The korean journal of orthodontics (대한치과교정학회지)

The Korean Association Of Orthodontists (대한치과교정학회)
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Efficiency of ceramic bracket debonding with the Er:YAG laser

세라믹 브라켓의 제거 시 Er:YAG 레이저의 효능

  • Suh, Chung-Hwan (Department of Orthodontics, School of Dentistry, Wonkwang University) ;
  • Chang, Na-Young (Department of Orthodontics, School of Dentistry, Wonkwang University) ;
  • Chae, Jong-Moon (Department of Orthodontics, School of Dentistry, Wonkwang University) ;
  • Cho, Jin-Hyoung (Department of Orthodontics, School of Dentistry, Wonkwang University) ;
  • Kim, Sang-Cheol (Department of Orthodontics, School of Dentistry, Wonkwang University) ;
  • Kang, Kyung-Hwa (Department of Orthodontics, School of Dentistry, Wonkwang University)
  • 서충환 (원광대학교 치과대학 치과교정학교실) ;
  • 장나영 (원광대학교 치과대학 치과교정학교실) ;
  • 채종문 (원광대학교 치과대학 치과교정학교실) ;
  • 조진형 (원광대학교 치과대학 치과교정학교실) ;
  • 김상철 (원광대학교 치과대학 치과교정학교실) ;
  • 강경화 (원광대학교 치과대학 치과교정학교실)
  • Received : 2009.03.04
  • Accepted : 2009.05.30
  • Published : 2009.08.30
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Abstract

Objective: The aim of this study was to find out whether Er:YAG laser can aid in debonding ceramic brackets, and to see what kind of method will be the most appropriate for debonding. Methods: One hundred and ninety teeth, monocrystalline brackets ($MISO^{TM}$, HT, Ansan-Si, Korea), polycrystalline brackets ($Transcend^{TM}$ series 6000, 3M Untek, Monrovia, CA, USA) and the KEY Laser3 (KavoDental, Biberach, Germany) were used. Experimental groups were classified according to the type of ceramic brackets, and the amount of laser energy (0, 140, 300, 450, 600 mJ). After applying laser on the bracket at two points at 1 pulse each, the shear bond strength was measured. The effect of heat caused by laser was measured at the enamel beneath the bracket and pulp chamber. After measuring the shear bond strength, adhesive residue was evaluated and enamel surface was investigated using SEM. Results: All ceramic bracket groups showed a significant decrease in shear bond strength as the laser energy increased. The greatest average temperature change was $3.78^{\circ}C$ on the enamel beneath the bracket and $0.9^{\circ}C$ on the pulp chamber. Through SEM, crater shape holes caused by the laser was seen on the enamel and adhesive surfaces. Conclusions: If laser is applied on ceramic brackets for debonding, 300 - 450 mJ of laser energy will be safe and efficient for monocrystalline brackets ($MISO^{TM}$), and about 450 mJ for polycrystalline brackets ($Transcend^{TM}$ series 6000).

본 연구에서는 세라믹 브라켓 제거에 Er:YAG 레이저 조사가 도움이 되는지 알아보고, 브라켓 제거에 적합한 레이저 조사 방법을 연구하였으며, 또 이렇게 적용된 레이저가 치수와 법랑질에 손상을 주는지도 알아보았다. 총 190개의 치아, 단결정 세라믹 브라켓(MISO), 다결정 세라믹 브라켓(Transcend series 6000)과 KEY Laser3를 사용하였다. 실험군은 세라믹 브라켓의 종류(단결정, 다결정)와 레이저의 에너지(140, 300, 450, 600 mJ)에 따라 분류하였으며, 레이저를 브라켓당 두 곳에 1펄스씩 조사하고, 전단 강도를 측정하였다. 대조군은 레이저를 조사하지 않는 군으로 하였다. 레이저 조사에 의한 열 효과는 브라켓 하방 법랑질과 치수강에서 측정하였으며, 전단 강도 측정 후 치면에 남아있는 접착제의 양을 접착제 잔류 지수(adhesive remnant index)를 이용하여 평가하였다. 레이저 조사로 인한 접착제의 파괴 양상과 법랑질 표면 변화를 주사전자현미경으로 관찰하였다. 모든 세라믹 브라켓군에서 레이저 에너지가 증가할수록 전단 강도는 유의하게 감소하였다. 또한, 브라켓 하방 법랑질에서 최대 온도 변화는 평균 $3.78^{\circ}C$ 상승에 그쳤으며, 치수강에서 최대 온도 변화는 평균 $0.9^{\circ}C$ 상승에 그쳤다. 주사전자현미경을 이용한 법랑질과 접착제 단면 관찰에서 접착제 표면이 레이저에 의해 붕괴되어 분화구 모양의 구덩이로 관찰되었으며, 일부 시편에서 약 $10\;-\;30{\mu}m$의 법랑질 손상이 발견되었다. Transbond XT로 부착된 단결정 도재 브라켓(MISO)의 디본딩에 Er:YAG 레이저를 이용할 경우, 300 - 450 mJ의 레이저 에너지를, 그리고 다결정 도재 브라켓(Transcend series 6000)의 경우는 450 mJ 정도의 에너지를 사용하는 것이 효과적이고 안전할 것으로 생각된다.

Keywords

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