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CASE PRESENTATION: A Simple Approach to Indirect Bonding in Orthodontics

Categories: Orthodontics

Author(s): Melissa Shotell DMD, MS

Date: 05-18-2020 11:17:53 am

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 should be taken at the appointment prior to bonding. Models can be 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 will ensure the sectional trays can be removed from the models. The long access and height of contour of each tooth can be marked with a pencil to allow for easy visualization during bracket placement.

Orthodontic brackets (Empower Self-Ligating, American Orthodontics) are then positioned 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 is used to fabricate sectional trays and is readily available from any hobby store. The occlusal surface of the models and one-half of the bracket, including the slot, should be covered with the hot glue. The models are then soaked in warm water to remove the sectional trays; the brackets should remain in the sectional tray when removed. The sectional trays can then be placed in a small container with water and liquid dish soap in the ultrasonic to remove any pieces of plaster that may have adhered, then thoroughly rinsed with water. All sectional trays should be thoroughly dried prior to use.

Clinical Procedure

Standard isolation was achieved utilizing an OptraGate (Ivoclar Vivadent), and 35% phosphoric acid etch (Ultra-Etch, Ultradent) was 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 pealing motion, and brackets are light-cured again. Excess composite is then removed using a scaler or carbide finishing bur.


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