04 December 2019

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Clean-up after orthodontic debonding using fluorescent light

Davide Elsido

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In the latest issue (November 2019) of the Angle Orthodontist an article was published about a technique developed to help the removal composite during debonding of brackets with respect to time needed, composite remnants, and tooth substance loss. After orthodontic treatment, the enamel surface should be returned to its original condition as close as possible without any composite remnants and without damaging the tooth surface. So far, no consensus exists as to the most efficient technique to remove composite remnants after bracket debonding. Despite many different approaches used in daily practice, the tungsten bur remains the most preferred tool to remove composite remnants. Tungsten carbide burs are effective in removing composite remnants but result in a rough enamel surface.

Therefore, enamel polishing is required to avoid bacterial adhesion. This is recommended to be performed with Sof-Lex discs or similar. Although the ideal procedure for removing composite has been the subject of several investigations, less effort has gone into establishing a technique that facilitates the removal of composite remnants. The fluorescence properties of luminescent chemicals and tooth structures are different under a wavelength of 405 nm.

Therefore, fluorescence can be a good tool to use as a noninvasive method for detecting composites.
Two operators: an experienced orthodontist (A) and an undergraduate student (B) received six models each and were asked to remove the composite remnants by both a conventional light source (CLS), and fluorescent inducing light (FIT). The time taken was recorded, and a postoperative scan was digitally superimposed on the preoperative scan to quantify number of teeth with composite remnants and volume and thickness of enamel loss and composite remnants. Compared to CLS, both operators needed significantly less time when using the FIT method and degree of enamel loss, height, and volume of composite remnants and total remaining composite remnants were significantly reduced. Due to infiltration of composite after etching, complete removal of the remnants is almost never possible without damaging the enamel surface. By conventional light, the primer and sealant agent may still remain on the teeth even though, clinically, the surface might look clean. The resin infiltrated enamel could be responsible for color changes of the enamel in the long term. Due to the FIT method, this infiltrated enamel layer becomes visible, which will then be removed during the clean-up process.

Enamel scratches should be avoided as much as possible since they enhance bacterial adhesion and cannot be eliminated by polishing. Improper handling of the tungsten carbide bur at the line angle and cervical areas can lead to visible grooves and the pressure against the enamel is operator-dependent.

Conclusions: Cleanup after orthodontic debonding with the FIT was superior regarding time needed and removal of composite remnants. Total enamel loss reduction was operator-dependent.

For additional informations:  Evaluation of a Fluorescence-aided Identification Technique (FIT) to assist clean-up after orthodontic bracket debonding.