Bonding in orthodontics

Bonding in Orthodontics
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Contents
 Introduction
 Brief history
 Banding verses bonding
 Bonding agents
 Types and classification
 Different types of bonding
agents
 Ideal properties of bonding
agents
 Steps in bonding
 Debonding
 Recycling
 Bonding failures
 Conclusion
 Refernces

BRACKET BONDING

Brackets
 Three types of attachments are presently
available for orthodontic bracket bonding –
 plastic based
 ceramic based
 metal based
 Stainless Steel
 Gold coated
 Titanium

Bonding Procedure
 Steps involved in direct and indirect bracket
bonding on facial or lingual surfaces are as
follows;
 Cleaning
 Enamel conditioning
 Sealing
 Bonding

The reduction of the contact angle formed between
tooth surface and adhesive by increasing the wettability
of the enamel surface.

Bonding to Amalgam

Direct Bonding with Light-
Cured Adhesive Precoated
Brackets

Transcend 2000 adhesive precoated ceramic bracket.

Application of single-patient light-cure primer.

Removal of APC bracket from well.

Removal of flash during bracket positioning.

Final light curing.

Electrothermic Bonding

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.

Six lower anterior teeth with composite applied to their
prepared surfaces.

Brackets being applied with the Vorster tweezer.

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.

A length of chain stretched between the beaks of a
modified electrothermic tweezer before being applied
to composite on a tooth.

A length of stainless steel chain fixed directly to a drop
of composite on an embedded upper left cuspid.

A Method for Light-Cured
Indirect Bonding

Memosil injected over brackets on working cast

Memosil tray completed

Residual PVA adhesive removed from tray

Light curing of brackets through tray.

A New Look at Indirect
Bonding

Pencil marks drawn along incisal edges, mesiodistal
center points, and long axes of teeth to ensure proper
bracket placement

Brackets, with Therma Cure composite resin on bases,
positioned on casts.

Casts placed in toaster-oven for curing at 325°F for 15
minutes.

Light vinyl polysiloxane impression material applied
with syringe over all brackets, extending onto occlusal
or incisal surfaces and partly onto lingual surfaces

Essix .020" or .030" clear thermoplastic material
vacuum-formed over cast, brackets, and undertray.

Trays separated from casts and trimmed to final
form

Inside of bracket-tray complex after washing and
lightly abrading composite surfaces.

Maxillary and mandibular arches isolated and
etched

Enhance primer applied to composite bases.

Enhance primer applied to teeth, unfilled resin
applied to composite bases and teeth, and entire
tray assembly seated.

Maxillary and mandibular trays in
place.

Clear overtray removed after setting

Flexible undertray gently teased away from
teeth.

Both undertrays "peeled" away from
teeth.

Brackets in place.

A MAJOR IMPROVEMENT
IN THE INDIRECT
BONDING TECHNIQUE

New ultraviolet lamp (Clev-Dent Division of Cavitron
Corporation, Cleveland, Ohio).

A Thermal-Cured, Fluoride-
Releasing Indirect Bonding
System

Brackets placed on cast with Therma Cure adhesive.

Silicone transfer tray placed in mouth.

Removal of transfer tray after polymerization of
Maxicure sealant.

Removal of excess sealant with scaler.

An Indirect Bonding
Technique

Sticky wax placed at interface of bracket and height
gauge to stabilize gauge.

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.

A. Soft strip of cold-cure acrylic molded to contact
height gauges without indexing teeth.
B. Acrylic splint after curing.

A. Splint removed from model with gentle vertical
pressure.
B. Bracket pads remain clean after splint removal.

Transfer splint made with acrylic wafer in pressure
molding device. Maxillary and mandibular splints

Brackets bonded to teeth.

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.

Controlled Etching System for
Direct and Indirect Bonding

Prewarmed Sugar Daddy candy placed at bracket sites
on model.

Brackets positioned on model.

Red occlusal spray on model.

Fracturing candy to remove brackets and tray.

Cutting Copyplast to top of papilla.

Using explorer to make small hole for air and excess
adhesive to escape.

Colored model shows bracket base positions.

CE System with stamps for various bracket sizes.

Scalpel can be used to cut around brackets.

Tongue-Away and bonding trays on both arches.

One-way cartridge used to apply phosphoric acid gel.

Needle holder used to pull Copyplast toward gingiva
and slip it over bracket.

Excess adhesive removed with explorer.

Cavitron used to clean teeth.

Customized Indirect Bonding
Method for Lingual
Orthodontics

Diagnostic setup mounted on semi-adjustable
articulator.

Bracket-placement equipment. A. General surveyor.

Flat plates with vertical posts, used to line up slots of
upper anterior teeth (1), lower anterior teeth (2), and
bicuspids (3).

Upper anterior bracket slots lined up on surveyor with
flat plate.

Lower anterior bracket slots lined up on surveyor with
flat plate

Bicuspid bracket slots lined up on surveyor with flat
plate.

All bracket slots are then aligned horizontally.

Transfer wires inserted into bracket slots and extended
to approximate incisal edges or buccal cusp tips.

Inlay pattern resin indexes each transfer wire to tooth (a
= elastomeric ligature; b = transfer wire; c = inlay
pattern resin).

Customized torque and in-out are built into resin (*) on
each bracket base.

Light-curing of adhesive under bracket.

Complete set of customized transfer trays.

Archwire engaged immediately after light-curing.

Lingual Orthodontics: A Status
Report
Part 3 Indirect Bonding ¾
Laboratory and Clinical
Procedures

When using a conventional height gauge, error
can be significantly greater on the lingual.

A torque and angulation reference gauge is used to
align the lingual surface relative to the more consistent
labial anatomy.

Lingual bracket slot height and angulation are
determined utilizing surveyor and dilatometer.

Brackets set to the surveyed heignts and angulations are
temporarily attached to the model and sealed in place.

A low-viscosity silicone encapsulates the brackets,
followed by the heavy body tray silicone.

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.

A. Archwires
are formed.
B. Initial
archwire
ligation.
C. Completed
bonding.

The original indirect tray can be sectioned for
rebonding of individual brackets.

Indirect Bonding of a
Malformed Lateral Incisor

Technique Clinic: Indirect Bonding of a Malformed
Lateral Incisor

Predictable Indirect Bonding

lmm - Bioplast soft
Isolite
2mm - Biocryl hard

Hard tray seated over soft tray. Soft tray is trimmed to
gingival margin, hard tray to bracket slot.

Dry Field System in place.

Small bead of composite applied to gingival portion of
bracket base.

Patient stabilizes upper and lower soft and hard trays by
biting on cotton rolls.

After complete indirect bonding of both arches.

Indirect bonding technique
for lingual orthodontics

Accurate set of models., dry mark wit pencil

Orientation card. Place backets and contour the base

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.

All brackets in position on models.

Forming the transfer tray using Optosil

Trimming the tray.

Dental midlines notched on trays.

GAC retractor, Dri-Angles, and Unitek lingual tongue
shield in place.

Placing the maxillary tray.

Removing the maxillary tray.

Completed case.

Indirect Bonding Revisited

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.

Contouring pliers may be used to flatten an
overcontoured bracket.

A CR syringe, preloaded wth Sugar Daddy, is used to
inject a small amount of adhesive onto each tooth.

Bracketed cases are stored in hermetically sealed
Tupperware container that is dehumidified with a
dehumidifying canister. This will prevent brackets from
floating.

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.

Optosil is adapted over the occlusal and incisal of each
tooth. Excess material is rolled into the sulcular area,
attempting to capture each bracket.

A completed and trimmed tray. Indirect bonding trays
should be about 3mm thick and extend about 3mm
gingival to the gingival line.

A completed tray. Note how the Optosil completely
captures each bracket with a minimum of voids around
the bracket pads.

Retraction system with distal extensions holding Dri-
angles against the cheeks. Note the cotton rolls sealing
off the tongue, preventing saliva contamination.

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.

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.

Typical adhesive flash. Some adhesive flows gingivally
Into the Interproximal area. The use of reservoirs
minimizes gingival flow and facilitates cleanup.

A completed case. It Is Important to place archwires at
the bonding appointment to minimize lip irritation.

Indirect Bonding Technique

Bracket placement indicator.

Location of brackets on tooth crowns and long axis of
each tooth marked with pencil on working model.

To distalize root apices, bracket indicator is positioned
mesial to vestibular pencil mark.

Horizontal short arm of indicator is used to build in
rotations.

Torque is built in with sagittal angulations of
indicators.

For torque more pronounced than the model allows, the
long arm of the indicator can be reversed.

All brackets positioned on working models.

Model placed on Biostar machine.

Brackets fixed in plastic templates.

Entire arches from second molar to second molar can
be bonded indirectly.

Indirect Bonding with
Adhesive Precoated Brackets

Vertical axes and bracket heights marked on cast.

Thin coating of separating medium painted on cast.
Diluted to 4:1

Removal of adhesive flash after final bracket
positioning.
Cure for 20 sec

Completed hard 1.5mm and soft 2mm trays over
brackets.

Application of APC primer before seating of trays.

Adhesive cured with Ortholux light

Soft tray removed by lifting away from gingival
hooks and tie wings.

A Precise and Predictable
Laboratory Procedure for
Indirect Bonding

Fig. 1 Bases of working casts trimmed to horseshoe
shape to allow maximum lingual detail.

Fig. 2 Tooth surfaces to be bracketed marked
with fluorescent yellow pen.

Fig. 3 Long axes scribed with fine-line pencil.

Fig. 4 Horizontal reference lines scribed at
appropriate bracket heights.

Fig. 5 Reference lines checked for accuracy
under ultraviolet black light.

Fig. 6 Bracket positioned on working cast.

Fig. 7 Maxillary brackets in place.

Fig. 8 Bracket positions checked under
ultraviolet black light.

Fig. 9 Midline of second transfer tray marked
with indelible pen for reference.

Fig. 10 Transfer trays after final cleaning.

Fig. 11 Transfer tray checked under ultraviolet
black light to identify any remaining adhesive tags.

New Indirect Bonding Method
for Lingual Orthodontics

A New and Improved
Indirect Bonding Technique

For placing brackets
on the cast

Thank You

Bonding in orthodontics

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