Abstract Objective: Pain is a problem during bracket removal, and more comfortable treatment is needed. This study examined the association of pain with the removal force required for ceramic brackets, compared with metal and plastic brackets, to determine which removal method resulted in less pain and discomfort. Methodology: 81 subjects (mean age, 25.1 years; 25 males and 56 females) were enrolled, from whom 1,235 brackets (407 ceramic, 432 plastic, and 396 metal) were removed. Measured teeth were distinguished at six segments. Pain was measured with a visual analogue scale (VAS) during the removal of each bracket. An additional grip was placed on the grips of debonding pliers with right-angled beaks; a mini loading cell sensor pinched by the grips was used to measure removal force during debonding. VAS and force values were statistically analyzed. The Kruskal–Wallis test followed by the Mann–Whitney U test with Bonferroni correction were performed for multiple comparisons; multiple regression analysis was also performed. Results: Forces in the upper and lower anterior segments were significantly smaller (p<0.05) than those in the other segments. Pain tended to be greater in the upper and lower anterior segments than in the posterior segments. In all segments, the removal force was greater for metal brackets than for plastic or ceramic brackets. Ceramic brackets caused significantly greater pain than plastic brackets for the upper and lower anterior segments. Debonding force was involved in the brackets, following adjustments for pain, upper left segment, age, and sex. Conclusions Pain and discomfort are likely to occur during bracket debonding.

The relationship between orthodontic force and friction produced from an archwire and brackets affects the sliding of the wire in the leveling stage. Objective: The purpose of this study was to evaluate the relationship between force and friction in a small esthetic nickel-titanium (Ni-Ti) wire. Material and Methods: Five esthetic wires (three coated and two plated) and two small, plain Ni-Ti wires (0.012 and 0.014 inches) were used. We performed a three-point bending test according to ISO 15841 and the drawing test with a dental arch model designed with upper linguoversion of the lateral incisor in the arch (displacements of 0.5, 1.0, 2.0 and 3.0 mm), and evaluated the relationship between them. Results: Unloading bending forces of all wires at displacements of less than 1.0 mm were larger than friction forces, but all friction forces at displacements exceeding 2.0 mm were larger than unloading bending forces. The arch likely expands when displacement from the proximal brackets exceeds 1.0 mm. The friction force of a martensite 0.014-inch Ni-Ti wire was significantly greater than those of the other esthetic and austenitic wires. Conclusions: A wire with the smallest possible friction force should be used in cases with more than 1.0 mm displacement.