Pain and removal force associated with bracket debonding: a clinical study.

OBJECTIVE: Pain is a problem during bracket removal, and more comfortable treatment is needed. This study examined the association of pain with the removal force required for ceramic brackets, compared with metal and plastic brackets, to determine which removal method resulted in less pain and discomfort. METHODOLOGY: 81 subjects (mean age, 25.1 years; 25 males and 56 females) were enrolled, from whom 1,235 brackets (407 ceramic, 432 plastic, and 396 metal) were removed. Measured teeth were distinguished at six segments. Pain was measured with a visual analogue scale (VAS) during the removal of each bracket. An additional grip was placed on the grips of debonding pliers with right-angled beaks; a mini loading cell sensor pinched by the grips was used to measure removal force during debonding. VAS and force values were statistically analyzed. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction were performed for multiple comparisons; multiple regression analysis was also performed. RESULTS: Forces in the upper and lower anterior segments were significantly smaller (p<0.05) than those in the other segments. Pain tended to be greater in the upper and lower anterior segments than in the posterior segments. In all segments, the removal force was greater for metal brackets than for plastic or ceramic brackets. Ceramic brackets caused significantly greater pain than plastic brackets for the upper and lower anterior segments. Debonding force was involved in the brackets, following adjustments for pain, upper left segment, age, and sex. CONCLUSIONS: Pain and discomfort are likely to occur during bracket debonding.

Pain and removal force associated with bracket debonding: a clinical study

Abstract Objective: Pain is a problem during bracket removal, and more comfortable treatment is needed. This study examined the association of pain with the removal force required for ceramic brackets, compared with metal and plastic brackets, to determine which removal method resulted in less pain and discomfort. Methodology: 81 subjects (mean age, 25.1 years; 25 males and 56 females) were enrolled, from whom 1,235 brackets (407 ceramic, 432 plastic, and 396 metal) were removed. Measured teeth were distinguished at six segments. Pain was measured with a visual analogue scale (VAS) during the removal of each bracket. An additional grip was placed on the grips of debonding pliers with right-angled beaks; a mini loading cell sensor pinched by the grips was used to measure removal force during debonding. VAS and force values were statistically analyzed. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction were performed for multiple comparisons; multiple regression analysis was also performed. Results: Forces in the upper and lower anterior segments were significantly smaller (p<0.05) than those in the other segments. Pain tended to be greater in the upper and lower anterior segments than in the posterior segments. In all segments, the removal force was greater for metal brackets than for plastic or ceramic brackets. Ceramic brackets caused significantly greater pain than plastic brackets for the upper and lower anterior segments. Debonding force was involved in the brackets, following adjustments for pain, upper left segment, age, and sex. Conclusions Pain and discomfort are likely to occur during bracket debonding.

Evaluation of pain perception during orthodontic debonding of metallic brackets with four different techniques.

OBJECTIVE: The aim of this study was to evaluate patients' pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different. MATERIAL AND METHODS: One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients' levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal-Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05. RESULTS: Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group. CONCLUSIONS: Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.

Evaluation of pain perception during orthodontic debonding of metallic brackets with four different techniques

Abstract Objective The aim of this study was to evaluate patients' pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different. Material and Methods One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients' levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal-Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05. Results Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group. Conclusions Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.

Técnica para remoção do remanescente adesivo após descolagem de braquetes ortodônticos / Technique for removal of remmant adhesive after debonding od orthodontic brackets

A etapa de remoção de aparelhos ortodônticos deve ser realizada tentando preservar, ao máximo, a estrutura dentária. Apesar de existirem vários protocolos e materiais disponíveis no mercado, alguns profissionais desconhecem os efeitos destes materiais na superfície do esmalte, o que pode contribuir para que o esmalte seja permanentemente danificado, ou desconhecem que, quando a resina não for adequadamente removida, pode ocorrer um aumento na agregação de biofilme, tornando o esmalte mais suscetível a doenças cárie e periodontal. / Objetivo / O objetivo desse trabalho foi demonstrar, por meio de um caso clínico, uma sequência de acabamento e polimento pós-terapia ortodôntica. / Métodos / Após a remoção dos braquetes, a resina residual foi evidenciada com pó dourado (Texturmarker, Benzer Dental AG, Suíça). Em seguida, foi utilizada broca multilaminada (Komet), discos Sof-Lex (3M ESPE), borrachas para acabamento Astropol e Astrobrush (Ivoclar Vivadent), escova de pelo de cabra e FlexiBuff com pasta Enamelize (Cosmedent). / Conclusão / Pôde-se concluir que a sequência de materiais utilizados foi efetiva e de fácil execução, preservando a estrutura dentária.

Avaliação cromática do esmalte submetido à clareação dentária com peróxido de hidrogênio a 35% após tratamento ortodôntico / Colour evaluation of enamel submitted to 35 % hydrogen peroxide thooth whitening after orthodontic treatment

Objetivo: avaliar as possíveis alterações cromáticas ocorridas na superfície dos dentes (pré-tratamento ortodontico; pós-descolagem e acabamento, e pós-clareação com peróxido de hidrogênio a 35 %), bem como verificar o grau de diferença de cor entre a área que sofreu intervenção ortodôntica e a que não sofreu. Metodologia: trinta peças confeccionadas com dentes bovinos foram divididas em grupo controle (I) e experimental (II), sendo igualmente preparadas e armazenadas em saliva artificial, em estufa (37ºC), durante todo o experimento. No grupo II, os acessórios ortodônticos foram colocados em resina fotopolimeralizável, seguido da descolagem e remoção da resina remanescente. Em seguida, nos dois grupos, foi realizada a clareação com peróxido de hidrogênio a 35 %, seguindo as especificações do fabricante. Um espectrofotômetro computadorizado foi utilizado para os testes colorimétricos nos grupos I (T1 - início; T3 - pós-clareação) e II (T1 - início; T2 - pós-descolagem; T3 - pós-clareação) e os valores avaliados pelo sistema CIELAB, sendo usados apenas os valores de L* (escurecimento ou clareação do dente, numa escala de 0-100) e grau de amarelo. Resultados: houve um aumento nos valores de L* (luminosidade) entre T1/T3 para ambos os grupos e entre T2/T3 para o grupo II, e uma diminuição nos valores de grau amarelo ente T1/T3 em ambos os grupos e entre T2/T3 para o grupo II. Conclusão: não houve diferença de resposta à clareação dentária, imediatamente após a remoção do aparelho, entre dentes submetidos à colagem ortodôntica e dentes não colados, não sugerindo haver influência do provável remanescente resinoso na coloração dentária imediata.

Assessment of enamel damage after removal of ceramic brackets.

INTRODUCTION: Since the introduction of ceramic brackets, research has been performed to evaluate enamel damage caused during their removal. One problem in comparing treated and control groups is the absence of assurance that the surfaces were undamaged before the brackets were bonded and debonded, or that superficial treatment applied to the enamel could hinder damage detection. The aim of this in-vitro study was to evaluate enamel injuries during debonding of 3 types of ceramic brackets. METHODS: Forty-five premolars, extracted for orthodontic purposes, were divided into 3 groups of 15. The enamel surfaces were photographed with a magnifying loupe (60 times) in an optical stereomicroscope (Stemi 2000-C, Zeiss, Oberkochen, Germany) with a digital camera. A different type of backet was bonded and debonded in each group: mechanical retention, mechanical retention with a polymer base, and chemical retention. After debonding, the surfaces were again photographed. The photographs were evaluated for quality of enamel surface according to a predetermined scale. The results were tested by method error and the chi-square test. RESULTS: The damage evaluation comparing the same surface before bonding and after debonding showed no significant statistical difference between the mechanical retention group and the polymer base retention group. There was a significant statistical difference (P <0.05) for the chemical adhesion ceramic bracket group. CONCLUSIONS: The difference between the enamel surfaces before bonding and after debonding brackets with chemical retention was statistically significant; bonding and debonding these brackets resulted in enamel damage.

Orthodontic bracket lost in the airway during orthognathic surgery.

In orthodontic treatment before orthognathic surgery, all erupted molars should be banded or bonded to prevent the creation of an occlusal step. Bonded attachments are often used rather than bands because it is easier to bond to partially erupted teeth, there is no need for orthodontic separation or cementation, and they offer improved periodontal health and patient comfort. However, bonded brackets can fail during conventional orthodontic treatment, and the chance of failure might be greater during surgical procedures. Our purpose in this article was to report an intraoperative second-molar bracket failure in the airway during orthognathic surgery. Although there are advantages of bonding relative to banding for molars, the technique should be used with caution in patients who will require surgery because of the high failure rate of molar bonds and the potential for serious consequences associated with failure during surgery, including contamination or infection.

Resistência ao cisalhamento da colagem de tubos ortodônticos / Shear strength od orthodontic tube

O presente trabalho objetivou avaliar in vitro a resistência ao cisalhamento da interface de colagem de tubos de base lisa jateada com aplicaçäo de adesivo para metais e um grupo de controle formado por tubos com a base de tela preparada pelo fabricante. Utilizou-se como substrato terceiros molares inclusos. Através da microscopia eletrônica de varredura, foi observada uma camada de esmalte aprismático em todas as amostras. Apenas o grupo primer apresentou a resistência à descolagem considerada adequada para suportar as forças ortodônticas