Şeffaf Plak Ataşmanlarında Farklı Debonding Teknikleri Sonrası Mine Yüzeyinin 3 Boyutlu Olarak Değerlendirilmesi

Abstract

TÜRKOĞLU BOYNUYOĞUN, H. 3D evaluation of the enamel surface after different debonding techniques in clear aligner attachments. Hacettepe University Faculty of Dentistry, Department of Orthodontics, Specialization Thesis, Ankara, 2024. Aim: The aim of this in-vitro thesis study was to evaluate the enamel surface roughness and topographic changes in 3D after different debonding methods (plier application followed by fiberglass bur and carbide bur followed by renew stone) of attachments formed with 2 different composite resins which were flowable (GC Universal Injectable) and packable (GC Genial Restorative). It was also aimed to evaluate the remaining composite volume after removing different composite resins from the tooth surfaces in the groups where the Plier method was applied. Materials and Methods: 88 premolar teeth were divided into 2 different composite resin groups (Group 1 and 2), with 44 teeth in each group. These groups were then divided into 2 subgroups (N=22) (A and B) in which different debonding methods would be used. Vertical rectangular attachments were created using GC Universal Injectable composite resin in Groups 1A and 1B, and GC Genial Restorative composite resin in Groups 2A and 2B. In Groups 1A and 2A, the attachments were removed from the tooth surfaces using the "attachment debonding plier" and then the composite resins remaining on the tooth surfaces were removed with "white fiberglass". Following this process, the tooth surfaces were polished with "blue fiberglass". In Groups 1B and 2B, the excess parts of the composite attachments were first removed using a 12-blade carbide bur, and then, when the enamel surface was approached, the remaining composite was cleaned with a 24-blade carbide bur. Following this process, Renew stone was used for polishing. After the attachments on the teeth in Groups 1A and 2A were removed with the "attachment debonding plier", the remaining composite amount was measured quantitatively using Geomagic Control X software and qualitatively with ARI scoring. Debonding and polishing times of the attachments, enamel surface roughness and morphological change of the enamel were measured and compared between groups. Results: There was no statistically significant difference in the measurement medians of the total clinical practice time spent in the debonding and polishing phase between 4 different groups. Residual composite resin volume did not show a statistically significant difference between composite resin groups (1A-2A). The enamel demineralization volume and area change medians in Group 2A (0.49 mm3 and 0.52 mm²) were statistically significantly higher than the volume and area change medians observed in Group 2B (0.30 mm3 and 0.19 mm2) (p<0.05). There was no significant difference between the groups (2A-2B) in terms of demineralization depth change and enamel mineral density change. The differences between Group 1A and Group 1B in terms of changes in the roughness parameters Ra (T1-T0), Ra (T2-T0), Rq (T1-T0) and Sa (T1-T0) were 0.069 µm, 0.090 µm, 0.068 µm and 0.653 µm, respectively, and it was found to be significantly higher in Group 1B than in Group 1A (p<0.05). In the comparison of Group 2A and Group 2B, the differences in terms of Ra (T1-T0), Sa (T1-T0) and Sq (T1-T0) parameters were 0.067 µm, 0.067 µm and 0.664 µm, respectively, and were found to be significantly higher in Group 2B compared to Group 2A (p<0.05). When the effect of different composite types on the roughness parameter was evaluated, in terms of the change in the Sa parameter, there was a greater increase in roughness in Group 2B compared to Group 1B. Conclusion: While the use of the fiberglass method with the "attachment debonding plier" in the debonding phase of clear aligner treatments resulted in a smoother enamel surface compared to the carbide bur application, which is a conventional method, it caused significantly more area and volume loss in terms of enamel demineralization in the Micro-CT evaluations made after polishing.