Orthodontic Ceramic Bracket Removal Using Lasers: A Systematic Review.

Objective: 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).

Materials and methods: 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.

Results: The review highlighted significant heterogeneity in laser parameters, measurement protocols, and study methodologies. Among the evaluated lasers, CO₂ 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.

Conclusions: Laser-assisted debonding of ceramic orthodontic brackets is an effective and safe technique when applied with appropriate laser parameters. CO₂ 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.