Article on Labial Indirect Bonding techniques for Orthodontics using the instruments TAD and BPD. This technique was used to accurately program torque and doesn't go into the realms of what torque should be used...this would be an entirely new article!
It highlights how modern Indirect Bonding for Orthodontics can be done via precise instruments that control the TORQUE. This is something that even today CAD CAM techniques have problems with. They can position the brackets on the teeth, but as we know in Orthodontics, torque is a factor that can change many other things, one of the obvious ones being the leveling of the teeth, When Torque is leveled out between slightly differing morphologies of teeth, then height will be more predictable.
A brief summary about the information usually required to be provided to the laboratory with regards to a case for Lingual Orthodontics. Here I have included our own preferences and lab forms with also a guideline of how to fill in the lab forms and some explanations as to why we need this info.Also some things for the clinician to keep in mind when preparing a Lingual case.
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
A brief summary about the information usually required to be provided to the laboratory with regards to a case for Lingual Orthodontics. Here I have included our own preferences and lab forms with also a guideline of how to fill in the lab forms and some explanations as to why we need this info.Also some things for the clinician to keep in mind when preparing a Lingual case.
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
A summary / description about what the "IN-tendo" system of indirect bonding is and what clients are likely to expect. It is related to both Lingual and Labial Indirect bonding at "The Torque and Angulation lab", Chiang Mai, Thailand.
How we use the Tip and Torque surveyor to derive values for Tip ( Angulation) and Torque ( Inclination ) in Orthodontic Indirect Bonding to the master models.
Actually 'Torque' is a torsional force (as described in most engineering and physics books) between the wire and the bracket slot. When the slot has been programmed with a certain value for a prescribed inclination required in relation to the flat wire plane, then the flat wire will be distorted in the slot causing a torsional force to move the tooth to the desired position. However this does depend on many factors including slot V's wire size causing 'slop' or the 'Torque Trap' and of cause the bio-mechanics.
Simplified Composite placement techniques for predictable restorations requires efficient ways of providing quality work.
In today’s economic environment there is an increased demand for direct restorations.
Composite restorations have traditionally been viewed as
Provisional restorations finalised /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Journal Club Presentation on Overlay Removable Partial DentureNeerajaMenon4
Overlay removable partial dentures (ORPDs), a subset of overdentures, are often referred to as an RPD that has part of their components covering the occlusal surface of the abutment teeth to restore them into a functional occlusion
With the Organization of the Torque and Angulation Lab, we managed a 2 day Lingual Orthodontics course with Dr Rafi Romano and 1 day lab course with lab techniques from IN-tendo and the Torque Angulation lab.
Nov 3,4 and 5th 2011. Probably the biggest Lingual Course event to be ever held in Thailand and the first time Dr. Rafi Romano was lecturing here.
A great introduction to Lingual Orthodontics from many clinical and laboratory lectures.
An article written about our techniques by Terry Whitty, with my texts and photos.
Lingual Orthodontics lab techniques and new instruments used for Indirect Bonding of Lingual Brackets, following the same theory that the TARG from Ormco was based on. However these instruments were revolutionary in that they were the first 'Digital' ones and so easy to use! It is through their built in precision and the "Ease of Use" factor that enables us to not only work easier as Dental Technicians, Orthodontists, Assistants and whoever else wants to be involved, but also do more to help the clinic with diagnostics. The T.A.D. or "Torque Angulation Device" evolved to not only follow the TARG and B.E.S.T techniques of Lingual, but was also designed to measure Orthodontic models for Tip and Torque values.
Crown Angulation and Inclination with good occlusionPeter Sheffield
This was my first contribution to an Orthodontic article. With Dr. Dhirawat of the Chiang Mai Orthodontic faculty, we measured many models of Northern Thai's with good occlusion and facial profile with our NEW instrument the T.A.D. or Torque Angulation Device. This instrument was the first digital instrument able to measure Tip and Torque accurately and easily from Orthodontic study models. As all previous studies were probably done on a particular population and geographical location, then we wanted to compare the values derived with previous studies such as Andrews, Hilgers, Bennet, Roth, MBT, etc.. having a new instrument also meant that the readings were more in tune with the related tooth morphology Conclusions, should bracket prescriptions differ for different races, facial types, etc?.
An article written for a magazine in India about the evolution of IN-tendo and some history of Ortho as background to where we are today.
An evolution of the Lab techniques we use in our 'Indirect Bonding for Orthodontics' via accurate bracket placement using standard Orthodontic brackets for Labial and the Lingual technique. How we customize cases by measuring malocclusion models, doing diagnostic set-ups and Kesling models, then measuring the difference in Tip and Torque to get individualized prescriptions for bonding. A technique started in 2010 by Peter Sheffield in Chiang Mai, Thailand.
12th ESLO POSTER Presentation about Height V's Torque in Lingual orthodontics Peter Sheffield
This study was done at 'The Torque and Angulation Lab' by Peter Sheffield actually a couple of years before the ESLO 2016 but never used or published.
It highlights one of the common problems in Lingual Orthodontics, which is bracket placement with regards to 'Torque'. As positive crown Torque increases, even with the same vertical height setting to the wire plane, then the brackets will be bonded more and more gingival. This has other effects as the distance from bracket slot to the vestibular face of the tooth in question increases on anterior teeth. Thus understanding this phenomenon and just how much 'torque loss' we can expect due to wire sizes, then we should be able to adjust the height setting to match our results if we really desire a 'flat wire'. Also by understanding the "Thickness'" measurements, we can compensate with composite pads to reduce 1st Order bends in the anterior arch wire.
A summary / description about what the "IN-tendo" system of indirect bonding is and what clients are likely to expect. It is related to both Lingual and Labial Indirect bonding at "The Torque and Angulation lab", Chiang Mai, Thailand.
How we use the Tip and Torque surveyor to derive values for Tip ( Angulation) and Torque ( Inclination ) in Orthodontic Indirect Bonding to the master models.
Actually 'Torque' is a torsional force (as described in most engineering and physics books) between the wire and the bracket slot. When the slot has been programmed with a certain value for a prescribed inclination required in relation to the flat wire plane, then the flat wire will be distorted in the slot causing a torsional force to move the tooth to the desired position. However this does depend on many factors including slot V's wire size causing 'slop' or the 'Torque Trap' and of cause the bio-mechanics.
Simplified Composite placement techniques for predictable restorations requires efficient ways of providing quality work.
In today’s economic environment there is an increased demand for direct restorations.
Composite restorations have traditionally been viewed as
Provisional restorations finalised /certified fixed orthodontic courses by In...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Journal Club Presentation on Overlay Removable Partial DentureNeerajaMenon4
Overlay removable partial dentures (ORPDs), a subset of overdentures, are often referred to as an RPD that has part of their components covering the occlusal surface of the abutment teeth to restore them into a functional occlusion
With the Organization of the Torque and Angulation Lab, we managed a 2 day Lingual Orthodontics course with Dr Rafi Romano and 1 day lab course with lab techniques from IN-tendo and the Torque Angulation lab.
Nov 3,4 and 5th 2011. Probably the biggest Lingual Course event to be ever held in Thailand and the first time Dr. Rafi Romano was lecturing here.
A great introduction to Lingual Orthodontics from many clinical and laboratory lectures.
An article written about our techniques by Terry Whitty, with my texts and photos.
Lingual Orthodontics lab techniques and new instruments used for Indirect Bonding of Lingual Brackets, following the same theory that the TARG from Ormco was based on. However these instruments were revolutionary in that they were the first 'Digital' ones and so easy to use! It is through their built in precision and the "Ease of Use" factor that enables us to not only work easier as Dental Technicians, Orthodontists, Assistants and whoever else wants to be involved, but also do more to help the clinic with diagnostics. The T.A.D. or "Torque Angulation Device" evolved to not only follow the TARG and B.E.S.T techniques of Lingual, but was also designed to measure Orthodontic models for Tip and Torque values.
Crown Angulation and Inclination with good occlusionPeter Sheffield
This was my first contribution to an Orthodontic article. With Dr. Dhirawat of the Chiang Mai Orthodontic faculty, we measured many models of Northern Thai's with good occlusion and facial profile with our NEW instrument the T.A.D. or Torque Angulation Device. This instrument was the first digital instrument able to measure Tip and Torque accurately and easily from Orthodontic study models. As all previous studies were probably done on a particular population and geographical location, then we wanted to compare the values derived with previous studies such as Andrews, Hilgers, Bennet, Roth, MBT, etc.. having a new instrument also meant that the readings were more in tune with the related tooth morphology Conclusions, should bracket prescriptions differ for different races, facial types, etc?.
An article written for a magazine in India about the evolution of IN-tendo and some history of Ortho as background to where we are today.
An evolution of the Lab techniques we use in our 'Indirect Bonding for Orthodontics' via accurate bracket placement using standard Orthodontic brackets for Labial and the Lingual technique. How we customize cases by measuring malocclusion models, doing diagnostic set-ups and Kesling models, then measuring the difference in Tip and Torque to get individualized prescriptions for bonding. A technique started in 2010 by Peter Sheffield in Chiang Mai, Thailand.
12th ESLO POSTER Presentation about Height V's Torque in Lingual orthodontics Peter Sheffield
This study was done at 'The Torque and Angulation Lab' by Peter Sheffield actually a couple of years before the ESLO 2016 but never used or published.
It highlights one of the common problems in Lingual Orthodontics, which is bracket placement with regards to 'Torque'. As positive crown Torque increases, even with the same vertical height setting to the wire plane, then the brackets will be bonded more and more gingival. This has other effects as the distance from bracket slot to the vestibular face of the tooth in question increases on anterior teeth. Thus understanding this phenomenon and just how much 'torque loss' we can expect due to wire sizes, then we should be able to adjust the height setting to match our results if we really desire a 'flat wire'. Also by understanding the "Thickness'" measurements, we can compensate with composite pads to reduce 1st Order bends in the anterior arch wire.
Linguals Orthodontics, Lab technique with Instruments Pt 2Peter Sheffield
The second article from our friend Terry Whitty which uses a lot of my texts and images, to highlight awareness to the Lingual orthodontic laboratory techniques used for Indirect Bonding of Orthodontics brackets in Lingual Orthodontics. This article shows in slides and describes some of the 'step by step' techniques we used back then for bonding lingual brackets directly to the malocclusion models to a prescribed tip and torque, then making a successful transfer tray system to help the Orthodontists, place them accurately in the mouth using whatever IDB technique they liked...chemical cure or light cure.
Succession “Losers”: What Happens to Executives Passed Over for the CEO Job?
By David F. Larcker, Stephen A. Miles, and Brian Tayan
Stanford Closer Look Series
Overview:
Shareholders pay considerable attention to the choice of executive selected as the new CEO whenever a change in leadership takes place. However, without an inside look at the leading candidates to assume the CEO role, it is difficult for shareholders to tell whether the board has made the correct choice. In this Closer Look, we examine CEO succession events among the largest 100 companies over a ten-year period to determine what happens to the executives who were not selected (i.e., the “succession losers”) and how they perform relative to those who were selected (the “succession winners”).
We ask:
• Are the executives selected for the CEO role really better than those passed over?
• What are the implications for understanding the labor market for executive talent?
• Are differences in performance due to operating conditions or quality of available talent?
• Are boards better at identifying CEO talent than other research generally suggests?
Anterior Torque: Second and Third order Problems in Lingual Orthodontics Revi...Peter Sheffield
Another look to show clearly the problems relating to bracket height on anterior teeth with relation to Torque prescribed in slot with Lingual Orthodontics.
A guide to communicating the necessary information for laboratory work with regards to Orthodontic diagnostic set-ups and Indirect bonding of orthodontic brackets for labial or Lingual.
Innovation of the 'Tip & Torque Surveyor' T.T.S)Peter Sheffield
Some history and details about this instrument for Surveying Tip and Torque in Orthodontics. It's origins came after I was training with the Modified TARG at Dr.Fillion's Lab, Paris in May 2004 (2 weeks) and May 2005 for again 2 weeks.
I have always looked for precision with a critical eye, but think it's useless with ergonomics and "ease of use".
The future goal is to link this instrument to a Digital software to align both the manual precision with 3D user technology.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Digital Removable Complete Denture—an Overview.pptxNishu Priya
There is a great responsibility for a dentist and a dental technologist to fabricate high-quality removable complete
dentures. Factors, such as a meticulous diagnosis and treatment planning, a personal communication between the
involved persons, and a profound knowledge of the clinical and technical possibilities, should lead to an easy, simple,
cost-effective, and highly satisfying denture fabrication workflow.
Bisecting angle vs paralleling technique /orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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Labial Indirect Bonding...an accurate method of controling Torque.
1. Volume : II No. 4 - December 2011
ORIGINAL ARTICLE
LABIAL / BUCCAL INDIRECT BONDING: APOS Trends in Orthodontics..
A NEW MANUAL METHOD ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
ABSTRACT :
With the advent of more and more CAD / CAM techniques and ever increasing costs for the
Orthodontist, we at 'Precise Indirect Bonding Systems' and the Torque Angulation Lab have
been using our instruments to transfer our knowledge and 'In-tendo" techniques to Labial
IDB. Using the T.A.D and B.P instruments we are able to do a manual IDB technique which
.D
can customize Tip and Torque via the composite pads ( with relation to the crown
morphology), so any bracket system can be used and customized to the patients
requirements.
KEY WORDS:
Labial Orthodontics, Indirect Bonding. HOL, Morphology, Tip and Torque, Angulation and
Brackets
Labial indirect bonding has been around for a long time. Some people love it and some
hate it. Some Orthodontists still have difficulties with it or find it unreliable especially with
brackets coming off the teeth at the most inconvenient times. The challenge has been not
just to get the brackets in the right position, but also been the transfer of the brackets to the
mouth. With the introduction of new adhesives this is now much easier and demand for
labial indirect bonding is on the increase.
The old laboratory technique known as by “Eye and Hand” is the one generally used by
technicians when setting up brackets on plaster models. The doctor or technician marks
the long axis lines on the model, and then using a ‘Bracket-positioning Gauge’, marks the
height bisecting the axis line for each tooth. The height depends on that required for the
individual treatment plan, or follows a recommended bracket positioning chart such as the
one by Andrews / MBT, etc. Using the boon gauge reduces errors in vertical positioning to
a certain degree.
The Brackets are then positioned using tweezers so the bracket wings are parallel to the
long axis of the tooth. Depending on the method required the brackets are adhered to the
model using a water-soluble adhesive, denture wax or a composite resin. If wax is used it
should be as thin as possible, but this can be removed easily removed by placing the tray
in warm water and then using steam to clean away all residue.
The height is re-checked using the Bracket Positioning Gauge. When all the brackets have
been placed on the model a separating medium painted onto the occlusal and lingual
surface of the teeth in preparation for the transfer tray, this can be pressure formed or PETER SHEFFIELD
various types of silicones can be used. INNOVATOR OF THE TAD AND BPD,
FOUNDER OF “IN-TENDO”,
TECHNICAL DIRECTOR OF THE TORQUE
AND ANGULATION LAB.
The New Technique, Using the TAD and the BPD technology for improved accuracy. CHIANG MAI, THAILAND.
petersheff@hotmail.com
2. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
The difference being with the “In-tendo” technique is that angulation. This is exactly the same method as used in the
precision instruments are used to determine accurately the lingual technique.
position of the slot with relation to the tooth. Using direct
bonding or indirect via “eye and hand” lab techniques, we 4. Once the tooth to be bonded has been set in the desired
cannot be sure that the bracket we have placed will be position with relation to torque and angulation and the
delivering the required slot values stated on the prescribed HOL, then we can transfer over to the BPD for bracket
system. For example an MBT 17 degree Torque and 4 degree positioning using the horizontal or vertical slot bracket
Tip, could well be at different angles because we just cannot holders to the prescribed height.
really check such a small slot with our eyes. There have been
studies to show that the Torque can be up to 20 degrees out on ** The accuracy of the BPD is 0.01mm and will not move
Central incisors due to the morphology of the teeth. Torque more than 0.02mm whilst bonding the bracket to the
errors will cause height errors to varying degrees depending on model. It will hold the brackets exactly perpendicular to the
the amount. setting of the TAD**
Using the TAD (Torque and Angulation Device) and the BPD 5. The bracket is placed in the sprung jaws of the holder and
(Bracket Positioning Device) we can eliminate these errors and offered up to the model to check the positioning before
place the bracket at the values we would like, including any fixing in place with light cured resin such as ‘Tansbond XT’
compensation values. from 3M.
If the right pre-programmed brackets are selected then the 6. Using the light-curing unit, the bracket is fixed and then the
amount of composite to customize the built in tip and torque in procedure repeated for every tooth.
base is minimal. This will be discussed later.
** The advantages of using a light cured resin pad are
The step by step techniques: mainly that the programming is set into the pad and
1. Prepare the models in exactly the same way, but for therefore the accuracy of the slot with regards to the axis
increased precision check the HOL using the adjustable can be better controlled, and the Orthodontist does not
survey base and the BPD. The Horizontal Occlusal Line as need to use so much bonding material, thus saving time
described by Andrews or HOL for short hand, is the and money!**
imaginary occlusal plane achieved by taking three
reference points. Because we often deal with gross Sometimes with under erupted teeth and badly inclined it
malocclusions it is often difficult to get the model base can be difficult or impossible to use the TAD and BPD
parallel with the Occlusal plane by using the model (such as last molars) and it is recommended to use the jig
trimmer. It is helpful then to measure the first two molars system and/or judgment of the technician.
for crown height and bisect this value from the occlusal
edge with a mark. Do the same for the two centrals and 7. The transfer tray system is done as described in the
then get the average of the two. This gives us three pictures using a hard resin key and Memosil silicone.
reference points with which to balance on a survey table
to the same level. Either scribing a line around the model There are advantages of system over that over vacuum or
base and grinding back on the trimmer, or using a jig to pressure forming for the following reasons:
hold the model whilst a new plaster base is made that is
parallel to the HOL, thus having a good reference point for There seems to be less risk of moving the bracket
the bracket positioning procedure. positions whilst the tray is formed.
2. Once the HOL is determined you can use a jig to make a Also the tray is more stable with its hard resin locator keys
new plaster base which is parallel to the HOL. Then all of for accurate positioning and especially when it is
the FA points are marked for teeth to be bonded, so the sectioned.
TAD is referenced to the same point for each tooth thus
eliminating errors in torque due to morphology. It can be sectioned down to individual units with ease
using a scalpel blade, so therefore re-bonding is easy.
3. Using the TAD and the adjustable survey base we align Clear vision and numbered teeth all help for ease of
each tooth according to the prescription for torque and placement.
3. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
Also for teeth that will need the brackets re-setting such as
palatally placed laterals, we can place the first brackets with
negative crown torque to move the roots out and then have the
final brackets prepared in individual transfer trays with our
desired torque, angulation and height for the final alignment,
thus removing some of the ‘guess work’.
The use of the TAD and the BPD make labial indirect bonding
easier and far more accurate than the traditional method and is
a great way to learn bracket placement.
Torque and Angulation using TAD. Exact readout via digital
display.
Lines are drawn on model as described.
Alternate view of TAD
Torque and Angulation are referenced with the Torque and
angulation Device. TAD
Transfer of Torque and Angulation to the Bracket placement
Device. BPD
4. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
Using the Bracket Placement Device BPD to position Using the BPD for the bicuspid.
Brackets.
Close-up of BPD Close-up of bracket position test.
Brackets are accurately placed using BPD Adding light cure custom base material to bracket.
(Transbond)
5. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
Completed bracket placement.
Clean up the custom base.
Using hand held light to cure. Area marked for Light Cured Blockout
Bracket in Place. Paint on separator
6. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
Apply light Curing LC- Blockout ( Ultradent ) Adding mechanical retention.
Blockout to cover incisal edge and occlusal surfaces. With hand held light while adding retention.
Add tooth number identification. Light cure hard key gives stability to transfer tray.
7. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
Memosil Clear Silicone Leave for about 10-15 Minutes then rinse with cool water.
Fabrication of silicone transfer tray with Heraeus Memosil. Use compressed air to ease from model.
Use a small amount of washing liquid and work with fingers.
This prevents the Memosil from sticking to your fingers. Trim tray
8. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
Posterior
Gently prise from model.
Trim Lingual Removed from the model.
Light cure again from the inside.
Trimmed transfer tray.
9. Volume : II No. 4 - December 2011
LABIAL / BUCCAL INDIRECT BONDING:
A NEW MANUAL METHOD APOS Trends in Orthodontics..
ASIAN PACIFIC
ORTHODONTIC SOCIETY
Journal of the Asian Pacific Orthodontic Society
This is I believe the aim of the new CAD / CAM systems such as
Insignia, from Ormco, Harmony from American Orthodontics,
and was the basis for the famous lingual technique called
Incognito.
However all of these systems increase the total price of the
treatment plan by high lab prices.
How do we determine the values we might need, such as
central torque? Can we measure the teeth for real values with
regards to the occlusal plane (OP) or HOL?
Yes with the TAD or Ray-Set we can get a pretty good idea and
then measure the values of the finished set-ups, to compare
movements required.
Finished tray.
Another good reason for a diagnostic set-up is so we determine
Essentially the transfer tray method is similar to the one what is possible and what is not. We can do IPR on the model to
described in eLaborate magazine Vol 5 No 1 Jan/Feb 2008. see the outcome of centre line, OJ and OB, not to mention
Please refer to that article for a more detailed explanation. aesthetics with regards to shape and contact points, then you
can present your goal to the patient.
Discussion:
Question: If the right brackets are selected? This is the big REFERENCES :
Anterior tooth morphology and its effect on Torque.
question for many orthodontists as there are many bracket M.van Loenen, J.Degrieck, G. De Pauw and L.Dermaut.
systems out there and in the words of a prominent Indian Sytemized Orthodontic Treatment Mechanics, Mclaughlin, bennet and Trevisi.
Contemporary Orthodonttics, William R. Proffit.
Orthodontist… Normal Torque of the Buccal Surface of Mandibular Teeth and its Relationship with Bracket
“ the salesmen are becoming the gurus of orthodontics”. Positioning: A study in Normal Occlusion.
Marcel Antonio Mestriner, Carla Enoki and Jose Neslon Mucha
Practice based comparison of Direct and Indirect Bonding.
Sometimes we just need to return to basics and the mechanics S.Thomas Deahl, Norman Salome, John P Hatch and John D. Rugh.
.
Indirect Bonding: Reference Manual.
that were, and are taught in many faculties around the world. In Speciality Appliances.
Bracket Positioning in Lingual v's labial Systems and Direct V's Indirect Bonding.
fact there is a returning trend on the “return to basics” ideas and Nir Shpack, Silvia Geron, Ionnis Floris, Moshe Davodovitch, Tamar Brosh and Alexander Dan
many orthodontists, including lecturers are going off for Vardimon.
Vitual Indirect Bonding in 3-D: does it have a future in Orthodontics?
courses to refresh. It’s a bit like engineering in the mouth and Dr Francesco Garino
that’s maybe why I seem to pick up quickly the ideas of; forces, Vertical Forces in labial and lingual orthodontics applied on maxillary incisors-a theoretical
approach.
levers, tip, torque, etc. This combined with the dental Silvia Geron, Rafi Romano and Tamar Brosh
knowledge learned at dental school should give most
orthodontists the tools to evaluate cases and pick brackets not
according to their name, but rather the values and efficiency
built into them. So base to slot angles depending on amount of
torque needed AND the tooth morphologies. Slot types and
sizes depending on the mechanics used, self-ligating, low
friction, etc…but remember when a tooth is tipped it will have a
friction with the wire at some point no matter if the corners of
the slot are angled, it just depends on the amount of tip!
This brings me to another point: If the patients are all individuals
and the teeth are all different how can one system and set of
values work for all? Surely the only way to get the correct
bonding values is to do a diagnostic set-up and then base the
slot values on the values of the set-up, with allowances for over
corrections, tip backs, torque loss, etc.