BONDING – II

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INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

BONDING IN ORTHODONTICS – II:

BONDING IN ORTHODONTICS – II www.indiandentalacademy.com

CONTENTS:

CONTENTS Evolution of bonding agents Banding Indirect bonding Bonding to special surfaces Other applications Bond strength Debonding Decalcification & Demineralization www.indiandentalacademy.com

INDIRECT BONDING:

INDIRECT BONDING “Location! Location!! Location!!!” www.indiandentalacademy.com

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Limitations of direct bonding technique: Limited access to surfaces of malposed teeth Poor visualization of posteriors Limited precision Greater possibility of moisture contamination Increased doctor chair time Limited working time with self-cure composites. www.indiandentalacademy.com

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Indirect bonding was first introduced in 1972 by Silverman et al in AJO – “A universal direct bonding system for both metal and plastic brackets.” Principle – brackets positioned on cast using adhesive (water-soluble/cement/resin), transferred to teeth using custom trays. www.indiandentalacademy.com

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Advantages of indirect bonding: Better visualization - Precise bracket positioning Improved ability to bond the posteriors Bands on post teeth not required – separators Resin thickness between bracket and tooth better controlled – better expression of built-in prescription Better debonding Decreases chairside time Improved patient comfort and hygiene Less stressful for orthodontist www.indiandentalacademy.com

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Limitations of indirect bonding technique: More complex and technique sensitive More time for rebonding on failure Posterior attachments more likely to fail if the patient chews on hard food Excess adhesive around the bracket bases -difficult and time consuming to remove Difficult on very short clinical crowns Additional set of impressions Skilled laboratory manpower www.indiandentalacademy.com

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Early pioneers - Silverman and Cohen (1972), Thomas(1979), Moin and Dogon(1977) Current procedures are modifications- Temporary attachment of brackets to model Type of transfer tray or any other mechanism Adhesive or sealant employed Method of transfer-mechanism removal www.indiandentalacademy.com

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INDIRECT BONDING PROCEDURES: Indirect bonding with silicone transfer trays Indirect bonding with double-sealant technique www.indiandentalacademy.com

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INDIRECT BONDING WITH SILICONE TRANSFER TRAYS Step 1: Step 2: Water soluble adhesive on each bracket base www.indiandentalacademy.com

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Step 3: Step 4: www.indiandentalacademy.com

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Step 5: Immerse tray and model in hot water Step 6: Trim tray and mark midline Step 7: Step 8: Adhesive - base of brackets Step 9: Tray seated and held for 3 mins Step 10: Tray is peeled off after 10 mins & excess adhesive on tooth is removed www.indiandentalacademy.com

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INDIRECT BONDING WITH DOUBLE-SEALANT TECHNIQUE Adhesive paste instead of temporary adhesives - to bond the brackets onto the cast After 10 mins tray is vacuum formed Immersed in water Trays separated and trimmed within 2 mms of brackets Embedded bracket bases lightly abraded with mounted stone www.indiandentalacademy.com

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Prepare tooth surface Bracket bases – PartB /catalyst sealant resin Teeth - PartA / universal sealant resin Tray seated & held for 3 min Peeled from lingual to buccal Clean up simple - less flash & resin unfilled www.indiandentalacademy.com

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SILVERMAN AND COHEN – 1972 Direct bonding technique to bond ‘all’ teeth Adhesive – 2 components Sealant – Pit and fissure sealant of Buonocore 3 parts BisGMA + 1 part MMA + Benzoin methyl ether (UV light sensitive catalyst) Caulk NuvaLight system New experimental by GAC – powder + liquid www.indiandentalacademy.com

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Cast – cement Transfer – plastic Vanguard material www.indiandentalacademy.com

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Bonding – cement www.indiandentalacademy.com

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Updated technique – 1974 by same authors Used perforated metal bracket bases Only one adhesive- BisGMA- UV light activated Nuva–Tach by L.D.Caulk company Plastic tray Increased working time www.indiandentalacademy.com

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MOIN & DOGON TECHNIQUE (1977) : “ Concise Enamel Bond” Cast – Sticky wax Transfer - Polyether impression trays Bonding – low viscosity sealant - high viscosity bonding agent www.indiandentalacademy.com

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Lab procedure Step 1: Sticky wax Step 2: Warm and place brackets at desired level and angulation www.indiandentalacademy.com

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Step 3 : Polyether impression trays Step 4 : -Tray separated from cast -Brackets remain in situ -Remove bracket from cast -Warmed to remove residual wax -Placed back into impression www.indiandentalacademy.com

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Clinical procedure: “ Concise Enamel Bond” Pumice Isolate – Dri-angles - for molars – pro-Banthine – 15mg – ½ an hour before etching 37% phosphoric acid – 60 secs Sealant –tooth – universal + catalyst sealant Bonding –bracket- universal + catalyst liquid Tray placed, impression removed Floss, scaler Bracket margin – dilute mix of resin www.indiandentalacademy.com

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INDIRECT BONDING OF MANDIBULAR CANINE TO CANINE LINGUAL RETAINER www.indiandentalacademy.com

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THOMAS TECHNIQUE: (1979) Concise / Dyna-Bond Cast – Catalyst(B) + Universal (A) Transfer - plastic Vanguard trays Bonding – Teeth - liquid sealant ‘Universal’ resin part A Bracket bases- liquid sealant ‘Catalyst’ resin part B www.indiandentalacademy.com

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A new approach to indirect bonding technique using light-cure composites - AJO-DO 1997 - Paul Kasrovi et al Conventional indirect bonding – Non-transparent trays Poor visualization Self-cure resin – difficult to clean-up on setting Time lost in removing set flash Improperly seated tray revealed only after removal – misplaced brackets, failed procedures www.indiandentalacademy.com

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Modifies the fabrication of transfer tray Provides direct visualization & access to the brackets - during both lab and clinical procedures www.indiandentalacademy.com

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Lab adhesive for IDB www.indiandentalacademy.com

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Technique is highly predictable & reproducible Visibility and accessibility from start to finish Ability to remove composite flash before curing www.indiandentalacademy.com

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Efficient and effective indirect bonding -Anoop Sondhi (AJO-DO 1999) Traditional indirect bonding Excessive flash Clean-up problematic Excessively high lab working time Experiments with various adhesives www.indiandentalacademy.com

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New resin by 3M Unitek specially for IDB -”SONDHI INDIRECT ADHESIVE” Decreased setting time - 30 sec Completely cured in 2 mins. Viscosity is increased APC www.indiandentalacademy.com

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APC / TransBond XT Triad light curing unit – 10 mins www.indiandentalacademy.com

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Mor-tight / wax Biostar /silicone transfer materials www.indiandentalacademy.com

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Type A Resin Type B Resin www.indiandentalacademy.com

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LINGUAL BRACKET BONDING:

LINGUAL BRACKET BONDING Late 70s – Bonding – viable procedure – popular Ceramic & plastic brackets – compromise ULTIMATE AESTHETIC APPROACH “Bonding brackets on lingual surfaces” www.indiandentalacademy.com

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Pioneered in Japan by FUJITA (1982) Mushroom arch Kurz, Kelly, Paige, Creekmore Rapid popularity in early 80s Abandoned – finishing stages www.indiandentalacademy.com

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Problem not with brackets coming loose Pronunciation difficulties Difficult Time-consuming Awkward working position More precision in adjusting archwires – reduced interbracket span www.indiandentalacademy.com

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Clinical comparison of direct versus indirect bonding with different bracket types and adhesives – AJO 1978 -Zachrisson and Brobakken Purpose of the study: To make a blind comparison in the clinic of some most commonly used materials Compare clinical experiences with direct and indirect techniques www.indiandentalacademy.com

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Several advantages of Direct bonding - Easier to remove flash Working area visible at all times Brackets firmly placed in close contact Uniform adhesive layer Allowed to set without disruption www.indiandentalacademy.com

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Advantages of Indirect bonding- High degree of precision in bracket angulation and position Auxiliary personnel www.indiandentalacademy.com

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CONCLUSION: Mesh-base – stronger, hygienic Small filler particles – hygienic & as strong Direct bonding more advantageous over IDB Failure rate with both – low More failure with IDB Both techniques – clinically satisfactory results www.indiandentalacademy.com

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Assessment of bracket strength and bond strength when comparing direct bonding to indirect bonding techniques - AJO 1982 - Aguirre, King & Waldron To compare bracket placement, bond strength, failure rate and time involved for 2 techniques 11 patients, 206 bonded, 189 studied www.indiandentalacademy.com

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Results: Vertical placement – no difference Max canines – IDB Mandb II premolars – DB Angular placement – SS differences IDB better for maxy and mandbr canines Bond strength – great variability Bracket failures – more for DB Time – DB – 42.18 mins IDB – 53.73 mins total; 23.91 - clinical www.indiandentalacademy.com

BONDING TO UNCONVENTIONAL SURFACES:

BONDING TO UNCONVENTIONAL SURFACES Crowns and restorations: Amalgam / Cast metal Porcelain Acrylic Gold www.indiandentalacademy.com

AMALGAM / CAST METAL CROWNS:

AMALGAM / CAST METAL CROWNS Modification of metal surface – Sandblasting Diamond-bur roughening www.indiandentalacademy.com

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Use of intermediate resins that improve bond strength Ex. All-Bond 2, Enhance, Metal Primer All-Bond 2 – 3 rd generation DBA 10% phosphoric acid for conditioning www.indiandentalacademy.com

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Primer A + Primer B – mix Apply to enamel till acetone evaporates Air-dry for 10 secs Primer B – metal primer Further and more research www.indiandentalacademy.com

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New adhesive resins that bond chemically to precious and non-precious metals Ex. 4 – META - Superbond C & B, Molecule orients towards O / OH group in metal – HYDROGEN BOND Bond strength to amalgam less than that with other sandblasted metals Setting time – 10 mins Better – Orthomite Super Bond, MCP Bond www.indiandentalacademy.com

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10 – MDP bis-GMA resins - Panavia EX Phosphate ester group Oxides of metal – Ni, Cr, Co, Sn Anaerobic environment – Oxyguard gel www.indiandentalacademy.com

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Procedure: Sandblast - 50 microns Al 2 O 3 for 3 secs Etch with 37% phosphoric acid - 15–30 secs Large restorations – coat of Metal Primer for 30 secs Sealant Bond with adhesive resin Should not occlude with antagonist Repolish with rubber cups after debonding. www.indiandentalacademy.com

PORCELAIN:

PORCELAIN Adult patients Feldspathic porcelain (10-20% Al 2 O 3 ), high aluminous porcelains, glass ceramics Conventional acid etch ineffective Technique – Roughening of surface with burs/green stones Porcelain primer Highly filled adhesive www.indiandentalacademy.com

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WOOD et al (1986) Bond strength equal/greater than to enamel surface with this technique Damage to porcelain surface ZACHRISSON et al (1993 ) Unacceptably high failure rates Lab tests – high bond strength In vitro – continuously increasing force In vivo – traumatic incidents, repeated stress – propagation of micro cracks www.indiandentalacademy.com

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Instead of silane – PORCELAIN ETCHANTS 9.6% Hydrofluoric acid gel – 2-4 mins Equivalent etch by – 1.23% APF for 10 mins 4% APF – 2 mins Microporosities for mechanical interlock Frosted appearance like enamel www.indiandentalacademy.com

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Procedure: Isolate Deglaze - sandblasting 50 microns Al 2 O 3 –3 secs Intraoral sandblasting – Microetcher High-speed evacuater www.indiandentalacademy.com

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9.6% HF gel - 2 mins Strong acid – careful isolation - remove gel with cotton first - copious rinsing - high-volume suction - immediate drying Bond with highly filled BisGMA resin Use of silane optional www.indiandentalacademy.com

COMPOSITES:

COMPOSITES Old composites – Decrease in free MMA groups Exposed filler particles from silane leached out Superficial layer abraded with diamond or carbide bur 37% phosphoric acid Silanation Bonding www.indiandentalacademy.com

ACRYLIC:

ACRYLIC Temporary restorations Wet surface with MMA for 3 mins Bonding – unfilled resin or composite www.indiandentalacademy.com

GOLD:

GOLD Not in much use Sandblasting Electrolytic tin plating – chemical and mechanical bonding to resin Gallium-tin solution (Adlloy) Metal primers www.indiandentalacademy.com

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Bond strength not enough to withstand occlusal forces VTD adhesive monomer (triazine-dithiol), 4-META www.indiandentalacademy.com

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Thank You www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com

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