This document provides an overview of debonding procedures in orthodontics. It discusses the objective of restoring the tooth surface after removing attachments and adhesive resin. It describes different procedures for removing steel and ceramic brackets, as well as residual adhesive, using mechanical methods, electrothermal debonding, lasers, or ultrasonic tools. It compares the advantages and disadvantages of these debonding methods and discusses indices for evaluating the amount of remaining adhesive and surface changes to the enamel.

1. DEBONDING PROCEDURES
IN ORTHODONTICS
PRESENTED BY:
FASAHAT AHMED BUTT
ROLL# 36
GROUP: C

2. OBJECTIVE
 To remove the attachment and all the
adhesive resin from the tooth and restore
the surface as closely as possible to its
pretreatment condition without inducing
iatrogenic damage

3. PROCEDURES
Bracket removal
Steel bracket
Ceramic bracket
Removal of residual adhesive

4. Steel brackets
Ceramic
brackets

5. REMOVAL OF STEEL
BRACKETS
 Place the tip of bracket remover against mesial and
distal (or occluso-cervically) edges of the bonding base
and cut the brackets off
 A gentler technique is to squeeze the bracket wings
mesiodistally and lift the bracket with the peel force

7. REMOVAL OF CERAMIC
BRACKETS
 With the introduction of ceramic brackets, a new
concern over enamel fracture and loss from
debonding has arisen.
 Because of differences in bracket chemistry and
bonding mechanism, various ceramic brackets
behave differently on debonding
 More recent ceramic brackets have
mechanical lock base and vertical slot
that will split the bracket by squeezing

8. CERAMIC BASE DESIGN

9. MEANS OF REMOVAL
 Mechanical
 Thermal debonding
 Lasers
 Ultrasonic

10. MECHANICAL

11. ELECTROTHERMAL

13.  Takla and Shivapuja (1995) study in which 30 teeth were
schduled for orthodontic extractions
 15 extracted 24 days after ETD
 7 extracted 28-32 days after ETD
 8 were control teeth and debonded by conventional
method, with pliers
 In control group pulp was normal
 Significant hyperemia in teeth extracted after 24 day
 In case of teeth extracted after 28-32 day variation was seen
from complete recovery to persistent inflammation
 Jost-Brinkmann et al (1997) did an in vivo study in which 12
human premolars scheduled for extraction were bonded with
ceramic brackets which were subsequently debonded using
ETD. After 4 weeks, teeth were extracted and histologically
examined . No signs of pulpal inflammation were seen

14. LASERS
 The use of laser eliminates problems like enamel tear
outs, bracket failures and pain.
 Lasers decreases debonding force and less time
consuming.
 Strobl et al (1993) Removal of ceramic brackets from
enamel surface by means of laser heating was investigated
with the use of C02 and YAG laser
 Polycrystalline alumina
 Monocrystalline alumina

15.  Laser-aided debonding significantly reduced debonding
force by thermal softening of adhesive resin.
 In 69-75% incident light reached enamel surface when
Nd:YAG laser was used which has the potential to cause
pain or damage to tooth surface

16. ULTRASONIC

17. DEBONDIN
G
METHODS
Mechanical
ADVANTAGES
Low cost
Electrothermal o Reduced incidence of
bracket failure
o Short debonding time
DISADVANTAGES
Risk of enamel fracture
Potential for pulpal damage
and mucosal burn
Laser
Experimental, but
increased precision
regarding time and
amount of heat
application
High cost of equipment
Ultrasonic
o Potentially reduced
enamel damage
o Reduced likelihood of
bracket failure
o Adhesive removal after
debonding may be
o Increased debonding time.
o Extensive wear of
expensive ultrasonic tip
o Some force required
o Potential for soft tissue
injury

18. ADHESIVE REMNANT INDEX
(ARI)
 Used to evaluate the amount of adhesive left on the tooth




after debonding
SCORE 0: No adhesive left on tooth
SCORE 1: Less than half of adhesive left
SCORE 2: More than half left
SCORE 3: All adhesive left on tooth with distinct with
distinct impression of bracket mesh

19. RESIDUAL ADHESIVE
SCOR
E0
SCOR
E1
SCOR
E2
SCOR
E3

20. REMOVAL OF RESIDUAL RESIN
 Ultrasonic scaler
 Scraping with a sharp bond removing removing plier

21.  Burs
 Tungsten carbide bur
 Ultrafine diamond bur
 White stone finishing bur

22. ENAMEL SURFACE INDEX
SCORE 0: Instrument tested left the tooth surface with its
perikymata intact
SCORE 1: Plain cut and spiral fluted tungsten carbide burs
operated at about 25,000 rpm were the only instruments that
provided the satisfactory surface appearance

23.  SCORE 2: Fine sandpaper disks produced several
considerable and some even deeper scratches
 SCORE 3: Medium sandpaper disks and a green rubber
wheel produced similar scratches, that could not be
polished away

24.  SCORE 4: Diamond instruments were unacceptable
and even fine diamond burs produced coarse
scratches and gave a deeply marred appearance

25. POLISHING