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Debonding procedures in orthodontics

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Debonding procedures in orthodontics

  1. 1. DEBONDING PROCEDURES IN ORTHODONTICS PRESENTED BY: FASAHAT AHMED BUTT ROLL# 36 GROUP: C
  2. 2. OBJECTIVE  To remove the attachment and all the adhesive resin from the tooth and restore the surface as closely as possible to its pretreatment condition without inducing iatrogenic damage
  3. 3. PROCEDURES Bracket removal Steel bracket Ceramic bracket Removal of residual adhesive
  4. 4. Steel brackets Ceramic brackets
  5. 5. REMOVAL OF STEEL BRACKETS  Place the tip of bracket remover against mesial and distal (or occluso-cervically) edges of the bonding base and cut the brackets off  A gentler technique is to squeeze the bracket wings mesiodistally and lift the bracket with the peel force
  6. 6. REMOVAL OF CERAMIC BRACKETS  With the introduction of ceramic brackets, a new concern over enamel fracture and loss from debonding has arisen.  Because of differences in bracket chemistry and bonding mechanism, various ceramic brackets behave differently on debonding  More recent ceramic brackets have mechanical lock base and vertical slot that will split the bracket by squeezing
  7. 7. CERAMIC BASE DESIGN
  8. 8. MEANS OF REMOVAL  Mechanical  Thermal debonding  Lasers  Ultrasonic
  9. 9. MECHANICAL
  10. 10. ELECTROTHERMAL
  11. 11.  Takla and Shivapuja (1995) study in which 30 teeth were schduled for orthodontic extractions  15 extracted 24 days after ETD  7 extracted 28-32 days after ETD  8 were control teeth and debonded by conventional method, with pliers  In control group pulp was normal  Significant hyperemia in teeth extracted after 24 day  In case of teeth extracted after 28-32 day variation was seen from complete recovery to persistent inflammation  Jost-Brinkmann et al (1997) did an in vivo study in which 12 human premolars scheduled for extraction were bonded with ceramic brackets which were subsequently debonded using ETD. After 4 weeks, teeth were extracted and histologically examined . No signs of pulpal inflammation were seen
  12. 12. LASERS  The use of laser eliminates problems like enamel tear outs, bracket failures and pain.  Lasers decreases debonding force and less time consuming.  Strobl et al (1993) Removal of ceramic brackets from enamel surface by means of laser heating was investigated with the use of C02 and YAG laser  Polycrystalline alumina  Monocrystalline alumina
  13. 13.  Laser-aided debonding significantly reduced debonding force by thermal softening of adhesive resin.  In 69-75% incident light reached enamel surface when Nd:YAG laser was used which has the potential to cause pain or damage to tooth surface
  14. 14. ULTRASONIC
  15. 15. DEBONDIN G METHODS Mechanical ADVANTAGES Low cost Electrothermal o Reduced incidence of bracket failure o Short debonding time DISADVANTAGES Risk of enamel fracture Potential for pulpal damage and mucosal burn Laser Experimental, but increased precision regarding time and amount of heat application High cost of equipment Ultrasonic o Potentially reduced enamel damage o Reduced likelihood of bracket failure o Adhesive removal after debonding may be o Increased debonding time. o Extensive wear of expensive ultrasonic tip o Some force required o Potential for soft tissue injury
  16. 16. ADHESIVE REMNANT INDEX (ARI)  Used to evaluate the amount of adhesive left on the tooth     after debonding SCORE 0: No adhesive left on tooth SCORE 1: Less than half of adhesive left SCORE 2: More than half left SCORE 3: All adhesive left on tooth with distinct with distinct impression of bracket mesh
  17. 17. RESIDUAL ADHESIVE SCOR E0 SCOR E1 SCOR E2 SCOR E3
  18. 18. REMOVAL OF RESIDUAL RESIN  Ultrasonic scaler  Scraping with a sharp bond removing removing plier
  19. 19.  Burs  Tungsten carbide bur  Ultrafine diamond bur  White stone finishing bur
  20. 20. ENAMEL SURFACE INDEX SCORE 0: Instrument tested left the tooth surface with its perikymata intact SCORE 1: Plain cut and spiral fluted tungsten carbide burs operated at about 25,000 rpm were the only instruments that provided the satisfactory surface appearance
  21. 21.  SCORE 2: Fine sandpaper disks produced several considerable and some even deeper scratches  SCORE 3: Medium sandpaper disks and a green rubber wheel produced similar scratches, that could not be polished away
  22. 22.  SCORE 4: Diamond instruments were unacceptable and even fine diamond burs produced coarse scratches and gave a deeply marred appearance
  23. 23. POLISHING

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