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After performing the laboratory/clinical exercises, the student will be able to do the following:
1. Explain the rationale for removing composite adhesive resin from the teeth following orthodontic treatment.
2. Discuss the clinical objectives for debonding.
3. Describe the effects of using improper debonding techniques or materials on enamel.
4. Demonstrate each step in the debonding procedure.
5. Self-evaluate the effectiveness of the debonding procedure.
6. Explain three follow-up considerations to be discussed with the newly debonded orthodontic patient.
Adhesive composite materials are commonly used to attach orthodontic brackets to enamel surfaces. These brackets hold the arch wire in place by means of elastics or ligature wires, as illustrated in Figure 13.1. Common orthodontic materials are discussed in Chapter 13, Specialty Materials. The orthodontist generally removes the fixed appliances and the adhesive resin at the end of orthodontic treatment. Debonding is the complete removal of composite and cement material from enamel surfaces after these appliances are removed. Generally, the orthodontist performs this procedure. However, if the orthodontic practice employs a dental hygienist, then he or she usually debonds the patient. Patients are normally referred to their general dentist for a complete dental examination, radiographs, and prophylaxis after the debonding appointment. The dental hygienist in the general practice is often the first person to see the patient after the active phase of orthodontic treatment is completed. Occasionally, fine remnants of adhesive resin remain on the facial surfaces of the patient’s anterior and premolar teeth where the orthodontic brackets had been attached. The task of eliminating the residual composite material is then the responsibility of the general practice dental hygienist. It is important to completely remove all composite resin material to avoid the following:
- Plaque accumulation
- Poor esthetics
- Demineralization and/or caries formation
- Gingival inflammation
- Mucosal response from rough resin
All debonding methods remove some enamel. The dental hygienist must select the least traumatic instruments and methods to accomplish the resin removal.
I. Objective of Debonding
The primary objective of debonding is to return the enamel surface to its natural, pretreatment appearance. A secondary objective is to return the enamel surface to its pretreatment texture or feel.
II. Problems with Improper Debonding Techniques and Materials
A number of hand and rotary instruments as well as a variety of abrasives have been investigated for use in debonding. Most studies indicate that some enamel alteration results from the debonding process. In addition, decalcified enamel surfaces (white spots) are much more likely to exhibit enamel loss than intact enamel. Faster techniques and coarser abrasives cause more damage to the enamel surfaces. Researchers generally agree that diamond burs, green stones, white stones, sandpaper discs, manual or ultrasonic scalers, pliers, and band removers should not be used to remove the composite adhesive resin that remains after bracket removal.
III. Debonding Procedure
Enamel surfaces that are gouged or scratched as a result of improper debonding methods or materials may cause the same problems that would result from leaving remnants of adhesive resin on the tooth. It is critical for the dental hygienist to follow the steps in the debonding procedure in sequential order to provide a smooth enamel surface. The materials needed for debonding are listed in Table 32.1.
TABLE 32.1. Armamentarium for Debonding Orthodontic Adhesive Resin
A. Identification of the Resin
Identification of the remaining composite adhesive resin is necessary to avoid causing inadvertent damage to the enamel surface during resin removal. The resin that remains immediately after bracket and band removal (Fig. 32.1) is easily visible compared to the residual remnants that are frequently seen in general practice settings. The clinician may use one of the following methods to identify the location and amount of remaining resin:
FIGURE 32.1. Facial view of anterior teeth with adhesive resin still remaining after removal of orthodontic brackets. (Reprinted from Gutmann ME. Composite adhesive resin removal following active orthodontic treatment. J Pract Hyg. 1996;5(3):16–19, with permission; ©1996, Montage Media Corporation.)
1. Dry the tooth with air to see the resin. The resin appears as a square, opaque substance on the tooth surface.
2. Apply disclosing solution to the tooth with a cotton-tipped applicator. The composite material may stain the same as plaque.
3. Examine the tooth surface with an explorer. Resin will feel rough compared to smooth enamel. Some composite materials may also abrade the metal explorer, leaving a gray line on the surface.
4. Ask the patient to rub his or her tongue over the tooth surface to identify the exact location of the resin.