Novel Digital Technique to Quantify the Area and Volume of Cement Remaining and Enamel Removed after Fixed Multibracket Appliance Therapy Debonding: An In Vitro Study.

Álvaro Zubizarreta-Macho,Jorge Alonso Pérez-Barquero,Martina Triduo,Clara Guinot Barona,Alberto Albaladejo Martínez

doi:10.3390/jcm9041098

Abstract

The aim of this study was to construct a novel, repeatable, reproducible, and accurate measurement protocol for the area and volume of the remaining cement after removal of fixed multibracket appliances, the area and volume of remaining cement after cement removal, the area and volume of enamel removed after cement removal, and the volume of cement used to adhere fixed multibracket appliances. A total of 30 brackets were cemented and removed with over 30 extracted teeth embedded into three experimental models of epoxy resin. The models were scanned before and after bracket placement, bracket debonding, and polishing the remaining cement. The brackets were submitted to micro-computed tomography. The standard tessellation language digital files were aligned, segmented, and re-aligned using geomorphometric software. The digital measurement technique accuracy, repeatability, and reproducibility were analyzed using Gage R&R statistical analysis. The variability attributable to the area and volume measurement techniques of the total variability of the samples was 0.70% and 0.11% for repeatability, respectively, and 0.79% and 0.01% for reproducibility, respectively. The re-alignment procedure is a repeatable, reproducible, and accurate technique that can be used to measure the area and volume of the remaining cement after removal of fixed multibracket appliances, the area and volume of remaining cement after cement removal, the area and volume of enamel removed after cement removal, and the volume of cement used to adhere the fixed multibracket appliance.

Highlights

Fixed multibracket appliance therapy has been widely used in orthodontic treatments to improve adhesion in terms of materials and techniques [1]
Resin cement removal after fixed multibracket appliance therapy debonding can lead to cracks or tear-outs, compromising tooth health and integrity [7], dental plaque formation due to the micro-roughness increase, dental hypersensitivity due to accidental enamel removed during the resin cement removal [8], and dental stains caused by the staining of the remaining cement after inadequate resin cement removal [9]
The aim of this work was to describe a novel digital technique that could be used to quantify the amount of cement necessary to adhere fixed orthodontic therapy, the cement remaining after orthodontic treatment removal, and the enamel removed during cement removal, with a null hypothesis (H0) stating that no difference exists between the geomorphometric measurement protocol used with regards to the measurement accuracy of the amount of cement remaining after fixed multibracket appliance removal, the amount of orthodontic cement necessary to fix multibracket appliances, and the amount of enamel removed after fixed multibracket appliance removal

Summary

Introduction

Fixed multibracket appliance therapy has been widely used in orthodontic treatments to improve adhesion in terms of materials and techniques [1]. The adhesion technique used for fixed multibracket appliance therapy includes the use of 37% orthophosphoric acid to allow the dissolution of the enamel surface, obtaining a micro-porosity of around 5–50 μm that improves the bonding-agent penetration through these micro-porosities inside the enamel surface and enhances the micro-retention effect of the resin cement into the conditioned enamel [3,4,5]. This is why, Bertacci et al recommended a single application of a stannous fluoride-containing toothpaste on eroded enamel to prevent acid-induced permeability on the enamel surface after acid agent application [6]. Samruajbenjakul and Kukiattrakoon reported that metal brackets should have a clinical detachment resistance between 6 and 8 MPa [13]; higher detachment resistance values may require excessive force to remove the bracket, possibly damaging enamel [14]

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