Removing a fixed orthodontic appliance consists of the following procedures: debonding brackets, removing the remaining adhesive (orthodontic clean-up) and polishing. Debonding may be performed using bracket removal pliers, side-cutting pliers, lift-off debracketing pliers or air-pressure pulse devices. The bonding resin infiltrates etched enamel into various depths depending on the use of 37% phosphoric acid or a self-etching system. Therefore, bond failure occurring on the interface between composite and enamel results in enamel damage detectable in direct scanning with blue light technology. Thus, it seems safer to the enamel if the bond failure occurs between the bracket and bonding material. Then, the remaining adhesive must be mechanically removed. Unfortunately, no technique allows performing orthodontic clean-up without enamel damage so far. In the event of improper procedure, removing a fixed orthodontic appliance may result in:(i) leaving adhesive remnants on the tooth surface (ii)iatrogenic enamel damage resulting from an excessively aggressive procedure which,in addition to removing the composite, causes quantitative damage to the enamel surface, such as enamel cracking and fracture, removal of the external layer of enamel rich in fluoride and roughening of the surface. This lecture will analyse and demonstrate different systems for post-orthodontic clean-up, together with the technologies used to measure in vitro iatrogenic damage, adhesive residue and the resulting alteration of the physiological properties of light refraction and enamel surface staining. New clinical protocols for more careful management of post-orthodontic clean-up will be discussed and demonstrated.


Learning Objectives
After this lecture, you will be able to identify and apply the most effective debonding methods after fixed multi-bracket orthodontic treatment and after removable treatment with clear aligners.
After this lecture, you will be able to identify and apply the most effective post-orthodontic clean-up clinical procedures after fixed multi-bracket orthodontic treatment and after removable treatment with clear aligners.
After this lecture, you will be able to assess and document any iatrogenic damage that may occur after a post-orthodontic clean-up procedure.