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Bonding for an Exquisite Finish. All You Need to Know About Digital Indirect Bonding. Dalia-ElBokle / George Antonopoulos. Episode 126. September 8th 2021 Part 3

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Hosted by
Farooq Ahmed

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

 

 

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

  1. Scan patients
  2. Orthodontist prescription
  3. CAD –Software system to place bracket and customise base / bracket
  4. Print model
  5. Brackets placed on model: allowing for bracket base customisation through either keypads or jigs, customising bracket base with composite
  6. CAM – Lab design indirect bonding tray (IBT)
    1. VFR
    2. Silicone transfer tray / Memosil material
  7. Process IBT
  8. Post processing chemical and UV light
  9. 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

 

 

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