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INDIRECT BOUNDING

The indirect bounding technique has been used by the orthodontics profession for more than 25 years. Although several practitioners have practised this technique successfully, indirect bounding failed to become an industry standard because problems arose. However, new technologies such as individualized bracket placement, special adhesive systems and clear transfer trays have helped the indirect set-up technique evolve over the years into a reliable, high-precision technique that dentists and orthodontists can now fully trust.

THE TECHNIQUE USED AT THE LABORATORY
Using the indirect set-up technique, brackets are positioned with adhesive on a working model, enabling them to be moved in slow, successive steps. Technicians can have a fellow technician validate the selected bracket positions before permanently fitting the brackets onto the model. This technique provides a definite advantage coupled with unmatched accuracy.

BRACKET PLACEMENT
AT BELLOMO LAMBERT

When a case for indirect bonding is received at the laboratory, the first step is to evaluate the quality of the constructions. After verifying the accuracy of the models and reviewing the Panorex and prescription, a base line is drawn on the stone models to indicate bracket locations. Then the incisive and occlusal surfaces of each tooth are traced, followed by long axial and vertical height lines to obtain base indicators. There are two placement techniques to choose from: the incisive end placement technique and the marginal ridge placement technique. Contact a member of our technical support team if you have questions regarding these two options.

THE TWO-LAYER SYSTEM

At Bellomo Lambert, we have opted for the time-proven “two-layer tray” technique. First, brackets are covered with a flexible, vacuum-pressurized vinyl inner plate. Then a hard, thermoformed acrylic layer is applied directly onto the flexible vinyl layer. The trays serve as both “transfer and basis units” by exerting positive pressure to ease bracket placement. In addition, this system helps the practitioner to easily position and place the tray by not obstructing the visual field. In certain cases, especially with serious crowding, the inner tray containing the brackets may be separated from the hard, outer matrix of the tray and placed with slight twisting. The outer layer of the tray is then immediately replaced on the lower layer of the tray. All transfer trays can be split into sections according to the dentist’s preference.

THE CLEAN BASE AND CUSTOM BASE METHODS

Two bonding methods are available. The Clean Base method is delivered with the inner mesh pad of brackets clean and micro-etched. The brackets may then be bonded using the standard techniques and bonding agent. Since the bonding agent will be polymerized before the vinyl trays are removed, it is essential that the proper dose of bonding agent be measured before fitting onto the teeth.

Although practitioners must be quite skilled and careful when using the Custom Base method, it provides great advantages. The BluGloo™ glue from Ormco is applied directly onto the Mesh Pad of brackets by laboratory technicians. During chair time, the technique consists of simply adding a bonding agent that causes the glue on the brackets to react. This technique serves to prevent excess glue from appearing around the metallic bases of brackets once they are bonded. However, it is recommended that the Clean Base method be tried on a few cases before using this method.

RECOMMENDATIONS FOR THE CUSTOM BASE METHOD

– Etch teeth according to the bracket section to be bonded
– Mix together the Maximum CureTM products available from the Reliance company;
– Apply the mixture directly on the teeth;
– Apply the mixture directly on the teeth;
– Exert constant pressure against the matrices fitted on the teeth for at least 120 seconds.
– Allow the bonding agents to set for at least 4 additional minutes without pressure.
– As recommended by the manufacturer, wait for 6 minutes overall before removing the matrices.

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