Tooth color is an important factor in smile esthetics and dental bleaching has emerged as an increasingly popular esthetic procedure, even for orthodontic patients.[1] The most common bleaching agent is hydrogen peroxide, with carbamide peroxide also being used, and sodium perborate used only in intracoronal and selected bleaching procedures.[1] However, when undergoing orthodontic treatment, the implications of bleaching can extend beyond color to the surface of the enamel that is the substrate to which orthodontic brackets are attached.[2]

Enamel changes caused by peroxide and/or bleaching can affect the polymerization of resin within the bracket and the bond of the bracket to the surface.[3] In a systematic review published by Boccuzzi et al. (2015), they found 11 studies with a total of about 1000 human and bovine teeth and concluded that bleaching has a negative effect on orthodontic bracket adhesion, but the degree of the effect depends on the type of bleaching agent used, concentration, bonding technique, and waiting time.[4]

The ability to achieve a successful orthodontic treatment is dependent upon maintaining good bracket adhesion during active tooth movement.[5] Bracket failure is a clinically significant issue as it can lengthen treatment time, add extra appointments, add to the overall cost of treatment, and disrupt intended treatment.[6] Another systematic review and meta-analysis Hardenet al. also highlighted that an inadequate bonding can lead to a longer treatment time, to a higher patient burden, and that the different types of bonding materials and techniques can affect bonding failure rates. Therefore, understanding factors that modify the bracket–enamel interface is important for achieving predictable orthodontic treatment outcomes.[7]

Decreased orthodontic adhesion due to bleaching can be mainly attributed to the alteration of the enamel substrate, and the presence of residual oxygen and peroxide products.[3] These changes can hinder resin infiltration and polymerization, which can affect bond strength and failure location. The shear bond strength (SBS) test is a method to determine the force necessary to debond an orthodontic bracket, while the Adhesive Remnant Index (ARI) provides additional information on the amount of adhesive left on the enamel after debonding.[8]

Clinically relevant is that failure at different interfaces can mean different consequences for preserving the enamel and for subsequent removal of the adhesives.[9] The failure pattern is of greater importance than bond strength, as recent evidence has demonstrated that the process of orthodontic debonding and adhesive clean-up can be responsible for measurable enamel loss.[10]

The purpose for the present study is that while recent studies have examined the effects of bleaching on orthodontic bracket bond strength, relatively little attention has been focused on the pattern and quantity of debonded adhesive, especially when the pattern of debonded adhesive is compared across different types of mechanical testing and various types of bleaching agents. In addition, there may be differences between visual and magnified ARI assessment that could affect the interpretation of adhesive failure.

A comparison of the effectiveness of 10% hydrogen peroxide, 10% carbamide peroxide (2 g sodium perborate) in terms of adhesive failures at various post-bleaching time periods can therefore be useful. This can be useful to orthodontists when determining when to bond and which techniques to use after bleaching to avoid unwanted enamel damage when brackets are removed and the adhesive cleaned up. Therefore, the present study was designed to compare the Adhesive Remnant Index (ARI) following orthodontic bracket debonding after bleaching with 10% hydrogen peroxide, 10% carbamide peroxide, and 2 g sodium perborate at 24 hours and seven days, using shear bond strength and microtensile strength testing and assessing adhesive remnants by naked-eye examination and 40× magnification.

A university-based experimental in-vitro study was carried out in the Department of Orthodontics, to evaluate the adhesive remnant patterns after orthodontic bracket debonding. The study was carried out over a period of 6 months, from October, 2025 to March 2026.

The total number of observations used in the experiment were 240. The sample size was determined by the formula that calculates the number of samples needed to estimate the prevalence of an outcome in a single population, where n = required sample size, Z = the standard normal value (1.96) for a 95% confidence level, p = the anticipated prevalence of the outcome (50%), q = 1-p (50%), and E = the margin of error (6.35%). Thus: n = (1.96)² × 0.50 × 0.50 / (0.0635)² ≈ 240.  Therefore, 240 observations were selected for this study, with the assessment of the adhesive remnant index (ARI) after debonding.

Tooth extraction was performed in the clinic and the teeth that were extracted met the set inclusion criteria, were selected at random for the study. The teeth were extracted and placed in 0.1% thymol solution for about one week at room temperature and then stored in distilled water and were included if they were stored in this way. Teeth that had their buccal surfaces intact and suitable for orthodontic bracket bonding were selected. It was placed in the center of the buccal surface as the bonding area. A jig was used for the preparation and mounting of the specimens to assure that the buccal bonding surface was kept at 90 degrees to the base of the mounting tube.

Any teeth that were inadvertently debonded during specimen preparation or testing were excluded. Chemically treated teeth, formalin, alcohol, hydrogen peroxide, and other bleaching solutions, were also excluded. Irregularly formed teeth and hypoplastic areas, dental fluorosis or history of endodontic treatment were not included.

The selected plants were randomly divided into four groups based on the treatments they received. Group 1: Non-bleached control teeth. Group 2 were teeth bleached using 10% hydrogen peroxide, Group 3 were teeth bleached with 10% carbamide peroxide, and Group 4 were treated with 2g sodium perborate. They were 10% hydrogen peroxide (Pola Office, SDI), 10% carbamide peroxide (Whiteness Perfect, FGM, Joinville, Brazil) and sodium perborate (Proderma, Piracicaba, Brazil).

The enamel surfaces of the buccal aspect of the natural teeth were cleaned for about 5 seconds with a rubber cup with water and a slow-speed handpiece, and then washed using water for 10 seconds and then air dried. Enamel surface of the control specimens was etched with 37% phosphoric acid for 30 seconds and rinsed for 10 seconds and then air dried. Bleaching materials (materials to be bleached) were prepared and applied following the directions given by the manufacturers. Specimens in each bleaching group were covered with a uniform layer of the assigned bleaching material on the buccal enamel surface of 1 mm thickness. The specimens were thoroughly washed and returned to room temperature distilled water after following the prescribed bleaching procedure.

The specimens were tested after 24 hours and seven days post-bleaching. The specimens were kept in distilled water during the bleaching, orthodontic bonding and testing procedures.

After the treatment period, a light cured orthodontic adhesive was used to bond the metallic orthodontic brackets to the central buccal enamel surface. Where necessary, O-rings were soldered to brackets to achieve proper positioning in the brackets slots. Any excess adhesive on brackets was carefully removed and brackets were securely placed on the enamel surface. The bonded specimens were kept in distilled water at room temperature until tested as per the procedure. Once the specified bonding and testing process was completed, the brackets were debonded using a universal testing machine. The mechanical loading was applied in standardized conditions for ensuring controlled removal of the brackets. The remaining adhesive on the enamel surfaces and the bases of the brackets were then assessed.

Measurement of the amount of adhesive remaining on the enamel post bracket debonding was done using the Adhesive Remnant Index (ARI).[11] All specimens were viewed first with the naked eye and then at 40×. The magnified assessment was performed using a Supereyes B008 USB digital microscope (500× maximum magnification; 5.0 MP, manual-focus) operated at 40× magnification for the study assessment. The amount of adhesive remaining on the enamel surface after debonding was noted to record the ARI score. Enamel surface and bracket bases were photographed and kept in the study record. The shear bond strength and microtensile strength test specimens were subjected to ARI for comparison between adhesive remnant patterns of the bleaching groups and the non-bleached control group.

Data were collected for each specimen using a structured data collection sheet, including the bleaching treatment, post-bleaching interval, type of bond-strength testing, visual assessment method and associated ARI score. Shear bond strength and microtensile strength were both tested and recorded separately, both with naked eye and at 40× magnification, with ARI. Shear bond strength and microtensile strength were both tested and recorded separately, both with naked eye and under 40× magnification, with ARI.

The analysis of data was done using SPSS (Version 20). Data on ARI scores for each study group and assessment method were reported in descriptive statistics. Mean, Standard deviation, minimum and Maximum values were calculated. To determine the normality of the distribution of the continuous variables, the values were evaluated before selecting the inferential statistical test. When the assumptions of parametric tests were met, one-way analysis of variance (ANOVA) was used to compare the means of the study groups. If multiple-group comparisons were significant, the least significant difference (LSD) post hoc test was performed for pairwise comparisons. A p value of ≤0.05 was used as the criterion for statistical significant.

After a seven-day shear bond strength test, the 10% hydrogen peroxide group had a majority of lower ARI scores, especially score 1, while the 10% carbamide peroxide and sodium perborate groups had a higher distribution of scores 2 and 3. The same overall trend was seen at the low end of the magnification levels (under 40×), but some movement within the ARI groupings became visible. In general, the adhesive remaining on the enamel surface was less with the H2O2 group than with the other bleaching groups. (Table 1)

Table 1. Distribution of ARI scores after shear bond strength at 7 days

All bleaching groups had scores no higher than 0 and 1, and in each group, the majority of the scores were 1 after 24 hours following shear bond strength testing. Therefore, in each of the bleaching groups, no specimens had ARI scores of 2 or 3 on this interval. At 24 hours, the pattern was the same whether assessed with the naked eye or at 40× magnification – there was consistency between the two assessment methods. (Table 2)

Table 2. Distribution of ARI scores after shear bond strength at 24 hours

Shear bond strength testing revealed that the non-bleached control group had only two and three scores of ARI. A few more specimens had scores of 3 than of 2, and no specimens had scores of 0 or 1. There was no difference in the observed ARI pattern between the naked-eye and 40× magnification assessment, suggesting that the magnification did not affect the observed ARI pattern in the control group. (Table 3)

Table 3. Distribution of ARI scores after shear bond strength in the non-bleached control group

The carbamide peroxide group had mostly ARI scores of 2 and 3, whereas the sodium perborate group had a similar distribution of scores, but with a higher percentage of score 2. The majority of the hydrogen peroxide group, on the other hand, had scores of 1 and 2 and no score 3 when evaluated with the naked eye. The sodium perborate group had a relatively high frequency of score 3 under 40× magnification, while hydrogen peroxide had a relatively high frequency of scores 1 and 2. (Table 4)

Table 4. Distribution of ARI scores after microtensile strength at 7 days

The majority (or most) of the results for the three bleaching groups on naked eye assessment for ARI at 24 hours after microtensile strength testing was score 1. Only the carbamide peroxide group showed any score 3, which was very few. The overall pattern was similar when the 40× assessment was used, though there were some moving between adjacent ARI categories, especially between 0, 1, and 2. (Table 5)

Table 5. Distribution of ARI scores after microtensile strength at 24 hours

The non-bleached control group after microtensile strength tests showed only ARI scores 2 and 3. Naked eye scores 3 was slightly more common while under 40× magnification scores 2 was the most common. In the shear bond strength control group, however, magnification caused a certain amount of variation in the observed distribution of adhesive remnants. (Table 6)

Table 6. Distribution of ARI scores after microtensile strength in the non-bleached control group

Shear bond strength at 40× magnification revealed a significant difference between the four study groups (p<0.001). The non-bleached control group had the highest mean score of the ARI, which indicates strong enamel surface retention, with the 10% carbamide peroxide group having the lowest mean score. The intermediate values were shown by the perborate and peroxide groups of Na. (Table 7)

Table 7. Comparison of ARI after shear bond strength under 40× magnification

After performing the microtensile strength tests under 40× magnification, the mean ARIs were found to be different among the study groups, but this difference was not statistically significant (p=0.829). The mean ARI for the carbamide peroxide group was the lowest while the group of sodium perborate had a mean similar to the non-bleached control. The findings here suggest that there was no significant difference between the bleaching treatments and control in the patterns of adhesive remnants obtained by microtensile tests as compared to shear bond strength tests. (Table 8)

Table 8. Comparison of ARI after microtensile strength under 40× magnification

There was also a significant difference between the mean ARI scores of the study groups (p<0.001) when the data were evaluated by naked eye after shear bond strength testing. The non-bleached control group had the highest mean ARI, whereas the 10% carbamide peroxide group had the lowest value. Sodium perborate and hydrogen peroxide gave intermediate mean scores, indicating that there was a significant change in the quantity of remaining adhesive on the enamel surface after debonding as a result of the bleaching treatment. (Table 9)

Table 9. Comparison of ARI after shear bond strength by naked-eye assessment

When the results of the microtensile strength were compared and the mean ARI score was used for naked-eye assessment, the differences between the four study groups were not statistically significant (p=0.101). The non-bleached samples had a mean ARI value similar to the sodium perborate group, with the carbamide peroxide and hydrogen peroxide groups having the lowest mean values. Therefore, it was found that there was no statistical difference in the results despite the observed variation in numbers. (Table 10)

Table 10. Comparison of ARI after microtensile strength by naked-eye assessment

In the present in-vitro study, it was found that the pattern of adhesive remnants after bracket debonding were affected by bleaching treatment, especially after shear bond strength testing. When viewed under 40×, there was a significant difference in ARI score between the non-bleached control and the carbamide peroxide, 2 g sodium perborate and 10% hydrogen peroxide groups (p<0.001). The highest mean ARI score was achieved by non-bleached control (2.53±0.50) while the lowest mean score was obtained by 10% carbamide peroxide (0.86±0.65). Statistically significant difference was found between the naked-eye assessment (p<0.001). On the other hand, there was no significant difference between the ARI values after microtensile testing at 40× magnification (p=0.829) and naked eye assessment (p=0.101). The results suggest that the effect of bleaching on the patterns of adhesive failure may vary with the mechanism of debonding.

The greater numbers of adhesive remaining attached to enamel shown by the higher ARI after the shear testing in the non-bleached control suggest that failure of the adhesive to enamel occurred with lower shear forces. This is in line with Sharma et al. (2025) where they compared unbleached teeth with the teeth treated using 10% carbamide peroxide and 35% hydrogen peroxide. Both bleaching groups had more ARI scores with lower adhesive retention, and the control group had higher adhesive retention. They also determined that their study showed a progressive decrease in shear bond strength after bleaching, with the lowest strength after applying 35% H2O2. This is similar to the present result and suggests a possible explanation of how bleaching affects the enamel–adhesive-underlying bond and increases failure near the enamel surface.[12]

The present results also concur with the results of Perciano and his colleagues (2021) which tested the impact of one and three bleaching sessions on orthodontic esthetic brackets. Their study employed bovine incisors and esthetic brackets, but the ARI score 3 was most prevalent in nearly all groups, including the unbleached control group, meaning that most of the adhesive was attached to the enamel/bracket system. The study also revealed that their absolute ARI distribution differs from what was found in the present study, which could be attributed to the bracket and adhesive system they used. However, it has been confirmed by both studies that a bleaching and orthodontic bonding should not be regarded separately when assessing the location of failure of the bonding.[13]

The results of Boccuzzi et al. (2023) give more general corroboration to the current results. The systematic review of 11 studies with some 1,000 human and bovine teeth yielded generally lower orthodontic bracket bond strength with bleaching; there was significant variation, however, between the various bleaching agents, concentrations, bracket types, bracket adhesives, and waiting periods. The authors found that bleaching may interfere with enamel bonding, and that orthodontic bonding delayed following bleaching may be more effective at bonding. The present study adds to this evidence by showing that the distribution of adhesive remnants also changes after debonding, especially for shear loading, as a consequence of the bleaching.[4]

A more pertinent comparison can be done with the work of Sadeghian et al. (2023) on Shear Bond Strength of Orthodontic Brackets under effects of bleaching, sodium ascorbate antioxidant treatment and delayed bonding. They evaluated the stud they studied after debonding and showed that bleaching and timing of bonding had effects on orthodontic adhesion. The authors also investigated if sodium ascorbate could reverse any negative effects of bleaching. The present study is distinguished from others by the lack of antioxidant intervention, and by directly comparing three bleaching materials. However, both studies uphold the idea that bleaching alters the enamel substrate and consequently influences the orthodontic adhesive's behavior.[14]

The effect of fluoride-containing and non-fluoride-containing in-office desensitizing agents on orthodontic bracket bonding was studied by Pamungkas, Karunia and Suparwitri (2024). They informed that the treatment for desensitization might provide better shear bond strength, but it did not significantly alter the ARI score. With regards to the results of the present invention, this is important given that it shows that the effect of ARI on bond strength does not always follow suit. After shear testing, significant difference in ARI was found in the present study, but no significant difference in microtensile testing results was found. Therefore, ARI does not seem to be a true measure of the intensity of the bond strength, but a measure of where bond failure occurs.[15]

Likewise, Ambersari, Karunia and Alhasyimi (2024) examined the different desensitizing treatments for metal brackets bonded after 37% hydrogen peroxide bleaching. Their study revealed that there significant differences in the distribution of the ARI, with the treatment group 2 showing ARI score 2 and the other treatment group showing ARI score 3. Their results show that the post-bleaching enamel treatment has an effect on the residual adhesive after debonding. The present investigation is unique in that a desensitizing agent was not added so it can examine the ARI patterns of carbamide peroxide, sodium perborate, and hydrogen peroxide directly. The marked difference found in the present shear-testing results is thus consistent with the overall findings that the post-bleaching enamel condition influences the adhesive failure behavior.[16]

The results obtained by Roy et al. (2025) are also applicable, as they evaluated the effects of 35% hydrogen peroxide on enamel and compared the performance of two different primer systems—conventional and moisture-insensitive—under dry and moist conditions. They also found that shear bond strength and ARI were significantly different for each bonding system for each moisture condition. They have shown that the extent of bleaching is not the only factor that affects the degree of ARI, but also the interaction between the enamel substrate, adhesive system and bonding environment. This could account for the differing results obtained after shear testing, but not after microtensile testing, in the present study, and for the different results obtained after these tests when investigating the same bleaching treatments.[17]

In addition, Ay and Dursun (2025) showed that bleaching of enamel could affect orthodontic bracket bonding. They tested 35% hydrogen peroxide bleaching in combination with various bonding methods and found statistically significant differences in the distribution of ARIs for some treatment groups. They found that there was no uniform pattern of adhesive failure in peroxide treated enamel. The 10% H2O2 showed an intermediate response on ARI after shear testing; the 10% carbamide peroxide was the lowest mean ARI in the present study. The variances obtained between these observations and studies performed with high concentration hydrogen peroxide could be due to differences in peroxide concentration, exposure procedure, adhesive system, and post-bleaching time.[18]

In recent years, Miranda-Castro et al. (2026) conducted a study that tested both shear bond strength (SBS) and ARI after bleaching with 22% carbamide peroxide and 35% hydrogen peroxide at 24 hours, 7 days and 14 days. They concluded that shear bond strength was significantly different with the different bleaching agents and different post-bleaching time, but the distributions of ARI were not significantly different among the waiting periods. In the present study, 24 hour and seven day assessments were also made and the ARI patterns were distinctly modified after the shear testing for bleaching groups. The present results indicate, however, that the bleaching agent may have a greater effect on ARI than the shorter post-bleaching interval studied. Another difference could be due to the different concentrations of perchlorate used, and the presence or absence of sodium perborate in the present study.[19, 21]

Wang, et al. (2026) confirm the significance of post-bleaching timing in their study. They tested bleaching, desensitizing, combined bleaching/desensitizing, and various bonding delays, from 24 hours to 3 weeks, using extracted human premolars. The researchers observed a much lower shear bond strength after bonding brackets 24 hours after bleaching than for the untreated control. Debonding ARI assessment was also performed during the investigation. These results agree with the current observation that the early post-bleaching period could be correlated with changes in adhesion. The present study further shows, however, that the magnitude and direction of the ARI response is dependent on the type of bleaching material and mechanical test applied.[20, 22]

The study by Schoppmeier et al. (2026), also a recent study, also gives new evidence regarding the interaction of whitening and orthodontic bracket bonding. They examined the bond of brackets when they were infiltrated with resin before bleaching with 25% hydrogen peroxide or 10% carbamide peroxide. In-office bleaching resulted in a lower shear bond strength than the negative control, but the effect was not as pronounced as observed for the home bleaching with 10% carbamide peroxide. The authors were thus able to show that the orthodontic adhesion can be impaired to a greater degree depending on the type of bleaching protocol used. It is consistent with the current result that the three bleaching treatments did not give exactly the same ARI patterns and that the three "bleaches" (carbamide peroxide, sodium perborate and hydrogen peroxide) have different distributions after shear testing.[3]

The 10% carbamide peroxide group had a relatively low ARI following shear testing, which should be taken into account. The present study demonstrated the lowest mean ARI with the use of carbamide peroxide, but this is not indicative of the overall effect of carbamide peroxide as an orthodontic bonding deconstructor. The recent literature, however, is inconsistent about the effect of using either carbamide peroxide or hydrogen peroxide, and Boccuzzi et al. (2023) pointed out the variability in the literature about the carbamide peroxide or hydrogen peroxide concentration and protocol used. In the present study, hydrogen peroxide concentration was 10% while Sharma et al. (2025) used 35% hydrogen peroxide, showing that the bond strength reduced more significantly in the former group. Variations in concentration, exposure duration, transformation of the carbamide peroxide into hydrogen peroxide, adhesive composition and testing modality, may then explain the various patterns found between studies.

Limitations

There are in-vitro studies that have been performed under laboratory conditions and settings; these may not completely replicate the complex oral environment, such as saliva, temperature changes, chewing motion, and extended exposure to bleaching agents. The study compared certain bleaching agents and post-bleaching times and the results may not be applicable to all bleaching products or concentrations or clinical circumstances. In addition, it is possible that there could be some subjective interpretation of the assessment of ARI even though the magnification is standardized.

The patterns of adhesive remnant after shear debonding were significantly different and were more likely to have adhesive removed from the bleached enamel than the non-bleached enamel. These effects were especially marked after 7 days, while a comparatively small difference was seen among the groups in the microtensile tests. The results emphasize the need to pay attention to both the bleaching protocol and timing for orthodontic bonding in treatment planning, and to the patterns of adhesive failure and to preserve enamel.

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