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Difficulty in removing ceramic brackets Options · View
Ron Redmond DDS
Posted: Monday, September 2, 2002 1:03:00 AM
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I routinely experience difficulty when removing Clarity brackets. Recently, half of the 20 brackets fractured during removal and I needed to resort to a diamond bur and high speed handpiece to remove the remaining fragments. Is anyone else experiencing difficulties, and if not, what do you know that I don't?
Ron Redmond, DDS, MS
JCO Online Editor
keith hilliard dmd
Posted: Monday, September 2, 2002 8:51:00 AM
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I have experienced a problem with removing Clarity brackets. It is difficult to predict which brackets will fracture and leave the base still attached to the teeth. The remaining bracket base then has to be removed with a large diamond. It is frustrating to try to schedule appropriately. We already add time for a Clarity debonding over a metal debonding but the scheduled time may end up being inadequate if a large number of the bracket bases remain on the teeth. I have had cases where every bracket on one arch fractured.
The official antidote to this problem is to use the proper technique. The inference is that any technique that results in excessive fractures must be different than the correct technique.
Keith Hilliard, DMD
Lakeland, FL
leonard kessler dmd
Posted: Monday, September 2, 2002 2:13:00 PM
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We see the same thing in New Jersey. Some come off clean; others break and need to be removed with diamond burs, taking extra time in debanding.
Dan Merwin
Posted: Tuesday, October 22, 2002 5:11:00 PM
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We've noticed that most times, an old ligature cutter can be used to shear the bracket remnant off. Occasionally there is no purchase point. In that case, we use a thin diamond disk (similar to the one used for interproximal reduction in Invisalign) to create a "purchase point" in the adhesive on the mesial and distal aspects of the remnant. The ligature cutter can then be used to shear the remnant off. It works pretty well for us.
W. Ronald Redmond, DDS
Posted: Monday, November 11, 2002 5:18:00 PM
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Thanks Dan,
I'm meeting with the folks from 3M and Unitek as I write this. Some of the other clinicians suggested the same thing to me about using an old ligature cutter (but sharp enough to get a purchase) and pop the Clarity off that way. Are you seeing any visible damage to the enamel after this procedure? I am anxious to try your method. I hope it works as well for me as it does for you. I'm starting to get a little gun-shy when I see a ceramic debond on the schedule.
Ron Redmond
ronredmond@orthodontist.com
Irvine,CA
Dick Carter
Posted: Wednesday, December 18, 2002 8:17:00 AM
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FREE hot water option for removing sapphire brackets:

We have used sapphire anterior brackets ("A" Company, now Ormco Starfire, etc.) since 1986 on virtually all patients" anteriors. We have NEVER had a fractured tooth, fractured enamel, or any iatrogenic damage and have treated thousands of teeth. This is how we remove them, and it works for all ceramic brackets:
Because sapphire is harder than any metal except diamond, it does not flex. When we remove metal mesh brackets, we "peel" them off, like removing a pop top on a can. Attempting the same method with sapphire places great loads on the teeth. But, consider how workmen remove Formica countertops; they heat the surface first to soften the underlying adhesive, then the material peels away. That's how we remove ceramic brackets.
All metal brackets are removed first--still tied to the arches--the sapphire brackets are untied, and patients are given a mug of simple hot water to hold in their mouth for one minute, admonished not to swallow but keep it over their front teeth. We keep a coffemaker at the reception area with plain hot water, for tea, or chocolate, or debracketing, so we always have lawyer- approved correct temperature hot water available. Immediately after swallowing the hot water, a cotton roll is placed between the teeth to be debracketed and the patient instructed to bite hard and hold it. This gives a firm resistant surface. Then we use Ormco's vinyl debracketing pliers to squeeze occlusal/gingival wings, with a slight exception to stated goals by some doctors: we don't fracture or bend the brackets because that's not the property of sapphire. We peel away the GLUE, not the bracket. That's important. Sometimes it seems like it takes 30 seconds instead of 1 second, but the glue peels away in most cases. Of course we have some brackets which resist and need to be polished off. We use Brasseler diamond burs with lots of water and air. But most brackets come off clean and you see the "pad" of adhesive left on the tooth, quite the opposite of metal.
I agree with the concept of creating a purchase on mesial/distal, but careful removal of excess adhesive at the time of initial bracketing usually takes care of this in advance.
Ron Redmond DDS
Posted: Sunday, December 22, 2002 1:53:00 AM
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I have tried just about every other technique, except "hot water". Thanks for the suggestion, Dick, I continue to struggle with ceramic bracket removal; four bracket removals last week and every one had fractured brackets requiring highspeed intervention. I love the brackets, we just need to figure out a way to remove them in a predictable fashion. I will try the hot water technique.
Ron Redmond
D. Frech
Posted: Tuesday, May 13, 2003 7:59:00 PM
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Ron,
I have used ceramic brackets for a long time, and they continue to be unpredictable. I have settled on Clarity brackets and have used them since they came out. I do not differ in my technique for removal of the ceramic brackets anymore. I use a band splitting plier and leave the wires tied in the archwire slots. I take the ceramic brackets off just like the metal brackets by grabbing the occlusal and gingival edges of the brackets and torquing the bracket. I do not use ceramic brackets on the lower arch. I have not fractured any enamel using this approach, and there are a few times each week that I must polish off the remains of a bracket. I use a diamond wheel on a high speed to polish off the bracket down to the cement. This has greatly reduced the time to remove the ceramic brackets. I have not found a technique that is 100% reliable for removal in an efficient manner.
Ron Redmond DDS
Posted: Monday, May 19, 2003 12:47:00 AM
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Thanks for your comments....I must admit that after some intense scrutiny, my success in removing ceramic brackets has improved dramatically. I now use hot water (suggested by Dick Carter in a previous message) and a special band seating plier with flat tips that is perfect for collapsing the bracket. I also have an occasional ceramic remnant to remove and use a high-speed diamond. I must say that my technique has improved measurably, and I no longer dread a ceramic removal. My thanks to all who have helped.
Ron Redmond
wfbird
Posted: Thursday, March 9, 2006 10:02:00 PM
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3M now makes a plier made especially for debonding Clarity and it seems to work really well for me. I take a finishing bur first around the edges of the bracket to make sure that no extra adhesive has piled over the base, and then use the pliers. It has been quick and predictable.
Carlos Brazil
Posted: Friday, April 14, 2006 11:09:00 PM
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Can anybody help me? I live in Brazil and I need the article:
Berger J, Byloff FK. The clinical efficiency of self-ligated brackets. J Clin Orthod. 2001 May;35(5):304-8.
My e-mail is soudebauru@terra.com.br.
kathy_perini@masel.net
Posted: Thursday, August 24, 2006 2:52:12 PM

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Here is what I was able to find for you.

http://www.speedsystem.com/HTML/user_support/speed_journal_articles.html

This link should bring you to the SPEED Journal website, and they will send you this article free of charge. If you log on to pubmed.com, they will give you access to the article. Hope this helps. Let me know if there is anything else you need.

Denise M
Masel Enterprises
denise_cosby@masel.net
overbyte@earthlink.net
Posted: Sunday, April 26, 2009 9:48:03 AM

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I have no trouble removing Clarity brackets by squeezing them mesio-distally with band seating pliers and giving a slight mesiodistal rocking motion if they don't completely release with the squeeze.

On the other hand, I'm finding GAC In-Ovation C ceramic brackets quite difficult to remove because the squeeze technique doesn't work and band-slitting pliers (something like heavy duty ligature cutters) that work fine to remove metal brackets just can't budge these ceramic brackets without a lot of struggling and patient discomfort. Does anyone have any trick for removing In-Ovation self-ligating ceramic brackets easily?
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