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4. Brackets
Three types of attachments are presently
available for orthodontic bracket bonding –
plastic based
ceramic based
metal based
Stainless Steel
Gold coated
Titanium
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5. Bonding Procedure
Steps involved in direct and indirect bracket
bonding on facial or lingual surfaces are as
follows;
Cleaning
Enamel conditioning
Sealing
Bonding
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8. The reduction of the contact angle formed between
tooth surface and adhesive by increasing the wettability
of the enamel surface.
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20. The top tweezer is used for attaching brackets or
lingual buttons to teeth and It is connected to a source
of low voltage direct current.
The lower tweezer is used for attaching a steel traction
chain directly to a drop of composite placed on an
embedded tooth. It has Its own source of power from a
battery on the handle.
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21. Six lower anterior teeth with composite applied to their
prepared surfaces.
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23. A piece of steel chain
tied with ligature wire
to a lingual button with
mesh welded.
It fixed to an embedded
left central incisor by
means of composite.
The moment of set can
be retarded within
limits while bleeding Is
controlled.
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24. A length of chain stretched between the beaks of a
modified electrothermic tweezer before being applied
to composite on a tooth.
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25. A length of stainless steel chain fixed directly to a drop
of composite on an embedded upper left cuspid.
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26. A Method for Light-Cured
Indirect Bonding
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30. Light curing of brackets through tray.
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31. A New Look at Indirect
Bonding
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32. Pencil marks drawn along incisal edges, mesiodistal
center points, and long axes of teeth to ensure proper
bracket placement
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33. Pencil marks drawn along incisal edges, mesiodistal
center points, and long axes of teeth to ensure proper
bracket placement
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34. Brackets, with Therma Cure composite resin on bases,
positioned on casts.
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35. Brackets, with Therma Cure composite resin on bases,
positioned on casts.
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36. Casts placed in toaster-oven for curing at 325°F for 15
minutes.
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37. Light vinyl polysiloxane impression material applied
with syringe over all brackets, extending onto occlusal
or incisal surfaces and partly onto lingual surfaces
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38. Light vinyl polysiloxane impression material applied
with syringe over all brackets, extending onto occlusal
or incisal surfaces and partly onto lingual surfaces
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39. Essix .020" or .030" clear thermoplastic material
vacuum-formed over cast, brackets, and undertray.
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40. Trays separated from casts and trimmed to final
form
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41. Inside of bracket-tray complex after washing and
lightly abrading composite surfaces.
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58. Sticky wax placed at interface of bracket and height
gauge to stabilize gauge.
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59. A. Axial inclinations scribed
on model.
B. Rope wax placed at
midpoint of incisal edge
of crown.
C. Bracket seated by
pressing height gauge
into rope wax until
occlusal rest touches
incisal tip.
D. Sticky wax on lingual
surface of tooth stabilizes
occlusal rest.
E. Remaining brackets
positioned on model.
F. Rope wax removed.
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60. A. Soft strip of cold-cure acrylic molded to contact
height gauges without indexing teeth.
B. Acrylic splint after curing.
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61. A. Splint removed from model with gentle vertical
pressure.
B. Bracket pads remain clean after splint removal.
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62. Transfer splint made with acrylic wafer in pressure
molding device. Maxillary and mandibular splints
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64. A. Height gauges sectioned with ligature cutter occlusal to brackets to release
acrylic splint.
B. Released splint. Remaining portions of gauges are then removed from bracket
slots.
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83. Flat plates with vertical posts, used to line up slots of
upper anterior teeth (1), lower anterior teeth (2), and
bicuspids (3).
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84. Upper anterior bracket slots lined up on surveyor with
flat plate.
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85. Lower anterior bracket slots lined up on surveyor with
flat plate
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86. Bicuspid bracket slots lined up on surveyor with flat
plate.
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87. All bracket slots are then aligned horizontally.
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88. Transfer wires inserted into bracket slots and extended
to approximate incisal edges or buccal cusp tips.
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89. Inlay pattern resin indexes each transfer wire to tooth (a
= elastomeric ligature; b = transfer wire; c = inlay
pattern resin).
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90. Customized torque and in-out are built into resin (*) on
each bracket base.
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94. Lingual Orthodontics: A Status
Report
Part 3 Indirect Bonding ¾
Laboratory and Clinical
Procedures
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95. When using a conventional height gauge, error
can be significantly greater on the lingual.
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96. A torque and angulation reference gauge is used to
align the lingual surface relative to the more consistent
labial anatomy.
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97. Lingual bracket slot height and angulation are
determined utilizing surveyor and dilatometer.
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98. Brackets set to the surveyed heignts and angulations are
temporarily attached to the model and sealed in place.
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99. A low-viscosity silicone encapsulates the brackets,
followed by the heavy body tray silicone.
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100. a.Teeth are cleaned, isolated, and
etched.
B. A thorough rinsing, using an air-
water spray and high-speed evacuator,
is essential.
C. Sealant application. Note the frosty
enamel extending to the gingival crest.
D. The adhesive is injected into the
bracket mesh.
E. The tray is seated with firm pressure
and held with light, steady pressure for
3 minutes.
F. After 10 minutes, the tray is
removed, the brackets inspected, and
any deficient areas filled in with a thin
mix of bonding adhesive.
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120. Restorative Concise is used rather than orthodontic Concise. Orthodontic
Concise contains about 75 drops of liquid resin in each 16gm jar, while
restorative Concise has 15 drops of liquid resin.
Removing excess composite.
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121. All brackets in position on models.
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130. Brackets must be contoured to closely approximate the
enamel surface. This will produce a thin glue line and a
strong bond. Note the overcontour on this cuspid.
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131. Contouring pliers may be used to flatten an
overcontoured bracket.
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132. A CR syringe, preloaded wth Sugar Daddy, is used to
inject a small amount of adhesive onto each tooth.
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133. Bracketed cases are stored in hermetically sealed
Tupperware container that is dehumidified with a
dehumidifying canister. This will prevent brackets from
floating.
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134. Reservoirs of Sugar Daddy are injected at the incisal
edge of each bracket. This will minimize flow of excess
adhesive toward the gingival, and will facilitate
cleanup.
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135. Optosil is adapted over the occlusal and incisal of each
tooth. Excess material is rolled into the sulcular area,
attempting to capture each bracket.
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136. A completed and trimmed tray. Indirect bonding trays
should be about 3mm thick and extend about 3mm
gingival to the gingival line.
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137. A completed tray. Note how the Optosil completely
captures each bracket with a minimum of voids around
the bracket pads.
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138. Retraction system with distal extensions holding Dri-
angles against the cheeks. Note the cotton rolls sealing
off the tongue, preventing saliva contamination.
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139. Seated behind the patient, the clinician holds the upper
tray by crossing the index fingers and exerting a
superior and medial pressure in the premolar area.
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140. The lower tray is placed with the clinician seated in
front of the patient. The index and middle fingers
should exert an inferior and medial pressure in the
premolar area.
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141. Typical adhesive flash. Some adhesive flows gingivally
Into the Interproximal area. The use of reservoirs
minimizes gingival flow and facilitates cleanup.
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142. A completed case. It Is Important to place archwires at
the bonding appointment to minimize lip irritation.
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