Laser Er:YAG-Assisted Debonding May Be a Viable Alternative to the Conventional Method for Monocrystalline Ceramic Brackets.

In orthodontic practice, due to the increased interest among patients in smile aesthetics, different types of brackets are now being used, with those most frequently applied being ones made of polycrystalline and monocrystalline ceramic. The aim of this study was to evaluate the laser Er:YAG-assisted debonding technique compared to conventional methods for removing monocrystalline ceramic brackets from human teeth. The study sample included 60 vital teeth (frontals of the upper jaw) from 10 patients who had monocrystalline ceramic brackets and were in the final phase of orthodontic treatment. The debonding procedure was carried out following a split-mouth study design, using either the conventional technique or laser Er:YAG 2940 nm radiation. For each tooth, three variables were evaluated: the patient's sujective tooth sensitivity associated with the debonding, the time required for debonding, and pulp blood flow microdynamics after the debonding. Three evaluation instruments were used to assess and quantify the treatment effects: (i) the Wong-Baker FACES Pain Rating Scale for pain assessment; (ii) a digital stopwatch/timer to measure the time required to remove the bracket; and (iii) laser Doppler flowmetry (LDF) for recording the pulp blood flow evolution. The statistical analysis of the recorded data showed a statistically significant difference between the two debonding methods regarding the tooth sensitivity during the debonding and the time required for the procedure. The subjective tooth sensitivity was reduced from a mean ± standard deviation of 3.07 ± 1.46 to 0.47 ± 0.86 on the Wong-Baker FACES scale (Wilcoxon signed rank, p < 0.001). The necessary time for debonding was reduced by 0.697 ± 0.703 s per tooth (paired t -test, p < 0.001). There was no difference in the blood microdynamics between the two debonding techniques. According to the results of this study, the laser Er:YAG-assisted debonding technique may be a viable alternative to the conventional method for monocrystalline ceramic brackets.