You are on page 1of 2

Art of Debonding in Orthodontics

Dr. Akhil Agarwal Dr. Nidhi Dwivedi Dr. Juhi Yadav Dr. Rana Pratap
Ex-Post Graduate P.G. Student Consultant, Orthodontics Reader
Dept. of Orthodontics Dept. of Oral Pathology Melbourne, Australia Dept. of Orthodontics
FODS, King George's Medical College, Lucknow. Saraswati Dental college, Lucknow. U.P. Dental College, B.B.D.Univ., Lucknow.

Abstract with light cure and chemically cured resins accomplished by :

T he potential challenge at the end


of orthodontic treatment is to
restore the tooth structure as was
prior to the beginning of the treatment. The
aim of the article is to give a proper insight
penetrate the enamel rods to range of 25 - 40
m. The mechanical interlocking of resin to
enamel surface is stronger than the metal to
resin interface. The technique of debonding
of ceramic brackets is slightly different
Scraping the adhesive with a bond
removing plier or with a scaler. This
method is useful for debonding on
canines and premolars which have a
curved buccal surface.
into the methodology of debonding not only from that of the metallic brackets due to the Using a suitable bur with a contra angle
from the orthodontist's point of view but mechanical and chemical bonding to the handpiece9 is the preferred method for
also keeping in mind the general surfaces of tooth and the bracket. incisors, which have the flat labial
practitioners who follow the procedure. At Clinical Procedure surface. A plain - cut or a spiral - fluted
times, cases which are very well treated end The clinical debonding procedure may tapered Tungsten Carbide bur (#1171 or
up with enamel fractures or tears during be discussed under: #1172) in a contra angle handpiece is
debonding. Among the several methods 1. Bracket Removal used with speed in the range of 25000 -
recommended, the simplest and most Steel brackets 30000 rpm 9 (Fig. 3).
effective and popular method has been Ceramic brackets Speeds of over 30000 rpm are not
discussed in this article as a clinical tip. 2. Removal of the residual adhesive recommended due to the risk of damage to
Keywords : Debonding, Orthodontic 1. Bracket Removal enamel surface. Speeds of less than 10000
Brackets Steel Brackets: The conventional rpm are ineffective and the increased
Introduction method of bracket removal involves using jiggling vibration of the bur may be
The dramatic changes in Orthodontic the twin beaked plier where in the beaks of uncomfortable to the patient. Even an ultra
practice began after the introduction of the plier are engaged in mesial and distal fine high speed diamond bur produces
acid-etch bonding technique in 1955.1 In edges of the bonding base and squeezed to surface scratches. Sand paper discs are also
1965, Newman described the technique for remove the material from the resin-enamel not recommended.
use of epoxy resin for bonding attachments junction. Amount of enamel damage during
directly to enamel surfaces.2 Currently A more gentle technique is to squeeze debonding depends not only on the type of
available resins for Orthodontic use are the brackets gently mesio-distally and lift adhesive resin used, but also the
based on Bowen's BIS-GMA resin, the bracket off with the peeling - off force instruments and method employed during
modified to suitable viscosities for optimal which is in the outward direction3 (Fig. 1). prophylaxis. An initial prophylaxis with a
penetration into etched enamel surfaces.3 This results in a comparatively less bristle brush for 10 15 seconds per tooth
Direct bonding has transferred the tedium of damage to the enamel than the conventional abrades 10 m of enamel whereas the
appliance construction into a efficient and technique, as the debonding takes place at rubber cup abrades 5 m of enamel surface
pleasant operation for both patient and the bracket adhesive interface as seen on the and hence is preferred10,11. The microfilled
clinician. However the direct bonding first premolar (Fig.2) . resins generally require rotary
procedure requires debonding at the Ceramic Brackets: Unlike the metallic instrumentation. The enamel loss then may
termination of the treatment. The objectives brackets, the ceramic brackets do not flex be 10-25 m. The tungsten carbide bur
of the debonding are to remove the when debonding force is applied due to their removes 10 m of the enamel surface as
orthodontic attachment and all adhesive brittle nature. Hence, cutting off the compared to 20 m with a high speed bur12.
resin from the tooth and to restore the brackets with gradual pressure from the tips The removal of outermost layer of enamel is
enamel surface as closely as possible to its of the Twin beaked pliers is NOT not as harmful in accordance with recent
pretreatment condition. To achieve these recommended as it may result in enamel views on tooth surface dynamics because
objectives, correct bonding and debonding cracks. Hence the clinician must target the the thickness of enamel is in the range of
techniques are of fundamental importance. bracket adhesive interface while applying 1000 -2000 m. It has been demonstrated
Debonding of Orthodontic brackets has the force6. Thermal debonding and use of that caries do not develop at such sites even
been one among the many causes of enamel lasers have the potential to be less traumatic if the enamel layer is removed.
damage related to iatrogenicity. Hence, a in terms of enamel damage but are not Remineralisation of enamel after polishing
correct technique related to this procedure is practically viable based on the investment and completion of all dental procedures is
important from the dentist's point of view to on the inventory / equipment7,8. a r o u n d 1 - 2 m a y e a r. H e n c e ,
restore the enamel surfaces as closely as 2. Removal of Residual Adhesive remineralisation would compensate for the
possible. Because of the color similarity of the compromised wear during polishing.
The enamel thickness on labial surface adhesive and enamel surface, the clinician Summary
of the teeth is in the range of 1500 2000 m. must take utmost care while removing the Points to remember while debonding:
Bonding of brackets (metallic and ceramic) remaining residue. This may be Place the beaks of the plier on mesial

44 Healtalk / January-February 2012 / Volume 04 / Issue 03


Agarwal, et al. : Art of Debonding in Orthodontics

and distal sides of the bracket resin debonding. After all, as the saying goes It's 7. Tocchio RM, William PT. laser bonding of
Ceramic Brackets. Am J Orthod Dentofacial
interface and not occluso-gingivally / not over till it's over. Restoring a healthy
Orthop 1993; 103:155-8.
inciso-gingivally. and normal tooth structure after the end of 8. Staratmann U, Schaarschmidt K, Wegener H. The
Apply a peeling off / outward force to orthodontic treatment is as important as extent of enamel surface fractures a quantitative
minimize the chances of enamel achieving the goal of orthodontic treatment. comparison of thermally debonded ceramics &
mechanically debonded metal brackets by energy
damage. References
dispersive micro and image analysis. Eur J
The ceramic brackets should be 1. Buonocore MA. Simple method of increasing the
Orthod 1996;18:655-62.
adhesion of acrylic filling materials to enamel
debonded at the bracket adhesive 9. .Zachrisson BU. A post treatment evaluation of
surfaces: J. Dent Res 1955; 3H: 849-53.
interface while the metallic brackets can direct bonding in Orthodontics. Am J Orthod
2. Newman GV. Epoxy adhesive for orthodontic
Dentofacial Orthop 1979;75:121-7.
be debonded at the enamel adhesive attachments progress report. Am J Orthod
10. Thompson RE, Way DC. Enamel loss due to
interface. Dentofacial Orthop 1965; 51:901-12.
prophylaxis and multiple bonding and debonding
3. Oliver RG. A new Instrument for debonding clean
Residual adhesive should be removed of orthodontic attachments. Am J Orthod
up. J. Clin. Ortho. 1991:25;407-10.
with a plain cut or a spiral tungsten Dentofacial Orthop 1981;79: 282-95.
4. Zarrinnia K. Eid NM, Kehoe MJ. The effect of
11. Gwinnett AJ, Gorelick L: Microscopic evaluation
carbide taper bur (#1171 or #1172) in a different debonding techniques on the enamel
of enamel after debonding clinical application.
contra angle handpiece with speed of surface an invitro qualitative study. Am J Orthod
Am J Orthod Dentofacial Orthop 1997;71:65165.
Dentofacial Orthop 1995;108: 284 95.
25000 -30000 rpm. 12. Pus MD, Way DC. Enamel loss due to orthodontic
5. Krell KV, Courey JM, Bishara SE . Orthodontic
Use of rubber cups is preferred over bonding with filled and unfilled resins using
bracket removal using conventional and ultrasonic
various clean up techniques. Am J Orthod
bristle brushes. debonding techniques, enamel loss and time
Dentofacial Orthop 1980; 77:269-83.
Conclusion requirements. Am J Orthod Dentofacial Orthop
1993; 103:258 66. Legends
With the advent of newer bonding Fig.1. Holding the bracket mesio-distally
6. Bishara SE, Olsen M, VonWald L. Comparisons of
materials and changing trends in dentistry in shear bond strength of precoated and uncoated Fig.2. Adhesive as seen on the first premolar
general, it becomes imperative to employ brackets. American Journal of Orthodontics and Fig.3. Spiral-fluted tapered Tungsten Carbide bur
Dentofacial Orthopedics 1997;112:617-21. (#1171 or #1172)
the most effective and easy method of

Fig. 1 Fig. 2 Fig. 3

Healtalk / January-February 2012 / Volume 04 / Issue 03 45