JOURNAL

REVIEW
Kanish Agggarwal
PG Student
Dept. Of Orthodontics

 Original Article
Published in March 2015 issue of American
Journal of Orthodontics and Dentofacial
Orthopedics (AJO DO)

(Am J Orthod Dentofacial Orthop 2015;147:324-9)

Monthly journal covering orthodontic research

Dr. Rolf G. Behrents is the current editor-inchief

In-vivo evaluation of the

surface roughness and
morphology of enamel after
bracket removal and polishing
by different techniques
Authors : Elcio Mario Faria-Junior, Ricardo Danil
Guiraldo, Sandrine Bittencourt Berger, Americo
Bortolazzo Correr, Lourenco Correr-Sobrinho,
Edwin Fernando Ruiz Contreras, and Murilo
Baena Lopes

ARTICLE METRICES
No. of tables

02

No. of pictures

03

No. of parameters
used
No. of citations

03
00

INTRODUCTION

This study was conducted by Faria Junior et

al in Brazil, South America.
The aim of this study was to evaluate the
surface roughness and morphology of the
enamel using a Surface Roughness Tester and
Scanning Electron Microscope after the
removal of metal brackets from the maxillary
central incisors, in vivo.

 Since 1970, bonding of orthodontic brackets

to tooth enamel has become an accepted
clinical technique
Orthodontic treatment commonly involves
bonding of orthodontic brackets to tooth
enamel
The bonding procedure involves alteration of
the enamel surface by acid etching, followed
by the application of adhesive primer and
resin

 The basis for the adhesion of brackets to

enamel has been enamel etching with
phosphoric acid, as first proposed by
Buonocore in 1955
Other methods such as air abrasion have
also been employed for preconditioning of
enamel before bonding of brackets. Air
abrasion involves sandblasting enamel
surface with 50 m aluminum oxide
particles

 A study conducted by Waveren et al (Am J

Orthod Dentofacial Orthop 2000;117:20-6)
on 42 bovine incisors showed that the
amount of enamel loss was similar in case
of air abrasion when compared to acid
etching but the bond strength by air
abrasion was less than that of acid etching
Methods like crystal growth conditioning
have also been tested as an alternative to
acid etch procedure
Van Waveren Hogervorst WL, Feilzer AJ, Prahl-Andersen B. The air-abrasion technique versus
the conventional acid-etching technique: a quantification of surface enamel loss and a
comparison of shear bond strength. Am J Orthod Dentofacial Orthop 2000;117: 20-6.

In a study conducted by Artun J et al on 40

orthodontic patients it was found that the
bond strength in acid etching using 37 % ophosphoric acid was higher than enamel
preconditioning using a solution of sulphuric
acid, phosphoric acid and sodium sulphate
which was higher than bond strength
obtained by preconditioning enamel using a
solution of sulphuric acid and sodium
sulphate
Artun J, Bergland S. Clinical trials with crystal growth conditioning as an alternative to acid-etch
enamel pretreatment. Am J Orthod 1984;85:333-40

 After the completion of orthodontic

treatment the brackets are debonded and
the resin is removed
The final procedure in returning the enamel
surface to the original pretreatment
condition involves the removal of all
attachments such as brackets & bands and
remaining resin from the tooth surfaces

Various methods have been advocated for

debonding brackets
Mechanical debonding
Electrothermal debonding
Ultrasonic debonding
Laser assisted debonding

After debonding of the bracket, the resin might

remain on the tooth which is categorized as
0, no bonding resin left on the tooth;
1, less than half of the bonding resin left on
the tooth;
2, more than half of the bonding resin left
on the tooth;
3, all bonding resin left on the tooth, with a
distinct impression of the bracket mesh
Artun J, Bergland S. Clinical trials with crystal growth conditioning as an alternative to acid-etch
enamel pretreatment. Am J Orthod 1984;85:333-40

 Various techniques which are commonly

employed to remove the resin are
Scraping with a scaler
Scraping with a band-removing plier
Tungsten carbide bur
Abrasive discs

 Esthetics
is
one
of
the
primary
consideration
for
patients
to
seek
orthodontic treatment
The form and brightness of the maxillary
anterior teeth are important for both dental
and facial esthetics
The brightness of the buccal surface must
be restored after orthodontic treatment, a
goal that may not be possible to achieve
with rough surfaces

 Each debonding procedure can result in

variable surface quality according to the
instruments used and the different degrees
of enamel loss
Hence to achieve good esthetics it is
necessary that the resin removal method
should restore the enamel to its initial
surface morphology.
The null hypothesis : The surface roughness
and the morphology of the areas of
untouched enamel would not differ from
those in areas that were polished by an
aluminum oxide disc or a carbide bur.

MATERIAL
AND
METHODS

 This study was evaluation of 10 patients (5

male, 5 female) ranging in age from 14 years
to 21 years 7 months (mean, 17 years 6
months).
It was approved by the research ethics
committee of the University of North Parana
in Brazil
No patient had any caries, restorations,
history of trauma, bruxism, or cracks on the
maxillary incisors.

 The middle third of the buccal face of all

teeth was etched with 37% o-phosphoric acid
gel (Condac 37)
30 seconds, rinsed with air-and-water spray,
and air dried for 20 seconds

 One layer of adhesive primer (Adper Single

Bond 2) was applied to the etched area.
Stainless steel standard maxillary incisor
brackets (Roth) were bonded to the teeth with
Filtek Z100 (3M ESPE).
A microbrush was used to remove any excess.

 The resin was cured using Ultraled (Dabi

Atlante) light-emitting diode device at an
irradiance of 800 mW/per square
centimeter.
The edge of each bracket was exposed to
the light-emitting diode for 10 seconds,
with a total exposure time of 40 seconds.
Orthodontic treatment ranged from 15 to
28 months (mean, 21.5 months)

 After treatment, the brackets were removed

with pliers
Prophylactic procedures
were performed
with pumice and a Robinson brush
Impression was taken in Polyvinylsiloxane
using 1 step impression technique
The impression was cast in epoxy resin
The adhesive remnant index (ARI) of the
epoxy resin replicas was analyzed using
optical microscope at a 40x Magnification

 ARI was used to classify the failure mode as

follows:

 One side of the mouth was randomly

selected, and the teeth on that side were
finished and polished with aluminum oxide
discs
The discs were used at low rpm under
intermittent cooling, in decreasing order of
abrasiveness for 20 seconds each, until a
visibly smooth and polished surface was
obtained.

 On the other side, the teeth were finished

with a multilaminated carbide bur used at
low rpm under intermittent water cooling
until a visibly smooth and polished surface
was obtained (80 seconds).
After the removing the remaining resin, new
replicas with polished teeth were obtained
using polyvinylsiloxane impression and
casting using epoxy resin

For the surface roughness measurements, 3

sets of dental replicas were tested:

 The surface roughness was measured with

a surface roughness tester (SJ 400;
Mitutoyo, Kawasaki-Shi, Kanagawa, Japan)
at a speed of 0.05 mm per second, with a
length of 2.5 mm
Three measurements were made in different
directions with an angle of 120
Mean of the three readings was calculated

 Three replicas from each group were

analyzed by SEM (JSM 5600; Jeol, Peabody,
Mass). The specimens were gold sputtered
to a thickness of about 50 in a vacuum
evaporator (SCD 050; Oerlikon Balzers,
Balzers, Liechtenstein).
Photomicrographs
at
500
times
magnification were taken in representative
areas of the surfaces.

STATISTICAL
ANALYSIS

 The distributions of the measurements

were investigated with the KolmogorovSmirnov normality test; then parametric
tests were used.
Data
for
roughness
values
were
statistically
evaluated
by
repeated
measurements analysis of variance at the
5% significance

RESULTS

DISCUSSION

 The
maxillary
central
incisors
are
important determinants in evaluating
anterior dental esthetic
The surface roughness is connected directly
with the brightness and, thus, the esthetics
of the teeth
Orthodontic treatment has an inevitable
influence on the enamel surface.
Regardless of the method used, some groove
occurs after bracket debonding and resin
removal.

 Damage to the enamel surface may lead to

decreased enamel resistance and an
increased risk of decalcification.
Roughness of the enamel surface provides
an area for the attachment of dental
plaque
which
predisposes
it
to
decalcification

 In the study, the surface roughness values

obtained after finishing with aluminum
oxide discs were lower than the values in
the areas of pumice polished enamel.
Thus, polishing with aluminum oxide discs
may improve the light reflection of enamel.
The values of surface roughness for
tungsten carbide bur were higher than the
aluminum oxide group

 Eliades et al studied surface roughness

of 30 premolar crowns after debonding.
The resin removal was done by tungsten
carbide burs and ultra fine diamond
burs. The crowns were then polished
using aluminum oxide discs. It was
found that the surface roughness of
tungsten carbide group was lower but
diamond burs took half the time for
resin removal
Eliades T, Gioka C, Eliades G, Makou M. Enamel surface roughness following debonding
using two resin grinding methods. Eur J Orthod 2004;26:333-8.

 Karan S et al studied surface roughness of

20 premolars after debonding using atomic
force microscopy. The resin removal was
done using tungsten carbide bur and a
composite bur, reinforced by zircon-rich
glass fiber. It was found that the surface
roughness by composite bur was lower as
compared to the tungsten carbide bur but
the duration of resin removal was higher
for composite bur
Karan S, Kircelli BH, Tasdelen B. Enamel surface roughness after debonding.
Angle Orthod 2010;80:1081-8.

Zarrinia et al studied surface roughness of 60

premolars after resin removal by seven
different methods
1.Fine finishing diamond point
2.A no.169L carbide bur
3.A 12- fluted carbide finishing bur
4.A stainless steel finishing bur
5.Coarse,medium,and fine sandpaper disks
6.Medium,fine,and superfine aluminum oxide
disks
Zarrinia K, Eid NM, Kehoe MJ. The effect of different debonding techniques on the
enamel surface: an in vitro qualitative study. Am J Orthod Dentofacial Orthop
1995;108:284-93.

7. Shofu wheels from an enamel adjustment

kit
It was found in the study that best results
are obtained when resin is removed using
aluminum oxide discs, but the method is
time consuming
He recommended the removal of bulk of resin
with tungsten carbide bur and then use of
aluminum oxide discs and final polishing
with rubber cup and zircate paste

 From the result of the study the null

hypothesis was not accepted because
significant differences in the surface
roughness were found between the areas of
untouched enamel and the areas that were
polished by aluminum oxide discs
Differences in surface morphology were also
found between the areas of untouched
enamel and the areas that were polished by
aluminum oxide disc or carbide bur
.

LIMITATION
S OF THE
STUDY

1.The sample size was small

The sample size was small (n=10), which
decreases the potential of the study to be
generally applicable
2. Polyvinylsiloxane was used for impression
procedure
Impression material was used to create the
replica of the surface of the tooth to be
studied. There is always some detail loss
associated with the impression material

3. Study was conducted on epoxy resin

replicas
Epoxy resin replicas were made from the
impression of the teeth.
There is always some loss of surface detail,
this more so is important in this study as
surface morphology is being studied using
electron microscope

4. Only central incisors were studied

Central incisors, lateral incisors and canines
form important aspect of the smile and facial
esthetics.
5. Surface morphology was studied using
scanning electron microscope
Scanning electron microscope was used to
create 2-D images for the study of surface
morphology. Better microscopes such as atomic
force microscope are available which provide a
3D view and a better understanding of surface
morphology.

CONCLUSION

1. The aluminum oxide disc system resulted

in less enamel roughness than did the
carbide bur system for polishing enamel after
bracket removal.
2. The areas of untouched enamel showed no
significant difference in surface roughness
compared with enamel polished by the
carbide bur system.
3. The morphology of the enamel that was
polished by aluminum oxide discs resulted in
no apparent grooves.

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