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Orthodontic Ceramic Bracket Removal Using Lasers: A Systematic Review.

Mateusz Michalak¹, Sylwia Kiryk², Agnieszka Kotela¹

¹Medical Center of Innovation, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland.

Journal of Functional Biomaterials

|April 25, 2025

Summary

Laser debonding of ceramic orthodontic brackets is effective and safe with proper settings. CO2 and Er:YAG lasers show promise for reducing bond strength and preserving enamel, but more trials are needed.

Keywords:

fixed appliance laser orthodontic ceramic bracket removal teeth

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Published on: December 20, 2024

Area of Science:

Orthodontics
Biomaterials Science
Laser Dentistry

Background:

Conventional mechanical methods for debonding ceramic orthodontic brackets can cause enamel damage.
Laser technology offers a potential alternative for bracket removal.
Evaluating laser effectiveness and safety is crucial for clinical application.

Purpose of the Study:

To systematically review the effectiveness and safety of laser systems for debonding ceramic orthodontic brackets.
To compare laser debonding with conventional mechanical removal methods.
To assess outcomes including enamel damage, pulp temperature, adhesive remnant index (ARI), and shear bond strength (SBS).

Main Methods:

Systematic literature search of PubMed, Scopus, and Web of Science (WoS) databases.
Inclusion of 41 studies meeting PRISMA guidelines for qualitative and quantitative analysis.
Risk of bias assessment and inclusion of only studies with accessible full texts.

Main Results:

CO2 and Er:YAG lasers demonstrated high efficacy in debonding ceramic brackets while maintaining enamel integrity.
Laser application reduced shear bond strength (SBS) to clinically acceptable levels (7-12 MPa) and increased ARI scores (2-3), indicating safer removal.
Most lasers, within optimal parameters, did not exceed safe pulpal temperature thresholds, though diode and Tm:YAP lasers posed overheating risks in some studies.

Conclusions:

Laser-assisted debonding of ceramic orthodontic brackets is effective and safe with appropriate parameters.
CO2 and Er:YAG lasers are most effective for reducing SBS and preserving enamel.
Further randomized controlled trials (RCTs) are needed to establish standardized, evidence-based clinical protocols due to study heterogeneity and limitations.