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Enamel Integrity and Residual Composite Following Clear Aligner Attachment Removal: A Systematic Review.
Nicolas Nassar1,2,3, Karim Corbani4,5, Rim Bourgi4,6
1Department of Orthodontics, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut 1107 2180, Lebanon.
Clinics and Practice
|March 27, 2026
Summary
Removing clear aligner attachments can cause enamel loss and leave composite residue. Multi-step polishing with magnification offers the best balance for enamel preservation and composite removal, but more clinical research is needed.
Area of Science:
- Dental Materials Science
- Orthodontic Technology
- Biomaterials Engineering
Background:
- Clear aligner therapy is increasingly popular, necessitating effective methods for attachment removal.
- Attachment removal can lead to undesirable enamel surface alterations and residual composite material.
- Optimizing removal techniques is crucial for maintaining enamel integrity and aesthetic outcomes.
Purpose of the Study:
- To systematically review enamel surface changes and residual composite after clear aligner attachment removal.
- To evaluate the impact of removal techniques, instruments, operator experience, and magnification on enamel preservation.
- To assess cleaning efficiency and identify optimal protocols for attachment debonding.
Main Methods:
- A comprehensive systematic search of multiple databases (PubMed, Scopus, Embase, Web of Science, Scielo) was conducted.
- Inclusion criteria covered in vitro, ex vivo, and clinical studies assessing enamel loss, residual composite, or surface roughness.
- PRISMA 2020 guidelines and Cochrane Handbook were followed; narrative synthesis was used due to heterogeneity.
Main Results:
- Three studies were included, reporting enamel loss from 15 µm to over 50 µm.
- Residual composite covered 20-40% of enamel surfaces; multi-step carbide bur and silicone polisher protocols under magnification were most effective.
- Magnification loupes (≥2.5×) improved precision and reduced residual composite; fiberglass burs increased enamel loss.
Conclusions:
- Clear aligner attachment removal causes measurable enamel loss and composite residue, influenced by instruments and visualization.
- Sequential carbide-silicone polishing under magnification shows promise for balancing composite removal and enamel preservation in lab settings.
- Limited evidence and lack of clinical trials preclude direct clinical recommendations; further research is essential.
