Indirect Bonding
Valo light from Opal. 3200 mW. We use two passes of 3 seconds per tooth for a total of 6 seconds per tooth.
It is has a cord and no batteries and is about the size of a handpiece. There is no light guide so the patient does not have to open as far.
I am now using Opal Seal and Opal Flow for indirect bonding. We do not air thin the Opal Seal as we are careful to place a thin layer. The Opal Flow is a white shade which makes application easier due to the contrast between the bracket base and the adhesive resin.
Affinity Crystal Clear/ 0.5mm Splint Biocryl Tray
The author wishes to give credit to his mentor, Dr. Michael Wainwright of Vancouver, B.C., who is one of the pioneers of indirect bonding and who taught the author the original indirect bonding technique in 1981.
Indirect or Precision Bonding is the cornerstone of the author's "Straight to the Target" technique to decrease the treatment time in full edgewise appliances. Indirect bonding and the CAAPP system of brackets and archwires allow for rapid and comfortable alignment and space closure so the orthodontist can concentrate on the correction of the malocclusion. When bracket positions are not ideal treatment time is extended with bracket repositioning appointments, archwire compensation appointments, or finishing with poor tooth positions. There are orthodontists who think that rapid bracket placement and months of archwire adjustment to compensate for poor bracket positioning is normal.
The part of treatment that the orthodontist has control over (other than the treatment plan) is Alignment and Space Closure (ASC). The patient has control over elastic wear to coordinate the arches and finish the occlusion. I looked at 42 consecutively treated patients. 34 were non-extraction and 8 were extraction cases. ASC took an average of 9 months to complete for the non-extraction group and 11 months for the extraction group. This is why our average treatment time in full braces is 12 to 18 months for good cooperators.
To determine my average treatment time in full braces I looked at my last 145 consecutively debonded patients. The average treatment time from bonding to debonding was 16 months. 78% of patients had an average treatment time of 13.4 months.
Our treatment time has decreased approximately 6 months on average over the years as I became more effiicient and bracket placement became more precise. The short treatment time is also due to the fact that thanks to Xbow we don't put patients in full braces until the buccal occlusion is Class I. The Xbow phase of treatment can add 12 months to overall treatment time if the springs are on for 6 months and you have to expand the maxilla and hold for 5 months.
The following is a recently completed but as yet unpublished master's thesis.
In-Vitro Comparison of Three Indirect Bonding Adhesive Systems
Dr. M. Miller, Dr. T. Foley, Dr. A. Rizkalla, Dr. D. Banting
Division of Graduate Orthodontics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
Taken from Summary and Conclusions:
"Based on the data obtained in this in-vitro study, it thus appears that the modified Higgins indirect bonding system is superior to both the auto-cure (A-B) system and the Thermacure system. The modified Higgins indirect bonding system yielded SPBS (Shear-peel bond strength) values comparable to directly bonded brackets, without any apparent increased risk of enamel damage at debonding."
Lingual retainers indirect bonded before debond
Procedure for Indirect Bonding to Porcelain Crowns and Veneers:
Interface Ceramic Primer (Apex Dental Materials, Inc.) etches and silanates porcelain prior to placing Ortho Solo without using hydrofluoric acid. Prophy all teeth and then roughen the porcelain with a diamond bur in a slow speed handpiece. Isolate with the Nola Dry Field. Etch, rinse, dry, and place Ortho Solo where bonding to enamel. Use Interface on the roughened porcelain as follows:
Preparation of Interface
Interface is furnished in two bottles, labeled A and B, along with a mixing well and Microtip®
applicators.
1) A drop of Interface A and a drop of Interface B are dispensed into the same cavity of the mixing
well. At first the two liquids will not mix- one will form a “bubble” on the top of the other.
2) After 20-30 seconds, the bubble will break down, and at that time the mixture is stirred for 5 seconds
with the Microtip® applicator.
Note: The mixed Interface solution must be used within 3 minutes. Once it has become cloudy or opaque it is no longer useful.
Delivery of Interface
1) Using a Microtip® applicator, apply an even coating of the prepared Interface solution to the ceramic
surface and allow to dwell for 10 seconds. Keep the Interface away from gingiva.
2) Dry the Interface solution thoroughly (approximately 5 seconds) Hold the suction occlusally and blow air away from the gingiva so that the Interface is not blown onto the gingiva. The surface has now been etched and silanated. Place Ortho Solo on the prepared porcelain surface and then place the bonding tray with adhesive per instructions below.
Indirect Bonding with a Light Cured Adhesive and a Hybrid Transfer Tray
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