Assessment of Enamel Loss after Debonding of Ceramic, Composite and Metal Bracketsan: An In Vitro Study.

BACK GROUND: As more adult patients started seeking orthodontic treatment, this lead to the development and improvisation of newer esthetically superior bracket materials but still the disadvantages of these materials remain unresolved. One such aspect of concern is enamel loss and cracks after debonding of ceramic brackets. The amount of enamel lost during the removal of adhesive may be of clinical significance because of the removal of a major part of the protective fluoride-rich layer of enamel. Debonding consists of Debracketing and adhesive removal. This study is about enamel loss after debracketing of ceramic, composite plastic and metal (stainless steel) brackets. AIMS: To assess the enamel loss after debonding of ceramic, composite and metal brackets (Stainless steel) and to compare them. METHODOLOGY: The sample consisted of 90 maxillary I premolars (both right and left side) that were extracted for orthodontic purpose. The teeth were randomly assigned into three equal groups of 30 teeth each. Group I were bonded with ceramic brackets (Virage), Group II were bonded with composite plastic brackets (Silkon Plus) and Group III were bonded with stainless steel (Mini master series) brackets. The teeth were then stored for 48 hours in distilled water at 37°C before debonding All the brackets were debonded according to manufacturers’ instructions. After debonding all the tooth surfaces were evaluated by ARI index. Tooth surfaces are examined by scanning electron microscope in order to verify the presence and sites of the enamel cracks. All the bracket surfaces were examined under a stereomicroscope and scored according to the Modified Adhesive Remnant Index (m ARI). In addition, energy dispersive spectroscopy attached to High Resolution Scanning Electron Microscope was used to detect calcium (Ca) on the adhesive material removed during debonding of the brackets. All the results obtained were tabulated and analyzed using Pearson’s Chi-square test. RESULTS: Adhesive Remnant Index on tooth surface bonded with ceramic brackets showed least amount of lower ARITOOTH score which implies more damage to enamel surface and composite plastic and stainless steel brackets showed mostly higher ARITOOTH Score indicating less damage to tooth surface. On scanning electron microscopic examination, the enamel surfaces bonded with ceramic bracket resulted in more enamel cracks; composite plastic bracket showed negligible amount of enamel crack and stainless steel brackets showed no enamel cracks. Ceramic brackets showed higher ARIBRACKET score indicating more damage to enamel surface, composite plastic bracket and stainless brackets showed lesser values indicating least amount of enamel damage. Energy Dispersive Spectroscopy analysis proved that the loss of elemental calcium is more evident in tooth surface bonded with ceramic bracket. SUMMARY AND CONCLUSION: Enamel loss after debonding was assessed by both quantitative and qualitative methods in this study. The results indicate that after debonding of ceramic bracket enamel loss is more, when compared to that of composite plastic and metal brackets. This implies that debonding of ceramic bracket needs meticulous attention and strict adherence to manufacturer’s instructions is recommended