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Bonding for an exquisite Finish / Part 2: A step by step guide to Indirect Bonding Technique Dalia El-Bokle Part 2. Episode 125. September 1st 2021

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Hosted by
Farooq Ahmed

Join me for a summary of Dalia El Bokle’s lecture exploring finishing in orthodontics. Part 2 focuses on indirect bonding, a step by step process from model analysis to clinical delivery

 

 

Mark position on models

 

Intersection of horizontal and vertical lines

·      Posterior teeth

o   Vertical line: Long axis using OPG buccal, occlusal and lingual

o   Horizontal line x 2

§  1/ Marginal ridge line (outcome of treatment)

§  2/ Slot line (position of bracket, depending on bracket system 2mm from marginal ridge line

§  Start with 1st molar

§  Measure cusp to slot line using gauge distance marginal ridge to slot line

§  Mark slot line for rest of the teeth, using the difference in height from marginal ridge to slot line from the 1st molar measurement

§  Ensure gauge is used perpendicular to the teeth

·      Anterior teeth

o   Vertical line: Draw long axis using OPG, labially and lingually

o   1/ Horizontal line start with canine

§  Slot line marginal ridge level distal canine and mesial 1st premolar

§  Position canine mesial to the long axis

o   2/ Lateral = bracket gauge of the canine to tooth tip, 0.25mm more cervical or same as canine if lateral small

o   3 / Central – add 0.25-0.5mm than canine

§  = subtle smile arc

 

Transfer tray

·      Intersection of long axis to slot line – mark with wax knife

o   Mark where brackets should go

·      Tacky Glue to stick bracket to the model  – water soluble glue, remove excess with probe

o   Tip – use loupes / magnifying lens

·      Allow set for 10 minutes

·      Check occlusally, vertically and tip

o   Digitally check glue is set

o   Marginal ridge to slot line should be consistent

o   Visualise tooth movement

·      Relieve over the bracket hooks – wax or Tachy glue

·      Vacuum forming machine

o   1mm soft sheet

·      Check brackets have not moved – check vertical and horizontal lines

·      Trim excess retainer material

·      Soak 10 minutes, wash with water and interdental brush (ensure mesh of brackets clean)

·      Slits from the gingival aspect of the retainer to the gingival aspect of the bracket

o   Purpose is to expose the hooks of the brackets – difficult to remove when bond, aiming to uncover the hook from the retainer

·      Wax placed under the hooks – prevent composite

·      Section the tray if significant crowding

Clinical bonding IDB

·      Etch bracket surface only – looking at model of the tooth

·      Composite (light cure)

o   Small quantity on mesh base of each bracket

o   Microbrush to cover all surface and imbed into bracket mesh base

·      Bond

·      Seat IDB tray

o   Apply perpendicular pressure on each bracket with scaler

§  Avoids excessive composite on the bracket base

·      Light cure 20 seconds each tooth

·      Remove tray – from palatal aspect from distal molar

·      Flash removal

Trouble shooting

·      Bracket off

o   Don’t panic!

o   Maintain isolation

o   Remove excess composite, sharp scaler

o   Trim tray

o   Replace bracket in tray and re-insert transfer tray

·      Bracket positioning incorrect

o   Defective impression

o   Bracket not glued well on model

o   Defective vacuum forming

o   Ensure no drags

Disadvantage of IDB

·      Extra lab time

o   1 hour lab time

§  However reduced time in treatment and repositions / bends

o   Extra cost

§  $12 if in house

o   Excess flash

o   Technique sensitivity

§  Multiple check points

o   Accuracy

§  In Dalia’s opinion more accurate than direct bonding

 

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