Case Presentation: A Simple Approach to Indirect Bonding in Orthodontics
Precision bracket placement in orthodontics can be a challenge with even the most cooperative of patients. Tough visibility, poor isolation, and an active tongue are some of the many challenges when trying to place orthodontic brackets. Indirect bonding technique allows for accurate and precise bracket placement on a model that can then be transferred to the patient for quick, efficient, and precise bracket placement.
Multiple techniques can be utilized for indirect bonding. The following cases utilize an in-office workflow that can be incorporated into everyday practice, avoiding costly lab bills and shortening initial bonding appointments.
High-quality alginate impressions are taken at the appointment prior to bonding. Models are fabricated in Microstone or Laboratory Plaster (Whip Mix). Two coats of Al-Cote Separating Agent (Dentsply Sirona) are applied to the models and allowed to dry—this ensures that the sectional trays can be removed from the models. The long access and height of contour of each tooth are marked with a pencil to allow for easy visualization during bracket placement.
Orthodontic brackets (Empower Self-Ligating, American Orthodontics) are then placed on the models in the ideal position, utilizing orthodontic bracket adhesive (Transbond Adhesive, 3M). The brackets are then light-cured on the model (FlashMax P4 LED curing light, Rocky Mountain Orthodontics).
A thin layer of model separator (Great Lakes Separator, Great Lakes Orthodontics) is applied to the brackets and to the occlusal surface of the models. Low-temperature hot glue (available from any hobby store) is used to fabricate sectional trays. The occlusal surface of the models and one-half of the bracket, including the slot, are covered with the hot glue. The models are then soaked in warm water to remove the sectional trays; the brackets remain in the sectional tray when removed. The sectional trays are then placed in a small container with water and liquid dish soap in the ultrasonic to remove any pieces of plaster that may have adhered, and then thoroughly rinsed with water. All sectional trays are thoroughly dried prior to use.
Standard isolation is achieved utilizing an OptraGate (Ivoclar Vivadent), and 35% phosphoric acid etch (Ultra-Etch, Ultradent) is applied to the bonding surfaces of the teeth, then rinsed and primer applied (Transbond Primer, 3M) and light-cured. A small amount of flowable adhesive (Transbond Supreme LV Low Viscosity Light Cure Adhesive, 3M) is applied to the adhesive on the bracket pads, and sectional trays are transferred to the mouth.
The sectional trays are held firmly against the teeth as they are light-cured. Sectional trays are then removed using a scaler and a peeling motion, and brackets are light-cured again. Excess composite is then removed using a scaler or carbide finishing bur.
Figure 1—Orthodontic adhesive (Transbond Adhesive, 3M) is applied to the bracket (Empower Self-Ligating, American Orthodontic Products) and each is placed on the models in the desired position. Brackets are light-cured on the models for 15 seconds each.
Figure 2—Model separator is applied to the surface of each bracket and low-temperature hot glue is used to fabricate sectional trays. The occlusal surfaces of the teeth and half of the bracket including the slot should be covered with the hot glue.
Figure 3—Proper isolation for bonding is achieved using an OptraGate (Ivoclar) with cotton rolls, and 35% phosphoric acid etch (Ultra-Etch, Utradent) is applied to the teeth for 30 seconds and vigorous irrigation achieved.
Figure 4—Bonding agent (Transbond Primer, 3M) applied to each tooth and light-cured.
Figure 5—Translucent flowable adhesive resin (Transbond Supreme LV Low Viscosity Light Cure Adhesive, 3M) is applied to the bracket pad.
Figure 6—The sectional tray is placed over the teeth in the desired numerical position, fully adapting the tray and brackets in desired positions.
Figure 7—The trays with brackets and adhesive in position are light-cured for 20 seconds each. The translucent nature of the hot glue allows for light curing directly through the trays, simplifying the curing process.
Figure 8—The remainder of the trays are positioned and light-cured.
Figure 9—The final appearance of the sectional trays in place.
Ultra-Etch is a 35% phosphoric acid solution that features ideal viscosity for precise placement and superior control, without premature drying. It is selflimiting in its depth of etch, which creates an etch pattern that adhesives can penetrate for increased bond strength and reduced sensitivity.
800.921.4806 ext. 169
FlashMax P4 Light Pen is one of the world’s most powerful curing lights. Cure time on one charge is approximately 500 seconds (approximately 20 or more quadrants). Covers are disposable and available in bags of 10 pieces. Tips easily click on and off, and can be adjusted 30 degrees for optimal access. A 4- or 8-mm tip is available.
ROCKY MOUNTAIN ORTHODONTICS
800.921.4806 ext. 118