Effect of Orthodontic Debonding and Adhesive Removal on the Enamel – Current Knowledge and Future Perspectives – a Systematic Review

After orthodontic treatment, brackets are debonded and residual adhesive is removed, causing iatrogenic enamel damage. The aim of this study was to review the methods of orthodontic adhesive removal, find clear evidence, and provide a rationale for this procedure. A literature search was performed in PubMed, Dentistry and Oral Sciences, Scopus, Cochrane, Google, and Google Scholar using keywords: orthodontic adhesive removal, orthodontic debonding, orthodontic clean-up. Studies concerning human enamel roughness or loss from debonding and adhesive removal were considered. Forty-four full-text articles were analyzed and 3 were rejected after detailed reading; finally 41 papers were included. Fifteen qualitative studies, 13 studies based on indices of enamel surface, and 13 quantitative studies were found. No meta-analysis could be performed due to a lack of homogenous quantitative evidence. The most popular tools were tungsten carbide burs, which were faster and more effective than Sof-Lex discs, ultrasonic tools, hand instruments, rubbers, or composite burs. They remove a substantial layer of enamel and roughen its surface, but are less destructive than Arkansas stones, green stones, diamond burs, steel burs, and lasers. Multi-step Sof-Lex discs and pumice slurry are the most predictable enamel polishing tools. Arkansas stones, green stones, diamond burs, steel burs, and lasers should not be used for adhesive removal. The use of tungsten carbide bur requires multistep polishing. Further efforts should be made to find tools and methods for complete removal of adhesive remnants, minimizing enamel loss and achieving a smooth surface.