineralizing capacity
of oral fluids is exhausted and white spots established.
Microabrasion: A gel prepared from 18% HCl, pumice
and glycerine is applied professionally with a modified
toothbrush tip for 3-5 mins; followed by rinsing. This
is effective for removing white spots and brownyellow
enamel discolorations. In case of more extensive
mineral loss, grinding with diamond burs or composite
restorations may be required

Enamel microabrasion is a conservative method for
removing enamel to improve discolorations limited to the outer
enamel layer. Sundfeld, et al.36 (2007) noted in an in vitro study
that the enamel microabrasion technique results in a loss of
enamel of around 25 to 200 μm, depending on the number of
applications and acids concentration. The use of various acids to
remove enamel stains was described early, in 191626. Since then,
many variations of this principle have been described. The
enamel microabrasion technique has been suggested for aesthetic
improvements, employing a mixture of 18% hydrochloric acid
and pumice14 or 6.6% and 10%35 hydrochloric acid with silica
carbide particles, or even 37% phosphoric acid gel32associated
with extra fine grain pumice in proportions of equal volume

In Figure 1 was described the usuall microabrasion
technique. A teenage girl had idiopathic white
enamel demineralization of her maxillary central
incisors (Figure 1A). The enamel microabrasion
procedures were performed after enamel
macroabrasion of the affected enamel surfaces,
using a fine-tapered diamond bur (3195 FF, Kg
Sorensen Indústria e Comércio Ltda, Barueri, SP,
Brazil) under water and air cooling (Figure 1B).
Rubber dam isolation was applied and the dental
enamel surface was treated with an application of
the microabrasive product (Opalustre, Ultradent
Products Inc, South Jordan, UT, USA), three times
on each of the three teeth at 60-second intervals
(Figure 1C, ,DD and andE).E). Teeth were polished
with Herjos F fluoridated prophylaxis paste
(Vigodent Coltene SA Indústria e Comércio; Rio de
Janeiro, RJ, Brasil). A 2% neutral-Ph sodium
fluoride gel was applied for 4 minutes. The
immediate enamel aspects were satisfactory (Figure

MicroabrasionTechnique used to remove
superficial enamel opacities, brown-yellow
enamel discoloration, when re mineralizing
capacity is exhausted • Abrasive gel = 18%
HCL, fine pumice and glycerin Procedure: •
Isolate gingiva with rubber dam • Gel is applied
using electric tooth brush for 3-5 minutes •
Rinse for a minute • Procedure can be repeated
2-3 times/month
Enamel microabrasion is a conservative method for removing
enamel to improve discolorations limited to the outer enamel
layer.

Artun and Thylstrup(1986) after debonding, arrest
of further demineralization, and a gradual
regression of the lesion at the clinical level takes
place primarily because of surface abrasion with
some redeposition of minerals

Amount of Enamel Lost in Debonding
the reported amount of enamel loss is
between 4.1 and 30 microns, which is
approximately 0.05 mm3 in volume. In a
clinical perspective, the enamel loss
encountered with routine bonding and
debonding procedures, exclusive of deep
enamel fractures or gouges resulting from
an injudicious use of hand instrument or
burs, is not significant in terms of total
thickness of enamel.

 The surfaces usually bonded have a
thickness of 1500 to 2000 microns. The
claim that removal of the outermost layer of
enamel, which is particularly caries resistant
and fluoride rich, may also be harmful is
not in accordance with recent views on
tooth surface dynamics and with clinical
experience over many years.

ENAMEL CRACKS Clinical Implication • Pre-treatment
examination of cracks and its documentation • Inform
patient if pronounced cracks are visible • Observe
cracks after debonding • Detect any horizontal cracks-
bonding/debonding technique needs improvement •
Gentle manipulation of debonding instruments

Removal of decalcification Daily rinsing with
dilute (0.05%) sodium fluoride during treatment
and retention period • Fluoride dentifrices •
Fluoride varnish in decalcified areas • Oral
hygiene measure

Caries has been demonstrated not to develop in
sites even if the entire enamel layer is removed.
Similarly, no histologic or clinical evidence of
effects was experienced after significant
of canines that had been ground to resemble lateral
incisors when approximately one half of the enamel
thickness was removed as long as the surfaces were
left smooth and sufficient water cooling was

Operator Safety during Debonding
Recent research showed that aerosol particulates
produced during enamel cleanup might be
inhaled, irrespective of handpiece speed or the
presence or abcence of water coolant. This
aerosol may contain calcium, phosphorus,
silica,aluminum, iron and lanthanum. Blood,
hepatitis B surface antigen (HBsAg), and hepatitis
B virus–DNA were also detected in excess fluid
samples of the two hepatitis B carriers.

Although the particles are most likely
to be deposited in the conducting
airways and terminal bronchi, some
might be deposited in the terminal
alveoli of the lungs and cleared only
after weeks or months.
So Barrier equipment should be used
to prevent aerosol contamination.

Patients reported lower levels of pain and
discomfort when metallic brackets were
removed with lift off debonding instrument . The
use of a straight cutter plier caused the highest
pain and discomfort scores during debonding.
What is the best method for debonding
metallic brackets from the patient’s
perspective?

Debonding methods used. a Lift-off debonding instrument
(LODI). b Straight cutter (SC). c How plier (HP). d Bracket
removal plier (BRP)
What is the best method for debonding metallic
brackets from the patient’s perspective?

There is no doubt that fixed orthodontic treatment causes
irreversible damage to dental enamel.
Arkansas stones, green stones ,diamond burs, steel burs, and lasers
should not be used for adhesive removal. Tungsten carbide burs are
faster and more effective in adhesive removal than Sof-Lex discs,
ultrasonic tools, hand instruments, rubbers, or composite burs.
Effect of Orthodontic Debonding and Adhesive Removal on the Enamel –
Current Knowledge and Future Perspectives – a Systematic Review
Janiszewska-Olszowska J. et al.: Effect of debonding and adhesive
removal © Med Sci Monit, 2014; 20: 1991-2001
Finishing stone for composites
are made of white Arkansas
stone designed for polishing
composite and
porcelain. Polishing lab stone are
very useful for removing excess
of composite and polishing teeth.
tungsten
steel burs
Arkansas stones

They remove a substantial layer of enamel and roughen its
surface, and thus should be followed by multi-step Sof-Lex discs
and pumice slurry, which is the most reliable method of polishing.
Further efforts should be made to find tools and methods
allowing complete removal of adhesive remnants to minimize
enamel loss and to achieve a smooth surface after the
completion of treatment with a fixed orthodontic appliance
white stone dental

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