Table.
Recommendations and safety measures to minimize aerosols in orthodontic practice, per procedure
| Procedure | Aerosol-liable actions (conventional) | Safety measures | Future perspectives |
|---|---|---|---|
| Etching | |||
| High thickness and/or viscosity gel | Liquid gel and/or low viscosity | Nonetching mediated bonding | |
| Self-etching primer and/or no rinsing | |||
| Glass-ionomer cement and/or no rinsing | |||
| Bonding | |||
| Conventional resin-based adhesive | Glass-ionomer cement | Biomimetic based bonding with use of L-DOPA primers | |
| BPA-free adhesives | |||
| Debonding | |||
| Standard debonding with considerable amounts of adhesive remnants on enamel surface | Alteration of adhesive-bracket base interface | Command-debond adhesives (thermally expandable particles and ferrous micro-particles) | |
| Identify bracket base mesh and/or shape and/or size and adhesive combination for cohesive resin fracture | Irradiation of specific wavelength to reverse polymerization | ||
| Biomimetic bonding agents would eliminate use of rotary instrumentation | |||
| Standard rotary grinding to clean-up enamel | Removal of significant amounts of resin remnants with hand-instruments—avoid rotary instrumentation as much as possible | Temperature control and variation of adhesives (heat and/or freezing) plasticization and/or brittleness | |
| Use of tungsten burs∗ w/o water cooling for limited trace composite remnants (ie, individually debonded brackets during treatment) | |||
| Use of tungsten burs∗, under water cooling for enamel clean-up after debonding and/or attachment removal | |||
| Attachment grips for aligner treatment | Careful selection of patients and/or malocclusions for treatment with aligners; abandon company preset distribution of arrays of attachments | ||
| Attachment-free aligner treatment | |||
| Use of BPA-free composite to eliminate estrogenic activity (ie, PCDMA) | |||
| Preprocedural measures | Mouthrinse with (47°C) CHX 0.12%-0.2% for bacterial pathogens (0.5-1 min) | ||
| Mouthrinse with 0.2%-1% PI or 1% H2O2 for oxidation vulnerable viruses (0.5-1 min) | |||
| Personnel equipment and/or settings | Facemask, shield, gown, apparel for all clinic personnel, and fresh air and surgical suction |
L-DOPA, L-3,4-dihydroxyphenylalanine; w/o, without; PCDMA, phenylcarbamoyloxy-propane dimethacrylate; H2O2, hydrogen peroxide.
∗
Smaller number of flutes in the beginning of removal, advancing to 20-fluted for polishing.