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ffective and Efficient Indirect Bonding:he Sondhi Method

noop Sondhi

A new and comprehensive system for indirect bonding has been developed

and refined by the author. Previous deficiencies with other indirect systems

have been addressed, and a new resin designed specifically for indirect

bonding is presented. (Semin Orthod 2007;13:43-57.) © 2007 Elsevier Inc. All

rights reserved.

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he concept of indirect bonding was first men-tioned in the literature during the mid- to

ate 1970s, and various manifestations of the pro-ess have since been reported.1-6 In the initialrials of indirect bonding softened candy wassed to position brackets on the teeth, andhemically cured filled resins were used to bondhe brackets to the teeth. Although the methodas effective, it resulted in a significant amountf excessive bonding material or flash remaininground the bracket, and the cleanup of the resinresented a significant problem. This techniqueas also cumbersome and involved significantmount of doctor and laboratory time. Alterna-ive adhesives have been used over the years, but

ost have proved to be only moderately success-ul.

The next major improvement in the indirectethodology occurred during the 1980s. This

ccurred when heat-cured resins entered thearket. However, there were reports of clini-

ians experiencing problems with the bracketsrifting on the working models during the timeequired to heat cure the resin. The transferodel with the brackets attached had to beeated to 250°F to 300°F for approximately 15 to0 minutes as a means of curing the resin (Ther-acure; Reliance Orthodontic Products, Itasca,

L). Furthermore, some nonceramic esthetic

From the private practice of Dr. Anoop Sondhi, Indianapolis,N.

Address correspondence to Anoop Sondhi, DDS, MS, 9333 N.eridian Street, Ste. 301, Indianapolis, IN 46260. Phone: 317-

46-1455; E-mail: sondhi@indyortho.com© 2007 Elsevier Inc. All rights reserved.1073-8746/07/1301-0$30.00/0

bdoi:10.1053/j.sodo.2006.11.006

Seminars in Orthodontics, Vol 13, N

rackets could not be exposed to this heat. Thisecessitated placing the brackets separately on

he models after the metal brackets had beeneat cured and resulted in a more cumbersomerocedure. When the bracket bases are fabri-ated with heat-cured resin, bonding of therackets on the teeth is generally accomplishedith chemically cured sealants or bonding res-

ns. However, if a transparent tray is used, aight-cured resin, with cure-on-demand benefits,an be used.7

esins Previouslysed in Indirect Bonding

ith the increasing popularity of indirect bond-ng over the past two decades, different methodsf bonding the brackets to the teeth have beeneveloped. When brackets had been posi-ioned on the models with softened candy orarious glues, the bonding of the brackets tohe teeth was accomplished with a filled resin,uch as Concise (3M Unitek). The indirectransfer trays were usually formed with siliconeray materials. Although the bond strength withhe filled resins was adequate, the technique wasumbersome, and the excessive amount of flashround the bracket bases was difficult to remove.ith heat-cured resin bases, different sealants,

nd mixtures of sealants and resins, have beenttempted over the years. It became increasinglyvident that one of the deficiencies in the avail-ble systems came from the fact that all theesins and procedures had been originally de-igned for direct bonding and had subsequently

een adapted for indirect bonding.

43o 1 (March), 2007: pp 43-57

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44 A. Sondhi

One of the important properties required of aesin designed for direct bonding is a generousindow of working time. The latter property is aistinct disadvantage in indirect bonding be-ause an extended cure time is not requirednce the tray has been placed. An effort washerefore made to develop a resin designed spe-ifically for indirect bonding. Following labora-ory testing and clinical trials, an efficient andffective indirect bonding procedure has beeneveloped.8,9 Among the benefits of the newlyeveloped process is the elimination of the ther-ally cured resin on the working models, sincecustom base of the bracket is fabricated usinglight-cured resin.

eveloping a Customized Resin Base

n an effort to determine the best method forreparing a custom resin base, a number oflinical trials were undertaken. It was found thatlight-cured resin was an ideal material for plac-

ng brackets on models, and it was also ideal fororming a custom resin base. Using Adhesiverecoated Brackets (3M Unitek), contaminationas eliminated and laboratory time reduced to ainimum because individual brackets do noteed to be sorted and resin does not need toe applied to the base before placing the brack-ts on the model. If precoated brackets are notsed, then Transbond XT (3M Unitek) is rec-mmended as the material of choice for prepar-

ng the custom resin bases. Other resins withighter viscosities have proven to be ineffectiveecause of bracket drift on the working models.

For the current indirect bonding procedure,he author now uses a new indirect bondingesin10 in conjunction with APC brackets (orransbond XT adhesive applied in the labora-

ory) for the custom base. This article provides atep-by-step explanation of the indirect bondingrocedure recommended.

igure 1. (A-E) Intraoral views of the pretreatment mlass III tendency, and minor maxillary and mandib

vailable online.)

New Indirect Bonding Resin

s discussed earlier, there are significant disad-antages in indirect bonding with a resinhat had originally been designed for directonding. It became evident that a new resin wasequired specifically for indirect bonding. Thisesin was developed with the aid of 3M UnitekSondhi Rapid Set, 3M Unitek). The materialas designed with several objectives in mind.irst, although an unfilled resin is not very vis-ous, it does not have the property of being ableo fill imperfections in the custom base formedith a light-cured resin, or imperfections in thet of the tray, without compromising bondtrength. The viscosity of the new resin was in-reased with the use of a fine-particle-fumedilica filler (approximately 5%), so that it wouldave the ability of filling any such voids withoutompromising bond strength. Second, becausehere is no need for increased working timence the trays have been placed, the new resinas developed with a quick-set time of 30 sec-nds. The latter significantly decreases the timeeeded to hold the bonding tray in place duringuring. The resin is completely cured in 2 min-tes, which allows for rapid removal of the bond-

ng tray.10 This new resin has been specificallyesigned for indirect bonding and would not beseful for direct bonding.

The complete indirect bonding procedure,rom the laboratory process to clinical deliveryf the appliances, is described herein. Therocess is demonstrated on a patient who had alass I malocclusion, with a distinct Class III ten-ency (Fig 1A-E). A minor maxillary and mandib-lar arch length deficiency is noted. Most often,

n a typical Class I malocclusion, bracket place-ent is performed according to the prescription

elected by the orthodontist (Fig 2A and B).owever, this patient had a distinct anterior

pen bite and a reversed curve of Spee. The

lusion. A Class I malocclusion is noted, with a distinctarch length deficiencies. (Color version of figure is

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45The Sondhi Method

racket locations for this patient were deliber-tely atypical to address the vertical discrepancyFig 3A and B). In patients who have a deepnterior overbite the bracket placement woulde reversed as a method of effecting the desiredertical changes (Fig 4A and B).

aboratory Procedure:reparation of the Bonding Trays

1. Working models are made from orthodonticstone, prepared from accurate alginate im-pressions. Care should be taken to ensurethat there is no distortion of the impres-sions. The working models should be pre-pared with careful trimming, removal of bub-bles, and filling of small voids. If there arelarge bubbles or voids, it will adversely affectthe fit of the bonding tray (Fig 5A and B).

2. A thin layer of diluted Al-Cote (Densply In-ternational, Inc., York, PA) separating me-dium (1 part Al-Cote to 4 parts water)should be applied to the model and allowedto dry for approximately 1 hour (Fig 6).

3. If APC Adhesive Coated brackets are used,the brackets that are preoriented may beremoved directly from the sealed blisterpack and positioned on the individual teethof the working model. The excess adhesive

igure 2. (A and B) Graphic depiction of standardracket placement for the prescription currently usedy the author. (Color version of figure is availablenline.)

igure 3. (A and B) Atypical bracket placement toddress the open-bite discrepancy. (Color version ofgure is available online.)

igure 4. (A and B) Illustration of atypical bracketlacement to address a malocclusion with a deep

verbite. (Color version of figure is available online.) fi

should be removed and the position of thebracket carefully checked with a bracketgauge. If noncoated brackets are used, thenTransbond XT Light Cure Adhesive shouldbe placed on the mesh pad of individualbrackets before they are positioned on themodel (Fig 7A and B).

4. After all brackets have been placed, a finalcheck of the bracket positions is done and theexcess resin removed. The models should beplaced in the black plastic box that is provided

igure 5. (A and B) Anterior and occlusal views ofhe maxillary working models. Note the detail of den-al and soft tissue structures, and an absence of anyubbles or voids in the pour-up. (Color version ofgure is available online.)

igure 6. Separating medium being applied to theaxillary working model. (Color version of figure is

vailable online.)

igure 7. (A and B) Brackets being applied on theandibular and maxillary models. (Color version of

gure is available online.)

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46 A. Sondhi

with the resin, or in another suitable light-free location, and left for final approval andpositioning by the orthodontist (Fig 8A-D).

5. When all the bracket positions have beenchecked, the upper and lower modelsshould be placed in the Triad 2000 (DensplyInternational) curing unit (Fig 9A and B)and cured for 10 minutes. Although theresin actually cures in less time, extra time isallowed to ensure complete curing, sincethe access to light between the plaster modeland the bracket base is limited. If a lightchamber is not available, curing can beeffected with a chairside light-curing unit.However, using a chairside light-curing unitis obviously more time consuming and cum-bersome. The amount of time for light cur-ing is substantially reduced with clear es-thetic brackets, and 1 minute of exposure tothe light is adequate.

6. Before forming the indirect bonding trays,it is recommended that a light separating

igure 8. (A-D) Anterior and occlusal views of theracket positioning for indirect bonding. (Color vers

igure 9. (A) The Triad™ 2000 Light Curing Cham-er. (B) Maxillary and mandibular indirect bondingodels placed in the Triad 2000 Light Curing Cham-

er. The rotating tray table permits exposure of lighto bracket bases from all directions. (Color version of

maxillary and mandibular models, demonstrating final

gure is available online.)

igure 10. Brackets being sprayed with PAMTM be-ore forming the indirect bonding tray. This permitsasier tray removal following bonding of the brackets.

Figure 11. Model with first layer of BioplastTM.

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47The Sondhi Method

spray be used to facilitate easy removal ofthe tray from the brackets. A silicone spraymay be used. Alternatively, a light cookingspray, such as PAM (International HomeFoods, Inc., Parsippany, NJ), may be usedand is quite effective. The brackets should

igure 12. Excess Bioplast™ material being trimmedrom the model. (Color version of figure is availablenline.)

igure 13. The Bioplast™ layer being sprayed withAMTM before the BiocrylTM is adapted, to permitasier separation of the two layers. (Color version of

gure is available online.) o

be sprayed lightly; the spray should be forless than 1 second (Fig 10).

7. The indirect bonding trays can now be placedover the brackets. The author uses a Biostar(Great Lakes Orthodontics, Tonawanda, NY)unit to vacu-form a 1.5-mm-thick layer of Bio-plast, overlayed with a 0.75-mm-thick layer ofBiocryl (Great Lakes Orthodontics). The Bio-plast (Great Lakes Orthodontics) layer is vacu-formed onto the model first, and the excessmaterial is trimmed away (Figs 11 and 12).The Bioplast surface should be sprayed with

igure 14. BiocrylTM layer, vacu-formed over the Bio-lastTM layer. The outer, hard shell of Biocryl pro-ides rigidity to the tray.

igure 15. Occlusal view of a silicone transfer tray,emonstrating bracket bases that can be coated withesin for the indirect bonding process. (Color version

f figure is available online.)

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48 A. Sondhi

PAM before the Biocryl is adapted. The lat-ter permits easier separation of the two traymaterials (Fig 13). The outer layer of 0.75-mm-thick Biocryl can then be vacu-formed(Fig 14). The outer hard shell should betrimmed away from all heights of contour,since its purpose is only to permit firm seat-ing of the soft inner tray. The hard outerlayer provides rigidity to the bonding tray,and the soft inner layer permits easy separa-tion from the brackets.

igure 16. Superior view of an indirect bonding trayormed with expressed silicone impression material. Autty tray of this kind can be used if a vacu-formed

ray is not desired or a BiostarTM is not available.Color version of figure is available online.)

igure 17. The bonding tray being sectioned for re-oval from the model. (Color version of figure is

vailable online.) a

8. If it is the clinician’s preference to use abonding tray made with a silicone transfermaterial (Figs 15 and 16), the Biostar unitis not necessary. A bonding tray can bemade with a suitable silicone transfer mate-rial. Once the putty has been mixed with theactivating agent, a small button of the sili-cone material is placed around individualbrackets, followed by the placement of theremaining material rolled into the shape ofa cylinder. The occlusal and lingual surfaces

igure 18. Vacu-formed indirect bonding tray beingemoved from the model. (Color version of figure isvailable online.)

igure 19. Excess tray material being trimmed withrown and bridge scissors. (Color version of figure is

vailable online.)

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49The Sondhi Method

of the teeth should also be covered with thetray material. This technique has been pre-viously described by Kalange.8

9. Soaking the model for approximately 1 houris recommended to permit the separatingmedium to dissolve. This allows for easier

igure 20. Trimmed indirect bonding trays placedn the TriadTM chamber for additional curing. One

inute of additional curing is recommended to en-ure complete polymerization of the resin base.Color version of figure is available online.)

igure 21. The trays being cleaned with a detergentolution in an ultrasonic cleaner. (Color version ofgure is available online.)

igure 22. (A and B) External and internal views of

he maxillary bonding tray. u

igure 23. Custom resin bases being micro-etchedith 50-�m aluminum oxide particles. (Color version

igure 24. Properly formed custom resin bases on an

ndirect bonding case.

igure 25. Teeth being polished with a pumice pasteefore etching. A nonfluoridated paste should be

sed. (Color version of figure is available online.)

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separation of the bonding trays. The bond-ing trays are then removed from the models,and should be sectioned with a bur (Fig 17).It is usually necessary to tease the tray offwith a plaster knife (Fig 18). Any excessmaterial should be trimmed with crown andbridge scissors or a scalpel (Fig 19). Afterthe bonding trays have been trimmed, theyshould be placed in the Triad 2000 unit foran additional minute to ensure that any un-cured resin is cured (Fig 20).

0. The bonding trays can now be examined.The trays should now be cleaned in anultrasonic cleaner with a dishwashing deter-gent, for example, Dawn (Procter andGamble, Cincinnati, OH) for 10 minutes(Fig 21). The trays are then placed inan ultrasonic machine, in water only, for anadditional 5 minutes. The trays are thenrinsed and dried thoroughly. Figure 22Aand B show a view of the bonding trays fromthe Bioplast surface, as well as the Biocrylsurface.

igure 26. (A and B) The patient isolated with aolaTM dry field system in preparation for bonding.

Color version of figure is available online.)

igure 27. Teeth being air dried before placement ofhe etching gel. (Color version of figure is available

nline.) t

1. The trays are then carefully examined forany remaining separator or tray materialcovering the adhesive custom base on thebracket. A micro-etching unit is then usedto lightly sandblast the adhesive custombases (Fig 23). A fine aluminum oxide par-ticle (50 �m) is recommended. Care istaken not to abrade the resin base. If there isany contamination of the adhesive custombases, especially if touched with your finger-tips, the trays should be cleaned with a de-tergent, rinsed, and dried. The author doesnot recommend the application of acetoneto adhesive bases, since recent informationhas indicated that this may result in degra-dation of the resin. Figure 24 demonstratesthe appearance of properly formed customresin bases for an indirect bonding case.

linical Procedure: Indirect Bonding

Preparation of the Patient

. Seat patient and place a napkin around theneck. The author recommends the use of anantisialagogue, such as Sal-Tropine (HopePharmaceuticals, Scottsdale, AZ) or Propan-theline. The patient should be instructed toremove any contact lenses when they take theantisialagogue tablet.

igure 28. (A and B) Etching gel being applied to theaxillary arch. (Color version of figure is available

nline.)

igure 29. (A) Etching gel being suctioned off theeeth. (B) Etching gel being rinsed from the maxillary

eeth. (Color version of figure is available online.)

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51The Sondhi Method

. Pumice all teeth. Explain to the patient thatthis is one of several procedures in prepara-tion for bonding (Fig 25).

. Rinse and suction well with water.

. Show the bonding trays to the patient andexplain the procedure—from taking the im-pressions to placing the brackets in proper

igure 30. (A) The teeth being air dried to ensureomplete desiccation. (B) A view of the maxillary archollowing completion of the etching process. (Colorersion of figure is available online.)

igure 31. The dispensing wells supplied with thendirect resin. Resin A is applied to the tooth surfacend should be placed in the well identified with theooth icon. Resin B is applied to the bracket base andhould be placed in the well with the bracket icon.

Color version of figure is available online.) a

position and forming the tray. It is importantto stress the time the orthodontist spendspositioning the brackets and supervising theentire process. The author believes that thereis a significant value in emphasizing to thepatient the importance of proper bracketplacement and the role of the orthodontist inappliance design.

. If there are bands to be placed, this should becompleted after the indirect bonding proce-dure has been completed. Since the resinused in this indirect bonding system has sucha fast set time, the band placement can bestarted immediately following the indirectbonding of the brackets.

Placement of Bonding Trays

1. The decision to use a single tray for anentire arch, or whether sectional trays areused, is based on the degree of isolation of

igure 32. Resin A being applied to the teeth. (Colorersion of figure is available online.)

igure 33. Resin B being painted on the resin pads inhe indirect bonding tray. (Color version of figure is

vailable online.)

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52 A. Sondhi

the teeth that is feasible. If there is signifi-cant crowding and imbrication of the teeth,it may be easier to section the tray. Since theworking time with this indirect bondingresin is virtually unlimited (since the adhe-sive does not need to be mixed and does notset until the trays are seated), the degree ofisolation and ease of tray placement are thedetermining factors on whether to sectionthe trays or not. If isolation is difficult, thetray may be sectioned at the midline to per-mit easier bonding. On rare occasions, itmay be advisable to consider sectioning thetray into thirds, in which case the trays maybe sectioned as follows:a. Cuspid to cuspid (3-3):

anterior segmentsb. Second molar to first bicuspid (4-7):

posterior segments2. The patient described in this article was

bonded with a single tray in each of themaxillary and mandibular arches.

3. Isolate the teeth that are to be bonded withthe Nola (Nola Specialties, Hilton Head,SC) dry-field system (Fig 26A and B). Occa-sionally, plastic cheek retractors, TongueAway (TP Orthodontics, LaPorte, IN), cot-ton rolls, and Dri-Angles (Young Dental,Earth City, MO) may be used.

4. Using an air syringe, dry the teeth thor-oughly (Fig 27).

5. Dab—do not rub—etching solution ontoteeth and set a stopwatch for 15 seconds.

Note: Etching solution should be appliedwith extreme care. Do not allow etch tocontact skin or gingiva.

The etchant should be applied in thegeneral area that is to be covered by thebracket. Do not allow the etchant to flow

igure 34. (A and B) The maxillary bonding trayeing positioned. It should be held in place with firm

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into the interproximal contacts to ensureeasier cleanup (Fig 28A and B).

6. After 15 seconds, the etching gel can besuctioned off the tooth (Fig 29A). Rinse witha steady stream of water for another 15 sec-onds (Fig 29B). Rinse with a steady spray ofwater and air for another 30 seconds. Suc-tion excess water and be careful to avoidsaliva contamination of the etched enamel.The teeth should now be air dried to ensurecomplete desiccation (Fig 30A and B).

7. Replace cotton rolls and Dri-Angles—again,making sure that saliva does not contact theetched enamel.

8. (A) If the clinician chooses to use a mois-ture-insensitive primer, such as TransbondMIP (3M Unitek), on the enamel surface forthe bonding procedure, the air syringeshould be used to remove excess moisture.Complete desiccation of the teeth is op-tional. A liberal coat of Transbond MIPshould be painted onto the enamel surface.Air-dry for approximately 2 seconds. Lightcuring of this primer is not necessary forindirect bonding. (B) If Transbond MIPMoisture Insensitive Primer is not used,

igure 35. The maxillary bonding tray in place.Color version of figure is available online.)

igure 36. (A and B) Gel etching material beingpplied to the mandibular teeth. (Color version of

nger pressure for 30 seconds. (Color version of fig- gure is available online.)

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53The Sondhi Method

and the bonding is accomplished with theindirect bonding resin, then all visible mois-ture should be removed. The etched teethshould have a frosty appearance, and becompletely desiccated. If a frosty appear-

igure 37. (A-D) Removal of the etching material, fColor version of figure is available online.)

igure 38. The mandibular teeth being painted withesin A. (Color version of figure is available online.)

igure 39. (A and B) The mandibular bracket baseseing painted with resin B. (Color version of figure isvailable online.)

igure 40. (A and B) The mandibular bonding trayeing placed on the mandibular teeth. The trayhould be held with firm finger pressure for 30 sec-

ollowed by rinsing and drying of the mandibular teeth.

nds. (Color version of figure is available online.)

igure 41. The maxillary and mandibular bondingrays in place. (Color version of figure is available

igure 42. The maxillary BiocrylTM layer being re-oved with a scaler. (Color version of figure is avail-

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igure 43. (A and B) The inner BioplastTM layereing removed with scaler and fingers. (Color version

f figure is available online.)

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54 A. Sondhi

ance is not apparent, repeat the etchingprocess for 15 seconds.

9. Small amounts of the indirect bonding resinA and B liquids should be poured into wells(Fig 31). Take care to keep the liquids sep-arate. Resin A can be painted onto the toothsurface with a brush, and resin B can bepainted on the resin pads in the indirectbonding tray (Figs 32 and 33).

0. If too much resin has been placed on theenamel, gently remove the excess with abrush. The overall method of painting theresin on the enamel and the custom bases issimilar to painting one fingernails with nailpolish.

1. Position the tray over the teeth and seat thetray with a hinge motion. With the fingers,apply equal pressure to the occlusal, labial,and buccal surfaces (Fig 34A and B). Holdfor a minimum of 30 seconds. Figure 35shows the maxillary bonding tray in place.

2. In the additional 2 minutes required forcomplete curing of the Rapid Set Resin, themandibular arch can be etched andbonded. Figure 36A and B show placementof the mandibular etch. Figure 37A-D showremoval of the etching material, followed byrinsing and drying of the maxillary teeth.

3. The mandibular teeth can now be paintedwith resin A (Fig 38), and the mandibularbracket bases can be painted with resin B(Fig 39A and B). The mandibular bondingtray can now be placed on the mandibularteeth (Fig 40A and B). Figure 41 shows both

igure 44. The bonded maxillary arch, with all brack-ts in place. (Color version of figure is available on-ine.)

bonding trays in place. (

4. Since 2 minutes’ time has elapsed duringseating of the mandibular tray, the maxillarytray can now be removed. Remove the outertray by using a scaling instrument (Fig 42).The inner Bioplast layer can be removed byusing a scaler to peel that tray from the teethand the brackets. Use extreme care whenremoving the tray from around bracketwings (Fig 43A and B). Figure 44 shows thebonded maxillary arch, with all brackets inplace. The mandibular tray is removed in a

igure 45. (A-C) The mandibular tray can be re-oved with the same procedure as the maxillary tray.

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55The Sondhi Method

similar manner (Fig 45A-C). Scale the excessresin from around the brackets and floss theinterproximal contacts (Fig 46A). Use den-tal floss to check that all contacts are open(Fig 46B). Figure 47 shows the bonded ap-pliances in place.

5. The initial archwires can now be inserted.Please note the immediate and completeengagement of all teeth, including secondmolars at this bonding appointment (Fig48A-E). Resin-reinforced glass-ionomer ce-ment has been placed on the occlusal sur-faces of maxillary first molar teeth to permitdisclusion to protect the second molarsbrackets, and also to permit early correctionof the vertical discrepancy.

igure 46. (A) A scaler being used to remove thexcess resin around the brackets. (B) Dental flosseing used to check that all contacts are open. (Colorersion of figure is available online.)

igure 47. The maxillary and mandibular bondedppliance in place. (Color version of figure is avail-ble online.)

igure 48. (A-E) Initial archwires engaged. Note therchwire, as well as the vertical control introduced by pement has been placed on the occlusal surface of te

olar brackets. (Color version of figure is available online

6. This patient was seen 8 weeks followingthe initial bonding, and early correction ofthe vertical discrepancy was already evi-dent. The resin-reinforced glass-ionomercement has been reduced by the orthodon-tist on the occlusal surface of the maxillarymolars, and the open bite was reduced(Fig 49A-E).

esults

his system has been used by clinicians in manyountries, and treatment on numerous patientsas indicated the effectiveness. Many orthodon-

ists who have used this system report that theonding is consistent and efficient. Obviouslyccasional bond failures do occur and are thesere usually related to contamination or an im-roper technique. In instances where bond fail-res occur, it is a simple matter to section theonding tray, reapply the adhesive, and reseathe transfer tray.

Bond strength tests have also indicated thefficacy of the resin. Bond strength comparesavorably with indirect bonding using Concisenamel Bond (3M Unitek) and Custom IQ (Reli-nce Orthodontic Products, Itasca, IL). Figure 50And B provide important data, since the bondtrength immediately after curing is of criticalmportance during tray removal, and initialrchwire insertion. Results of the study indicatedhat the new indirect resin had substantiallyreater bond strength than the other resins athe time of initial curing. Although the finalond strength was not statistically different, thelinical efficiency of this resin is greatly en-anced by the higher bond strength when testedminutes following bonding, since that is the

ime when the indirect bonding tray would beemoved, and the archwire inserted.

trol over molar positioning with the initial levelingse bracket placement. Resin-reinforced glass-ionomerNos. 3 and 14 to permit disclusion for protection of

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The first independent, university-based studyhat compared different indirect bonding tech-iques was published by Klocke and cowork-rs.11 They concluded that indirect bondingith the Rapid Set resin achieved bond strengthsomparable with direct bonding techniques. “In-irect bonding with thermally cured custom

igure 49. (A-E) The same patient seen 8 weeks later,lso permits removal of part of the resin-reinforcedolars. (Color version of figure is available online.)

igure 50. (A and B) Bond strength 5 minutes afterracket placement. These data are of critical impor-ance, since the immediate bond strength is importanturing tray removal and initial archwire insertion.

Color version of figure is available online.)

ases showed significantly lower bond strengthshen compared with light cured custom bases.”he other system that demonstrated bond

trengths comparable to the Transbond/Rapid-et resin system required trays to remain inlace for 7 minutes, compared with the 2 min-tes required for the Rapid Set resin.

iscussion

new method for effective and efficient indirectonding of orthodontic brackets has been pre-ented. The custom adhesive bases are easilyormed with Transbond XT or APC brackets, andhe indirect bonding is accomplished using a newesin developed specifically for this purpose. Bondtrength has proven to be excellent, and the au-hor and others have used this system for the indi-ect bonding of complete dental arches, from sec-nd molar to second molar, on pediatric, adult,nd orthognathic patients.

Bond strength tests have also proven the effi-acy of this resin.9 Although the eventual bondtrength is comparable to other resins, the clinicalfficiency of this resin is greatly enhanced by theigher bond strength developed within the first 2inutes following bonding. Tray removal is there-

ore possible within 2 minutes, and archwire inser-ion can be immediately carried out.12,13

eferences

1. Thomas R: Indirect bonding: simplicity in action. J ClinOrthod 13:93-106, 1979

2. Moin K, Dogon IL: Indirect bonding of orthodonticattachments. Am J Orthod 72:261-275, 1977

3. Simmons M: Improved laboratory procedure for indirectbonding of attachments. J Clin Orthod 12:300-302, 1978

4. Silverman E, Cohen M: A report on major improvementin the indirect bonding of attachments. J Clin Orthod

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