Orthodontic debonding and enamel surface integrity. A systematic review of the literature

The aim of a debonding protocol is to ensure the complete removal of composite resin without altering the enamel surface. A systematic review was conducted to analyze the effects of resin removal after the debonding of orthodontic brackets using different mechanical instruments, from both a qualitative and quantitative perspectives.

An electronic search, following PRISMA guidelines, was conducted across three databases until March 2023, supplemented by a manual search. All controlled randomized studies or in vitro studies, comparing the removal of adhesive with tungsten carbide burs to other mechanical instrumentation techniques and assessing enamel surface, were included.

Twenty-seven eligible articles were included, comprising two randomized studies and 25 in vitro studies, with varying bias levels. Compared to tungsten carbide burs, ultrasonic instruments and sandblasting showed similar or better results in terms of enamel loss and surface roughness. The enamel surface was equally less rough when using discs (Sof-Lex) or a fiberglass bur, or a fiberglass bur, although these techniques were time-consuming. The exclusive use of a diamond bur, stainless steel bur, or manual scaler for complete resin removal resulted in much rougher surfaces, clinically unacceptable.

Preserving the enamel surface seems optimal with a two-phase protocol, involving the use of tungsten carbide burs for initial removal of most of the resin, followed by a less invasive technique for finishing resin removal. Beyond the findings of this review, a final polishing step also appears to be relevant.