Indirect Bonding Techniques for Optimal Orthodontic Treatment
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The document discusses various methods of indirect bonding in orthodontics. It describes several techniques developed between 1972-2007, including the Silverman technique, Simmons technique, Thomas technique, Rajagopal technique, Sondhi method, Kalange technique, Koga technique, and Moskowitz technique. It details the laboratory and clinical procedures for each method. The goal of indirect bonding is to transfer brackets to teeth using models and transfer trays for more accurate placement and reduced chairside time compared to direct bonding.
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Indirect Bonding Techniques for Optimal Orthodontic Treatment
- 1. 1 INDIRECT BONDING DR. ANJU SARAH JACOB
- 2. CONTENTS ■ INDIRECT BONDING ■ LIMITATIONS OF DIRECT BONDING ■ METHODS OF INDIRECT BONDING ■ STUDIES (DIRECTVS INDIRECT BONDING) ■ REFERENCES 2 DR. ANJU JACOB
- 3. Indirect Bonding DR. ANJU JACOB
- 4. DR. ANJU JACOB 4 WHAT IS INDIRECT BONDING? KalangeJT,Thomas RG. Indirect bonding: a comprehensive review of the literature. Semin Orthod. 2007;13:3-10 “Indirect Bonding is technique in which orthodontic brackets and other attachments are transferred from dental casts (working models) and placed on to the dentition using a transfer device”
- 5. DR. ANJU JACOB 5 LIMITATIONS OF DIRECT BONDING Zachrisson B, BüyükyılmazT. Bonding in orthodontics. In: GraberTM,Vanarsdall R,Vig K, eds. Orthodontics:Current Principles andTechniques. 6th ed. St. Louis: Mosby; 2017:812–867 Limited access to malposed tooth Poor visualization of posterior teeth Increased chair side time Greater chances of moisture contamination
- 6. DR. ANJU JACOB 6 METHODS OF INDIRECT BONDING SILVERMANAND COHENTECHNIQUE (1972) IMPROVED LABORATORY PROCEDURE FOR INDIRECT BONDINGOF ATTACHMENTS (MICHAEL D. SIMMONS, 1978) THOMASTECHNIQUE (1979) A NEW INDIRECT BONDINGTECHNIQUE (RAJAGOPAL, 2004) THE SONDHI METHOD (ANOOP SONDHI, 2007)
- 7. DR. ANJU JACOB 7 METHODS OF INDIRECT BONDING PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING (JOHNT. KALANGE, 2007) QUICK IDBS (MASATADA KOGA, 2007) INDIRECT BONDINGWITH ATHERMAL CURED COMPOSITE (MOSKOWITZ, 2007) THE ACCUBOND SYSTEM (MICHAEL C. ALPERN, 2009) A NEW APPROACHTO INDIRECT BONDING (AKHTER HUSAIN, 2009)
- 8. DR. ANJU JACOB A UNIVERSAL DIRECT BONDING SYSTEM FOR BOTH METAL & PLASTIC BRACKETS – SILVERMAN ET AL, 1972 Silverman E, Cohen M, Gianelly AA, DietzVS. A universal direct bonding system for both metal and plastic brackets. AmJ Orthod. 1972;62:3. 8 Silverman et al, 1972 ADHESIVE SYSTEM PLACEMENT OF BRACKETS Bisphenol A + Glycidal methacrylate (3 parts) Methyl methacrylate monomer (1 part) 5 parts liquid 2 parts powder Pit and fissure sealant (Buonocore) Experimental adhesive (GAC)
- 9. DR. ANJU JACOB Silverman E, Cohen M, Gianelly AA, DietzVS. A universal direct bonding system for both metal and plastic brackets. AmJ Orthod. 1972;62:3. 9 • 2 sets of casts prepared • Brackets are tacked to the teeth, using the bracket adhesive cement (1 drop / bracket) • Each cast is placed in aVanguard unit, and a plastic wafer is centered over the model • The plastic tray is then carefully removed from the cast A UNIVERSAL DIRECT BONDING SYSTEM FOR BOTH METAL & PLASTIC BRACKETS – SILVERMAN ET AL, 1972
- 10. DR. ANJU JACOB Silverman E, Cohen M, Gianelly AA, DietzVS. A universal direct bonding system for both metal and plastic brackets. AmJ Orthod. 1972;62:3. 10 • Isolation, etching of teeth is done & sealant painted (Prevent bridging of teeth) • The NuvaSeal gun, with its ultraviolet light waves (30 seconds for each tooth) • The bonding cement is mixed to a syrupy consistency & placed on each bracket • Tray inserted into mouth and held for 5 minutes to ensure setting of the cement. A UNIVERSAL DIRECT BONDING SYSTEM FOR BOTH METAL & PLASTIC BRACKETS – SILVERMAN ET AL, 1972
- 11. DR. ANJU JACOB IMPROVED LABORATORY PROCEDURE FOR INDIRECT BONDING OF ATTACHMENTS - MICHAEL D. SIMMONS, 1978 Simmons MD. Improved laboratory procedure for indirect bonding of attachments. JClin Orthod. 1978;12(4):300‐302. 11 • Uses caramel candy softened and preloaded into syringe Small amount of caramel is warmed (50⁰ C) & loaded into syringe Preloaded syringe is warmed to 50⁰ C for 5 min (Soften caramel) Caramel holds bracket in place Impression made with brackets positioned Syringe loaded with adhesive, applied to bracket bases Impression removed with brackets bonded
- 12. DR. ANJU JACOB INDIRECT BONDING: SIMPLICITY IN ACTION – ROYCE G.THOMAS, 1979 12 • Modification of Silverman & CohenTechnique Determine bracket position on model: • Mix each bonding resin paste - Catalyst (B) and Universal (A) and apply to the bracket • Place bracket in desired position • Allow bonding material to set at least 10 minutes before forming tray Tray formation: • 5" square sheets of bioplast used • Model is dipped into water (3-5 seconds) & placed under a dry heat source with the arch blank on top (drapes down) • Vacuum is applied till good adaptation occurs • The tray removed, trimmed & backs of the bases are lightly abraded Thomas RG. Indirect bonding: simplicity in action.J ClinOrthod. 1979;13(2):93‐106
- 13. DR. ANJU JACOB INDIRECT BONDING: SIMPLICITY IN ACTION – ROYCE G.THOMAS, 1979 Thomas RG. Indirect bonding: simplicity in action.J ClinOrthod. 1979;13(2):93‐106 13 Clinical Procedure • All teeth that are to receive brackets are polished, isolated, etched and dried • Inside of the tray Concise Enamel Bond Catalyst (Part B) liquid Teeth Concise Enamel Bond Universal (Part A) liquid • The tray is inserted into the mouth, seated fully and held to place for 1½ minutes • The tray is then removed from the lingual toward the buccal Advantages: • Accurate • Chairside time greatly reduced
- 14. DR. ANJU JACOB A NEW INDIRECT BONDINGTECHNIQUE – RAJAGOPAL, 2004 Rajagopal R,Vankatesan A,Gnanashanmugham K, Harish Babu S. A new indirect bonding technique.J ClinOrthod. 2004;38(11):600‐602 14 • Existing systems attached brackets to working cast • If adhesive mesh not removed Bond strength is compromised • Reason for development: 1. Leaves an adhesive-free mesh prior to bonding 2. Uses readily available materials for bonding Long axes and bracket height scribed Brackets affixed to adhesive side of tape Tape cut around each bracket
- 15. DR. ANJU JACOB Rajagopal R,Vankatesan A,Gnanashanmugham K, Harish Babu S. A new indirect bonding technique.J ClinOrthod. 2004;38(11):600‐602 15 Tray placed Cyanoacrylate glue applied to non adhesive side of tape Result after indirect bonding Brackets placed on cast Brackets with adhesive free mesh embedded in tray material A NEW INDIRECT BONDINGTECHNIQUE – RAJAGOPAL, 2004
- 16. DR. ANJU JACOB EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi, Anoop. (2007). Effective and Efficient Indirect Bonding:The Sondhi Method. Seminars inOrthodontics. 13. 43-57 16 • New indirect bonding resin introduced (3M Unitek) • Advantages of new indirect resin 1. The viscosity of resin increased Fill voids in the custom base without compromising bond strength 2. Quick set time (30 seconds)
- 17. DR. ANJU JACOB EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi, Anoop. (2007). Effective and Efficient Indirect Bonding:The Sondhi Method. Seminars inOrthodontics. 13. 43-57 17 LABORATORY PROCEDURE: Working models Al Cote separating medium Brackets placed Light curing chamber (10 minutes)
- 18. DR. ANJU JACOB EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi, Anoop. (2007). Effective and Efficient Indirect Bonding:The Sondhi Method. Seminars inOrthodontics. 13. 43-57 18 Preparation Of BondingTrays: Biostar tray (1.5mm Bioplast + 0.75mm Biocryl) First layer – Bioplast & trimmed Additional curing of trimmed trays Silicone transfer tray Maxillary bonding tray Biocryl formed over Bioplast Excess material trimmed
- 19. DR. ANJU JACOB EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi, Anoop. (2007). Effective and Efficient Indirect Bonding:The Sondhi Method. Seminars inOrthodontics. 13. 43-57 19 CLINICAL PROCEDURE: Preparation Of Patient Pumicing done Adhesive application Resin B applied to tray ResinA applied to teeth Etchant applied Etched tooth surfaces
- 20. DR. ANJU JACOB EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi, Anoop. (2007). Effective and Efficient Indirect Bonding:The Sondhi Method. Seminars inOrthodontics. 13. 43-57 20 Insertion of trays: Tray placed Excess removed Removal of tray
- 21. DR. ANJU JACOB PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHNT. KALANGE, 2007 Kalange, John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars inOrthodontics. 13. 19-42 21 Advantages Over OtherTechniques • Horizontal &Vertical lines drawn (Template) • Quick, efficient, accurate & reliable • Bonding time reduced • Enhances patient comfort Recontour the incisal edges of the anterior teeth Working models
- 22. DR. ANJU JACOB PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHNT. KALANGE, 2007 Kalange, John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars inOrthodontics. 13. 19-42 22 Armamentarium Used Horizontal & vertical reference lines Horizontal line (Red) : Marginal ridge lines Vertical line : Long axis of teeth Slot line 1:3 (separating medium: water) applied in two light coats
- 23. DR. ANJU JACOB PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHNT. KALANGE, 2007 Kalange, John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars inOrthodontics. 13. 19-42 23 Brackets are placed in pairs Excess removed Light Cured Bracket positioning verified
- 24. DR. ANJU JACOB PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHNT. KALANGE, 2007 Kalange, John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars inOrthodontics. 13. 19-42 24 Polyvinyl siloxane (PVS) mixed in equal parts PVS material adapted to the brackets and models Trays are cleaned with distilled water and a clean toothbrush Final trays trimmed
- 25. DR. ANJU JACOB PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHNT. KALANGE, 2007 Kalange, John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars inOrthodontics. 13. 19-42 25 Etchant applied Bonding agent applied to teeth & custom resin base Trays inserted Trays removed Excess material removed
- 26. DR. ANJU JACOB QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada &Watanabe, Kazuya & Koga,Takako. (2007). Quick Indirect BondingSystem (Quick IDBS): An Indirect BondingTechniqueUsing a Double- Silicone BracketTransferTray. Seminars in Orthodontics. 13. 11-18 26 • Uses a double silicone bracket transfer tray Working models Reference lines are marked Brackets are placed Light curing
- 27. DR. ANJU JACOB QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada &Watanabe, Kazuya & Koga,Takako. (2007). Quick Indirect BondingSystem (Quick IDBS): An Indirect BondingTechniqueUsing a Double- Silicone BracketTransferTray. Seminars in Orthodontics. 13. 11-18 27 Attach white wax 2-3mm gingival to facial side & cervical areas on palatal / lingual surfaces Injection of soft silicone followed by hard silicone The plastic film surrounds the model and serves to forms the facial wall of the tray
- 28. DR. ANJU JACOB QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada &Watanabe, Kazuya & Koga,Takako. (2007). Quick Indirect BondingSystem (Quick IDBS): An Indirect BondingTechniqueUsing a Double- Silicone BracketTransferTray. Seminars in Orthodontics. 13. 11-18 28 Once silicone has set, remove plastic film and white wax Detach the tray beginning from the posterior end Final seating of tray Initial archwire inserted
- 29. DR. ANJU JACOB QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada &Watanabe, Kazuya & Koga,Takako. (2007). Quick Indirect BondingSystem (Quick IDBS): An Indirect BondingTechniqueUsing a Double- Silicone BracketTransferTray. Seminars in Orthodontics. 13. 11-18 29 ADVANTAGES: 1. Firm, dimensionally stable 2. Easy to check bracket position 3. Esthetic DISADVANTAGES: 1. Technique sensitive 2. Silicone begins to set at room temperature and must be handled carefully. 3. The high cost of the silicone.
- 30. DR. ANJU JACOB INDIRECT BONDINGWITH ATHERMAL CURED COMPOSITE (MOSKOWITZ, 2007) Moskowitz, Elliott. (2007). Indirect Bonding with aThermal Cured Composite. Seminars in Orthodontics. 13. 69-74. 30 • Modification ofThomasTechnique It uses • Thermally cured composite material. • Reprosil - vinyl polysiloxane impression material (PVS) • Vacuum-form Essix 0.020 inch (0.5 mm) clear material tray
- 31. DR. ANJU JACOB INDIRECT BONDINGWITH ATHERMAL CURED COMPOSITE (MOSKOWITZ, 2007) Moskowitz, Elliott. (2007). Indirect Bonding with aThermal Cured Composite. Seminars in Orthodontics. 13. 69-74. 31 Light bodied polyvinylsiloxane (PVS) impression material applied over all brackets, extending onto occlusal or incisal surfaces and onto lingual surfaces Essix tray formed Trays separated and trimmed Inside of bracket-tray complex after washing and lightly abrading composite surfaces
- 32. DR. ANJU JACOB INDIRECT BONDINGWITH ATHERMAL CURED COMPOSITE (MOSKOWITZ, 2007) Moskowitz, Elliott. (2007). Indirect Bonding with aThermal Cured Composite. Seminars in Orthodontics. 13. 69-74. 32 Enamel surfaces etched Unfilled bonding resin mixed and applied to the composite bases of brackets and teeth The trays are seated & held in place for approx 1 minute. Kept in place for 4 more minutes Excess material can be removed with scaler / floss
- 33. DR. ANJU JACOB THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern, Michael & Primus, Carolyn & Alpern, Ada. (2009).The AccuBond system for indirect orthodontic bonding.Journal of clinical orthodontics : JCO. 43. 572-6; 33 • Uses 2 adhesives to create a customised base for each bracket Ultrafluid material which interlocks with the retentive elements in bracket base A polymer covers this to form custom base
- 34. DR. ANJU JACOB THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern, Michael & Primus, Carolyn & Alpern, Ada. (2009).The AccuBond system for indirect orthodontic bonding.Journal of clinical orthodontics : JCO. 43. 572-6; 34 LABORATORY PROCEDURE: • Using a 10-megapixel digital camera and a macro lens, the lab takes close-up images of each bracket from three angles and posts them on a secure website • Each view includes a millimeter gauge to facilitate adjustments • Orthodontist must view the brackets and approve the positions Polyvinyl siloxane full arch impression Brackets placed with reference lines
- 35. DR. ANJU JACOB THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern, Michael & Primus, Carolyn & Alpern, Ada. (2009).The AccuBond system for indirect orthodontic bonding.Journal of clinical orthodontics : JCO. 43. 572-6; 35 CLINICAL PROCEDURE: • Cleaning, polishing, etching & drying is done • AccuBond primer/sealant to the inner surfaces of each mandibular custom bases & the teeth & Light cure them
- 36. DR. ANJU JACOB THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern, Michael & Primus, Carolyn & Alpern, Ada. (2009).The AccuBond system for indirect orthodontic bonding.Journal of clinical orthodontics : JCO. 43. 572-6; 36 CLINICAL PROCEDURE: Final tray removal Removal of blue inner liner with scaler Bioforce wire placed immediately with full bracket slots
- 37. DR. ANJU JACOB A NEW APPROACHTO INDIRECT BONDING (AKHTER HUSAIN, 2009) Husain, Akhter & Ansari,Tariq & Mascarenhas, Rohan &Shetty, Sandeep. (2009). A new approach to indirect bonding.Journal of clinical orthodontics :JCO. 43. 652-4. 37 DRAWBACKS OF INDIRECTTECHNIQUES: 1. Occlusogingival insertion of a transfer tray causes the adhesive-coated bracket to scrape along the long axis of each tooth 2. When opaque transfer trays are used Prevents light-curing from palatal / occlusal PROCEDURE Brackets placed on working cast with water-soluble adhesive. Working cast centered on flat, horseshoe- shaped platform. Putty applied over buccal surface of cast.
- 38. DR. ANJU JACOB Husain, Akhter & Ansari,Tariq & Mascarenhas, Rohan &Shetty, Sandeep. (2009). A new approach to indirect bonding.Journal of clinical orthodontics :JCO. 43. 652-4. 38 Two sticks of acrylic bent at 90° angles and attached to form handles Tray tried in patient’s mouth Midline marked on transfer tray Bracket bases cleaned with brush Primer applied to bracket bases Brackets after curing A NEW APPROACHTO INDIRECT BONDING (AKHTER HUSSAIN, 2009)
- 39. DIRECT VS INDIRECT BONDING 39 DR. ANJU JACOB
- 40. DR. ANJU JACOB SHEAR BOND STRENGTH COMPARISON BETWEEN DIRECT AND INDIRECT BONDED ORTHODONTIC BRACKETS Yi GK, DunnWJ,Taloumis LJ. Shear bond strength comparison between direct and indirect bonded orthodontic brackets. AmJ Orthod DentofacialOrthop. 2003;124(5):577‐581 40 • 54 extracted premolars were mounted & randomly divided into 2 groups . Orthodontic brackets bonded to premolars with an indirect bonding adhesive system Brackets were bonded with the direct method • The mean shear bond strengths were Indirect group – 11.2 MPa Direct group – 10.9 Mpa • Both exceeding the minimum shear bond strength range of 5.9 to 7.8 MPa often cited in the literature for clinical success.
- 41. DR. ANJU JACOB ASSESSMENT OF BRACKET PLACEMENT AND BOND STRENGTHWHEN COMPARING DIRECTTO INDIRECT BONDINGTECHNIQUES Aguirre MJ, King GJ,WaldronJM. Assessment of bracket placement and bond strength when comparing direct bonding to indirect bonding techniques. AmJ Orthod. 1982;82(4):269‐276 41 The techniques were compared with respect to 4 factors: Bracket placement • Vertical bracket placement : No statistically significant differences. Maxillary canines indirect technique yielded better results Mandibular 2nd premolars direct-bonded brackets placed closer to ideal • Angular bracket placement : Statistically significant differences Maxillary & mandibular canines Indirect bonds more accurate. Bond strength • Great variability
- 42. DR. ANJU JACOB ASSESSMENT OF BRACKET PLACEMENT AND BOND STRENGTHWHEN COMPARING DIRECTTO INDIRECT BONDINGTECHNIQUES Aguirre MJ, King GJ,WaldronJM. Assessment of bracket placement and bond strength when comparing direct bonding to indirect bonding techniques. AmJ Orthod. 1982;82(4):269‐276 42 Rate of failure • Bracket failures (3 months after appliance placement) 4.5% (indirect technique) 5.3% (direct technique) Clinical & Laboratory time • Direct bonding technique 42.18 minutes • Indirect bonding technique 53.73 minutes (23.91 minutes - actual clinical time)
- 43. DR. ANJU JACOB COMPARISON OFTHE ACCURACY OF BRACKET PLACEMENT BETWEEN DIRECT & INDIRECT BONDING TECHNIQUES Koo BC, Chung CH,Vanarsdall RL. Comparison of the accuracy of bracket placement between direct and indirect bonding techniques. AmJ Orthod DentofacialOrthop. 1999;116(3):346‐351 43 • 19 sets of duplicated Class II malocclusion models were divided into 3 groups 1. Ideal bracket placement (1 set) 2. Direct bonding on mannequins (9 sets) 3. Indirect bonding (9 sets) • Overall, indirect bonding showed better bracket placement in bracket height whereas, no statistically significant difference was found regarding the angulation and mesiodistal position.
- 44. DR. ANJU JACOB ■ Anusavice, K. J., Phillips, R.W., Shen, C., & Rawls, H. R. (2013). Phillips' science of dental materials. St. Louis, Mo: Elsevier/Saunders ■ GraberTM,Vanarsdall R,Vig K, eds. Orthodontics: Current Principles andTechniques. 6th ed. St. Louis: Mosby ■ Schmage P, Nergiz I, Herrmann W, Ozcan M. Influence of various surface-conditioning methods on the bond strength of metal brackets to ceramic surfaces. Am J Orthod Dentofacial Orthop. 2003;123(5):540‐546 ■ Kalange JT,Thomas RG. Indirect bonding: a comprehensive review of the literature. Semin Orthod. 2007;13:3- 10 ■ Silverman E, Cohen M, Gianelly AA, DietzVS. A universal direct bonding system for both metal and plastic brackets. Am J Orthod. 1972;62:3. ■ Simmons MD. Improved laboratory procedure for indirect bonding of attachments. J Clin Orthod. 1978;12(4):300‐302. ■ Rajagopal R,Vankatesan A, Gnanashanmugham K, Harish Babu S. A new indirect bonding technique. J Clin Orthod. 2004;38(11):600‐602 ■ Koo BC, Chung CH,Vanarsdall RL. Comparison of the accuracy of bracket placement between direct and indirect bonding techniques. Am J Orthod Dentofacial Orthop. 1999;116(3):346‐351 44 REFERENCES
- 45. DR. ANJU JACOB ■ Thomas RG. Indirect bonding: simplicity in action. J Clin Orthod. 1979;13(2):93‐106 ■ Sondhi, Anoop. (2007). Effective and Efficient Indirect Bonding:The Sondhi Method. Seminars in Orthodontics. 13. 43-57 ■ Kalange, John. (2007). Prescription-Based Precision FullArch Indirect Bonding. Seminars in Orthodontics. 13. 19-42 ■ Koga, Masatada &Watanabe, Kazuya & Koga,Takako. (2007). Quick Indirect Bonding System (Quick IDBS): An Indirect BondingTechnique Using a Double-Silicone BracketTransferTray. Seminars in Orthodontics. 13. 11-18 ■ Moskowitz, Elliott. (2007). Indirect Bonding with aThermal Cured Composite. Seminars in Orthodontics. 13. 69-74. ■ Alpern, Michael & Primus, Carolyn & Alpern, Ada. (2009).The AccuBond system for indirect orthodontic bonding. Journal of clinical orthodontics : JCO. 43. 572-6; ■ Husain, Akhter & Ansari,Tariq & Mascarenhas, Rohan & Shetty, Sandeep. (2009). A new approach to indirect bonding. Journal of clinical orthodontics : JCO. 43. 652-4. ■ Aguirre MJ, King GJ,Waldron JM. Assessment of bracket placement and bond strength when comparing direct bonding to indirect bonding techniques. Am J Orthod. 1982;82(4):269‐276 ■ Yi GK, DunnWJ,Taloumis LJ. Shear bond strength comparison between direct and indirect bonded orthodontic brackets. Am J Orthod Dentofacial Orthop. 2003;124(5):577‐581 45 REFERENCES
- 46. Thank You!
Editor's Notes
- Good afternoon everyone. Today I will be continuing with the 3rd and last session of my seminar on Evolution of Brackets – Part II
- I will be continuing with steps in bonding to enamel & artificial tooth surfaces. I will also be talking about indirect bonding in detail
- Advantages of indirect bonding: Reduced chair time Brackets more accurately positioned Improved efficiency and patient comfort
- The concept of indirect bonding was first mentioned in the literature during the mid- to late 1970s. In the initial trials, softened candy was used to position brackets, and chemically cured filled resins were used to bond the brackets to the teeth Significant amount of flash remaining around the bracket, and the cleanup of the resin presented a significant problem New adhesives introduced
- One of the first few articles to throw light on indirect bonding. They tested an adhesive technique for placing metal or plastic orthodontic attachments directly to the enamel surfaces of all teeth. This article will dealt with two important facets of the technique - the adhesive system and the vehicle by which the brackets are placed upon the teeth. The Caulk NuvaLight system is a sealant that penetrates the enamel surface. It is one part of two components in the adhesive system. The first is a pit and fissure sealant for use in the prevention of decay. It contains three parts by weight of the reaction produce of bisphenol A and glycidyl methacrylate and one part by weight of methyl methacrylate monomer in which approximately 2 per cent benzoin methyl ether is dissolved as an ultra-violet light-sensitive catalyst. The second half of the adhesive system is a new experimental adhesive developed by GAC. It consists of a clear liquid and powder mixed in a ratio of approximately five parts liquid to two parts powder
- Two sets of casts are prepared. One is for the conventional study models and the other will be used in bracket placement (model casts) 2) ….Brackets are placed in their desired position. All brackets covered by Rocky Mountain bracket guards so that the tie wings are kept clear of excess adhesive. 3) ….Hand pressure assists in the adaptation of this plastic tray over all the teeth and gingiva. 4) The plastic tray is then carefully removed from the cast with the brackets embedded within the tray in their exact positions
- Preparation of teeth – Prophylaxis, isolation, etching (50% H3PO4 for 60-70secs) and application of sealant. The sealant is painted onto the labial or buccal surfaces of the teeth avoiding the interproximal surfaces so as to prevent “bridging” of the teeth. The NuvaSeal gun, with its ultraviolet light waves, is then passed over the treated teeth for an average of 30 seconds for each tooth. With a small cement like spatula, the mixture is placed on each bracket. The brackets are set into the Vanguard tray in their proper positions. In one rapid motion, the tray is inserted into mouth and the teeth enter the sockets in the tray in much the same manner as in insertion of a tooth positioner. The tray must be held for 5 minutes to ensure setting of the bonding cement. When the tray is removed, the brackets should be positioned exactly as they were on the work model. In a matter of 10 or 15 minutes, all the brackets in one arch are bonded directly to their respective teeth in proper alignment. The bracket covers are removed and the flash of bonding cement is removed. Drawbacks - Failure to clean the tooth properly / improper moisture control / Allowing too much time for placement of the bonding cement to the brackets, thus causing the cement to set or semi-set during insertion of the tray into the mouth.
- This technique uses a caramel candy softened and preloaded into a Centrix Syringe. A small amount of caramel is warmed to approximately 50° C. A spatula is then used to load the caramel into the plastic tip of the syringe. The preloaded syringe is warmed to 50° C. for approximately 5 minutes. This softens the candy enough to extrude from the syringe. Bracket positioning done. Caramel holds bracket in place. An impression is made of the model with the brackets in position, using an impression material. After the impression has set, hot water is run over the dental cast and impression for easy removal of the impression, leaving the brackets in place on the cast. Any residual caramel on the brackets is easily flushed clean with the hot water. A clean syringe is loaded with the bonding adhesive, which is then applied to the bracket bases prior to seating the impression. The impression is removed with brackets bonded to teeth The advantage of the caramel candy is its solubility in hot water
- Most current concepts of indirect bonding techniques are based on the procedure developed and perfected by Cohen and Silverman. The clinical procedure is a technique established Alginate impressions taken and poured. 2 - … checking height and angulation for accuracy. Remove excess flash from periphery of base & check positioning Tray - Cut tray material. The 5-in. square sheets are quartered 2 - … The arch blank is heated until it drapes down over the model. The D - P (Vanguard) vacuum former is used as a vacuum source. This apparatus is used to vacuum-form the placement tray. Spray the bottom (rubber dam) of the vacuum former and the hot arch blank with the silicone spray lubricant to keep them from sticking together. 3 - …After good adaptation has been achieved, cold water is poured into the top of the vacuum former to hasten the cooling of the tray material. Model placed into a bowl of water: allows the bonding agent to be released from the stone before the tray is removed from the model Trays are trimmed and midline points marked
- Patients are premedicated with Banthine 100mg. The inside of the tray is then painted with Concise Enamel Bond Catalyst (Part B) liquid (6 drops per arch). The teeth are painted with Concise Enamel Bond Universal (Part A) liquid. These same procedures are then repeated in the opposite arch before removal of the tray. This provides adequate setting time before tray removal. The tray is then removed from the mouth by removing from the lingual toward the buccal, peeling the tray off, leaving the brackets behind With this procedure, chair time of 30 mins required for bonding
- Many variations have been developed, using conventional dental composites, adhesives to attach the brackets to the working casts. Most of these adhesives must be removed from the bracket mesh with running water, or other means before the bonding resin is applied and the brackets are bonded to the teeth. If the adhesive is not completely removed from the mesh, the bond strength may be compromised. The method illustrated here uses readily available materials and leaves an adhesive-free mesh prior to bonding 1. On the working cast, scribe vertical lines for the long axes of the clinical crowns and horizontal lines for the bracket slot heights. 2. Spread out a 10mm strip of Micropore** adhesive tape on a glass plate with the adhesive side up. Place the brackets on the tape by quadrant 3. Cut out the tape around each bracket
- 4. Apply a drop of cyanoacrylate glue to the non-adhesive side of each piece of Micropore tape 5. Affix each bracket to the working cast in its prescribed position 6. Place the cast in a vacuum-forming machine, and fabricate a transfer tray using a 2mm soft sheet of BioPlast.† Trim the tray with a scissor, 3mm apical to the gingival margin on all sides. 7. Remove the tray from the cast. The Micropore tape will adhere to the cast because of the strong bond of the cyanoacrylate glue. The bracket, with adhesive-free mesh, will be embedded within the transfer tray material 8. Etch the patient’s teeth with 37% phosphoric acid for 15 seconds. 9. Apply a single-paste, resin-based luting agent (Heliosit‡) to the bracket bases. 10. Position the transfer tray in the mouth and cure each bracket for 40 seconds 11. For easy removal, peel the transfer tray away from the lingual. Check the positions of the bonded brackets
- When brackets had been positioned on the models with softened candy or various glues, the bonding of the brackets to the teeth was accomplished with a filled resin - Concise (3M Unitek). The technique was cumbersome, and the excessive amount of flash around the bracket bases was difficult to remove. With heat-cured resin bases, different sealants, have been attempted over the years. It became evident that the deficiencies in the available systems came from the fact that all the resins and procedures had been originally designed for direct bonding and had subsequently been adapted for indirect bonding New bonding resin introduced (Aid of 3M Unitek) 1 - Although an unfilled resin is not very viscous, it does not have the property of being able to fill imperfections in the custom base formed / imperfections in the fit of the tray, without compromising bond strength 2 – No need for increased working time, new resin developed with …
- 2 - Thin coat of Al Cote separating medium and casts allowed to dry for 1 hr 4 - When all the bracket positions have been checked, the upper and lower models should be placed in the Triad 2000 (Densply International) curing unit for 10 minutes to ensure complete curing
- Before forming the indirect bonding trays, it is recommended that a light separating spray be used to facilitate easy removal of the tray from the brackets (Silicone tray). The indirect bonding trays can now be placed over the brackets. A Biostar unit to vacu-form a 1.5-mm-thick layer of Bioplast, overlayed with a 0.75-mm-thick layer of Biocryl. The Bioplast layer is vacuformed onto the model first, and the excess material is trimmed away. Biocryl.. The latter permits easier separation of the two tray materials. Soaking the model for approximately 1 hour is recommended to permit the separating medium to dissolve. This allows for easier separation of the bonding trays. The bonding trays are then removed, sectioned & trimmed. Then they are placed in the Triad 2000 unit for an additional minute to ensure that any uncured resin is cured If it is the clinician’s preference to use a bonding tray made with a silicone transfer material, the Biostar unit is not necessary
- Teeth are pumiced, isolated and etched. Small amounts of the indirect bonding resin A and B liquids should be poured
- Position the tray over the teeth and seat the tray with a hinge motion. With the fingers, apply equal pressure in all areas. Hold for a minimum of 30 seconds. In the additional 2 minutes required for complete curing of the Rapid Set Resin, the mandibular arch can be etched and bonded & tray seated. Max tray removed. Remove the outer tray by using a scaling instrument. The inner Bioplast layer can be removed by using a scaler to peel that tray from the teeth and the brackets. Scale the excess resin from around the brackets and floss the interproximal contacts It has proven to be a great aid in treatment from many standpoints, including patient comfort, decreased chair time, decreased inventory, accuracy of appliance placement, diagnosis, ease of entering retention, improved esthetics, and improved tissue health. The new indirect resin had substantially greater bond strength than the other resins at the time of initial curing. Although the final bond strength was not statistically different, the clinical efficiency of this resin is greatly enhanced by the higher bond strength when tested 5 minutes following bonding, since that is the time when the indirect bonding tray would be removed, and the archwire inserted
- The reason for this is that the reference for bracket placement in the anterior region in this technique is the incisal edge.
- It is very important to make these lines as thin as possible and yet visible. Here a 0.03 mm black lead pencil, and a 0.05 mm red pencil (0.07mm – 1mm variation bracket position). Using a bow divider, measure 2 mm between the tips of the divider, and then transfer this measurement to the working models (PM & 1st molar). 2nd molar reduce by ½. Measure the distance from the slot line to the cusp tip on the first bicuspid. Transfer the 4.5 mm measurement to the central incisor. Decrease by ½ for lateral incisor. Add ½ for canine (truly customized prescription for bracket placement has been created)
- 2.5mm – 2 -3
- Formation of transfer trays: This material is prepared by thoroughly mixing equal portions of the two putty components to form a thick rope.. 2… is extended over occlusal and onto the lingual. Once the trays have hardened, place the models into a bowl of warm water and allow them to soak for 30 minutes. The trays are then removed from the models and placed upright into the Triad 2000 for an additional minute
- Before isolation of the teeth, they should be cleaned with a fluoride-free pumice paste. The teeth are etched with a 37% phosphoric acid solution or gel for 30 seconds per arch, then rinsed and thoroughly dried. The lower tray is seated from the 5 o’clock position using light finger pressure and held in place for 30 seconds. The upper tray is seated from the 12 o’clock position and held in place for 30 seconds. Both arches are allowed to cure for an additional 2 minutes. The trays are removed by placing a scaler under the distolingual edge of the tray and pealing from the lingual over the occlusal. The tray will come off easily and will come off in pieces. Using the curette, the cement guards are removed as well as any remaining pieces of transfer tray material
- Fabrication of Working Model and Marking for Tooth Position: Models are poured and trimmed. Reference lines are marked. Application of Resin Separator to the Model Bracket Positioning on the Working Model: with a light-cured resin, or use brackets that have composite previously added to the base Light Curing of Individualized Bracket Bases After bracket position has been finalized, place the model in a light-curing unit for 5 to 7 minutes
- Fabrication of Double-Silicone Bracket Transfer Tray: Place and firmly attach white boxing wax to the models at a level 2 to 3 mm gingival to the brackets on the facial side and in the cervical areas on the lingual or palatal surfaces. This wax is used to block the flow of the silicone. Inject soft silicone only around each bracket using a dispensing gun. This should be immediately followed by injection of hard silicone material to cover the soft silicone inner tray. Before the silicone cures, place a plastic film around the model 3….. Finally, place a plastic plate such as an arch form template cut in a trapezoid shape over the occlusal surface of the silicone to form the roof for the tray. Silicone materials stored in the refrigerator as chilling of the material extends the available working time
- After the silicone has set, remove the plastic film, plastic cover plate, and the white wax from the model and soak the model in water for 30 minutes. Take the model out of the water and carefully peel the silicone tray off the model, starting from the posterior end of the tray and working toward the anterior. Place the trays back into the light curing unit, and irradiate the bracket bases with light for 1 minute to finalize their polymerization. Trays trimmed and midlines marked and seated.
- The double-silicone bracket transfer tray is firm and dimensionally stable when placed on the teeth and accurately reproduces bracket position for each tooth. Easy to check bracket position during curing of the composite because the two clear silicone materials used for the tray allow good visualization of brackets. The hard outer silicone gives the tray adequate strength and elasticity for ease of handling Disadvantages: Injecting the two silicones is technique sensitive and requires a rapid and efficient application of the materials.
- - as a highly accurate but flexible inner tray - covers PVS inner tray which encases the brackets & other attachments Fabrication & Preparation of indirect working casts: Prophylaxis is done and alginate impressions are poured. Reference lines are marked – Long axis and mesiodistal center of tooth. Separating medium applied and allowed to dry Bracket Placement: Therma cure composite material applied on each bracket pad and positioned (unlimited working time) Curing of composite resin: Place the casts in a heated oven to cure. Requires 15 minutes at 325°F. Casts are allowed to cool
- 1 - Apply the Reprosil impression material with a syringe over the thermally cured brackets. Care should be taken to avoid the undertray becoming thick 2 - Vacuum-form Essix clear thermoplastic material over the cast, brackets, and undertray complex. After cutting away the excess thermoplastic material, soak the assembly in warm water for about 5 minutes, then separate both trays from the cast. The brackets will easily release from the stone and remain seated in the flexible undertray. 3 - …
- Chairside Bonding Procedure: Isolation done, enamel etched. Mix 2 drops each of Enhance A and B primer. Apply the mixture to the composite bases and the tooth surfaces 1, 2….. Remove the clear overtray material. Tease the flexible undertray from the teeth with an explorer or scaler using a gentle, rolling motion from the lingual surface of the flexible tray to avoid dislodging the brackets Adv: The thermal-cured bonding composite, flexible undertray, and thermoplastic overtray all contribute to an indirect bonding technique that is highly predictable and consistently reproducible. The thermal cured adhesive allows precise bracket positioning in the laboratory without the time constraints associated with chemically and light-cured resins.
- Provides accurate and stable bracket placement, simplifies tray placement and removal & reduces chairtime. The AccuBond tray material is not acrylic, silicone or polyvinyl siloxane. High elasticity enables the tray to conform tightly to the shape of the dental model Flexibility allows easy intraoral removal; thinness facilitates light curing. Material does not warp after forming nor does it distort after removing from the cast
- Impression – reference lines for bracket placement drawn – Once the orthodontist approves all the positions the lab begins to construct the AccuBond tray system. The trays are trimmed and the centre lines are marked
- Just before insertion, place a small amount of AccuBond indirect adhesive on each custom base. Insert the tray
- Using a dental scaler, lift the tray at the most posterior tooth on the lingual side and begin to roll the tray toward the buccal. Grasp the free end of the tray with a Weingart plier. Peel the tray from the lingual/occlusal to the labial/buccal, finally clearing the incisors. it is designed for lingual removal only, because the brackets are labially placed. Remove any remaining blue inner-tray material & flash using scaler
- In addition to being a highly technique-sensitive procedure, indirect bonding has two significant disadvantages 1 – resulting in more uneven distribution of adhesive 2 - the putty covering the palatal surfaces Our indirect technique uses a modified acrylic platform (horseshoe shaped) in which the putty is placed only on the labial and buccal surfaces, providing easier access for light-curing.
- Two L-shaped handles are squeezed together (acrylic / metal) to flare out the transfer tray, allowing placement of the posterior brackets at right angles to the tooth surfaces. Try the transfer tray in the mouth, first holding it against the anterior teeth while squeezing the handles together, then slowly releasing the handles to position the posterior brackets perpendicularly Load the brackets with an appropriate amount of chemically or light-cured adhesive. Transfer the loaded tray to the mouth while gently squeezing the handles for posterior expansion. This technique combines the major advantages of direct bonding (uniform adhesive distribution from perpendicular bracket placement) and indirect bonding (precise placement and shorter chairtime)
- No significant difference in shear bond strength between the 2 groups was detected
- Bonded from premolar to premolar Ideal – Models had all of their teeth reset ideally in wax, and brackets were then bonded with Transbond Direct - Brackets were bonded with Transbond on the models Indirect – Brackets were bonded on models with heat cured composite resin - Thermacure Both direct and indirect bonding techniques failed to execute ideal bracket placement