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Objectives: To evaluate and compare the enamel microcracks (EMCs) characteristics (qualitative and quantitative) in the form of tooth damage before and after debonding from human teeth of in vitro studies., Eligibility Criteria: Laboratorial studies evaluating EMCs characteristics before and after debonding metal and ceramic brackets from human teeth with intact buccal enamel., Information Sources: An electronic search of four databases (all databases of the Cochrane Library, CA Web of Science, MEDLINE via PubMed, and Google Scholar) and additional manual searches were carried out, without language restrictions. Studies published between 2000 and 2017 years were selected. Reference lists of the included articles were screened, and authors were contacted when necessary., Risk of Bias: The following six parameters were analyzed: blinding of examiner and outcome assessment, incomplete outcome data before bonding and after debonding, selective outcome reporting, and incomplete reporting of EMCs assessment., Included Studies: Out of 430 potentially eligible studies, 259 were screened by title and abstract, 180 were selected for full-text analysis, 14 were included in the systematic review. Seven studies were selected for the meta-analysis., Synthesis of Results: The results for EMCs characteristics were expressed as mean differences (MDs) with their 95 per cent confidence intervals (CIs), and calculated from random-effects meta-analyses. Debonding was associated with the increase in number (three studies, MD = 3.50, 95% CI, 2.13 to 4.87, P < 0.00001), length (seven studies, MD = 3.09 mm, 95% CI, 0.75-5.43, P < 0.00001), and width (three studies, MD = 0.39 µm, 95% CI, -0.01 to 0.79, P = 0.06) of EMCs. Considerable statistical heterogeneity was found for two forest plots evaluating the changes of number and length characteristics during debonding., Conclusions: There is weak evidence indicating length and width of EMCs increase following bracket removal and the scientific evidence concerning quantitative evaluation of the number parameter before and after debonding is insufficient. However, there is a strong evidence that after debonding the number of EMCs is likely to increase., Registration: No registration was performed.

The purpose of this study was to evaluate and compare enamel micro-crack characteristics of adult patients before and after removal of metal brackets. After the examination with scanning electron microscopy (SEM), 45 extracted human teeth were divided into three groups of equal size: group 1, the teeth having enamel micro-cracks, group 2, the teeth without initial enamel micro-cracks, and group 3, control group to study the effect of dehydration on existing micro-cracks or formation of new ones. For all the teeth in groups 1 and 2, the same bonding and debonding procedures of metal brackets were conducted. The length and width of the longest enamel micro-crack were measured for all the teeth before and after removal of metal brackets. The changes in the location of the micro-cracks were also evaluated. In group 3, teeth were subjected to the same analysis but not bonded. The mean overall width of micro-cracks after removal of metal brackets was 3.82 μm greater than before bonding procedure (P < 0.05). Also, a significant difference was noticed between the width of micro-cracks in first zone (cervical third) and third zone (occlusal third) after debonding procedure (P < 0.05). New enamel micro-cracks were found in 6 of 15 (40 per cent) examined teeth. Greatest changes in the width of enamel micro-cracks after debonding procedure appear in the cervical third of the tooth. On the basis of this result, the dentist must pay extra care and attention to this specific area of enamel during removal of metal brackets in adult patients.