# Laser Applications in Metal Orthodontic Bracket Debonding: A Systematic Review
## 3 Results
### General Characteristics of the Included Studies  
The studies included in this systematic review exhibited heterogeneity regarding the types of lasers used for debonding metal orthodontic brackets, the parameters evaluated, and the outcomes related to enamel and pulp. The primary objective of most studies was to assess the effectiveness of Nd:YAG [41], Er:YAG [5; 42; 43], Er,Cr:YSGG [44; 45], and diode lasers [46; 47] with various wavelengths, focusing on the pulp temperature changes [5; 41; 42; 43; 44; 45], enamel damage [5; 41; 42; 44; 45; 46; 47], and adhesive residue after the debonding procedure [5; 41; 44; 45; 46; 47] (see Table 1). The studies by [PERSON] et al. [41] was the only investigation that specifically examined the application of an Nd:YAG laser for debonding metal orthodontic brackets. [PERSON] et al. [41] found that using a 2 W Nd:YAG laser resulted in a significant increase in pulp temperature and changes in enamel structure, making it unsuitable for bracket removal. [PERSON] et al. [45] examined the use of an Er,Cr:YSGG laser, obtaining an insignificant pulp temperature increase. The study by [PERSON] et al. [43] analyzed temperature changes on the enamel surface and in the pulp chamber during the use of an Er:YAG laser for orthodontic metal bracket removal. The laser was found to be safe when used with water cooling, as the temperature increases did not reach dangerous levels for the pulp tissue. Two included studies evaluated the use of the Er:YAG laser for debonding metal orthodontic brackets, focusing on its efficacy and safety in this application [5; 42]. [PERSON] et al. [42] compared the effects of the Er:YAG laser on debonding metal and ceramic brackets. The study showed that the temperature rise was safe for tissues, and the enamel was less damaged in the irradiated groups compared with the controls. Additionally, findings reported by [PERSON] et al. [5] suggested that the S-shaped movement of the Er:YAG laser tip, when used for ceramic brackets, was safer for the surrounding tissues compared to the circular movement employed around the metal brackets. This technique reduces the risk of temperature increase, thereby minimizing the potential damage to both the enamel and adjacent tissues during the debonding process. \begin{table}
\begin{tabular}{c c c c} \hline \hline
\begin{tabular}{c} The 2 W Na-YAG laser led to a significant rise in pulp temperature. \begin{table}
\begin{tabular}{c c c} \hline
**Study** & **Aim of the Study** & **Material and Methods** & **Results** \\ \hline \hline \multicolumn{3}{c}{The objective was to evaluate the enamel surface and temperature changes during the \(\mathrm{d}\)-resolution of metal and ceramic brackets using \(\mathrm{E}\)-resolution. Following the chosen environment index (ARI) and energy dispersive X-ray spectroscopy (EDS) were analyzed with scanning electron microscopy (SEM). & No significant differences in the adhesive remnant index (ARI) were found between the openings. However, the exposed area is only lower temperature increase than the circular motion. EDS analysis revealed a higher elevation percentage on the removal of other sand of soft bathed with laser assistance, indicating remnant index (ARI) and energy dispersive X-ray spectroscopy (EDS) were analyzed with scanning electron microscopy (SEM). & The EZ-CFSC  
In the case of comparison, the adhesive remnant index (ARI) studies conducted by [PERSON] et al. [44] and [PERSON] et al. [45] demonstrated that laser-assisted debonding resulted in significantly less adhesive residue on the teeth when compared to conventional methods. [PERSON] et al. [44] demonstrated that the Er,Cr:YSGG laser was effective, although the debonding process took longer and caused less enamel roughness compared to conventional methods. [PERSON] et al. [45] examined the use of the Er,Cr:YSGG laser, demonstrating that it minimized the adhesive residue index (ARI) and enamel damage. In two other studies by [PERSON] et al. [46] and [PERSON] et al.