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

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