Does attachment removal damage enamel? Influence of adhesive, resin, and bur on surface integrity

To evaluate the combination of composites, adhesive systems, and burs considering artificial accelerated aging (AAA), influence enamel roughness and morphology after attachment removal. One hundred ninety-two bovine enamel specimens were divided according to composite type (Transbond XT, flowable, bulk-fill flowable), adhesive system (Single Bond Universal or Transbond XT primer), and bur for attachment removal (multilaminated carbide or zirconia). Half of the samples were stored for 24 h at 37°C and the other half underwent 300 h of AAA. Surface roughness was measured using confocal laser scanning microscopy before and after attachment removal. Data were analyzed using three-way anova with Bonferroni post hoc tests. Significant differences in enamel roughness were observed according to composite type, adhesive system, and bur used. Multilaminated bur produced higher surface roughness compared to zirconia bur. Transbond composite, particularly when combined with orthodontic adhesive, exhibited greater enamel alteration after AAA. None of the protocols fully restored enamel surface to its original smoothness. Attachment removal inevitably alters enamel morphology, regardless of the materials used. Composite, adhesive, and bur's choice, as well as proper finishing and polishing, is essential to minimize enamel damage after clear aligner treatment.