Aesthetic brackets: nightmare during debonding?

There are several types of aesthetic brackets:

1. Ceramic or Aluminium oxide (Alumina – Al2O3) which subdivided into Polycrystalline and Monocrystalline

2. Zirconium oxide (Zirconia – ZrO2)

3. Polymeric brackets

The main advantages of aesthetic brackets, in particular, the ceramic type are (Bishara and Trulove 1990):

1. “Good” aesthetics

2. Inert with no deterioration (no nickel allergy)

3. Useful for patients require regular magnetic resonance imaging (MRI)

However, there are many problems with the ceramic brackets including:

1. Cost

2. Errors in bracket positioning due to their visibility

3. Fracture during ligation

4. Increased friction

5. Enamel wear and abrasion

6. Increased bond strength which might lead to problematic and painful debonding

Several options have been suggested to reduce the latter problem (problematic and painful debonding), such as:

1. Bracket with failure bonding point

2. Moderate mechanical retention features

3. Metal mesh in base (but poor aesthetics)

4. Biting on a wafer or gauze during debond (Almuzian et al. 2019)

5. Use weaker bonding resin

6. Co2 Laser debonding

7. Manufacturer special pliers (Almuzian et al. 2018)

8. Chemicals to soften adhesive prior to debonding

9. Ultrasonic instruments

10. Electro-thermal instruments

11. Flash-free bond adhesive (not much evidence available)

Angle Orthodontists Journal in their June 2020 issue published a split-mouth trial that tried to explore the effectiveness of the last option (Flash-free bond adhesive).

The paper is titled “Effects of adhesive flash-free brackets on debonding pain and time: A randomized split-mouth clinical trial”.

The paper was undertaken by a Turkish team led by Dr Çokakoğlu.

The study recruited 30 patients who had orthodontic treatment using either:

1. APC flash-free ceramic brackets (APC)

2. Conventional ceramic brackets (CCB)

In summary, APC brackets are mildly less painful to remove and their adhesive can be cleaned faster than for CCB brackets.

What do you think?

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PS: No financial interest