Michalak Mateusz, Kiryk Sylwia, Kotela Agnieszka, Wiśniewska Kamila, Kiryk Jan, Zborowski Jacek Zbigniew, Matys Jacek, Dobrzyński Maciej
Medical Center of Innovation, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland.
Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland.
J Funct Biomater. 2025 Apr 1;16(4):123. doi: 10.3390/jfb16040123.
The aim of this systematic review was to evaluate the effectiveness and safety of various laser systems for debonding ceramic orthodontic brackets compared to conventional mechanical removal methods. The primary outcomes assessed included enamel damage, pulp temperature changes, adhesive remnant index (ARI), and shear bond strength (SBS).
A systematic search was conducted in November 2024 across the PubMed, Scopus, and Web of Science (WoS) databases following PRISMA guidelines. The initial search yielded 453 records, of which 41 studies met the inclusion criteria for qualitative and quantitative analysis. The risk of bias was assessed using a standardized scoring system, and only studies with accessible full texts were included.
The review highlighted significant heterogeneity in laser parameters, measurement protocols, and study methodologies. Among the evaluated lasers, CO and Er:YAG were the most frequently studied and demonstrated high efficacy in debonding ceramic brackets while maintaining enamel integrity. Sixteen studies assessing SBS reported a reduction from baseline values of 13-23 MPa to clinically acceptable ranges of 7-12 MPa following laser application. ARI was analyzed in 25 studies, with laser-treated groups exhibiting higher scores (2-3), indicating safer debonding with more adhesive remaining on the tooth surface, thereby reducing enamel damage. Pulpal temperature increases were examined in 23 studies, revealing that most laser types, when used within optimal parameters, did not exceed the 5.5 °C threshold considered safe for pulpal health. However, diode and Tm:YAP lasers showed potential risks of overheating in some studies.
Laser-assisted debonding of ceramic orthodontic brackets is an effective and safe technique when applied with appropriate laser parameters. CO and Er:YAG lasers were the most effective in reducing SBS while preserving enamel integrity. However, variations in laser settings, study methodologies, and the predominance of in vitro studies limit the ability to establish standardized clinical guidelines. Further randomized controlled trials (RCTs) are necessary to develop evidence-based protocols for safe and efficient laser-assisted bracket removal in orthodontic practice.
本系统评价旨在评估与传统机械去除方法相比，各种激光系统用于去除陶瓷正畸托槽的有效性和安全性。评估的主要结果包括釉质损伤、牙髓温度变化、粘结剂残留指数（ARI）和剪切粘结强度（SBS）。
2024年11月，按照PRISMA指南，在PubMed、Scopus和科学网（WoS）数据库中进行了系统检索。初步检索得到453条记录，其中41项研究符合定性和定量分析的纳入标准。使用标准化评分系统评估偏倚风险，仅纳入可获取全文的研究。
该评价强调了激光参数、测量方案和研究方法存在显著异质性。在所评估的激光中，CO激光和Er:YAG激光是研究最频繁的，在去除陶瓷托槽时显示出高疗效，同时保持釉质完整性。16项评估SBS的研究报告称，激光应用后，SBS从基线值13 - 23兆帕降至临床可接受范围7 - 12兆帕。25项研究分析了ARI，激光治疗组得分较高（2 - 3），表明脱粘更安全，牙齿表面残留更多粘结剂，从而减少釉质损伤。23项研究检查了牙髓温度升高情况，结果显示，大多数激光类型在最佳参数范围内使用时，不会超过对牙髓健康安全的5.5℃阈值。然而，在一些研究中，二极管激光和Tm:YAP激光显示出过热的潜在风险。
当采用适当的激光参数时，激光辅助去除陶瓷正畸托槽是一种有效且安全的技术。CO激光和Er:YAG激光在降低SBS同时保持釉质完整性方面最为有效。然而，激光设置、研究方法的差异以及体外研究的主导地位限制了制定标准化临床指南的能力。有必要进行进一步的随机对照试验（RCT），以制定基于证据的方案，用于正畸实践中安全有效地进行激光辅助托槽去除。
