Measurement of three-dimensional perioral soft tissue changes in dentoalveolar protrusion patients after orthodontic treatment using a structured light scanner

Objective:To evaluate the three-dimensional (3D) perioral soft tissue changes after orthodontic treatment in patients with dentoalveolar protrusion using structured light–based scanners.Materials and Methods:Forty-four Korean adults (19 men and 25 women, 21.4 ± 3.4 years) with dentoalveolar protrusion treated by extraction of all four first premolars and then en masse retraction with maximum anchorage were evaluated. Lateral cephalograms and 3D facial scans were obtained before treatment (T1) and immediately after debonding (T2). Superimposition was performed, and 27 perioral landmarks were identified. The 3D changes in the landmarks and ratio of movement of the soft tissue relative to the horizontal incisal tip were evaluated. A paired t-test and one-way analysis of variance were performed.Results:The upper incisors were retracted 5.76 mm and the lower incisors were retracted 4.62 mm (P < .001). The upper lip moved inferoposteriorly, and the lower lip moved superoposteriorly. In the lower lip, upward movement was greater than backward movement (P < .001). The most prominent changes appeared at the greatest bulge area. The relative ratios were 42%–53% in the upper lip area and 22%–82% in the lower lip area. The lip corners moved superoposteriorly (P < .001). Subnasale moved downward (P < .05) and posteriorly (P < .001), while the landmarks under the nostrils moved upward and posteriorly (P < .001).Conclusion:Facial scans from white structured light scanners efficiently evaluated 3D perioral soft tissue in dentoalveolar protrusion patients. Backward movement and significant vertical movement of the lip were observed. The nasal and lip angle areas showed considerable changes.     

Three-dimensional Analysis of Lip Changes in Response To Simulated Maxillary Incisor Advancement

ObjectiveTo assess the immediate response of lips in three dimensions (3D) resulting from simulated maxillary incisor advancement.Materials and MethodsIncremental maxillary incisor advancement was simulated by placing wax of increasing thickness (+2 mm, +4 mm, +6 mm) on the incisors of 20 participants, and the induced lip changes were recorded using 3D stereophotogrammetry. The induced displacement of lip landmarks was quantified using 3D image analysis software. Data were analyzed using a repeated-measures analysis of variance (ANOVA) after adjusting for age and sex of the study participants.ResultsA large interindividual variation in lip response to simulated incisor advancement was observed. A significant overall effect on 3D lip changes was found for increasing values of simulated incisor advancement (F = 13.2; P < .001) as well as significant differences between anatomical landmarks of the lip (F = 7.4; P < .01). Most points moved outward and anterosuperiorly, except the midpoint and corners of the lip. Greatest movement was observed in the sagittal plane, followed by the vertical and transverse planes.ConclusionsMaxillary incisor advancement significantly affects upper lip change in three planes of space: particularly the anteroposterior plane, in which the response to simulated advancement appears to be nonlinear.     

Bracket base remnants after orthodontic debonding

Objective:To evaluate whether the debonding procedure leads to restitutio ad integrum of the enamel surface by investigating the presence of enamel within the bracket base remnants after debonding.Materials and Methods:Sixty patients who completed orthodontic treatment with fixed appliances were included. A total of 1068 brackets were microphotographed; the brackets presenting some remnants on the base (n  =  818) were selected and analyzed with ImageJ software to measure the remnant area. From this population a statistically significant sample (n  =  100) was observed under a scanning electron microscope to check for the presence of enamel within the remnants. Energy dispersive x-ray spectrometry was also performed to obtain quantitative data.Results:Statistically significant differences in the remnant percentage between arches were observed for incisor and canine brackets (P < .0001 and P  =  .022, respectively). From a morphologic analysis of the scanning electron micrographs the bracket bases were categorized in 3 groups: group A, bases presenting a thin enamel coat (83%); group B, bases showing sizable enamel fragments (7%); group C, bases with no morphologic evidence of enamel presence (10%). Calcium presence was noted on all evaluated brackets under energy dispersive x-ray spectrometry. No significant difference was observed in the Ca/Si ratio between group A (16.21%) and group B (18.77%), whereas the Ca/Si ratio in group C (5.40%) was significantly lower than that of the other groups (P < .323 and P  =  .0001, respectively).Conclusion:The objective of an atraumatic debonding is not achieved yet; in some cases the damage could be clinically relevant.     

Enamel loss following ceramic bracket debonding: A quantitative analysis in vitro

Objective:To measure enamel surface changes after ceramic bracket debonding and after cleanup.Materials and Methods:Forty extracted teeth were scanned in three dimensions using an optical scanner (baseline). Two ceramic bracket systems were placed (19 metal-reinforced polycrystalline ceramic brackets; 21 monocrystalline ceramic brackets). Seven days later, brackets were debonded and teeth scanned (post-debond). Adhesive remnants and bracket fragments were recorded. Tooth surfaces were cleaned using a finishing carbide bur and scanned again (post-cleanup). Post-debond and post-cleanup scans were aligned with the baseline, and surface changes were quantified. Results were statistically compared using t-tests and Mann-Whitney tests (α  =  .05).Results:The depth of enamel loss (mean ± standard deviation) post-debond was 21 ± 8 µm and 33 µm and post-cleanup was 28 ± 14 µm and 18 ± 8 µm (P  =  .0191); the post-debond remnant thickness was 188 ± 113 µm and 120 ± 37 µm (P  =  .2381) and post-cleanup was 16 ± 5 µm and 15 µm for polycrystalline and monocrystalline ceramic brackets, respectively. The monocrystalline ceramic brackets predominantly left all adhesive on the tooth; the polycrystalline ceramic brackets were more likely to leave bracket fragments attached.Conclusion:Both systems allowed successful removal of the brackets with minimal enamel loss. However, the polycrystalline ceramic brackets left more fragments on the tooth, which complicated cleanup efforts.     

The effect of two different bracket types on the salivary levels of S mutans and S sobrinus in the early phase of orthodontic treatment

Objective:To determine the difference in the levels of Streptococcus mutans and S sobrinus in stimulated saliva in orthodontic patients with different bracket types (stainless steel and esthetic brackets) using polymerase chain reaction and cultivation method.Materials and Methods:Thirty-two patients, aged 13 to 30 years, were selected following these criteria: 1) orthodontic treatment indication, 2) systemic health, and 3) no tobacco and antibiotic consummation for three months prior to the commencement of the study. Patients were divided into two groups according to the bracket type; 16 patients formed the conventional bracket group (stainless steel brackets), and 16 patients formed the esthetic bracket group (plastic brackets). The levels of S mutans and S sobrinus in stimulated whole saliva samples were collected prior to fixed orthodontic appliance placement (T1) and 12 weeks after placement (T2), as were the Decayed, Missing, and Filled Surface Index (DMFS) and Oral Hygiene Index-Simplified (OHI-S). Mann-Whitney, Wilcoxon, and chi-square tests were used for statistical analysis.Results:Statistical analysis (chi-square test) showed no difference in S mutans and S sobrinus counts among patients with different brackets at either T1 or T2. There was no difference in total bacteria counts after fixed orthodontic appliance placement.Conclusion:The number of colony-forming units of S mutans and S sobrinus in stimulated saliva samples does not seem to be significantly different between patients with stainless steel brackets and patients with plastic brackets.     

Suitability of orthodontic brackets for rebonding and reworking following removal by air pressure pulses and conventional debracketing techniques

Aim:To test the null hypothesis that there are no significant differences in the reusability of debonded brackets with regard to debonding technique and adhesive used.Method:Ninety-six osteotomed third molars were randomly assigned to two study groups (n  =  48) for bonding of a 0.018-inch bracket (Ormesh, Ormco) with either a composite adhesive (Mono-Lok2; RMO) or a glass ionomer cement (GIC; Fuji Ortho LC;GC). Each of these two groups were then randomly divided into four subgroups (n  =  12) according to the method of debonding using (1) bracket removal pliers (BRP; Dentaurum), (2) a side cutter (SC; Dentaurum), (3) a lift-off debracketing instrument (LODI; 3M-Unitek), or (4) an air pressure pulse device (CoronaFlex; KaVo). The brackets were subsequently assessed visually for reusability and reworkability with 2× magnification and by pull testing with a 0.017- × 0.025-inch steel archwire. The proportions of reusable brackets were individually compared in terms of mode of removal and with regard to adhesives using the Fisher exact test (α  =  5%).Results:The null hypothesis was rejected. Not taking into account the debonding method, brackets bonded with GIC were judged to a significant extent (81%; n  =  39; P < .01) to be reworkable compared with those bonded with composite (56%; n  =  27). All brackets in both adhesive groups removed with either the LODI or the CoronaFlex were found to be reusable, whereas 79% (46%) of the brackets removed with the BRP (SC) were not. The proportion of reusable brackets differed significantly between modes of removal (P < .01).Conclusion:With regard to bracket reusability, the SC and the BRP cannot be recommended for debonding brackets, especially in combination with a composite adhesive.     

Bonding and debonding characteristics of orthodontic brackets to human enamel using modified 4-META/MMA-TBB resin

The purpose of this study was to evaluate the performance of modified 4-META/MMA-TBB resin for debonding orthodontic brackets to enamel in terms of easy and safe debonding without loss of adequate bracket bond strength. A mixture of α-tricalcium phosphate (α-TCP) and calcium fluoride (CaF₂) (1:1, w/w) was added to the polymer powder of 4-META/MMA-TBB resin. Human enamel was etched with phosphoric acid or treated with self-etching primer, and then the modified resin was applied to the treated enamel for bonding with orthodontic brackets. The shear bond strength was measured before and after the specimens were subjected to 10,000 thermal cycles between 5 °C and 55 °C. Using TCP/CaF₂-modified resins, the shear bond strength decreased significantly after thermal cycling in phosphoric acid etched specimens but did not change significantly after thermal cycling in self-etching primed specimens. Moreover, in the self-etching primed specimens, no significant differences in shear bond strength were detected among the different TCP/CaF₂-modified resins after thermal cycling. Phosphoric acid etched specimens showed enamel fracture upon debonding of orthodontic bracket. On the contrary, no enamel fracture was recognized in self-etching primed specimens. The addition of TCP/CaF₂ tended to be associated with more residual resin on the tooth surface after debonding, which suggests a lower risk of enamel fracture. TCP/CaF₂-modified resin used with self-etching primer appears to allow easy and safe debonding of orthodontic brackets without loss of adequate bracket bond strength.     

A novel biomimetic orthodontic bonding agent helps prevent white spot lesions adjacent to brackets

Objective:To compare changes in enamel microhardness adjacent to orthodontic brackets after using bonding agents containing various compositions of bioactive glass compared to a traditional resin adhesive following a simulated caries challenge.Materials and Methods:Extracted human third molars (n  =  10 per group) had orthodontic brackets bonded using one of four novel bioactive glass (BAG)-containing orthodontic bonding agents (BAG-Bonds) or commercially available Transbond-XT. The four new adhesives contained BAG in varying percentages incorporated into a traditional resin monomer mixture. Teeth were cycled through low-pH demineralizing and physiologic-pH remineralizing solutions once each day over 14 days. Microhardness was measured on longitudinal sections of the teeth 100, 200, and 300 µm from the bracket edge and beneath the brackets, at depths of 25 to 200 µm from the enamel surface. Normalized hardness values were compared using three-way analysis of variance.Results:Significantly less reduction in enamel microhardness was found with the experimental adhesives at depths of 25 and 50 µm at all distances from the bracket edge. In all groups, there were no significant changes in enamel microhardness past 125-µm depth. Results varied with the different BAG-Bonds, with 81BAG-Bond showing the smallest decrease in enamel microhardness.Conclusions:The BAG-Bonds tested in this study showed a reduction in the amount of superficial enamel softening surrounding orthodontic brackets compared to a traditional bonding agent. The results indicate that clinically, BAG-Bonds may aid in maintaining enamel surface hardness, therefore helping prevent white spot lesions adjacent to orthodontic brackets.     

Treatment time,outcome, and anchorage loss comparisons of self-ligating and conventional brackets

Objective:To compare the treatment time, outcome, and anchorage loss among orthodontic patients treated by self-ligating brackets (SLBs) and conventional brackets (CBs).Materials and Methods:A retrospective cohort study compared 34 patients (SLB group) treated by SmartClip brackets (3M Unitek, Monrovia, Calif) to 35 patients (CB group) treated by conventional preadjusted Victory series brackets (3M Unitek) and ligated by stainless steel wire ligatures. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were traced and analyzed using Pancherz sagittal-occlusion analysis to obtain skeletal and dental changes in the maxilla and the mandible. The dental cast models were assessed by the Peer Assessment Rating (PAR) Index for the treatment outcomes.Results:The mean treatment time for SLBs (19.19 months) did not show a statistically significant difference from 21.25 months of CBs; the treatment time and pretreatment PAR scores were strongly correlated. There was no difference in anchorage loss between the SLB and CB groups. There were significant dental and skeletal changes among adolescent orthodontic patients regardless of the bracket used. The lingual inclination of the mandibular incisors in the CB group was 3.62° more than in the SLB group (P < .01).Conclusions:The treatment time and anchorage loss are not influenced by the type of bracket used. There are significant dental and skeletal changes among adolescent orthodontic patients regardless of the bracket used. There is significantly greater lingual inclination of mandibular incisors in the CB group than in the SLB group.     

Effects of adhesive flash-free brackets on debonding pain and time: A randomized split-mouth clinical trial

ObjectivesTo evaluate the effects of adhesive precoated (APC) flash-free brackets on the level of pain, amount of remnant adhesive, and removal time during the debonding procedure.Materials and MethodsThirty patients (20 female, 10 male) aged 12 to 18 years undergoing nonextraction fixed orthodontic treatment were included in this study. APC flash-free and conventional ceramic brackets were bonded with a split-mouth study design. Bracket types were randomly allocated to quadrants. During the removal of the brackets, the visual analogue scale (VAS) was used to assess the level of pain for each tooth. The adhesive remnant index (ARI) was used to determine the amount of adhesive remaining on the tooth surface. Adhesive removal times were calculated per quadrant. The data were analyzed using the Wilcoxon test for comparisons between groups.ResultsPain scores were generally higher for the conventional group than for the flash-free group. There were no differences in VAS scores across most tooth types during debonding. Overall, ARI results showed more adhesive remnants in the conventional bracket group (P < .001). Except for the right maxillary quadrant, the times required to remove the adhesive were significantly longer for the flash-free brackets than the conventional brackets (P ≤ .005).ConclusionsAlthough removal time was slightly longer for the flash-free adhesive than for the conventional adhesive, lower pain scores were generally observed for the flash-free adhesive brackets during the debonding procedure. Both time and pain differences could be considered clinically insignificant.     

Evaluation of stresses developed in different bracket-cement-enamel systems using finite element analysis with in vitro bond strength tests

Background

The purpose of this study was to determine the bond strength of different orthodontic bracket materials (ceramic, stainless steel, and titanium) as well as stresses developed in bracket-cement-enamel systems using finite element (FE) analysis.

Methods

One hundred and thirty-five extracted human caries-free upper central incisors were divided into three groups (n = 45/group) according to the type of orthodontic bracket materials (stainless steel, ceramic, and titanium). Each group was further subdivided into three subgroups (n = 15/group) according to the bond strength test loading mode (shear short side, shear long side, and tensile). After debonding, the fractured specimen was examined, and the adhesive remnant index (ARI) was determined. FE analysis models analyzed the stress distribution within the cement and enamel. Bond strengths were analyzed using ANOVA and Tukey''s test, and the ARI scores were analyzed using chi-square (χ²) test.

Results

Shear loading at the short side of the bracket resulted in the highest bond strength and lowest maximum principal stress both on cement and enamel compared with the other loading modes (P < 0.05). Ceramic brackets presented with higher bond strength and lower maximum principal stress than metallic brackets (P < 0.05). There was a significant difference for ARI scores between the type of brackets (χ² = 64.852, P < 0.001).

Conclusion

The findings suggest that the manner of loading orthodontic brackets and the selection of orthodontic bracket materials affect the bond strength and stresses developed both on cement and enamel.     

Effect of bracket type on halitosis,periodontal status,and microbial colonization

Objective: To determine the effect of bracket type on halitosis, periodontal status, and microbial colonization.Materials and Methods:Forty-six patients scheduled for fixed orthodontic treatment (age 11–16 years) were selected from the orthodontic department of Suleyman Demirel University. Patients were divided into two groups with random distribution of brackets; 23 patients were treated with self-ligating brackets (group SLBs), the others with conventional brackets (group CBs). Halitosis measurements and periodontal and microbial records were obtained before the placement of brackets (T0), 1 week later (T1), and 5 weeks after bonding (T2). Periodontal parameters, including plaque index (PI), gingival index (GI), and bleeding on probing index (BOP), were obtained from all the bonded teeth. Halitosis measurements were performed at the same time. Microbial samples were obtained from the buccal surfaces of all the bonded teeth. Data were analyzed by using a repeated-measurement analysis of variance test for the comparison of parameters between groups and times.Results:Periodontal parameters and halitosis results were higher in the CBs group than in the SLBs group (P < .05). In the SLBs group, halitosis and BOP values revealed no pronounced changes between T1 and T2 (P > .05). Intra- and intergroup comparisons showed that there were no statistically significant differences for microbial colonization between all the time intervals (P > .05).Conclusion:Bracket type has an effect on halitosis and periodontal status. Therefore, self-ligating brackets may be advised in order to prevent patients from developing halitosis and to increase the likelihood of good oral hygiene during orthodontic treatment.     

The prognostic value of visually assessing enamel microcracks: Do debonding and adhesive removal contribute to their increase?

Objective:To find a correlation between the severity of enamel microcracks (EMCs) and their increase during debonding and residual adhesive removal (RAR).Materials and Methods:Following their examination with scanning electron microscopy (SEM), 90 extracted human premolars were divided into three groups of 30: group 1, teeth having pronounced EMCs (visible with the naked eye under normal room illumination); group 2, teeth showing weak EMCs (not apparent under normal room illumination but visible by SEM); and group 3, a control group. EMCs have been classified into weak and pronounced, based on their visibility. Metal brackets (MB) and ceramic brackets (CB), 15 of each type, were bonded to all the teeth from groups 1 and 2. Debonding was performed with pliers, followed by RAR. The location, length, and width of the longest EMCs were measured using SEM before and after debonding.Results:The mean overall width (W_overall) was higher for pronounced EMCs before and after debonding CB (P < .05), and after the removal of MB. Pronounced EMCs showed greater length values using both types of brackets. After debonding, the increase in W_overall of pronounced EMCs was 0.57 µm with MB (P < .05) and 0.30 µm with CB; for weak EMCs, − 0.32 µm with MB and 0.30 µm with CB.Conclusions:Although the teeth having pronounced EMCs showed higher width and length values, this did not predispose to greater EMCs increase after debonding MB and CB followed by RAR.     

Nonsurgical miniscrew-assisted rapid maxillary expansion results in acceptable stability in young adults

Objective:To evaluate the stability of nonsurgical miniscrew-assisted rapid maxillary expansion (MARME) in young adults with a transverse maxillary deficiency.Materials and Methods:From a total of 69 adult patients who underwent MARME followed by orthodontic treatment with a straight-wire appliance, 20 patients (mean age, 20.9 ± 2.9 years) with follow-up records (mean, 30.2 ± 13.2 months) after debonding were selected. Posteroanterior cephalometric records and dental casts were obtained at the initial examination (T0), immediately after MARME removal (T1), immediately after debonding (T2), and at posttreatment follow-up (T3).Results:Suture separation was observed in 86.96% of subjects (60/69). An increase in the maxillary width (J-J; 1.92 mm) accounted for 43.34% of the total expansion with regard to the intermolar width (IMW) increase (4.43 mm; P < .001) at T2. The amounts of J-J and IMW posttreatment changes were −0.07 mm (P > .05) and −0.42 mm (P  =  .01), respectively, during retention. The postexpansion change in middle alveolus width increased with age (P < .05). The postexpansion change of interpremolar width (IPMW) was positively correlated with the amount of IPMW expansion (P < .05) but not with IMW. The changes of the clinical crown heights in the maxillary canines, first premolars, and first molars were not significant at each time point.Conclusions:Nonsurgical MARME can be a clinically acceptable and stable treatment modality for young adults with a transverse maxillary deficiency.     

Comparative effects of tungsten,diamond burs and laser for residual adhesive removal after orthodontic debonding on flexural strength,surface roughness and phase transformation of high-translucent zirconia: An in vitro study

ObjectivesInformation regarding the effects of orthodontic bracket debonding on zirconia restorations, and the preferred method for residual adhesive removal from the zirconia restoration surface is lacking. Thus, this study aimed to assess the effects of different methods of residual adhesive removal after orthodontic bracket debonding on flexural strength, surface roughness, and phase transformation of high-translucent (HT) zirconia.Materials and methodsThis in vitro study evaluated 72 bar-shaped HT zirconia specimens; 18 specimens were assigned to the control group. Metal brackets were bonded to the remaining specimens by resin cement. After bracket debonding, the residual adhesive on the surface of specimens was removed by three methods (n = 18): a 30-flute tungsten-carbide (TC) bur at low speed, an ultrafine diamond bur at high speed, and Er:YAG laser irradiation. The surface roughness (Ra and Rz) was measured. X-ray diffraction (XRD) analysis was carried out, and the flexural strength was measured as well. Data were statistically analyzed (α = 0.05).ResultsBefore polishing, all methods increased the Ra and Rz values (P < 0.05) except for the diamond bur yielding a Rz value comparable to that of the control group. The Ra values of the test groups were comparable after polishing, and still higher than that of the control group (P < 0.05). The flexural strength of all three test groups was comparable (P > 0.05), and significantly lower than that of the control group (P < 0.001). The monoclinic phase was not observed in any group.ConclusionsOrthodontic bracket debonding adversely affects the surface roughness and flexural strength of zirconia despite polishing.     

Clinical and microbiological parameters in patients with self-ligating and conventional brackets during early phase of orthodontic treatment

Objective:To determine the effect of different bracket designs (conventional brackets and self-ligating brackets) on periodontal clinical parameters and periodontal pathogens in subgingival plaque.Material and Methods:The following inclusion criteria were used: requirement of orthodontic treatment plan starting with alignment and leveling, good general health, healthy periodontium, no antibiotic therapy in the previous 6 months before the beginning of the study, and no smoking. The study sample totaled 38 patients (13 male, 25 female; mean age, 14.6 ± 2.0 years). Patients were divided into two groups with random distribution of brackets. Recording of clinical parameters was done before the placement of the orthodontic appliance (T0) and at 6 weeks (T1), 12 weeks (T2), and 18 weeks (T3) after full bonding of orthodontic appliances. Periodontal pathogens of subgingival microflora were detected at T3 using a commercially available polymerase chain reaction test (micro-Dent test) that contains probes for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola.Results:There was a statistically significant higher prevalence of A actinomycetemcomitans in patients with conventional brackets than in patients with self-ligating brackets, but there was no statistically significant difference for other putative periodontal pathogens. The two different types of brackets did not show statistically significant differences in periodontal clinical parameters.Conclusion:Bracket design does not seem to have a strong influence on periodontal clinical parameters and periodontal pathogens in subgingival plaque. The correlation between some periodontal pathogens and clinical periodontal parameters was weak.     

双颌前突正畸治疗前后软组织的三维变化

目的:探讨双颌前突患者矫治前后软组织的三维变化。方法:选取双颌前突成人患者24例,分别在治疗前后拍摄头颅侧位片和三维扫描,测量27个软组织项目。所有结果采用配对t检验。结果:上切牙内收6.12 mm,下切牙内收4.58 mm,上唇显著后移,而下唇显著向上向后移动。唇和切牙内收比率在上颌约为52%,下颌约为82%。结论:三维扫描可以有效的反应软组织变化。双颌前突患者的上下唇显著向后移动。     

Porcelain Surface Alterations and Refinishing After Use of Two Orthodontic Bonding Methods

Objective:To compare porcelain surfaces at debonding after use of two surface preparation methods and to evaluate a method for restoring the surface.Materials and Methods:Lava Ceram feldspathic porcelain discs (n  =  40) underwent one of two surface treatments prior to bonding orthodontic brackets. Half the discs had sandblasting, hydrofluoric acid, and silane (SB + HF + S), and the other half, phosphoric acid and silane (PA + S). Brackets were debonded using bracket removing pliers, and resin was removed with a 12-fluted carbide bur. The surface was refinished using a porcelain polishing kit, followed by diamond polishing paste. Measurements for surface roughness (Ra), gloss, and color were made before bonding (baseline), after debonding, and after each step of refinishing. Surfaces were also examined by scanning electron microscopy (SEM). Data was analyzed with 2-way ANOVA followed by Tukey HSD tests (α  =  0.05).Results:The SB + HF + S bonding method increased Ra (0.160 to 1.121 µm), decreased gloss (41.3 to 3.7) and altered color (ΔE  =  4.37; P < .001). The PA + S method increased Ra (0.173 to 0.341 µm; P < .001), but the increase in Ra was significantly less than that caused by the SB + HF + S bonding method (P < . 001). The PA + S method caused insignificant changes in gloss (41.7 to 38.0) and color (ΔE  =  0.50). The measurements and SEM observations showed that changes were fully restored to baseline with refinishing.Conclusions:The PA + S method caused significantly less damage to porcelain than the SB + HF + S method. The refinishing protocol fully restored the porcelain surfaces.