Loss of surface enamel after bracket debonding: An in-vivo and ex-vivo evaluation

While ARItooth results showed score 3 as the most frequent (41%) (P <0.05), followed by scores 0, 1, and 2 (28.7%, 17.9%, and 12.4%, respectively), ARIbracket results showed score 0 more often (40.6%) than the other scores (P <0.05). Maxillary anterior teeth had significantly more scores of 3 (49%) than the other groups of teeth (10%-25%) (chi-square; P <0.001). There were no enamel surface index scores of 0, 3, or 4. No correlation between the enamel surface index and ARItooth scores was found (Spearman rho = 0.014, P = 0.91). The incidence of Ca% from the scanned brackets showed significant differences between the maxillary and mandibular teeth (14% ± 8.7% and 11.2% ± 6.5%, respectively; P <0.05), especially for the canines and second premolars (Kruskal-Wallis test, P <0.01). With more remnants on the bracket base, the Ca% was higher (Jonckheere Terpstra test, P <0.05). Iatrogenic damage to the enamel surface after bracket debonding was inevitable. Whether elemental loss from enamel has clinical significance is yet to be determined in a long-term clinical follow-up of the studied patient population.