Case Presentation: A Simple Approach to Indirect Bonding in Orthodontics

Published Date 06/25/2019
 

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.

Laboratory Procedure
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.

Clinical Procedure
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.
 

GO-TO PRODUCTS USED IN THIS CASE
 
ULTRA-ETCH

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.

ULTRADENT PRODUCTS
800.921.4806 ext. 169
http://www.dps.li/a/68J-162
FLASHMAX P4 LIGHT PEN

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
http://www.dps.li/a/5R9-201

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