Loss of surface enamel after bracket debonding: An in-vivo and ex-vivo evaluation

Abstract

The objective of this study was to evaluate the surface enamel after bracket debonding and residual resin removal. Thirty patients (female, 20; male, 10; mean age, 18.4 years) who completed orthodontic treatment with fixed appliances (Twin Brackets, 3M Unitek, Monrovia, Calif) (n = 525) were included. The amounts of adhesive left on the tooth surfaces and the bracket bases were evaluated with the adhesive remnant index (ARI). ARI(tooth) (n = 498) was assessed on digital photographs by 2 operators. After resin removal and polishing, epoxy replicas were made from the maxillary anterior teeth (n = 62), and enamel surfaces were scored again with the enamel surface index. Elemental analysis was performed on the debonded bracket bases by using energy dispersive x-ray spectrometry mean area scanning analysis. The percentages of calcium and silicon were summed up to 100%. Tooth damage was estimated based on the incidence of calcium from enamel in relation to silicon from adhesive (Ca%) and the correlation between the ARI(bracket) and Ca%. While ARI(tooth) results showed score 3 as the most frequent (41%) (P<0.05), followed by scores 0, 1, and 2 (28.7%, 17.9%, and 12.4%, respectively), ARI(bracket) results showed score 0 more often (40.6%) than the other scores (P<0.05). Maxillary anterior teeth had significantly more scores of 3 (49%) than the other groups of teeth (10%-25%) (chi-square; P<0.001). There were no enamel surface index scores of 0, 3, or 4. No correlation between the enamel surface index and ARI(tooth) scores was found (Spearman rho = 0.014, P = 0.91). The incidence of Ca% from the scanned brackets showed significant differences between the maxillary and mandibular teeth (14% ± 8.7% and 11.2% ± 6.5%, respectively; P <0.05), especially for the canines and second premolars (Kruskal-Wallis test, P<0.01). With more remnants on the bracket base, the Ca% was higher (Jonckheere Terpstra test, P<0.05). Iatrogenic damage to the enamel surface after bracket debonding was inevitable. Whether elemental loss from enamel has clinical significance is yet to be determined in a long-term clinical follow-up of the studied patient population.