DEPARTMENT OF ORTHODONTICS

AND
DENTOFACIAL ORTHOPAEDICS

SRI AUROBINDO COLLEGE OF DENTISTRY AND P.G.

INSTITUTE

JOURNAL CLUB-1

Does orthodontic debonding leads to tooth sensitivity?

Comparison of teeth with or without visible microcracks.
By: Irma Dumbryte, Laura Linkeviciene, Tomas Linkevicius, M.
Malinauskas
AJDO- February 2017 Vol.151 Issue 2 Page No. 284-291
BY:ANKITA RAWAT( P.G. 1st year)

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 INTRODUCTION
• Tooth sensitivity- dental pain which is sharp and of short duration,
arising from stimulation of thermal, tactile, osmotic, chemical or
electrical stimuli, which cannot be ascribed to any other dental
disease.

• Pain and discomfort are one of the factors which discourages the
patient from seeking orthodontic treatment.

• Caries, restorations, enamel irregularities, tooth structure defects

might also contribute to tooth sensitivity after bracket removal.

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• Enamel microcracks(EMCs) may affect the enamel causing
stains, plaque accumulation and carious lesions.

• Enamel microcracks are of two types:

1. Weak EMCs
2. Pronounced EMC

• Weak EMCs- visible only by scanning electron microscopy.

• Pronounced EMCs- visible by naked eye under normal room

illumination.

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PRONOUNCED ENAMEL MICROCRACKS

MILD ENAMEL MICROCRACKS UNDER SEM

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AIM OF THE STUDY :
• Evaluate the sensitivity of teeth with and without pronounced EMCs just
before debonding and upto 1 week after bracket removal.

• Determine the time for a clinically significant reduction in sensitivity.

• Determine whether there is correlation between the tooth sensitivity just

before debonding and the likelihood of increasing during removal of
brackets.

• Whether insensitive teeth with or without visible EMCs just before

debonding might progress to sensitive ones immediately after debonding.

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MATERIAL AND METHODS
1. A sample size of 60 was selected, having 30 subjects in experimental
and control group each. The study was done in Lithuania.

2. The experimental group was divided into 2 sub groups-

1. with pronounced EMCs
2. without pronounced EMCs

3. Tooth sensitivity was assessed by timed application of compressed air

and cold stimulus.

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4. The intensity of sensitivity and
discomfort was measured by Visual
Analogue Scale(V.A.S)- 100mm.

5. Mean sensitivity intensity score

was determined at each time points.

VISUAL ANALOGUE SCALE-100mm

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Subject Selection Criteria:-
• Informed consent from patients and parents.

• Age- 12 to 24years.

• Patient bonded with metal brackets and light cure adhesive not more than
36 months.

• No recent desensitization history present.

• No relevant medical and dental history.

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Selection criteria for teeth:-
• Maxillary and mandibular premolars with intact buccal enamel.

• Any type of tooth anomaly should not be present.

• No pre-treatment with chemical agents.

• No previous orthodontic, endodontic, restorative treatment.

• No signs of gingival recession.

Secondary teeth selection criteria:-

• Enamel microcracks visible on buccal enamel surface.

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The Study Protocol:-

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Thermal Stimuli Application:

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Application of Stimulus:-

Application of compressed air Application of fresh melted ice

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• Visibility of EMCs was assessed repeatedly by the same investigator
on 1,3 and 7 days after debonding before sensitivity assessment
procedure.

• Same time of the day, tooth position, isolation method was used for
standardization.

• Each patients was assessed by 1 operator for entire study.

• The pain levels from VAS scale were measured using digital calliper's.

• The mean sensitivity intensity values were compared for each given
interval of time.

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• Statistical Package for Social Science(SPSS) was used for statistical
analysis.

• A paired-sample t test was performed to evaluate the sensitivity

difference at different time in the same group.

• An independent-sample t test was applied to compare mean

sensitivity intensity values between 2 unrelated groups.

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Results:-
Patient with EMCs:-
• The sensitivity was greatest immediately after debonding.

• Tooth sensitivity demonstrated gradual changes.

• The reduction in sensitivity scores were 33%

For patient without EMCs the results followed the same pattern as above but
the former showed higher mean sensitivity intensity at each time interval.

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Sensitivity intensity ,mean values(mm) compared with the
stimulus applied and time for patient having teeth with
visible microcracks:-

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Sensitivity intensity ,mean values(mm) compared with the
stimulus applied and time for patient having teeth without
visible microcracks:-

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DISCUSSION:-
• In all the patients of the experimental group, increased tooth sensitivity
just before debonding and upto 7 days after bracket removal is seen.

• The highest discomfort values were just after debonding.

• Statistically there was significant difference between experimental and

control group.

• Patients with visible EMCs had higher sensitivity values.

• A reduction of sensitivity intensity score of 33%was noticed at day 3.

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• Findings suggest that orthodontic bonding might play a role in tooth
sensitivity.

• Cellular and molecular changes in the dental pulp during orthodontic force
application might be the cause.

• Control group subjects with EMCs also experienced sensitivity, this

contributes to the assumption EMCs play a significant role in sensitivity
perception.

• Orthodontic debonding might strengthen the discomfort.

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CONCLUSION:-
• Debonding lead to short term increase in tooth sensitivity.

• Orthodontic patient with visible EMCs experienced higher level of

discomfort.

• The pattern of sensitivity was similar in all subjects.

• Control group subjects with visible EMCs also experienced tooth sensitivity
which indicates it has a significant role in strengthening tooth sensitivity.

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Take home message:-
• A careful explanation of the time course of tooth sensitivity after bracket
removal is recommended.

• Patient should be informed during initial consent.

• Desensitization methods should be used.
• These include: 1. fluoride gel
2. amino acid arginine dentrifices
3. GC Tooth Mousse- CPP-ACP (Recaldent)
4. iontophoresis- desensitron

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REFERENCES:-

• Ogura M. Kamimura H, Al- Kalayl A, Nagayama K, Taira K, Nagata J et

al, pain intensity during first 7 days following application of light and
heavy forces. Eur J orthod 2009; 31:314-9.

• Mangnall LA, Dietrich T, Scholey JM. A randomized controlled trial to

assess the pain associated with debond of orthodontic fixed
appliance.

• Erdinc AM, Dincer B, perception of pain during orthodontic treatment

with fixed appliances.

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• Yamaguchi M, Kasai K, inflammation in periodontal tissues in
response to mechanical force. Arch Immunol Ther Exp(warsz)
2005;53:388-98.

• Polat O, Karaman Al. Pain control during fixed appliance therapy,

Angles orthodondics 2005;136:160-9.

• Sample size calculator. Available at http://www.calculator.net/sample-

size -calculator.html. Accessed on Feb 14 2016.

• Chen Cs, Hsu ML, Chang KD, Kuang SH, Chen PT, Gunng YW. Failure
analysis: enamel fracture after debonding orthodontic brackets. Angle
Orthod 2008;78:1071-7
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