A Comparison Between Phosphoric Acid- and Er:YAG Laser-Mediated Re-Etching of Enamel for Orthodontic Bracket Re-Bonding.

Abstract

Objective: This study sought to compare enamel surface morphology and orthodontic bracket re-bonding strength after phosphoric acid- or erbium-doped yttrium aluminum garnet (Er:YAG) laser-mediated re-etching. Methods: A total of 81 extracted premolars were obtained from patients undergoing orthodontic procedures. Conventional etching with 35% phosphoric acid was first used to bond brackets to the enamel surface. Then brackets were de-bonded 1 week later. These samples were then separated randomly into three groups (n = 27 teeth each group) and re-bonded with new brackets after one of the following re-etching manners: Group A-35% phosphoric acid, Group B-Er:YAG laser (200 mJ, 30 Hz), and Group C-Er:YAG laser (250 mJ, 30 Hz). The enamel surface and the interface of enamel and adhesive were then analyzed through scanning electron microscopy. Shear bond strength (SBS) and adhesive remnant index (ARI) were also measured. Results: Samples in Group A exhibited significant residual adhesive at the enamel surface, whereas samples in Groups B and C showed a cleaner surface with more distinct and evenly distributed honeycomb-like structures. Further, samples in Group C displayed a larger average SBS value between the two laser-etching groups, although there were no significant differences in SBS values or ARI scores between the acid and laser re-etching groups (p > 0.05). Conclusions: Er:YAG laser-based enamel re-etching (250 mJ, 30 Hz) produces an uniform honeycomb-like structure and a trend of similar SBS compared with 35% phosphoric acid-mediated re-etching. Er:YAG laser-mediated re-etching seems to be a promising alternative approach for bracket re-bonding.