• Author / Uploaded
• Reliance Orthodontic Products

Citation preview

Chairside Indirect Bonding Procedure

Anthony J. Belgin Indirect Bonding Consultant

904 North Caroline Street Ebensburg, Pa 15931 814-242-1878 [email protected]

Materials for Chairside Indirect Bonding (IDB) Procedure

Product Pumice 1st and Final™ 9 grams Etchant Liquid 9 grams Etchant Gel 9 grams Porcelain™-Etch with Barrier Gel 15 cc Porcelain™ Conditioner Assure™ Universal Bonding Resin 6cc Flowtain™ L.V. with Blue syringe tips Enhance™ Adhesion Booster Self Cure: A 3cc (EBAA) B 3cc (EBAB)

Item # FF EL9 EG9 POE

Company Reliance Reliance Reliance Reliance

Telephone 800-323-4348 800-323-4348 800-323-4348 800-323-4348

$ Price 24.99 9.00 9.00 9.00

PO AS FTLV

Reliance Reliance Reliance

800-323-4348 800-323-4348 800-323-4348

13.00 55.00 15.00

Reliance

800-323-4348

A 25.00 B 25.00

Pro Seal™ 6ml Access™ Cheek Retractors: Adult Size Pedo Size Quest Dri-Field Pedo/Adult Dri-Angles Large/Small Micro Brushes Regular/Super fine Disposable Mixing Wells Tooth Dryer Replacement Nozzle Tips

PRO CH1 CH2

Reliance Reliance

800-323-4348 800-323-4328

60.00 14.95

Ortho Quest Dental Supply Practicon Dental Practicon Dental Quest Quest

877-678-4696

42.00

800-959-9505 800-959-9505 877-678-4696 877-678-4696

10.00 3.75 83.99

J0830 703949

Prices are subject to change as price increases occur.

1

Chairside Indirect Bonding (IDB) Procedure I. IDB Tray Preparation 1. Tray preparation can be done up to 2 hours before trays are inserted. Prepare the customized bases with Enhance Adhesion Booster®. Mix equal amounts of A & B, usually 3 drops each will be enough to apply 2 coats of Enhance to 28 bracket bases. Allow 20 seconds for the Enhance to penetrate into the customized base and for the evaporation of the ethanol. Lightly air dry until the customized bases have a dry sheen appearance to them. This is very important to the bond strength. If the custom bases appear dry and dull after air drying the Enhance, reapply 2 coats of Enhance. When you have a dry sheen appearance on the customized base, apply a small dot of Flowtain L.V.® on small bracket bases and on large bracket bases (example: molar bracket bases) apply a fine line of Flowtain L.V.® at the center of the bracket going mesial to distal of the base. Use the syringe tip to spread the Flowtain L.V.® into a thin layer to cover the base. •

Note: Custom bases require very little adhesive – too much adhesive results in excess flash.

II. Get Acquainted with the Patient 1. Take a couple minutes to discuss with the patient the procedures that will be taking place. For instance, the placement of cheek retractors, dri-angles and the dri-field system, the use of an air syringe, saliva ejector, what the indirect bonding trays look like, and what the curing light is and does, etc. This helps take some of the anxiety away that the patient may be experiencing, which may help reduce the extra saliva flow and aid in patient cooperation. •

Note: Ask the patient if they had a dental appointment between their last office visit and today’s visit for dental restorations or for tooth bleaching. a. Dental restorations done after the impressions were taken for the indirect bonding will alter the fit of the indirect bonding tray. b. Tooth bleaching: tooth preparation would need to include prophying with a slurry mix of a vitamin C tablet after pumicing the teeth.

III. Intra-oral procedure for IDB 1. Pumice using 1st and Final Pumice™. Prophy all tooth surfaces that will be IDB. Rinse all pumice residues from the tooth surfaces.

2

IV. Placement of Dri-Field System 1. When possible place 2 Dri-Angles® in reverse so the pointed end is anterior. This placement is in reverse of the manufacturers instructions. However, it makes for better retraction of tissue from 2nd molars. 2. Place cheek retractors. The type of retractor which holds the Dri-Angles® in place. 3. Place the Ortho Quest® Dri-Field System. We have found this dri-field system is user-friendly and patient-friendly and is excellent in maintaining a dri-field. • Note: Along with the dri-field system you will need a saliva ejector at times. 4. Prior to etching the enamel, check for the following surfaces: gold, stainless steel, amalgam, porcelain or composite. These surfaces will need to be buffed with a fine diamond stone or miro etched with 50 microns of aluminum oxide. Rinse all residues and air dry. When bonding to porcelain, you need to apply the porcelain etch for 4 minutes prior to etching the enamel. After the 4 minute etch, remove the porcelain etchant with a Q-tip or a cotton roll. The remaining porcelain etchant should be rinsed into a high volume suction. Do not apply porcelain conditioner at this time. Apply a thin coat of conditioner after the enamel surfaces have been etched, rinsed and air dryed. 5. Etchant: Liquid or gel (preference liquid) Labial & Buccal Surface • Normal enamel 30 seconds • Hypocalcified enamel 45 seconds • Deciduous enamel 60 seconds

Lingual Surface 45 seconds 60 seconds 75 seconds

6. Etch enamel, rinse and air dry with an air syringe and follow with a tooth dryer. • A tooth dryer makes a difference in bond strength. Check your etching. If not frosty white in appearance, re-etch for 10 seconds. Rinse and dry with an air syringe follow with a toothdryer. • If preparation of porcelain crown was done previously, now is when you apply a thin coat of porcelain conditioner, wait 60 seconds (no need to dry porcelain conditioner) and apply 2 coats of Assure®. 7. Application of Assure® Universal Bonding Resin (using a microbrush): DO NOT DISPENSE THE ASSURE® UNIVERSAL BONDING RESIN UNTIL YOU ARE READY TO USE IT. Replace the lid immediately after dispensing. a. Normal enamel surfaces apply 2 coats b. Atypical enamel surfaces apply 4 coats • Hypocalified • Fluorosed • Deciduous enamel • Dentin

3

c. Metal surfaces apply 4 coats (wait 30 seconds before air drying) • Amalgam • Gold • Stainless steel d. Porcelain and Veneer surfaces apply 2 coats 8. Assure® Universal Bonding Resin needs to be air dried with an air syringe a. Air dry until the Assure® appears dry and glossy • Note: After drying the Assure® and if it appears dry and dull, apply 2 more coats of Assure®, air dry until dry and glossy. b. When 4 coats of Assure® are needed, always dry after 2 coats and then reapply 2 more coats and dry until the Assure® is dry and glossy. 9. Pro Seal™ is an option that may be applied after the Assure® Universal Bonding Resin. a. It is a light cure fluorescing filled sealant with fluoride. b. Avoid any interproximal placement when using Pro Seal™. c. Follow mfg. instructions in curing the Pro Seal™. V. Placement of the Mandibular IDB Tray (hard and soft trays remain together) 1. Once in place, using the index finger and middle finger, apply light pressure to the IDB tray from cuspids to the molars to make sure the tray is completely seated. Do not apply pressure to the posterior teeth and then move your fingers to the anterior teeth and apply pressure. Changing finger positions could unseat the tray and bracket heights will not be accurate. When the tray is seated completely, there is no need to continue holding the tray in place as long as it fits well. • Note: Remember even pressure, right and left side only, cuspids to molars. 2. When the tray is seated, light cure 5 seconds, from the occlusal, the lower right second molar, then lower left second molar, then lower left 1st molar and then lower right 1st molar and then continue to cure from bicuspid to bicuspid from the occlusal. Then cure 5 seconds each tooth from the gingival. When all of the brackets are cured, repeat the IDB procedure for the maxillary arch. 3. After the maxillary arch is cured, remove the hard tray from the mandibular arch and then the soft tray. Repeat removal procedure for the maxillary arch. 4. Once all trays have been removed, use dental floss through each interproximal contact. There will be no bridging of contacts or excess flash when Flowtain is applied properly to the bracket bases. Arch wires can be inserted immediately after tray removal.

4