Indirect Bonding

11 worries Solved

1.         How do I know if the brackets will be positioned correctly?

A.        Positioning brackets correctly is vital if you are going to get a great result. It’s true that many specialist orthodontic labs do not understand correct positioning of brackets and therefore it is very important that you choose a lab with a lot of experience to do your indirect bonding. At Ortholab we follow a standard set of guidelines for correct bracket positioning, we allow the positions to be changed based on teeth that are either large or small, or that might be missing a cusp. Brackets may also be placed more gingivally or occlusally based on the individual case and doctors may want a particular bracket placed upside down or substituted for another bracket. Our guidelines are overruled by any request the doctor may write on the individual lab sheet.

2.         I have heard that when the trays are removed, many of the brackets will come off and stay in the tray.

A.        This problem can occur in two ways. Firstly if the doctor removes the tray too quickly, tearing it off like a band-aid. It must always be removed slowly, tooth by tooth. This can also happen if the lab is not experienced in making indirect trays. The machine that forms the bracket trays can have it’s pressure adjusted, and if it is set too high the tray material will form around the hooks and even into the slots, causing the brackets to come away when the doctor removes the tray. If the setting is too low, the brackets will not be held securely in the tray. At Ortholab, we know exactly the right setting to use to get the best results. Many doctors tell us that they always get 100% adhesion.

3.         I’m worried that I won’t have enough time to bond a whole arch in one go, that the adhesive may set or that it’s just too much to do in one go.

A.        These days most adhesives allow a long working time, and won’t set at all until it gets zapped from the light cure gun. You have plenty of time to cure the adhesive. Always read the instructions on the adhesive you use and make sure it’s not out of date and has been stored properly. If you do this you won’t have any problems curing an entire arch at a time.

4.         I really feel I need to have the tray sectioned in 2 or 3 pieces, it’s just too much to do at once.

A.        No you don’t need it sectioned. We can section it for you if you want but this just increases the time taken to do the bond up. Just give it a try, you can do it in one go and you will surprise yourself how easy it is.

5.         How can I trust a technician to get the brackets in the right place?

A.        The lab and technician you choose is the answer. If the technician can prove he has had the necessary training and has the experience then go for it. Do not choose a lab for indirect bonding based solely on price, you will be throwing your money away, loosing a patient and getting a bad reputation.

6.         What do I do if a bracket or two does remain in the tray when I remove it?

A.        Remove the brackets from the tray and manually direct bond them.

7.         I feel that when I send a case to the lab for indirect bonding, it makes me look as though I don’t know where to place the brackets myself. The lab must think I’m stupid!!

A.        Not at all. Firstly indirect bonding is primarily done to save time, enabling doctors to band up patients in 15 minutes or less, so it’s a time saving technique. Secondly, let’s suppose that you don’t know where to put the brackets, then it’s a very smart move to get someone who does know to do it for you.

8.         I’ve been told I can’t use indirect bonding for self ligating brackets

A.        Not true, all types of  labial brackets including self ligating, porcelain, composite, triangular or any other brackets ban be done with indirect bonding. The only issue we have with self ligating brackets is that we need to check that the gates are closed before we pressure form the trays.

9.         Can you use the indirect bond technique for lingual brackets?

A.        The short answer is yes, however indirect bonding of lingual brackets is a completely different technique which is far more complicated and takes a lot more time. It is not just the same technique done lingually.

10.       Should I use bands or bondable tubes on the molars?

A.        It makes sense to use bondable tubes, and this can be done in the indirect bonding tray at the same time as the 5-5 are being bonded, just ask on the lab sheet for 6-6 or 7-7 bonding. My advice is to use the bondable tubes with the large bases, these obviously have a larger gripping surface and therefore tend to debond less due to pressure. You can use bands but you should fit separating elastics AFTER you have bonded 5-5. If you don’t then the separating elastics will cause the adjacent teeth to move slightly during the time it takes to get the trays made. When you come to fit the tray, it will not be accurate.

11.       How much adhesive do I use?

A.        If you have done direct bonding, use the same amount. If you are just starting, then only experience will tell you how much to use. If you use too much, you will spend a lot of time cleaning up. If you use too little, then you will not get good adhesion. As a general rule, you actually need a lot less than you think.