BONDING BONDING

ININ

ORTHODONTICS ORTHODONTICS

25.02.2015Dr.Gyan P. Singh, KGMUOrthodontics&Dentofacial Orthopedics

Fixed orthodontic Fixed orthodontic ApplianceAppliance

BANDINGBANDING • The chief parts of modern fixed appliances are The chief parts of modern fixed appliances are

tooth bands,brackets and arch wires.tooth bands,brackets and arch wires.

• Tooth bands are made up of metals and cemented Tooth bands are made up of metals and cemented to the teeth and provides place for attachment of to the teeth and provides place for attachment of other auxiliaries like brackets, buccal tubes, lingual other auxiliaries like brackets, buccal tubes, lingual buttons etc. buttons etc.

• The tooth moving forces derived from the arch The tooth moving forces derived from the arch wires are transmitted to the teeth through the wires are transmitted to the teeth through the bracket bracket

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• MAGILL was the 1MAGILL was the 1stst to use plain band to use plain band

• Preformed steel bands Preformed steel bands came into widespread came into widespread use during the use during the 1960s1960s and are now available and are now available in anatomically correct shapes for all the in anatomically correct shapes for all the teeth.teeth.

• Teeth that will receive heavy intermittent Teeth that will receive heavy intermittent forces ( for the anchorage purpose-forces ( for the anchorage purpose-extraction cases) against the attachments extraction cases) against the attachments for the extra oral force like for the extra oral force like Head gear. Head gear. E.g.: upper 1E.g.: upper 1stst molars molars

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Banding TechniqueBanding Technique::

Separation Separation

Selection of band Selection of band materialmaterial

Fabrication and Fabrication and fittingfitting

CementationCementation

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•Elastomeric separatorsElastomeric separators;; which surrounds the contact point which surrounds the contact point

and squeeze the teeth apart over and squeeze the teeth apart over period of few days period of few days

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• PrefabricationPrefabrication

• Lower molar bands are Lower molar bands are designed to be seated initially designed to be seated initially with hand pressure on the with hand pressure on the proximal surface and then proximal surface and then heavy biting force along the heavy biting force along the buccal but not the lingual buccal but not the lingual margins.margins.

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BONDINGBONDING

For the patient to whom esthetics being For the patient to whom esthetics being the prime consideration even during the the prime consideration even during the treatment, the metallic look of the treatment, the metallic look of the orthodontic appliance has always been orthodontic appliance has always been the bone of contention.the bone of contention.

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•History:History:

Acid etching Acid etching M. G. BuonocoreM. G. Buonocore in 1955 using 85% phosphoric in 1955 using 85% phosphoric acid for 30 secacid for 30 sec

Newman (1965)Newman (1965) was the was the

first to apply bonded first to apply bonded orthodontic bracketsorthodontic brackets

Smith (Smith (1968) - zinc 1968) - zinc

polyacrylate and bracket polyacrylate and bracket bonding with this cement bonding with this cement

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..

Advantages over bondingAdvantages over bonding

• It is esthetically superior.It is esthetically superior.

• It is faster and simple.It is faster and simple.

• There is less discomfort for the patient There is less discomfort for the patient

• Arch length is not increased by band Arch length is not increased by band material.material.

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• It allows more precise bracket placement.It allows more precise bracket placement.

• Bonds are more hygienic than bands Bonds are more hygienic than bands Partially erupted teeth can be controlled.Partially erupted teeth can be controlled.

• Mesiodistal enamel reduction ( proximal Mesiodistal enamel reduction ( proximal reduction) is possible during treatment.reduction) is possible during treatment.

• Attachments may be bonded to artificial Attachments may be bonded to artificial tooth surfaces (eg., amalgam, porcelain, tooth surfaces (eg., amalgam, porcelain, gold) and to fixed bridge work.gold) and to fixed bridge work.

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• Caries risk under loose bands is Caries risk under loose bands is eliminated and interproximal caries can eliminated and interproximal caries can be detected and treated.be detected and treated.

• No band spaces are present to close at No band spaces are present to close at the end of treatment.the end of treatment.

• Lingual brackets, invisible braces, can Lingual brackets, invisible braces, can be used when patient rejects visible be used when patient rejects visible orthodontic appliance.orthodontic appliance.

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• The protection against the inter The protection against the inter proximal caries of well contoured proximal caries of well contoured

cemented band is absentcemented band is absent.. • Bonding is more complicated when Bonding is more complicated when

lingual auxiliaries are required or lingual auxiliaries are required or where headgears are attached.where headgears are attached.

• Debonding is more time consuming Debonding is more time consuming than debanding, since removal of than debanding, since removal of adhesive is more difficult than removal adhesive is more difficult than removal of cementof cement

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• Bonding procedures can be performed Bonding procedures can be performed in 2 ways in 2 ways

Direct bondingDirect bonding

Indirect bonding Indirect bonding

Direct bondingDirect bonding: :

This procedure is quite simple This procedure is quite simple and involves following stepsand involves following steps

CLEANING CLEANING

ENAMEL CONDITIONINGENAMEL CONDITIONING

SEALINGSEALING

BONDINGBONDING

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CleaningCleaning

• This requires rotary instruments, This requires rotary instruments, either a rubber cup or a polishing brush. either a rubber cup or a polishing brush.

• Studies have shown enamel loss due to Studies have shown enamel loss due to prophylaxis. prophylaxis.

• Mark Daniel pusMark Daniel pus et al ( AJO 1980)et al ( AJO 1980) showed that 10.7µm of enamel loss showed that 10.7µm of enamel loss during initial prophylaxis with bristle during initial prophylaxis with bristle brush was greater than the 5.0µm lost brush was greater than the 5.0µm lost when a when a rubber cuprubber cup as used and the as used and the difference was statistically significant.difference was statistically significant.

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• Enamel conditioning:Enamel conditioning: Moisture Moisture

controlcontrol Enamel Enamel

pretreatmentpretreatment

MOISTURE CONTROLMOISTURE CONTROL: : After the rinse, salivary control After the rinse, salivary control

and maintenance of a completely dry and maintenance of a completely dry working field is absolutely essential. Its working field is absolutely essential. Its presence may prevent the good bond presence may prevent the good bond between the sealant and bonding agent between the sealant and bonding agent

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•Enamel pretreatmentEnamel pretreatment• The conditioning solution or gel The conditioning solution or gel

((usually 37% phosphoric acidusually 37% phosphoric acid ) is then ) is then lightly applied over the enamel surface lightly applied over the enamel surface with a foam pellet or brush for 15 to with a foam pellet or brush for 15 to 30 sec. 30 sec.

• When etching solutions are used, the When etching solutions are used, the surface must be kept moist by surface must be kept moist by repeated applications. repeated applications.

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• Is etching time is different for young and old Is etching time is different for young and old teeth?teeth?

• K J. Nordenvall et al (AJO 1980)K J. Nordenvall et al (AJO 1980) did a did a comparison between the effects of 15 and 60 comparison between the effects of 15 and 60 seconds of etching with a 37 percent phosphoric seconds of etching with a 37 percent phosphoric acid solution on enamel surfaces of deciduous acid solution on enamel surfaces of deciduous and young and old permanent teeth.and young and old permanent teeth.

• For deciduous teethFor deciduous teeth, no difference was found in , no difference was found in effect between the etching periods. effect between the etching periods.

• For young permanent teethFor young permanent teeth, 15 seconds of , 15 seconds of etching created more retentive conditions than etching created more retentive conditions than 60 seconds. 60 seconds.

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• How much enamel is removed by etching How much enamel is removed by etching and how deep are the histological and how deep are the histological alterations?alterations?

Are they reversible? Is etching is harmful?Are they reversible? Is etching is harmful? A routine etching removes 3 to 10 A routine etching removes 3 to 10

μm of surface enamel. Another 25 μm μm of surface enamel. Another 25 μm reveals subtle histological alterations reveals subtle histological alterations creating necessary mechanical interlocks.creating necessary mechanical interlocks.

Deeper localized dissolutions will Deeper localized dissolutions will generally cause penetration to a depth of generally cause penetration to a depth of about 100µm or more. about 100µm or more. 20

BondingBonding Direct techniqueDirect technique in which the brackets in which the brackets

are placed directly on the enamel surface are placed directly on the enamel surface by the operator, as was initially described by the operator, as was initially described by by NewmanNewman. .

• The second method of bracket placement The second method of bracket placement is the is the indirect techniqueindirect technique, which was first , which was first described by described by Silverman et alSilverman et al

The recommended bracket bonding The recommended bracket bonding procedure consists of the following stepsprocedure consists of the following steps

1.TRANSFER1.TRANSFER 2.POSITIONING2.POSITIONING 3.FITTING3.FITTING 4.REMOVAL OF EXCESS4.REMOVAL OF EXCESS 21

TRANSFER:TRANSFER: • The bracket is gripped with a pair of The bracket is gripped with a pair of

cotton pliers or a reverse action cotton pliers or a reverse action tweezer (bracket holding forceps) and tweezer (bracket holding forceps) and the mixed adhesive is applied to the the mixed adhesive is applied to the back of the bonding base. back of the bonding base.

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POSITIONING:POSITIONING:

• A placement scaler, such as the RM 349 A placement scaler, such as the RM 349 or one with parallel edges is used to or one with parallel edges is used to position the brackets mesiodistally and position the brackets mesiodistally and incisogingivilly and angulate them incisogingivilly and angulate them accurately. accurately.

• The placement scaler with parallel edges The placement scaler with parallel edges allows visualization of the bracket slot allows visualization of the bracket slot relative to the incisal edge and long axis relative to the incisal edge and long axis of the teeth, with the scaler seated in slot.of the teeth, with the scaler seated in slot.23

FITTINGFITTING

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• REMOVAL OF EXCESSREMOVAL OF EXCESS

• Excess must be removed with the Excess must be removed with the scaler before the adhesive has set or scaler before the adhesive has set or it must be removed with bur after it must be removed with bur after setting.setting.

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INDIRECT BONDINGINDIRECT BONDING

• Several techniques for indirect bonding are Several techniques for indirect bonding are available. Most are based on the procedures available. Most are based on the procedures described by described by Silverman and Cohen ( JCO Silverman and Cohen ( JCO 1976). 1976).

• H. Stuart ( Jco 2003 )H. Stuart ( Jco 2003 ) suggested most indirect suggested most indirect bonding techniques are successful in bonding techniques are successful in accurately placing brackets but can be accurately placing brackets but can be expensive, he introduced a simplified method expensive, he introduced a simplified method that has reduced lab cost and chair time.that has reduced lab cost and chair time.

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Indirect bonding with Indirect bonding with silicone impression traysilicone impression tray

• Take an impression and pour up a Take an impression and pour up a stone modelstone model

• Select brackets for each toothSelect brackets for each tooth• Apply a small portion of water soluble Apply a small portion of water soluble

adhesive on each toothadhesive on each tooth• Position the brackets on the model, Position the brackets on the model,

check all the measurements and check all the measurements and allignments, reposition if neededallignments, reposition if needed

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Indirect bonding Indirect bonding In this technique temporary adhesive is In this technique temporary adhesive is

used to attach the brackets to the used to attach the brackets to the patients stone model patients stone model

• The bracket is placed on the model and The bracket is placed on the model and excess adhesive is removed from the excess adhesive is removed from the periphery of the baseperiphery of the base

• Before forming the indirect bonding tray Before forming the indirect bonding tray use of light separating spray is use of light separating spray is recommended to facilitate the easy recommended to facilitate the easy removal of the tray from the brackets.removal of the tray from the brackets.

• After 10 min placement tray is vacuum After 10 min placement tray is vacuum formed for each arch formed for each arch

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• Tray is removed by peeling from the Tray is removed by peeling from the lingual towads the buccal lingual towads the buccal

• Excess flash of sealant is carefully Excess flash of sealant is carefully removed from the gingival contact removed from the gingival contact areas of the tooth areas of the tooth

• Advantages Advantages

clean up is simple because little clean up is simple because little flash is presentflash is present

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DEBONDINGDEBONDING

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• Definition/Objective of debondingDefinition/Objective of debonding :- :-

--To remove the attachment and all --To remove the attachment and all the adhesive resin from the tooth and the adhesive resin from the tooth and restore the surface as closely as restore the surface as closely as possible to its Pre-treatment possible to its Pre-treatment condition without inducing iatrogenic condition without inducing iatrogenic damage.damage.

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Clinical ProceduresClinical Procedures

• Mainly divided into 2 stagesMainly divided into 2 stages

-- Bracket removal-- Bracket removal

-- Removal of residual -- Removal of residual adhesiveadhesive

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Bracket removalBracket removal

• Metal bracketsMetal brackets -- Debonding pliers-- Debonding pliers

• Ceramic bracketsCeramic brackets -- Pliers-- Pliers -- Separation at bracket adhesive -- Separation at bracket adhesive

interface (Bishara)interface (Bishara) -- Thermal debonding-- Thermal debonding -- Lasers -- Lasers

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Removal of residual Removal of residual adhesiveadhesive

• ScalerScaler• Scraping with a sharp band or bond Scraping with a sharp band or bond

removing plierremoving plier• Burs Burs -- Dome shaped TC bur-- Dome shaped TC bur -- Ultrafine diamond bur-- Ultrafine diamond bur -- White stone finishing bur-- White stone finishing bur

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REFERENCESREFERENCES•William R Proffit ,Contemporary William R Proffit ,Contemporary orthodontics Third Edition ,2002orthodontics Third Edition ,2002•Thomas M Graber , Robert L, Vanarsdall Thomas M Graber , Robert L, Vanarsdall , Orthodontics :Current Principles and , Orthodontics :Current Principles and Technique Fourth Edition,2003Technique Fourth Edition,2003•Robert E Moyers Handbook of Robert E Moyers Handbook of orthodontics Fourth Edition,1988orthodontics Fourth Edition,1988•Kharbanda.Diagnosis and Management Kharbanda.Diagnosis and Management of Malocclusion and Dentofacial of Malocclusion and Dentofacial deformities.Mosby,elsevier,2001deformities.Mosby,elsevier,2001

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MCQs:1. Complicated cases are most often treated by fixed appliances

than removal appliance because

(A)They apply heavy forces

(B)Wide range of tooth movements possible

(C)Require less anchorage

(D)They cannot be removed by the patients

2. Which of the following are examples of fixed active appliances

(A)Standard Edgewise and straight wire

(B)Begg and Herbst

(C) Activator and Herbst

(D) Bionator and twin-block41

3.All of the following can be classified as myofunctional appliances except

(A)An anterior bite plane

(B)Andresen appliance

(C)Begg appliance

(D)Oral screen

4. Rotation of teeth is best corrected by

(A)Hawley appliance

(B)Buccal retractor

(C) Fixed appliance

(D) All of the above42

5.Which of the following is not true of an fixed appliance

(A)Economical

(B)Rotation and extrusion movement are possible

(C)Patient cooperation is not required

(D)Tipping and bodily movement is possible

6. Passive component of fixed appliance

(A)Brackets

(B)Arch-wire

(C)Springs

(D)Elastics

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7.Which of the following components of the fixed appliance holds the arch-wire on the teeth except for that molars

(A)Cleats(B)Brackets(C)Bands(D)Lock springs

8. The direct bonded orthodontic stainless steel brackets device retention with composite because of

(A)The mechanical interlock with mesh at the bracket base(B)The chemical interlock of composite with bracket base(C)Both mechanical and chemical interlock of composite with the bracket

base(D)Biological interlock between the tooth and the brackets.

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9. Use of light cure in orthodontics is done in case of

(A)Bonded retainer

(B)Fixing the brackets

(C)Correction of 1 mm midline

(D)All of the above

10. A first order bend in an orthodontic wire is

(A)A twist in the wire

(B)In the vertical plane

(C)In the horizontal plane

(D)A horizontal bend with a twist

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