J. Orthod.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Journal of Orthodontics, Vol. 32, No. 2, 146-163, June 2005 doi:10.1179/146531205225021024
© 2005 British Orthodontic Society
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Russell, J. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Russell, J. S.

Article

Current Products and Practice

Aesthetic Orthodontic Brackets

J. S. Russell

Leeds Dental Institute, Leeds, UK

Address for correspondence: Joanne Russell, Orthodontic Department, Leeds Dental Institute, Clarendon Way, Leeds LS2 9LU Email: joannesrussell{at}yahoo.co.uk


   Abstract
Top
 Abstract
Introduction
 Plastic brackets
 Ceramic brackets
 Conclusion
 References
 
Due to an increasing demand for superior aesthetics during fixed appliance treatment, the use of aesthetic brackets has grown in popularity over recent years. Although often requested by patients, aesthetic brackets are not without their disadvantages. This article presents the currently available plastic and ceramic brackets and discusses the potential problems associated with each. Recent advances, introduced by manufacturers in an attempt to overcome their clinical disadvantages, are described.

Key words: Aesthetic brackets, ceramic/monocrystalline/polycrystalline brackets, plastic/polycarbonate brackets


   Introduction
Top
 Abstract
 Introduction
Plastic brackets
 Ceramic brackets
 Conclusion
 References
 
Orthodontic patients, including a growing population of adults, not only want an improved smile, but they are also increasingly demanding better aesthetics during treatment. The development of appliances that combine both acceptable aesthetics for the patient and adequate technical performance for the clinician is the ultimate goal. There has been a recent trend towards the development of smaller stainless steel brackets but although these generally provide the technical performance required by the orthodontist the aesthetic advantage over conventional sized appliances is limited. Lingual orthodontics satisfies the aesthetic criteria but it can be argued that it produces a decrease in the performance of the appliance and considerable additional technical difficulties and time requirement for the orthodontist. A more recent addition to the orthodontist’s armamentarium is Invisalign®. This aesthetically orientated technique uses a series of clear plastic aligners to treat simple to moderate alignment cases, especially in the adult patient. However, complex cases still require fixed appliance treatment and numerous brackets are now available for those clinicians and patients that are aesthetically orientated. Tables 1Go and 2Go give details of the currently available plastic and ceramic brackets.


View this table:
[in this window]
[in a new window]
  		Table 1 Plastic brackets
 

View this table:
[in this window]
[in a new window]
  		Table 2 Ceramic brackets
 

   Plastic brackets
Top
 Abstract
 Introduction
 Plastic brackets
Ceramic brackets
 Conclusion
 References
 
Plastic brackets were first marketed in the early 1970’s. Initially constructed from acrylic and later polycarbonate, their acceptance by orthodontists as an aesthetic alternative to metal brackets was short lived. Inherent problems were soon noticed, including staining and odours but more importantly their lack of strength and stiffness resulting in bonding problems, tie wing fractures1Go and permanent deformation. Permanent deformation, or creep, occurs when a material is subjected to a constant load over an extended period of time and is particularly important for thermoplastic materials such as polycarbonate resins. Polycarbonate bracket slots distorted with time under a constant physiologic stress (2000gm.-mm) rendering them insufficiently strong to withstand longer treatment times or transmit torque.2Go In a simulated intra-oral situation Harzer et al.3Go reported significantly higher torque losses and lower torquing moments with polycarbonate brackets compared to metal brackets. They recommended that manufacturers should provide data on the distortion to be expected in polycarbonate brackets, which must be offset by additional torque, or that the bracket torque should be omitted from the technical specification.

To compensate for the lack of strength and rigidity of the original polycarbonate brackets, high-grade medical polyurethane brackets and polycarbonate brackets reinforced with ceramic or fibreglass fillers and/or metal slots have been recently introduced and are becoming increasingly popular. Polycarbonate brackets with metal reinforced slots demonstrate significantly less creep than conventional polycarbonate brackets4Go although torque problems still exist. Approximately 15% loss in torque over 24 hours has been observed with both ceramic reinforced and metal lined polycarbonate brackets.5Go However, the performance of these brackets is significantly better than polycarbonate brackets and they probably have the potential to challenge ceramic brackets with future development. When comparing torque deformation characteristics of seven commercially available plastic brackets against stainless steel brackets, Sadat-Khonsari et al.6Go showed that metal slot reinforced brackets were subjected to the lowest degree of deformation, followed by pure polyurethane, pure polycarbonate and fibreglass reinforced polycarbonate brackets. Ceramic reinforced polycarbonate brackets showed the highest deformation under torque stresses. The addition of ceramic and fibreglass in the plastic brackets also failed to improve the torque stability of the polycarbonate brackets and pure polyurethane brackets showed no significant difference from pure polycarbonate at optimal torque. A comparison with stainless steel brackets illustrated that plastic brackets are only suited for clinical application if they have a metal slot.

Self-ligating aesthetic brackets are a further recent development. Polycarbonate self-ligating brackets have been shown in vitro to generate significantly greater static and kinetic frictional forces than stainless steel self-ligating brackets but are comparable to conventional stainless steel brackets.7Go


   Ceramic brackets
Top
 Abstract
 Introduction
 Plastic brackets
 Ceramic brackets
Conclusion
 References
 
Ceramic brackets were introduced in the 1980’s, offering many advantages over the traditional aesthetic appliances. Ceramic brackets provide higher strength, more resistance to wear and deformation, better colour stability and, most important to the patient superior aesthetics (Figure 1Go). Ceramic brackets are available in a variety of morphologies including true Siamese, semi-Siamese, solid and Lewis/Lang designs and also various appliance systems including Begg and variable force ligation brackets. Many brackets are made by specialist ceramic manufacturers and sold under proprietary names by manufacturers of orthodontic products or orthodontic supply companies. Therefore, some brackets from different manufacturers may be almost identical products.



View larger version (118K):
[in this window]
[in a new window]
  		Figure 1 Ceramic brackets (facial view)

 
Ceramic bracket composition
All currently available ceramic brackets are composed of aluminium oxide in one of two forms: polycrystalline or monocrystalline, depending on their distinct method of fabrication. The first brackets were milled from single crystals of sapphire (monocrystalline) using diamond tools.8Go These were closely followed by polycrystalline sapphire (alumina) brackets, which are manufactured and sintered using special binders to thermally fuse the particles together9Go,10Go (Figure 2Go). The most apparent difference between the two is their optical clarity: monocrystalline ceramic brackets being noticeably more translucent.



View larger version (85K):
[in this window]
[in a new window]
  		Figure 2 Polycrystalline ceramic brackets

 
Polycrystalline zirconia brackets (ZrO2), which reportedly have the greatest toughness amongst all ceramics, have been offered as an alternative to alumina ceramic brackets.11Go They are cheaper than the monocrystalline ceramic brackets but they are very opaque and can exhibit intrinsic colours making them less aesthetic. Good sliding properties have been reported with both stainless steel and nickel-titanium archwires12Go along with reduced plaque adhesion, clinically acceptable bond strengths and bond failure loci at the bracket/adhesive interface. However, Keith et al.13Go found no significant advantage of zirconia brackets over polycrystalline alumina brackets with regard to their frictional characteristics. As the clinical performance of alumina ceramic brackets has continued to improve over recent years, zirconia brackets have become obsolete and only alumina ceramic brackets will be considered further.

Ceramic brackets are not without their disadvantages including:

Bonding and bond strength
Ceramic brackets cannot bond chemically with acrylic and diacrylate bonding adhesives due to their inert aluminium oxide composition. Consequently, the early ceramic brackets used a silane-coupling agent to act as a chemical mediator between the ceramic bracket base and the adhesive resins. This chemical retention resulted in extremely strong bonds that caused the enamel/adhesive interface to be stressed during debonding, risking irreversible enamel damage in the form of crack and delamination that often required dental restorations. Consequently, the challenge was to develop a bond between the ceramic bracket base and the enamel that clinically has adequate strength to accomplish treatment but can be broken at debond without damage to the enamel surface. The majority of the currently available ceramic brackets rely solely on mechanical retention, using standard light or chemically cured adhesives, without the need for additional special bonding agents. Numerous mechanical base designs are now available ranging from microcrystalline, mechanical ball, dovetail, dimpled chemo/mechanical, silane coated buttons and polymeric bases with many manufacturers claiming consistent bond strengths and debonding characteristics comparable to that of stainless steel mesh.

Several researchers have evaluated the bond strength of ceramic brackets with different retention mechanisms and concluded that mechanically retained brackets have adequate bond strength and appear to cause less enamel damage at debond compared to the chemically retained variety.14Go–16Go Bond strength can also be modified by the choice of adhesive, different types of enamel conditioning17Go and different etch times.18Go The mean bond strength of metal reinforced brackets is reportedly significantly lower than conventional ceramic brackets and comparable with stainless steel brackets.19Go

Frictional resistance
Unlike stainless steel brackets, ceramic brackets can vary in fracture toughness and strength depending on the extent of the surface roughness. This, in turn affects the overall frictional properties of the bracket. Polycrystalline ceramics, due to their rougher more porous surface, have a higher coefficient of friction than monocrystalline ceramics and stainless steel, which are comparable. Polycrystalline ceramic brackets are manufactured either by an injection moulding process, which produces a smooth surface texture, or by milling or machining with diamond tools, resulting in a rougher final surface texture. Omana et al.,20Go showed conclusively that machined ceramic brackets produce significantly greater frictional forces than injection moulded brackets. Even so, polycrystalline brackets generate significantly greater frictional forces than stainless steel brackets.21Go,22Go When clearances no longer exist between the archwire and the bracket slot, polycrystalline brackets demonstrate a rapid non-linear increase in resistance to sliding once second-order angulations increase above 4.8 degrees. Scratches on the archwire, with stainless steel debris on the outer slot wall edges, have also been observed.22Go Regardless of form, the frictional characteristics of polycrystalline ceramic brackets are worst with any archwire combination, whether bearing against stainless steel, nickel-titanium, cobalt-chromium or beta titanium archwires, when compared to stainless steel brackets.23Go–26Go

In an attempt to improve the frictional characteristics of polycrystalline ceramic brackets, manufacturers have introduced metal lined/reinforced archwire slots (Figure 3Go). They claim to provide smoother sliding mechanics and additional strength, to withstand routine orthodontic torque forces, whilst preserving the aesthetic appeal. Many different metal lined polycrystalline brackets are currently available (see Table 2Go for details) with 18-carat gold inserts reportedly superior to stainless steel with regard to frictional resistance.27Go Researchers have shown promising results with stainless steel reinforced brackets, demonstrating competitive frictional forces to conventional stainless steel brackets11Go,27Go and self-ligating brackets.11Go Other studies have not reported such favourable results. Thorstenson and Kusy22Go found no significant difference in resistance to sliding between aesthetic brackets, with and without stainless steel inserts, when clearances exist between the archwire and the walls of the bracket slot. When clearances no longer exist, the frictional resistances for both brackets generally increase at a rate equal to or greater than stainless steel brackets. They concluded that the addition of stainless steel inserts to polycrystal-line brackets did not considerably improve the resistance to sliding over those aesthetic brackets without inserts. Nishio et al.28Go demonstrated significantly higher frictional forces with ceramic brackets with metal slots compared to stainless steel brackets. The difference is probably due to the difficulty in adapting the metal insert to the ceramic slot and due to their different expansion coefficients. Cacciafesta et al.29Go found metal-inset ceramic brackets generated significantly lower frictional forces than conventional ceramic brackets, but higher forces than stainless steel brackets.



View larger version (115K):
[in this window]
[in a new window]
  		Figure 3 Ceramic bracket with metal slot

 
In addition to the use of metal inserts, some manufacturers have attempted to reduce friction by use of a silica-lined slot to increase aesthetics and decrease friction (eg MystiqueTM). The diamond cut bracket slot is glazed with a silica treatment to eliminate imperfections. In addition, the slots’ proximal edges are recessed to reduce abrasion between the archwire and the slot. Another recent modification to both ceramic and stainless steel brackets, designed to further reduce friction, is the introduction of bumps along the floor of the slot. Unfortunately, the bumps do not appear to reduce classical friction as ceramic brackets with a single bump to the slot floor produce similar rates of binding to the conventional design.30Go

Bracket breakage and fracture resistance
The low fracture toughness of ceramics leads to a higher incidence of bracket breakages than with stainless steel brackets. Product design and the manufacturing process are the two main factors determining the strength of ceramic brackets, with the design of the inner slot and tie wing being critical to the strength of the appliance. Tie wings can easily fracture due to the high torsional forces exhibited by rectangular wires and surface flaws within ceramic brackets can lead to cracks and fractures when the bracket is stressed. Injection moulded brackets have a much smoother finish than machined brackets thus reducing the number of surface flaws. Refined manufacturing techniques including boron carbide tumbling process (Inspire IceTM) and surface heat treatments may produce ultra-smooth surface finishes and rounded facial contours to improve frictional resistance and patient comfort.

Iatrogenic enamel wear
Ceramic brackets, being second in hardness only to diamond, are significantly harder than enamel. Rapid and severe enamel wear to the opposing dentition has been reported when ceramic brackets are placed in the lower arch.31Go Therefore, caution should be exercised to prevent contact of the ceramic bracket with opposing enamel surfaces. The use of polycarbonate brackets in the lower arch has been recommended if overbite is a concern as they are less abrasive to the opposing dentition. In response to the risk of iatrogenic enamel damage some manufacturers no longer produce lower bicuspid ceramic brackets and have developed low profile or bevelled brackets for the anterior mandibular segment. Elastomeric ligatures that cover the occlusal tie wing slot, thus preventing contact of the opposing dentition with the ceramic bracket, are a further method of reducing the risk of enamel damage. However, these are bulky and concerns exist over oral hygiene implications. Alternatively, most patients will accept metal brackets on the lower arch, particularly when shown that they will display little if any of the lower brackets during normal function (Figure 4Go).



View larger version (87K):
[in this window]
[in a new window]
  		Figure 4 Upper ceramic brackets opposed by lower metal brackets

 
In addition, bonding ceramic brackets to compromised teeth e.g. endodontically treated teeth, enamel hypoplasia and cracks, or those with large restorations should be avoided if possible, thus reducing the risk of tooth damage during bracket removal.14Go

Debonding
Due to their pliable nature, metal brackets can be removed safely and atraumatically from the tooth surface via distortion of the base. However, rigid ceramic brackets present a debonding challenge, with enamel damage more likely from debonding ceramic as opposed to metal brackets.15Go The sudden nature and the degree of force required to achieve mechanical bond failure of the early chemically bonded ceramic bracket, often resulted in enamel fractures and delamination. Alternatively, the brackets shattered leaving the base still attached to the enamel surface. Removal of the residual ceramic, using a diamond bur in a high-speed handpiece is both difficult and time consuming. Grinding ceramic materials from the tooth surface generates heat, resulting in potential pulpal damage especially if low speed grinding without a coolant is used.32Go Large ceramic fragments pose the risk of aspiration of the radiolucent material by the patient and produce ceramic dust that has been associated with skin and eye irritation.33Go

Most ceramic brackets are now mechanically retained and many alternative debonding methods have been suggested, to avoid the complications associated with ceramic bracket removal. It is recommended that all excess flash be removed from the bracket/enamel interface prior to bracket debonding. Notching of the bonding adhesive prior to bracket placement has been shown ex vivo to significantly reduce the mean and maximal debond forces thus eliminating ceramic bracket fracture. This technique may help facilitate the removal of ceramic brackets but it is demanding of clinical time and expertise.34Go

The following methods of debonding ceramic brackets have been described and their advantages and disadvantages are discussed in Table 3Go.


View this table:
[in this window]
[in a new window]
  		Table 3 Ceramic bracket debonding techniques
 

Many manufacturers claim that current ceramic brackets debond as easily and as safely as metal brackets. 3M Unitek have patented a debonding slot and ‘stress concentrator’ located on the base of their ClarityTM bracket. The debonding slot concentrates stress at this point, causing the bracket to collapse under gentle pressure from How or Weingart pliers. This allows debonding in a similar method to metal brackets, with most of the residual adhesive remaining on the enamel surface.35Go The failure at the bracket/adhesive interface decreases the probability of enamel damage but necessitates the removal of more residual adhesive after debonding.36Go The patented crystal-mesh base of the MXi® and InVu brackets (TP Orthodontics) is squeezed with ligature cutters and the bracket reportedly releases from the tooth in the same manner as a metal bracket. The tensile forces generated during debonding claim to be much lower than those of conventional ceramic brackets and metal lined brackets as the polymeric base undergoes plastic deformation resulting in shear bond failure.35Go The failure at the bracket/adhesive interface decreases the probability of enamel damage but again necessitates the removal of more residual adhesive after debonding. It is important to consult the individual manufacturers’ guidelines regarding their recommended debonding instructions for removal of their brackets.


   Conclusion
Top
 Abstract
 Introduction
 Plastic brackets
 Ceramic brackets
 Conclusion
References
 
The superior aesthetics of ceramic and polycarbonate brackets compared to conventional stainless steel brackets are not only well accepted by patients, particularly adults, but are positively sought after. However, many clinicians are still less willing to accept aesthetic brackets due to their unfavourable clinical characteristics. In response, manufacturers have strived over recent years to address many of the clinicians’ concerns. Since their introduction, product design and clinical performance of aesthetic brackets has greatly improved. Modification of the archwire slot, advances in bracket base design and refined manufacturing processes have, to a certain extent, tackled some of the problems of friction, strength and force control associated with aesthetic brackets. Further development and research is required, preferably in the form of prospective randomised clinical trials, which will ultimately result in aesthetic brackets that clinically perform in a truly comparable manner to the current ‘Gold Standard’ stainless steel brackets.


   Acknowledgments
 
I would like to express my sincere thanks to the orthodontic manufacturers and distributors that provided information on their current aesthetic brackets and to Simon Littlewood for providing the clinical photographs.


   References
Top
 Abstract
 Introduction
 Plastic brackets
 Ceramic brackets
 Conclusion
 References
 
1 Arid JO, Durning P. Fractures of polycarbonate edgewise brackets. A clinical and SEM study. Br J Orthod 1987; 14: 191–5.[Abstract]

2 Dobrin RJ, Kamel IL, Musich DR. Load-deformation characteristics of polycarbonate orthodontic brackets. Am J Orthod 1975; 67: 24–33.[CrossRef][Medline]

3 Harzer W, Bourauel C, Gmyrek H. Torque capacity of metal and polycarbonate brackets with and without a metal slot. Eur J Orthod 2004; 26: 435–441.[Abstract/Free Full Text]

4 Alkire RG, Bagby MD, Gladwin MA, Kim H. Torsional creep of polycarbonate orthodontic brackets. Dent Mater 1997; 13: 2–6.[CrossRef][Medline]

5 Feldner JC, Sarkar NK, Sheriden JJ, Lancaster DM. In vitro torque-deformation characteristics of polycarbonate brackets. Am J Orthod Dentofac Orthop 1994; 106: 265–72.[Medline]

6 Sadat-Khonsari R, Moshtaghy A, Schelgel V, Kahl-Nieke B, Möller M, Bauss O. Torque deformation characteristics of plastic brackets: a comparative study. J Orofac Orthop 2004; 65: 26–33.[CrossRef][Medline]

7 Cacciafesta V, Sfondrini MF, Ricciardi A, Scribante A, Klersy C, Auricchio F. Evaluation of friction and stainless steel esthetic self-ligating brackets in various bracket-archwire combinations. Am J Orthod Dentofac Orthop 2003; 124: 395–402.[CrossRef][Medline]

8 Swartz ML. Ceramic brackets. J Clin Orthod 1988; 22: 82–8.[Medline]

9 Kusy RP. Morphology of polycrystalline alumina brackets and its relationship to fracture toughness and strength. Angle Orthod 1988; 58: 197–203.[Medline]

10 Saunders CR, Kusy RP. Surface topography and frictional characteristics of ceramic brackets. Am J Orthod Dentofac Orthop 1994; 106: 605–14.[Medline]

11 Kusy RP. Orthodontic Biomaterials: From the Past to the Present. Angle Orthod 2002; 72: 501–12.[Medline]

12 Springate SD, Winchester LJ. An evaluation of zirconium oxide brackets: a preliminary laboratory and clinical report. Br J Orthod 1991; 18: 203–9.[Abstract]

13 Keith O, Kusy RP, Whitley JQ. Ziconia brackets: an evaluation of morphology and coefficient of friction. Am J Orthod Dentofac Orthop 1994; 106: 605–14.

14 Bishara SE, Trulove TS. Comparisons of different debonding techniques for ceramic brackets: an in vitro study, part II. Am J Orthod Dentofac Orthop 1990; 98: 263–73.[Medline]

15 Redd TB, Shivapuja PK. Debonding ceramic brackets: effects on enamel. J Clin Orthod 1991; 25: 475–81.[Medline]

16 Wang WN, Meng CL, Tarng TH. Bond strength: a comparison between chemical coated and mechanical interlock bases of ceramic and metal brackets. Am J Orthod Dentofac Orthop 1997; 111: 374–81.[CrossRef][Medline]

17 Bishara SE, Fehr DE, Jakobsen JR. A comparative study of the debonding strengths of different ceramic brackets, enamel conditioners, and adhesives. Am J Orthod Dentofac Orthop 1993; 104: 170–9.[Medline]

18 Olsen ME, Bishara SE, Boyer DB, Jakobsen JR. Effect of varying etch times on the bond strength of ceramic brackets. Am J Orthod Dentofac Orthop 1996; 109: 403–9.[CrossRef][Medline]

19 Mundstock KS, Sadowsky PL, Lacefield W, Bae S. An in vitro evaluation of a metal reinforced orthodontic ceramic bracket. Am J Orthod Dentofac Orthop 1999; 116: 635–41.[CrossRef][Medline]

20 Omana HM, Moore RN, Bagby MD. Frictional properties of metal and ceramic brackets. J Clin Orthod 1992; 26: 425–32.[Medline]

21 Loftus BP, Årtun J, Nicholls JI, Alonzo TA, Stoner JA. Evaluation of friction during sliding tooth movements in various bracket-arch wire combinations. Am J Orthod Dentofac Orthop 1999; 116: 336–45.[CrossRef][Medline]

22 Thorstenson G, Kusy R. Influence of stainless steel inserts on the resistance to sliding of esthetic brackets with second-order angulation in the dry and wet states. Angle Orthod 2003; 73: 167–75.[Medline]

23 Angolkar PV, Kapila S, Duncanson MG, Nanda RS. Evaluation of friction between ceramic brackets and orthodontic wires of four alloys. Am J Orthod Dentofac Orthop 1990; 98: 499–506.[Medline]

24 Kusy RP, Whitley JQ. Coefficient of friction for arch wires in stainless steel and polycrystalline alumina bracket slots I: The dry state. Am J Orthod Dentofac Orthop 1990; 98: 300–12.[Medline]

25 Kusy RP, Whitley JQ, Prewitt MJ. Comparison of the frictional coefficients for selected archwire-bracket slot combinations in the wet and dry state. Angle Orthod 1991; 61 : 293–302.[Medline]

26 Kusy RP, Whitley JQ. Friction between different wire-bracket configurations and materials. Sem Orthod 1997; 3: 166–77.

27 Kusy RP, Whitley JQ. Frictional resistances of metal-lined ceramic brackets versus conventional stainless steel brackets and development of 3-D frictional maps. Angle Orthod 2001; 71: 364–74.[Medline]

28 Nishio C, Jardim da Motta AF, Elias CN, Mucha JN. In vitro evaluation of frictional forces between archwires and ceramic brackets. Am J Orthod Dentofac Orthop 2004; 125: 56–64.[CrossRef][Medline]

29 Cacciafesta V, Sfondrini MF, Scribante A, Klersy C, Auricchio F. Evaluation of friction of conventional and metal-insert ceramic brackets in various bracket-archwire combinations. Am J Orthod Dentofac Orthop 2003; 124: 403–409.[CrossRef][Medline]

30 Thorstenson JA, Kusy RP. Resistance to sliding of orthodontic brackets with bumps in slot floors and walls: effects of second-order angulation. Dent Mater 2004; 20: 881–892.[CrossRef][Medline]

31 Douglass JB. Enamel wear cased by ceramic brackets (case report). Am J Orthod 1989; 95: 96–98.

32 Vukovich ME, Wood DL, Daley TD. Heat generated by grinding during removal of ceramic brackets. Am J Orthod Dentofac Orthop 1991; 99: 505–12.[Medline]

33 Winchester LJ. Methods of debonding ceramic brackets. Br J Orthod 1992; 19: 233–7.[Abstract]

34 Lamour CJ, McCabe JF, Gordon PH. Notching of orthodontic bonding resin to facilitate ceramic bracket debond - an ex vivo investigation. Br J Orthod 1998; 25: 289–91.[Abstract]

35 Bishara SE, Olsen ME, VonWold BA, Jakobsen JR. Comparison of the debonding characteristics of two innovative ceramic bracket designs. Am J Orthod Dentofac Orthop 1999; 116: 86–92.[CrossRef][Medline]

36 Bishara SE, Olsen ME, VonWold L. Evaluation of debonding characteristics of a new collapsible ceramic bracket. Am J Orthod Dentofac Orthop 1997; 112: 552–9.[CrossRef][Medline]

37 Sheriden J, Branley D, Hastings J. Electrothermal debracketing- Part I: an in-vitro study. Am J Orthod 1986a; 89: 21–7.[CrossRef][Medline]

38 Sheriden J, Branley D, Hastings J. Electrothermal debracketing- Part II: an in vivo study. Am J Orthod 1986b; 89: 141–5.[CrossRef][Medline]

39 Crooks M, Hood J, Harkness M. Thermal debonding of ceramic brackets: an in vitro study. Am J Orthod Dentofac Orthop 1997; 111: 163–72.[CrossRef][Medline]

40 Kraut J, Radin S, Trowbridge HI, Emiling RC, Yankell SL. Clinical evaluation on thermal verses mechanical debonding of ceramic brackets. J Clin Dent 1990; 2: 92–6.

41 Sernetz F, Karaut J. Laboratory evaluation on thermal debonding of dental brackets. J Clin Dent 2001; 2: 87–91.

42 Brouns E, Schopf P, Kojancic B. Electrothermal debracketing of ceramic brackets: an in vitro study. Eur J Orthod 1993; 15: 115–23.[Abstract/Free Full Text]

43 Takla PM, Shivapuja PK. Pulpal response in electrothermal debonding. Am J Orthod Dentofac Orthop 1995; 108: 623–9.[CrossRef][Medline]

44 Cummings M, Biagioni P, Lamey PJ, Burden DJ. Thermal image analysis of electrothermal debonding of ceramic brackets: an in vitro study. Eur J Orthod 1999; 21: 111–8.[Free Full Text]

45 Boyer BD, Engelhardt G, Bishara SE. Debonding orthodontics ceramic brackets by ultrasonic instrumentation. Am J Orthod Dentofac Orthop 1995; 108: 262–6.[CrossRef][Medline]

46 Tocchio RM, Williams PT, Mayer FJ, Standing KG. Laser debonding of ceramic orthodontic brackets. Am J Orthod Dentofac Orthop 1993; 103: 155–62.[Medline]

47 Azzeh E, Feldon PJ. Laser debonding of ceramic brackets: a comprehensive review. Am J Orthod Dentofac Orthop 2003; 123: 79–83.[CrossRef][Medline]

48 Strobl K, Bahns TL, Willham L, Bishara SE, Stalley WC. Laser-aided debonding of orthodontic ceramic brackets. Am J Orthod Dentofac Orthop 1992; 101: 152–8.[Medline]

49 Lamour CJ, McCabe JF, Gordon PH. An ex vivo investigation into the effects of chemical solvents on the debond behaviour of ceramic orthodontic brackets. Br J Orthod 1998; 25: 35–9.[Abstract]





This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Russell, J. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Russell, J. S.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS