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2. Introduction
Tooth movement is made
possible by an orthodontist by
applying an optimal force.
Archwires,loops,springs,elastics,
etc- rigid attachment-bracket
3. Bands or bonds
Bonding – several advantages and
disadvantages
Advantages -
1.esthetic superiority
2.faster and simpler
3.less discomfort to the patient
4.arch length is not increased
4. Bonds are more hygienic than
bands
Mesiodistal enamel reduction
is possible
Interproximal areas are
accessible for comp buildups
Caries risk under loose bands
is eliminated
5. No band spaces are left behind
No large inventory of bands
Lingual brackets, invisible
braces
Brackets may be recycled
further reducing cost
8. The most widely used resin,
commonly referred to as Bowen’s
resin was designed to improve
bond strength and increase
dimensional stability by cross
linking
10. Types of bonding
1.Indirect bonding
2.Direct bonding -
a. chemical cured
b.light cured composite
c.glass ionomer cement
11. With the indirect bonding
technique, brackets fixed to the
tooth in the working casts and
then transferred to the patients
mouth with the help of an
impression tray which is usually
made of silicone
12. The bonding procedure in short
1. cleaning
2. enamel conditioning
3. sealing
4. bonding
a. transfer
b. positioning
c. fitting
d. removal of excess
13. Cleaning
pumice- plaque and organic
pellicle
rubber cup or polishing brush
bristle brush – more effective
but has certain disadvantages
14. Enamel conditioning
A. moisture control
After pumice-salivary control and dry
working field 1.cheek
retractors 2.saliva
ejectors 3.tongue
guards with bite blocks
4.salivary duct obstructers [dri-angles
–parotid]
15. 5. Cotton or gauze rolls
6. antisialogogues-
banthine,probanthine,
atropine sulphate etc
..both tablets and
injections ..PB inj are no
longer advised
..antisialogogues are generally not
16. banthine tab-50mgs/100lb-15
minutes before bonding
only under supervision of the
patients physician
contact lenses should be
removed-until next day
18. Next the teeth are
thoroughly dried with
moisture and oil free
source to obtain the well
known dull, frosty
appearance
19. Good bond strength is
dependent on
1.avoiding moisture
contamination
2.achieving undisturbed
setting of bonding adhesive
3.use of a strong adhesive
20. Sealing
Nothing but an intermediate
resin
Teeth dry-thin layer of sealant
Foam pellet or brush with a single
gingivo- incisal stroke The
sealant coating should be thin and
even
22. a slight bit of excess is
necessary
excess adhesive should be
removed
excess adhesive when not
removed-discolored
the first three procedures are
the same for direct and indirect
bonding techniques
24. Originally described by Dr.
Silverman and Cohen
several techniques-the brackets
are attached to the teeth on patients
model, transferred to the mouth with
some sort of tray to which the
brackets get embedded and then
bonded simultaneously
25. The clinical procedure
The techniques differ -
..the way brackets are attached
to the model
..type of transfer tray
..adhesive or sealant used
..the way transfer is removed
26. An over view of the indirect
bonding technique
a. Take an impression and pour
with stone. Model-dry. Long axis
and occlusal height
b. Select brackets
c. Apply water soluble adhesive
d. Position the brackets
29. e. Mix putty silicone and press it
onto the cemented brackets
f. Immerse model and tray in hot
water. Remove any remaining
adhesive
g. Trim the silicone tray and
mark the midline
h. Prepare the patients teeth
i. Load adhesive-bracket base
32. j. Seat the tray on the prepared
arch-3 minutes
k.Remove tray after 10 min. tray
must be cut longitudinally or
transversely
l. Complete bonding by careful
removal of excessive flash
36. Modifications
Several methods – bonding
resins, sticky wax etc
Dr. Michael.D.Simmons-1978-
April-JCO-caramel candy softened
and preloaded in syringe.
Small amount of caramel is
warmed to approx 500
c –loaded
preloaded syringe- 500
c-5min
39. A small amount is squeezed
onto each tooth to be bonded. The
brackets are then held with cotton
pliers warmed slightly in Bunsen
burner and then placed on the teeth.
Rest of the procedure is similar
Disadvantage of sticky wax.
Advantage of caramel candy
43. 2.Since one of the major
difficulties with indirect bonding…
double tray technique-
Elliott.M.Moskowitz and Douglas
Knight-1996 may JCO
Thermal cured composite
[unlimited working time] and vinyl
polysiloxane [flexible but highly
accurate under tray]
44. Apply thermacure composite to
the mesh pad of each bracket-cast.
Cast in heated oven -15 min at
325o
F. After cooling remove.
Apply vinyl polysiloxane over
thermally cured brackets.
Adapt the vacuum formed Essix
clear thermoplastic material over the
cast, brackets and under tray comp.
48. Chair side bonding
procedure.
1. Lightly abrade adhesive-
diamond bur or simply scrape
2. Isolate, etch, rinse and dry as
usual.
3. Apply bonding agent-tooth
and adhesive –bracket bases and
51. 4. Remove the clear over tray.
5. Tease the flexible under tray-
explorer or scaler without
dislodging the brackets.
Advantages…
The under trays are accurate,
stable and compact and will not
dislodge the brackets from teeth
when removed
54. 3. Light cured indirect
bonding.
JCO-1998-Aug-Michael Read
Transfer tray-silicone based,
addition cured elastomer [Memosil]-
stiff enough but easily removed .
1. Coat labial surface of teeth
with thin layer of Poly vinyl acetate
56. 2. Brush a thin layer of unfilled
resin onto each bracket base-light
cure it for 30 sec.
3. Add the filled composite to
bracket bases-brackets on the casts.
4. Cure each bracket-30 sec
from occlusal and 30 sec form
gingival.
5. Adapt the transfer tray.
57. 6. Soak the tray in cold water for
20 min.
7. Etch the teeth to be bonded as
usual. Paint thin layer of unfilled
resin over the etched enamel and
over the cured composite
8. Place the transfer tray in the
mouth and light cure each tooth for
30 sec.
59. 4.Thermal cured, fluoride releasing
indirect bonding system.
JCO-1998-Feb-Sinha,Nanda
Modification of previously
described IB with Therma cure.
Failure to remove excess
adhesive-accumulation of plaque.
Even when excess plaque is
reasonably removed-deposits .
60. The only modification in
this technique is we add
Maxicure sealants A and B. This
sealant contains hydrofluoric
acid in its monomer thereby
preventing caries
63. The lab procedure
Working models
Separating medium-1 hour
APC brackets-removed
directly from the sealed blister
If non coated brackets-
Transbond XT light cured adhesive-
placed on mesh pad
67. Remove the excess cement.
Cure the resin
Significant undercut areas are
blocked with wax.
Bonding trays are formed-either
double tray technique or with
silicone transfer material.
Cure it again to ensure that any
uncured resin is cured
69. The bonding procedure
Initial preparations
Micro-etching unit – sand blast
Contamination of custom
adhesive bases –acetone and air dry
MIP is optional
Sondhi Indirect adhesive – resin
A[tooth surface] and Resin B[resin
pads]
72. Position the tray over the teeth –
equal pressure- 30 sec- 2 min
Remove Tray with scaler- from
lingual to buccal
Repeat the procedure for the
opposite arch
73. Main indication -
lingual
Early 1970s – Dr Craven Kurz –
Assistant Professor of occlusion and
gnathology
Plastic lee fischer brackets –ant. and
metal for post. Shearing
force – debonding Uncomfortable to
the tongue
74. Turning point – ant.
Inclined plane – shearing
force to intrusive force –
intrusive and labial
76. Difficulties and modificationsDifficulties and modifications
Tissue irritation and speechTissue irritation and speech
earlier vs current bracketsearlier vs current brackets
smooth exteriors – normalsmooth exteriors – normal
activityactivity
Gingival impingementGingival impingement
earlier-broad bonding base-earlier-broad bonding base-
adequate oral hygiene,selfadequate oral hygiene,self
cleansing-compromisedcleansing-compromised
77. The bases now-incisally andThe bases now-incisally and
mesio distally widemesio distally wide
Additionally gingival hooksAdditionally gingival hooks
were redesigned so that theywere redesigned so that they
are shorter and also away fromare shorter and also away from
the gingivathe gingiva
78. Occlusal interferenceOcclusal interference
Predominant problem-shearingPredominant problem-shearing
force- upper ant bracketsforce- upper ant brackets
Redesigned with inclined planeRedesigned with inclined plane
Location of inclined plane..Location of inclined plane..
79. Base pad adaptation
Accurate contour of base pad
not only improves the retentive
capability but also the accuracy of
bracket placement – quality of
treatment
80. Appliance prescriptionAppliance prescription
Early 1970s – Andrews –Early 1970s – Andrews –
straight wirestraight wire
In-out varied dramatically-toIn-out varied dramatically-to
adjust this purely by bracketadjust this purely by bracket
design ?design ?
First order bends – where?First order bends – where?
81. Wire placement
Access for wire
placement is limited from
lingual aspect.
Redesigned – widening
the mesial opening
83. Gingival hooks
They are an integral part
of lingual appliance therapy.
Original hooks were
larger-redesigned – smaller
and away from gingival
margin
84. Generation of brackets
First generation - 1976
Flat maxillary Occlusal bite
plane.
Premolar brackets were low
profile.
No hooks on any bracket
86. Second generation- 1980.
Hooks were added to all
canine brackets.
Third generation – 1981.
Hooks were added to all
anterior and premolar brackets
89. Fourth generation – 1982-84.
Low profile anterior bite
plane.
Hooks were optional –
depending upon treatment plan
and hygiene requirements
91. Fifth generation – 1985-86
Inclined plane – more pronouncedInclined plane – more pronounced
Greater labial torque – maxGreater labial torque – max
incisorsincisors
Hooks were optionalHooks were optional
Sheath for TPA was availableSheath for TPA was available
Canine inclined plane-bi beveledCanine inclined plane-bi beveled
94. Sixth generation–1987–90.
Inclined plane – square shapedInclined plane – square shaped
TPA sheath was optionalTPA sheath was optional
Hinge cap attachment forHinge cap attachment for
molarmolar
96. Seventh generation-1990Seventh generation-1990
0nwards0nwards
Inclined plane is heart shapedInclined plane is heart shaped
Premolar brackets – widerPremolar brackets – wider
mesio distally with shortermesio distally with shorter
hookshooks
All hooks have greater recess –All hooks have greater recess –
ease of ligationease of ligation
99. Intrusion
Brackets closer to c res.
Intrusive forces closer to c res.
Bite plane effect – active
intrusion on ant and passive
extrusion of post
101. Maxillary arch expansion
although not clearly
understood,clinically…
possible reasons--
1. Centrifugal force
2. Thickness of brackets
3. Shorter IB span could
also be a possible cause
104. The CLASS system
1. Accurate impressions –
die stone.
2. Duplicate the cast .
3. Prepare a diagnostic set-up
– arch form,ant. Tip torque,
alignment etc
4. Clean the lingual surface –
apply separating medium
107. 6. Mount the model on model
holder with Occlusal plane
parallel to horizontal reference
plane.
7. Brackets are attached to the
set-up cast – two part heavy body
composite.
8. Transfer brackets to
malocclusion cast – light cured
109. 9. Brackets removed from
set-up model and attached to
malocclusion model – water
soluble adhesive.
10. Hot oven for 1 hour.
11. Remove the light
cured resin and fabricate
transfer – biostar machine
110. 12. Place the cast in warm
water for 30 min – remove the tray
13. Abrade the composite
slightly.
14. Trays are labeled and
placed in a clean sealed plastic bag
111. The TARG system.
Torque angulation reference
guide – ORMCO 1984.
Capable of positioning the
brackets at specific heights.
Consists of a torque gauge -
middle of labial surface.
A torque blade is used to orient
the brackets
114. The horizontal blade of TARG
gauge – bracket slot – moved
towards varnished model.
The gap – packed with a filled
resin – custom made bracket base
which accurately fits the lingual
surface is made.
Transfer tray fabricated
117. AdvantagesAdvantages
Permits more accuratePermits more accurate
placement of bracketsplacement of brackets
Decreases chair side timeDecreases chair side time
Less patient discomfortLess patient discomfort
Esthetically more pleasingEsthetically more pleasing
Incidence of caries is lessIncidence of caries is less
118. Avoiding band fitting onAvoiding band fitting on
posterior teethposterior teeth
Improved ability to bondImproved ability to bond
posterior teethposterior teeth
119. DisadvantagesDisadvantages
Technique sensitiveTechnique sensitive
Additional set of impressionsAdditional set of impressions
neededneeded
Posterior attachments morePosterior attachments more
likely to fail if the patientlikely to fail if the patient
chews ice etcchews ice etc
120. Removal of adhesive is moreRemoval of adhesive is more
difficult and time consumingdifficult and time consuming
Risk for adhesive deficiencies isRisk for adhesive deficiencies is
greatergreater
Failure rates seems to be slightlyFailure rates seems to be slightly
higherhigher
121. Extensive laboratory workExtensive laboratory work
requiredrequired
Risk of debonding is highRisk of debonding is high
122. Conclusion
when the laboratory and the
clinical procedures are strongly
adhered,indirect bonding is
undoubtedly a valuable technique. It
proves itself by saving chair side
time which is the most valuable for
a practitioner.
123. If not for the labial technique,it
is definitely a boon for the
lingual operating system
Thank you !