Join me for a summary of Dalia El Bokle’s lecture exploring finishing in orthodontics. Part 3 focuses on digital indirect bonding, from scan to tray production
Introduction
Straight wire appliance – based on bracket placement will correct tooth in 3 planes of space
- Not true – evidenced by finishing bends
Ideal bracket placement through indirect bonding IDB
- Level marginal ridges posteriorly
- Constant smile arc anteriorly
Digital indirect bonding time saving
- Brackets placed Layman 2019
- Time saving
- 21 minutes – digital indirect bonding Vs manual direct bonding
- 8 minutes – clinical time indirect Vs direct bonding
- Time saving
Different methods of making an indirect digital bonding tray
Method 1:
- Printed model
- VFR transfer tray
- Transfer tray made from the model
Method 2
- Printer tray (not model)
- Cost $105
- Tray biocompatible tray
- Cover occlusal half of the teeth and lingual aspect
- Insert bracket into model
- Advantage
- No model printing
- Clean base technique
Method 3 –
- Key pads – digitally planned material between bracket base and tooth
- Customises the bracket base
- Advantage
- Less flash
- Accuracy of bracket position in on the keypad
- Torque + in and out can be customised per tooth
- Models printed
- Lab place the brackets manually with composite onto the model with jigs
- Transfer tray made from the model
Case submission for DIDB
- Send STL file to lab
- Prescription for set up, e.g.
- Bracket selection customisation: Standard Damon Brackets, low torque lower incisors, high torque LL4.
- Teeth bonded: 7-7 Upper and lower
- Bracket positioning customisation: Smile arc – 0.5mm incisal U1s Vs U2s
- Clinician approval of set up
- Library of brackets – specify which type of bracket
Digital indirect bonding workflow overview
- Scan patients
- Orthodontist prescription
- CAD –Software system to place bracket and customise base / bracket
- Print model
- Brackets placed on model: allowing for bracket base customisation through either keypads or jigs, customising bracket base with composite
- CAM – Lab design indirect bonding tray (IBT)
- VFR
- Silicone transfer tray / Memosil material
- Process IBT
- Post processing chemical and UV light
- Insert bracket into tray with key holes as guides
Advantages of DIDB
- Full digital pathway with scanning
- Less working time
- Fewer appointments
- Can alter prescription
Disadvantage
- Cost
- Learning curve
- Production waste