Clinical comparison of different debonding techniques of clear aligner attachments: a single-center, split-mouth randomized clinical trial

Objectives: To evaluate effectiveness of different debonding methods for aligner attachments regarding pain level, attachment removal time, and remnant adhesive amount. Material and Methods: Thirty-two patients (13 female and 19 male; mean age: 26.0 ± 7.9 years) who underwent aligner attachment debonding were included. Attachments were debonded using two different techniques with a split-mouth design. For each patient, two diagonal quadrants were debonded with an adhesive removal plier (Plier group, n = 296), and contralateral quadrants with a 24-blade carbide bur (Bur group, n = 294). In the Plier group, a carbide bur was also used to remove remaining adhesive after debonding with pliers. Pain levels were recorded using a numeric rating scale (NRS) for anterior and posterior segments. In the Plier group, adhesive remnants were scored using adhesive remnant index. Average removal time per attachment was measured. Data were analyzed with Wilcoxon signed-rank, Mann-Whitney U, and Pearson's χ2 tests (P < .05). Results: Removal time per attachment was slightly longer with the Bur group; however, this difference was not statistically significant. In lower posterior segments, NRS scores were significantly higher with the Bur technique (median 2.0) compared to the Plier technique (median 1.0, P = .028). After plier debonding, ARI (adhesive remnant index) score "1" was more frequent in optimized (60.8%) than conventional (43.5%) attachments (P = .004). Conclusions: Both debonding techniques yielded clinically similar results. The Bur technique resulted in significantly higher pain only in lower posterior segments. Adhesive removal pliers were effective for optimized and conventional attachments, usually leaving less than half of the adhesive.