EVALUATION OF THE EFFECTS OF ER-YAG LASER WITH A DIGITAL SCANNING TIP ON DEBONDING OF CERAMIC BRACKETS VS. THE CONVENTIONAL METHOD

Öz

Objective: The aim of this study was to evaluate the effect of the Erbium-doped Yttrium Aluminum Garnet (Er-YAG) laser with a digital and homogeneous scanning (X-Runner) tip on the debonding process of ceramic brackets, comparing with conventional methods. Method: 80 extracted teeth were divided equally into four groups regarding the bracket material and the debonding procedure: Polycrystalline+ Laser (PL), Monocrystalline+ Laser (ML), Polycrystalline+ Conventional (PC) and Monocrystalline+ Conventional (MC). Enamel cracks were examined both before and after debonding and the remaining adhesive on the enamel surface was evaluated by using the adhesive reminant index (ARI) with the aid of a stereomicroscope. Additionally, the effect of the Er-YAG laser on pulpal temperature rise and the extent of penetration of Er- YAG laser beams into the adhesive were measured. The nonparametric Kruskal-Wallis statistical test was employed to evaluate remaining adhesive on the tooth surface and enamel cracks, while the Mann-Whitney statistical test was utilized to assess temperature rise. Results: No significant differences in enamel cracks or fractures were observed between the experimental groups concerning both bracket material and debonding procedure (p>0.05). Significant differences were found in ARI scores and pulpal temperature changes between the ML and PL groups. (p<0.05) Additionally, SEM images revealed that the Er: YAG laser beam did not significantly penetrate the adhesive and had no impact on the enamel surface. Conclusion: The Er:YAG laser, especially when used with the X-Runner head, provides precise control and minimal thermal impact, ensuring no damage to the enamel or pulp. Therefore, it can be safely utilized for the removal of ceramic brackets in clinical settings.

Anahtar Kelimeler

• Debonding
• Er:YAG laser
• Monocrystalline
• Polycrystalline

Kaynakça

1. Mundhada V V, Jadhav V V, Reche A. A Review on Orthodontic Brackets and Their Application in Clinical Orthodontics. Cureus. 2023;15:e46615.
2. Elabed I, Zheng Z, Zhang Y, et al. The Mechanical and Clinical Properties of Customized Orthodontic Bracket Systems-A Comprehensive Review. J Funct Biomater. 2024;15:299.
3. Ngan AY, Bollu P, Chaudhry K, et al. Survey on awareness and preference of ceramic bracket debonding techniques among orthodontists. J Clin Exp Dent. 2020;12:e656-e662.
4. Khalil AS, Tamish NM, Elkalza AR. Assessment of chemical, ultrasonic, diode laser, and Er:YAG laser application on debonding of ceramic brackets. BMC Oral Health. 2022;22:79.
5. Gorassini F, Fiorillo L, Marrapodi MM, et al. Debonding issues in orthodontics: an RCTs systematic review. Explor Med. 2024;477-491.
6. Sobouti F, Aryana M, Dadgar S, et al. Effects of Novel versus Conventional Porcelain Surface Treatments on Shear Bond Strength of Orthodontic Brackets: A Systematic Review and Meta-Analysis. Biomed Res Int. 2022;1-34.
7. Mesaroș A, Mesaroș M, Buduru S. Orthodontic Bracket Removal Using LASER-Technology-A Short Systematic Literature Review of the Past 30 Years. Materials. 2022;15:548.
8. Reza F, A.M. K, Farzaneh A, et al. Laser in Orthodontics. In: Naretto S, ed. Principles in Contemporary Orthodontics. InTech. 2011;130-180.

9. Hayakawa K. Nd: YAG laser for debonding ceramic orthodontic brackets. Am J Orthod Dentofacial Orthop. 2005; 128:638-647.
10. Rickabaugh JL, Marangoni RD, McCaffrey KK. Ceramic bracket debonding with the carbon dioxide laser. Am J Orthod Dentofacial Orthop. 1996;110:388-393.
11. Obata A. Super pulse CO2 laser for bracket bonding and debonding. Eur J Orthod. 1999;21:193-198.
12. Latić Hodžić L, Ionescu AC, Brambilla E, et al. Shear Bond Strength of Orthodontic Brackets Luted with RMGIC After Er:YAG Laser Etching with Two Pulse Modes Using a Digitally Controlled “X-Runner” Handpiece. Photomed Laser Surg. 2018;36:608-613.
13. Birlik M, Karamehmetoğlu H, Usumez A. Case report: Laser Applications with an Er:YAG Dental Laser and X-Runner Handpiece. J. LA&HA. 2013; 31-33.
14. Yassaei S, Fekrazad R, Shahraki N, et al. A Comparison of Shear Bond Strengths of Metal and Ceramic Brackets using Conventional Acid Etching Technique and Er:YAG Laser Etching. J Dent Res Dent Clin Dent Prospects. 2014;8:27-34.
15. Kitahara-Céia FMF, Mucha JN, dos Santos PAM. Assessment of enamel damage after removal of ceramic brackets. Am J Orthod Dentofacial Orthop. 2008;134:548-555.
16. Montasser MA, Drummond JL. Reliability of the Adhesive Remnant Index Score System with Different Magnifications. Angle Orthod. 2009;79:773-776.
17. Grzech-Leśniak K, Matys J, Żmuda-Stawowiak D, et al. Er:YAG Laser for Metal and Ceramic Bracket Debonding: An In Vitro Study on Intrapulpal Temperature, SEM, and EDS Analysis. Photomed Laser Surg. 2018; 36: 595-600.
18. Grazioli G, Hardan L, Bourgi R, et al. Residual Adhesive Removal Methods for Rebonding of Debonded Orthodontic Metal Brackets: Systematic Review and Meta-Analysis. Materials. 2021;14:6120.
19. Zheng X, Huang X. Evaluation of the re-bond strength of debonded metal and ceramic brackets following Er: YAG laser treatment. BMC Oral Health. 2024;24:710.
20. Fahimipour F, Houshmand B, Alemi P, et al. The effect of He-Ne and Ga-Al-As lasers on the healing of oral mucosa in diabetic mice. J Photochem Photobiol B. 2016;159:149-54.
21. Yang S, Yun Z, Zhao L, et al. Temperature Changes in Oral All-Ceramic Materials with Different Optical Properties under Er:YAG Laser Irradiation. Dis Markers. 2022;2022:1-8.
22. Ismatullaev A, Taşın S, Usumez A. Evaluation of bond strength of resin cement to Er:YAG laser-etched enamel and dentin after cementation of ceramic discs. Lasers Med Sci. 2021;36:447-454.
23. Hajrassie MKA, Khier SE. In-vivo and in-vitro comparison of bond strengths of orthodontic brackets bonded to enamel and debonded at various times. Am J Orthod Dentofacial Orthop. 2007;131:384-390.
24. Tocchio RM, Williams PT, Mayer FJ, et al. Laser debonding of ceramic orthodontic brackets. Am J Orthod Dentofacial Orthop. 1993;103:155-162.
25. Dumbryte I, Malinauskas M. In vivo examination of enamel microcracks after orthodontic debonding: Is there a need for detailed analysis? Am J Orthod Dentofacial Orthop. 2021;159: e103-e111.
26. Abdulaziz A, El-Kholy MM, Bushra SS, et al. Performance of two laser motion modes versus conventional orthodontic ceramic brackets debonding technique on enamel surface topography. Lasers Med Sci. 2024;39:156.
27. Mundethu AR, Gutknecht N, Franzen R. Rapid debonding of polycrystalline ceramic orthodontic brackets with an Er:YAG laser: an in vitro study. Lasers Med Sci. 2014;29:1551-1556.
28. Petersen M, Braun A, Franzen R. Thermal Effects on Dental Pulp during Laser-Assisted Bleaching Procedures with Diode Lasers in a Clinical Study. J Clin Med. 2024;13:2301.
29. Dostalova T, Jelinkova H, Remes M, et al. The Use of the Er:YAG Laser for Bracket Debonding and Its Effect on Enamel Damage. Photomed Laser Surg. 2016;34:394-399.
30. Sedky Y, Gutknecht N. The effect of using Er,Cr:YSGG laser in debonding stainless steel orthodontic brackets: an in vitro study. Lasers Dent Sci. 2018;2:13-18.
31. Sari T, Tuncel İ, Usumez A, et al. Transmission of Er:YAG Laser Through Different Dental Ceramics. Photomed Laser Surg. 2014;32:37-41.
32. Apel C, Franzen R, Meister J, et al. Influence of the Pulse Duration of an Er:YAG Laser System on the Ablation Threshold of Dental Enamel. Lasers Med Sci. 2002;17:253-257.
33. Erşahan Ş, Sabuncuoğlu FA, Ertürk E. Debonding of Ceramic Brackets by Er:YAG Laser. J Istanbul Univ Fac Dent. 2016;50(2):24-30.
34. Tozlu M, Oztoprak MO, Arun T. Comparison of shear bond strengths of ceramic brackets after different time lags between lasing and debonding. Lasers Med Sci. 2012;27:1151-1155.
35. Aksakalli S, Ileri Z, Yavuz T, et al. Porcelain laminate veneer conditioning for orthodontic bonding: SEM-EDX analysis. Lasers Med Sci. 2015;30: 1829-1834.
36. Zhang X, Dong H, Wu X, et al. Effects of Er:YAG laser debonding on changes in the properties of dental zirconia. PLoS One. 2024;19: e0313739.