Background:This study explored the synthesis of quercetin nanoparticles (QNPs) and evaluated the remineralization effect of QNPs on artificial white spot lesions on extracted human teeth. Material and Methods:QNPs were successfully synthesized, and their size was measured. Seventy-six extracted human molars were divided into 4 groups of n=19 to undergo a 10-day pH cycling protocol: 1000 ppm fluoride solution as aqueous NaF (group 1), 6.5% w/v quercetin microparticle solution (group 2), 4000 ppm QNP (group 3) and deionized water (group 4). Vickers microhardness tester, scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDX) and atomic force microscopy (AFM) were used to measure the surface microhardness (SMH), Ca:P ratio and surface roughness (Ra), respectively. Results:After remineralization, the SMH values were significantly different among all the experimental groups (p<0.001). The fluoride and QNP groups had significantly greater SMH values than the quercetin group. The AFM data showed a significant decrease, but the differences were not significant. The Ca:P values were significantly greater than those of the control in all 3 experimental groups, but the QNP and fluoride concentrations were significantly greater than those of quercetin. There were no significant differences between QNPs and fluoride according to any test. Conclusions:It can be concluded from the results of this study that QNPs have similar remineralization potential to fluoride and are more effective than quercetin. Key words:White Spot Lesion, Remineralization, Quercetin, Nanoparticles, Orthodontic Treatment.

The authors have requested that this preprint be removed from Research Square.

PURPOSE:The aim of this pilot study was to evaluate the knowledge and perception among dental educators regarding the use of relative value units (RVUs) in medicine, perceived benefits in dentistry, and the relative ranking of the components to define RVUs in dentistry. METHODS:A convenience sample of dental educators participating in the American Dental Education Association's Leadership Institute (2023-2024) cohort was surveyed for their knowledge and perception regarding RVUs. The responses were stratified based on experience with RVUs prior to statistical analyses (α = 0.05). RESULTS:Twenty-six dental educators from 18 different North American dental schools and nine different dental specialties participated in this pilot study. Although not significant, a higher proportion of dental educators with prior experience perceived RVUs as a valuable tool in dental practice for assigning chair time, developing payment models, and tracking student-resident progress in a clinical course. There was a lack of consensus among dental educators regarding the components for determining dental procedural RVUs. CONCLUSION:This pilot study provides limited evidence that prior knowledge of RVUs may be related to its perceived benefits among dental educators, but a broader study design is needed to draw meaningful conclusions and universally acceptable components for determining RVUs in dentistry.

Slow maxillary expansion is a technique used to achieve correction of maxillary transverse deficiency or posterior crossbite in patients where the midpalatal suture has closed. This is mostly achieved by buccal tipping of maxillary posterior teeth. The aim of this case report is to discuss the orthodontic treatment of a 20-year-old patient with bilateral posterior crossbite. The patient had moderate maxillary crowding and severe mandibular crowding, crossbites bilaterally on his posterior teeth, and maxillary lateral incisors. The patient had thin gingival biotype with gingival recession on the mandibular right canine. Orthodontic treatment was done with full fixed appliances, and extraction of a mandibular right lateral incisor. This case report shows that slow maxillary expansion can be used in an adult to achieve the objectives set by both the orthodontist and patient while also considering treatment modalities most agreeable to the patient. Key words:Orthodontic treatment, slow maxillary expansion, maxillary expansion, RPE, Hyrax expander, case report.

Background:This study evaluates the remineralization potential of enamel after bioactive glass (BAG) air abrasion, using Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy Analysis (SEM-EDS), Electron Probe Microanalysis (EPMA), and Atomic Force Microscopy (AFM).Material and Methods:Forty extracted human third molars were divided into four groups with ten samples each. Three groups were subjected to a demineralizing solution of 2.2 mM calcium chloride, 2.2 mM monopotassium phosphate, and 0.05 mM acetic acid, adjusted to a pH of 4.4 using 1 M potassium hydroxide at an intraoral temperature of 37°C for 96 hours. Of the three groups, two were subjected to air abrasion with BAG. One of the air abrasion groups was then further remineralized in 1.5 mM calcium chloride, 0.9 mM sodium phosphate, and 0.15 M potassium chloride, adjusted to a pH of 7.0 at 37°C. The teeth were then evaluated via SEM-EDS and EPMA to measure the calcium-to-phosphorous (Ca:P) ratios, and the surface morphology was investigated using AFM.Results:A measurable decrease in the Ca:P ratio was found after demineralization, which subsequently increased after remineralization. A thin layer of demineralized enamel was removed by the BAG air abrasion. AFM image analysis showed the presence of pits on the surface, which decreased in depth after demineralization, and further after BAG abrasion. Remineralized samples, in contrast, showed a slight increase in pit depth. While the observation of remineralization was statistically significant throughout our study, we could not find any evidence for BAG retention on the surface of the enamel.Conclusions:It is demonstrated that BAG, when delivered via air abrasion, indeed contributes to remineralization of the enamel; however, it does not seem to be a direct result of the presence of retained glass beads on the enamel surface. Given the increase of the Ca:P ratio after remineralization, a possible therapeutic benefit was observed, potentially reducing the probability of fractures in weakened enamel. Key words:Enamel, Demineralization, Remineralization, White Spot Lesions, Bioactive Glass, Air Abrasion, Energy Dispersive X-ray Spectroscopy, Electron Probe Microanalysis, Atomic Force Microscopy, Ca:P ratio, surface morphology.

The goal of this resident survey study was to investigate preparedness among orthodontic residents in providing orthodontic treatment with clear aligners and manage the digital workflow for in-house fabrication of clear aligners. A survey questionnaire was emailed to all active AAO resident members which included recent graduates of 2021 (n=1,124) to evaluate didactic edu-cation, clinical experience, confidence levels and the residents' future prac-tice plans with regards to clear aligner therapy. Inferential statistics were restricted to bivariate analysis employing Pearson's chi-square tests, CMH tests, and unpaired Student's t-test (p=0.05). A total of 277 Orthodontic residents responded to the survey, with an overall response rate of 25%. Nearly 50% of the residents did not receive didactic classes on clear aligner therapy or fabrication. About 13-17% of the respond-ents did not have access to CBCT, digital teeth alignment software or 3D printed models. A significant decrease in confidence was found among resi-dents who did not receive this training in their residency programs. Based on the findings of our survey, thorough training and education of the technology used in clear aligner therapy has the potential to improve resi-dents' confidence and competence in utilizing 3D technology and clear align-ers in their future practice. (Semin Orthod 2022; 28:80-84) (c) 2022 Elsevier Inc. All rights reserved.

Background:The purpose of this survey study and case review was to identify 1) the common causes related to filing a malpractice claim against an orthodontist and, 2) the factors mitigating against a potential malpractice claim in the United States (U.S). The objectives of the case review were to examine the current state of orthodontic malpractice litigation from a cause and mitigating point of view.Material and Methods:Data for this research was collected and reviewed using the following two methods: 1) A survey questionnaire on aspects of malpractice liability was electronically distributed to 2,241 active U.S. members of the American Association of Orthodontists (AAO). 2) Legal cases were reviewed on the online legal research database Lexis Advance Research, and 35 cases were analyzed.Results:Survey questionnaire results and legal case review results are as follows: 1) 77 orthodontists completed the survey. 9.1% of the respondents reported a malpractice claim having been filed against them with periodontal issues accounting for most of the claims. Survey participants reported good doctor-patient communication as being the most relevant contributory factor and most relevant mitigating factor in malpractice claims. 2) Negligence is the main reason patients sue a doctor for clinically related litigation, and failure to obtain a proper informed consent from the patient is the main cause of action for non-clinically related litigation.Conclusions:Most respondents reported doctor-patient communication, periodontal issues, and a lack of informed consent as the main triggering elements of a lawsuit, which is similar to other studies and case review analysis. Good doctor-patient rapport was ranked as being most helpful in mitigating a potential claim, which is also similar to other studies. Another aspect of the survey questionnaire that was evaluated was whether a non-orthodontist can provide expert testimony against an orthodontist, with most respondents reporting that this is not possible. It has been ruled, though, that a general dentist can be an expert witness and provide expert testimony against an orthodontist in a lawsuit depending on the circumstances. Negligence was the most common cause of clinically related orthodontic litigation, and a failure of the practitioner to obtain a proper informed consent from the patient was the most common cause of non-clinically related orthodontic litigation. Key words:Orthodontist, malpractice, legal, lawsuit, liability, medicolegal.

Background:Obstructive Sleep Apnea (OSA), a sleep-related breathing disorder that can affect both children and adults with systemic co-morbidities beyond disrupted sleep yet remains underdiagnosed in a substantial portion of the pediatric and adult orthodontic patient populations. The objective of this study was to assess the prevalance of orthodontists screening patients for OSA, their confidence level in screening, and to identify the various screening methods most commonly used in practice.Material and Methods:A survey on screening for OSA was emailed to 6,675 members of the American Association of Orthodontists (AAO) in the United States. Frequency distribution of different responses and their association with various demographic factors was assessed.Results:Out of 234 orthodontists completing the survey, 62% reported screening all of their patients for OSA, while 38% reported doing no OSA screening at all. More hours of continuing education (CE) and younger ages were observed to be statistically significantly associated with practice of screening for OSA (p<0.001 and 0.034, respectively, on regression analysis). Role of longer practice duration observed to be significant on univariate analysis, lost its statistical significance on regression analysis.Conclusions:CE hours on OSA seemed to be the most important factor that motivated the orthodontist to screen for OSA. A majority of orthodontists in the 35-54 year old age-group were screening their patients for OSA. Key words:Orthodontics, obstructive sleep apnea, screening, survey study.

Background:The purpose of this study was to evaluate general public's perception, knowledge and preferences on orthodontic treatment rendered by an orthodontist versus the "Do-It-Yourself" orthodontics (DIYO) concept without professional supervision. The secondary objective was to assess laypeople's awareness on the risks and limitations of DIYO.Material and Methods:A 24-question online survey questionnaire was administered to 526 laypeople who had no professional experience or background in dentistry and orthodontics. All data was collected over 3 days (July 20-23, 2020) by Qualtrics server and forwarded to the principal investigator. Statistical analysis was done with statistical software SPSS® version 26.Results:The most important reason for laypeople to opt for DIYO is financial reason. People who have undergone orthodontic treatment know the difference between a general dentist and an orthodontist, whereas people who have not had orthodontic treatment are less likely to know the difference. Of the 285 people who did not receive orthodontic treatment before by a dental professional, 43 have considered DIYO. 122 of the 526 people considered DIYO, and 79 of the 122 had orthodontic treatment before. 26 of the 122 did not consider the clinical exam and diagnostic records important and would be comfortable without in-person supervision. 83 of the 122 would be comfortable not having in-person supervision, and still considered this treatment modality "Doctor-Directed".Conclusions:The main reason laypeople utilize DIYO is the low cost. Some DIYO users do not consider risks involved and a small percentage consider their own dentist to be responsible if any issues arise with DIYO. One third of survey respondents will consider DIYO in the future. Key words:Do-It-Yourself (DIY), Direct-To-Consumer (DTC), Adult, Orthodontics, Dentistry, Surveys and Questionnaires.

Study design Prospective randomised placebo-controlled clinical trial.Cohort selection and data analysis Sixty-two healthy adults who underwent single dental implant placement without previous infection of the surgical bed or the need for bone grafting were included in this clinical trial. They were randomly divided into two groups (test and control). The test group was given a single dose of oral clindamycin (600 mg) one hour before surgery and the control group with a placebo. The surgical procedures were carried out by one oral surgeon and all the patients were observed post-operatively on days 1, 7, 14, 28, and 56 by a single observer for clinical, radiological, surgical variables, adverse events, and complications. Statistical analysis was performed with STATA 15 software and the number required to treat or harm (NNT/NNH) was also evaluated.Results In the test group, the authors observed two implant failures and one patient experienced gastrointestinal disturbances and diarrhoea. They also observed post-operative infections in three patients (two in the control group and one in the test group which eventually failed).Conclusions The authors concluded that pre-operative clindamycin administration during dental implant surgery in healthy adults may not reduce implant failure or post-surgical complications.

Study design Retrospective cohort study. Cohort selection and data analysis In total, 89 implants were placed in 34 patients (19 men and 15 women; average 62.1 years of age) using computer-guided implant surgery with cone beam computed tomography (CBCT). All patients included in this study were adults and the computed-guided implant surgery was planned according to a digital guide protocol based on CBCT. Group 1 patients received the implants with the guide and flapped surgical approach, Group 2 with the guide and flapless approach. Group 3 was the drop-out group which included other patients in who the implant could not be placed according to the guide. CBCT data from before and after the surgeries were superimposed to evaluate the accuracy of implant positioning among all the groups. The differences in distance of the entry point (deviation distance) and in the degree of the insertion angle (deviation angle) were measured on the superimposed CBCT. Statistical analysis was performed with SPSS software and an independent sample t-test was done to analyse the difference of measurements among the groups. Results The authors observed greater accuracy in Group 2 in terms of deviation distance and angulation when compared to Group 1. The deviated position of the implant fixtures was greater in the drop-out group when compared to the guided groups in terms of the displacement of entrance point and the degree of insertion. Conclusions The authors concluded that flapless guided implant surgery is more accurate than flap guided implant surgery. The results of this study can be useful to clinicians in making decisions between flapless surgical approach and flapped approach when using a guide for implant placement.

BACKGROUND:A survey was done on practicing Orthodontists in the United States on their experience with lingual orthodontics. The objectives of this survey study were to assess 1) the satisfaction level with cases treated with lingual orthodontics, 2) factors that influence clinicians' decision to utilize or not utilize lingual braces in their current practices, and 3) intention of using lingual braces in their future practices, if not used currently, in the U.S.MATERIAL AND METHODS:A survey questionnaire was electronically distributed to 2,200 active U.S. members of the American Association of Orthodontists (AAO).RESULTS:85 orthodontists completed the survey. About 25% of respondents practiced lingual orthodontics. Direct mentorship was the most common approach used by orthodontists to learn lingual technique. The most used lingual system among the clinicians that use lingual braces was INBRACE® (34.6%). All respondents were either satisfied or very satisfied with their treatment outcome of cases treated with lingual braces. Improved esthetics and practice differentiation were perceived to be the biggest advantages of practicing lingual orthodontics. Biggest challenges with lingual orthodontics were found to be patient discomfort, cost, longer chair time and technical difficulties. Most common reason for not using lingual braces was technical difficulty, followed by availability of alternative appliances, lack of demand and patient discomfort. Approximately, 70% of those that did not use lingual orthodontics in their current practices responded that they were very likely to incorporate lingual orthodontics in their future practices.CONCLUSIONS:Overall outcome satisfaction level with cases treated with lingual braces was high among the orthodontists that practiced lingual orthodontics. There seemed to be a strong interest in incorporating lingual orthodontics in future practices by clinicians that did not use lingual braces in their current practices. Some of the factors that influenced clinicians' decision to practice lingual orthodontics were improved esthetics, practice differentiation and increased case acceptance. Technical difficulties, availability of alternative appliances, lack of demand and patient discomfort were some of the factors that were identified to have influenced practitioners' decision to not offer lingual orthodontics in their current practices. Key words:Orthodontic brackets, Lingual braces, Lingual orthodontics.

Data sources Data was collected from six databases (Medline, Embase, Web of Science, The Cochrane Central Register of Controlled Trials [CENTRAL], China National Knowledge Infrastructure [CNKI] and Chinese Biomedical Literature Database). Studies published in English and Chinese languages comparing ceramic and metal-ceramic implant-supported fixed dental prostheses (FDPs) were searched. The literature search was performed on studies published until 2018. Manual search of the reference lists of the identified articles was also performed to find related review articles and studies. Study selection Randomised controlled trials (RCTs), prospective and retrospective cohort studies involving the comparison of ceramic and metal-ceramic implant-supported FDPs were selected using the PICOS model for the meta-analysis. For ceramic and metal-ceramic single crowns, the survival rate, marginal adaptation, marginal bone loss, pocket probing depth, crown colour match and mucosal discolouration were assessed. The authors also included studies on survival rate of implant-supported fixed partial dental prostheses (FPDPs) in this meta-analysis. Data extraction and synthesis Two investigators independently screened the articles from the literature search and extracted and analysed data from the included studies. The quality of the included RCTs were assessed using the Cochrane collaboration tool for assessment of risk of bias. For the selected non-randomised studies, the quality and risk of bias were assessed using the Newcastle-Ottawa scale. Twenty studies were included in data synthesis. Results Of the selected 20 studies, ten were RCTs and ten were prospective or retrospective cohort studies. Conclusions The results of this study can be useful to clinicians in making decisions between ceramic and metal-ceramic implant-supported single crowns. This study concluded that the ceramic implant-supported single crown has better crown colour match over a metal-ceramic single crown, but poorer marginal adaptation, and there was no difference observed in other parameters studied (survival rate, marginal bone loss, pocket probing depth and mucosal discolouration). The conclusions on survival rate of implant-supported FPDPs needs to be further evaluated with RCTs with larger samples.

The purpose of this 2 part review is to evaluate various debonding techniques for orthodontic ceramic bracket removal and their clinical applications.In this part 2 of the literature review, and studies on electrothermal debonding and Laser debonding techniques have been reviewed. Electrothermal debonding is a physiologically acceptable alternative to mechanical debonding. It requires minimal force following thermal softening of adhesive material and produces minimal changes to enamel surfaces compared to conventional methods. Minimal effects on enamel and intrapulpal temperature changes are noted with ytterbium fiber laser, diode laser and Tm:YAP laser. Different parameters are possible with CO laser, Nd:YAG laser and Er:YAG laser that may need further research before considering them in clinical practice.

The purpose of this in vitro study is to evaluate the effect of the incorporation of silanized and non-silanized silica nanoparticles (~ 160 nm) in mechanical properties and surface roughness of self-cured acrylic resins. Five groups of samples were produced (with six specimens each), following the ISO 20795-1:2013 specifications. In the control group (Ctrl), no particles were added in the resin composition. Non-silanized silica nanoparticles were added either into the polymer (0.7 wt%, group G1) or into the monomer (0.27 wt%, G2). Two equivalent groups were formed for composite resins with silanized nanoparticles (groups G3 with 0.7 wt% incorporated into the polymer and G4 with 0.27 wt% added into the monomer). Data were submitted to Shapiro-Wilk (α = 0.05) and ANOVA/Tukey (α = 0.05). Nanoparticle-loaded resins showed similar microhardness as the control and a reduced flexural strength (20–27%) which was neither dependent on the amount of filler added nor in the method of nanoparticle incorporation. Surface silanization caused no major improvement in the mechanical behavior of the nanoresins but appears to improve dispersibility, as indicated by a smaller surface roughness.

BACKGROUND:Rigid fixed functional appliances are most commonly used to correct skeletal Class II malocclusions. The objective of this study was to assess orthodontists' preference of different rigid fixed functional appliances used in the U.S.A for correction of skeletal Class II malocclusions.MATERIAL AND METHODS:A survey on use and preference of rigid fixed functional appliances for skeletal Class II correction was emailed to 2,227 members of the American Association of Orthodontists (AAO) in the U.S.A. Frequency distribution of different responses and their association with demographic factors was assessed.RESULTS:Out of 140 orthodontists completing the survey, 110 responded as using rigid fixed functional appliances. Eight incomplete responses were eliminated from data analysis. 51.5% (68/132) orthodontists used rigid fixed functional appliances. The most preferred rigid fixed functional appliance was the Herbst appliance with 72% response followed by Mandibular Anterior Repositioning Appliance (24%) and AdvanSync (4%). There was no statistically significant difference in use of rigid fixed functional appliances between different age groups (p=0.284). However, the 40-54 age group used the most rigid fixed functional appliances in practice, followed by the 25-39 year age group and the 55-69 age group using these appliances the least. There was statistical significance between the type of practice setting one works in and the use of rigid fixed functional appliances in practice (p=0.022).CONCLUSIONS:About 52% of orthodontists use rigid fixed functional appliances to correct skeletal Class II malocclusions. The Herbst appliance is the most commonly used and most preferred amongst all rigid fixed functional appliances with a 72% preferred rate. Key words:Orthodontic, Rigid fixed functional appliance, Skeletal Class II, Class II Malocclusion, Mandibular retrognathism, Herbst, Mandibular Anterior Repositioning Appliance (MARA), AdvanSync, Molar to molar, M2M.

Background: Chitosan, chitosan nanoparticle, ethanolic extracts of Anacyclus pyrethrum root and Cyperus rotundus rhizome were evaluated against plasmid mediated multidrug resistance of Enterococcus faecalis, Staphylococcus aureus and Bacillus sp. isolated from unstimulated saliva of chronic periodontitis. The main aim of the current study centres the reduction of antibiotic consumption and the development of natural compounds to combat multidrug resistance. Methods: Identification of bacteria, antimicrobial susceptibility, plasmid stability and plasmid curing was carried out for the characterization of resistance plasmids. Results: E. faecalis showed 89% of sensitivity to chitosan nanoparticle, chitosan 81%, C. Rotundus 69% and A. pyrethrum 62% for S. aureus, with the MIC >100 µg/ml. In comparison with the antimicrobials tested, maximum resistance to tetracycline (89%) for E. faecalis, is followed by ampicillin (87%) and tetracycline (81%) for S. aureus. Meanwhile, chloramphenicol and tetracycline (80%) for Bacillus sp. The plasmid stability for E. faecalis (20%), S. aureus (<4%) and Bacillus sp. (16%). The order of stability corresponding to the broth media is LB ˃ BHI ˃ nutrient for E. faecalis, S. aureus but similar in LB and nutrient broth for bacillus sp. The maximum plasmid curing efficiency of chitosan for S. aureus (76%), Chitosan nanoparticle for E. faecalis (88%), A. pyrethrum for S. aureus (73%), C. rotundus for E. faecalis (87%). The order of plasmid curing efficiency is chitosan nanoparticle>C. rotundus>chitosan>A. pyrethrum. Conclusion: Chitosan, Chitosan nanoparticle, C. rotundus, and A. pyrethrum offered a greater potential in eliminating plasmid mediated resistance acquired by periodontal pathogens, thus addressing this crisis in dentistry.

This study was conducted to evaluate antimicrobial activity of orthodontic elastomeric chains (OECs) coated with chlorhexidine (CHX) hexametaphosphate (HMP) nanoparticles and its effect on force decay. OECs were coated with CHX-HMP-5 (5 mM CHX and HMP), CHX-HMP-1 (1 mM CHX and HMP) nanoparticle colloidal solutions, CHX-5 (5 mM CHX) and CHX-1 (1 mM CHX) solutions. Release of CHX from coated OECs was evaluated over 28 days. Antimicrobial activity of the eluate collected on day 1 was tested against Streptococcus mutans and Lactobacillus rhamnosus by measuring the zone of inhibition after 4 days. OECs were observed by scanning electron microscope (SEM) to observe surface characteristics comparing: (1) uncoated and coated OECs and (2) before and after release of CHX. Force decay of OECs were measured over 28 days. SEM analysis showed that OECs were coated with nanoparticles. OECs coated with CHX-HMP-5 and CHX-HMP-1 released CHX over 28 days. The eluate from the coated OECs produced zones of inhibition after day 4 towards S. mutans and L. rhamnosus. Both CHX-HMP nanoparticle coated OEC released CHX over a period of 28 days that was capable of inhibiting the growth of S. mutans and L. rhamnosus. For all groups, the largest mean loss of force occurred over the first 24 h, followed by a relative plateau. All groups maintained >50% of the initial mean force over entire experiment of 28 days. This study showed that OECs can be coated with CXH-HMP nanoparticles that continuously elute the antimicrobial for extended periods. The coatings did not alter the force decay of OECs. Use of such coating on OECs can provide antibacterial activity to aid in the reduction of biofilm buildup and prevention of white spot lesions. This approach offers promising clinical applications.

The purpose of this 2 part literature review is to evaluate various debonding techniques for orthodontic ceramic bracket removal and their clinical applications.In part 1, and studies on mechanical and ultrasonic debonding techniques have been reviewed. Mechanical debonding (use of diamond burs, special pliers) is most widely applicable in clinical practice. Use of recommended pliers by manufacturers is key to minimize bracket failure modes as these pliers are designed specifically for the brackets. Ultrasonic debonding is advantageous in minimizing bracket failure but requires greater time to debond ceramic brackets than mechanical debonding and it may be uncomfortable to the patient due to longer duration of use. Studies on electrothermal and Laser debonding have been reviewed in part 2 of the literature review.

BACKGROUND:The objectives of this study was to evaluate the awareness of different ceramic bracket debonding techniques among orthodontists in the USA and the most commonly used debonding technique for ceramic bracket removal.MATERIAL AND METHODS:A survey on preference for debonding and awareness of debonding techniques was emailed to 2,227 members of the American Association of Orthodontists (AAO).RESULTS:119 orthodontists completed the survey. 111 responses were included in the study analysis of ceramic bracket users. The most common technique used was mechanical debonding. 86.5% used a specially designed bracket removing plier from the manufacturer. Overall, there were 59.5% of surveyed orthodontists who were aware of electrothermal debonding, 73% were unaware of ultrasonic debonding and 83.8% were unaware of laser debonding. There were more orthodontists with an affiliation with an academic institution aware of electrothermal debonding (p=0.002). There also was a trend of orthodontists having no affiliation with an institution who were unaware of laser debonding (p=0.015).CONCLUSIONS:This survey showed that the majority of orthodontists who responded to the questionnaire were unaware of alternative debonding techniques of ceramic brackets. All orthodontists who use ceramic brackets utilized mechanical debonding technique. Key words:Orthodontic ceramic brackets, mechanical, electrothermal, ultrasonic, laser debonding.