Indirect Bonding Manual

Dr Peter G Miles www.BeautifulSmiles.com.au 1 Predictable Indirect Bonding Background: I have been routinely indirect bonding all my cases since 1995, learning from the experience of others and then with small modifications, refined it to the technique described belo w. 1 This technique is supported by our own clinical research a nd is very predictable demonstrating only a 1.5 % to 2.5% clinical failure rate when bo ndi ng from the first molar forward. 2-4 I do not recommend thermally cured custom base s on the model as we have found these to be inferior to light cured custom bas es under certain types of br ack et s. 2 For this reason we use light cured custom bases to bond the bracket to the model. Clinically, t he bonding adhesive is 3M Transbond Supreme LV. This is also light cured and is as pre dic tab le as ou r pre vio us chemically cured adhesive (Maximum Cure, Reliance) bu t with the advantages of curing on demand (time to seat the tray without rushing bef ore applying the light) and less steps with no mixing of adhesives. I have used pre ssu re and vacuum formed transfer trays as well as clear silicon trays and pre fer the pre ssure and vacuum formed trays as they are less bul ky, especially when bon ding two arches simultaneously, and very quick and easy to fabricate. Like any new technique it takes pra ctice and ple ase don’t give up after one disaster (i.e. all the bra ckets fail to adhere which will likely happen once). I encourage you to try this technique as those who have mastered indirect bo ndi ng avoid direct bo ndi ng du e to the time savings clinically , reduced stress on the operator and patient, and the improved accuracy of vertical plac em ent of brac kets in the pos teri or segments. 5 Materials: Alginate (E.g. Aroma Fine Fast Set, GC) Lead penc il Separating medium (Vertex Divosep or Alcote ) – no dilution required APC II (N ot APC Plus )- adhesive pre coated br ackets (3M/Unitek) or suitable no n- runny adhesive for plac ing the brac kets on the model LED light (E.g. Ortholux, 3M/Unitek) Hot glue gun (from craft supply or hardware s tore) fo r blo cki ng ou t hooks, self- ligating mechanisms, et c or a clear PVS e.g. Peppermint Snap (Discus Dental) , Memosil (Kulzer), Affinity Crystal Clear or similar . Automotive silicon spray or other spray (E.g. Pam) if making a 2 nd hard overlay tray 1.5mm (0.06”) clear mouthguard material or similar to trap the brac kets 1-1.5mm (0.04-0.06”) clear retainer or splint material to make 2 nd overlay tray Crown and brid ge scissors and a flat plas tic instrument Petroleum jell y (Vaseline) Microetcher (Danville Engineering) , 90 -110 μm alumini um oxide parti cle s Dry field system saliva evacuator/retraction device (NOLA) Moisture Insensitive Primer (M IP) (3M/Unitek) Transbond Supreme LV (3M/Unitek) Preparation: Accurate alginate impressions (Aroma Fine Fast Set, GC International Corp., Tokyo, Japan) of clean teeth are taken and to improve accuracy, paint the gingival margins with a finger dipped in alginate prior to pla cing the impression tray to reduce air bu bbl es. Th e resultant impression is then pou red up in stone, al lowed to full y set, tr immed to a ‘U’-shaped archform ~5 -6m m be low the gingival margin and allowed to

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Indirect Bonding Manual