Healthy Adult, Laser, Orthodontic Brackets, Pain, Temperature Change
Conditions
Keywords
ceramic brackets, orthodontic debonding, enamel integrity, pulpal temperature, adhesive remnant index, pain assessment, Erbium-doped Yttrium Aluminum Garnet Laser, tooth enamel
Brief summary
This randomized split-mouth clinical trial evaluates enamel surface preservation, pulpal temperature variation, and patient-reported discomfort during ceramic orthodontic bracket removal using two Erbium-doped yttrium aluminum garnet (Er:YAG) laser parameter settings compared to conventional mechanical debonding. Pulpal temperature is monitored in real time using a thermocouple device. Enamel integrity is assessed using the Adhesive Remnant Index (ARI) under 40× magnification. The study aims to determine optimal laser parameters ensuring safe and conservative bracket removal.
Detailed description
Orthodontic bracket debonding must restore enamel close to its pretreatment condition while minimizing iatrogenic damage. Ceramic brackets demonstrate high bond strength and are associated with increased enamel fracture risk during conventional removal. Laser-assisted debonding has been proposed to reduce mechanical stress by softening the adhesive interface. However, concerns remain regarding pulpal temperature elevation and enamel surface alteration. This randomized split-mouth clinical trial compares two Er:YAG laser parameter settings with conventional plier debonding. Pulpal temperature variation will be measured using a thermocouple inserted into the pulp chamber. Enamel surface evaluation will be performed using 40× magnification to assess ARI score. Pain perception will be recorded using a visual analog scale (VAS). The study aims to optimize laser parameters while ensuring biological safety and enamel preservation. This split-mouth clinical trial includes 10 patients (100 maxillary teeth, teeth 15-25). Brackets are randomized by quadrant into: Laser Parameter 1 (Er:YAG, 4 W, 400 mJ, 10 Hz) Laser Parameter 2 (Er:YAG, 4.5 W, 300 mJ, 15 Hz) Conventional mechanical debonding Primary outcome: pulpal temperature variation (∆T). Secondary outcomes: ARI score and pain perception (VAS). Laser irradiation is performed using LightWalker II ST-E Pro+ (Fotona, 2940 nm), non-contact mode, 45° angle, 1 cm distance, MicroShort pulse (MSP) mode, air=1, water=1, 10-15 seconds scanning.
Interventions
DEVICEEr:YAG Laser - Parameter 1
Er:YAG laser (LightWalker II ST-E Pro+, Fotona, 2940 nm wavelength) applied in non-contact mode at 4 W average power, 400 mJ pulse energy, 10 Hz frequency, MSP mode (100 µs pulse duration), air=1 and water=1 settings. Laser applied at 45° angle, 1 cm distance, scanning method for 10-15 seconds until bracket detachment.
DEVICEEr:YAG Laser - Parameter 2
Er:YAG laser (LightWalker II ST-E Pro+, Fotona, 2940 nm wavelength) applied in non-contact mode at 4.5 W average power, 300 mJ pulse energy, 15 Hz frequency, MSP mode (100 µs pulse duration), air=1 and water=1 settings. Laser applied at 45° angle, 1 cm distance, scanning method for 10-15 seconds until bracket detachment.
PROCEDUREConventional Mechanical Debonding
Ceramic bracket removal using orthodontic debonding pliers (3M™ Unitek™ Debonding Instrument) applying controlled torsional force to bracket wings according to standard clinical protocol.
Sponsors
Saint-Joseph University
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Intervention model description
split mouth design
Eligibility
Sex/Gender
ALL
Age
20 Years to 35 Years
Healthy volunteers
No
Inclusion criteria
* Age 20-30 years * Completed orthodontic treatment * Maxillary teeth (15-25) bonded with 3M Clarity™ ceramic brackets * No analgesic use within 7 days * Good systemic health
Exclusion criteria
* Smokers * Systemic diseases affecting oral health * Teeth with restorations or crowns * Pulp necrosis or infection * Medications affecting pulp vascular dynamics
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Pulpal Temperature Variation (∆T) | During laser assisted bracket removal procedure | Real-time pulp chamber temperature measured using a calibrated K-type thermocouple during laser irradiation. Temperature change recorded in degrees Celsius (°C). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adhesive Remnant Index (ARI) | Immediately after bracket removal | Microscopic evaluation at 40× magnification using Artun and Bergland scale (0-3). |
| Pain Perception (VAS) | Immediately after each quadrant debonding | Patient-reported pain measured using a 10 cm Visual Analog Scale (0-10). |
Countries
Lebanon
Outcome results
None listed