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Hot-Water Bath Facilitates Ceramic Debracketing

When orthodontists removemetal mesh brackets, wepeel them off, similar to removinga pop-top on a can.Attempting the same methodwith sapphire brackets places anexcessive load on the teeth.Because sapphire is harder thanany material except diamond, itdoes not flex. Consider howworkmen remove Formica countertops:they heat the surfacefirst to soften the underlyingadhesive, then peel the materialaway at the glue layer. That'show we remove ceramic orthodonticbrackets in my office.

Metal brackets are removedfirst--still tied to thearches--and then the sapphirebrackets are untied. The patientis given a mug of plain hot waterwith instructions to hold thewater in the mouth for oneminute without swallowing,while allowing the water tocover the front teeth (Fig. A). Wekeep a coffeemaker in the receptionarea with hot water for tea,hot chocolate, or debonding, sowe always have water availableat a safe temperature.

Immediately after thepatient swallows the hot water, acotton roll is placed between theteeth to be debonded, and thepatient is instructed to bite downhard and hold it in place. Thisprovides a firm, resistant platform.Then we use a vinyl debracketingplier to squeeze theocclusal and gingival bracketwings of each ceramic bracket (Fig. B).

The difference betweenthis method and others is that wedon't fracture or bend the sapphire;we peel away the glue, notthe bracket. Sometimes it seemsto take 30 seconds instead of onesecond, but in most cases theadhesive peels off the back ofthe brackets, leaving pads ofadhesive on the teeth (Fig. C). Ofcourse, we have a few bracketsthat resist and need to be polishedoff, using Brasseler diamondburs with copious waterand air. But most brackets comeoff cleanly, with only the adhesiveleft behind--quite the oppositeof metal brackets.

We have used sapphireanterior brackets ("A" CompanyStarfire, now Ormco Inspire)since 1986 on virtually allpatients' anterior teeth. Out ofthese thousands of teeth, wehave never had a fractured tooth,fractured enamel, or any iatrogenicdamage. This hot-waterbath works for any brand ofceramic brackets.

Fig. A
Fig. B
Fig. C

RICHARD N. CARTER, DMD, MS

RICHARD N. CARTER, DMD, MS
3250 N.W. 185th, Portland, OR 97229. E-mail: drdcarter@mac.com.

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