Clinical Pearls

Bonding tips and a memorable giveaway

The Ever-Evolving Bonding Process

Scott Smoron, DDS, MSD

Scott Smoron, DDS, MSD
Mount Prospect, Ill

There are many ways to have a great bonding appointment. For me, the actual bonding process has been, and continues to be, an evolving process. I do variations on my normal bonding routine, assess those variations, and incorporate those changes that improve the routine. My bonding process has gone through many iterations to arrive at my current suctionless, waterless process. I am very happy with many aspects of my bonding procedure, but there are many ways in which I still have room for improvement. Below is what I do.

I do not use water to bond. I do not use suction. I do not use etch, unless bonding to porcelain. I do not use retractors any longer. I have dedicated air-syringes.

I love Adper L-pops with the hot-pink stick. I have been told that they are too strong and I will damage teeth; 6 or 7 years using them every day without a single instance of enamel damage would indicate otherwise. I reuse them for days; we pull the stick out without contaminating the packaging and place a new micro-brush in later. I have reused a stick that had been sitting around for a week without a problem. I typically get three or four repair bonds from a single L-pop.

I love Reliance Orthodontics’ Assure and Ormco’s Ortho Solo. They make bonding more predictable. Poor hygiene patients? Use Reliance’s Pro Seal.

I place all braces myself. I bond from second molar to second molar. I have several different parts that I can swap in or out, like hooks on premolars and lateral incisors, undersize molar tubes, and high-torque variants. I sometimes place them upside down to engage root torque earlier in treatment with gentler rectangular archwires.

I use a cordless LED light with a 4-second cure. I also have a second, older cordless LED that can cure in 10 seconds. All my chairs share this one light.

I normally indirect bond. The accuracy is better; any study not showing an improvement with the complicating factor of the oral cavity and patient motion taken out of the equation is missing something. However, the reason I do it is for the seal I can get to enamel and for patient comfort. I do not see decalcification under my braces, but I regularly see decalcification under braces on transfers. I do get decalcification around the braces due to poor hygiene compliance or soda consumption, but decalcification under a brace is iatrogenic and avoidable. I think the most common reason for it is direct placement of braces on teeth with greater than average contours where the placement of the brace results in a “rock” of the brace, pulling adhesive away on one side while seating on the other side. When I encounter this, I pick the brace back off, reapply the adhesive, and replace the brace without inducing a “rock.”

I use Reliance Orthodontics Therma-Cure for indirect setups; I never have to protect the setup from light, and it can be 100% cured in 10 minutes with a $15 toaster oven.

A successful bonding appointment takes into consideration patient comfort, not just consistency of bond strength. For this reason, I do not use retractors or suction. I break the bonding trays into sextants and use only a cotton roll—if that—for retraction. It is comfortable, and it is how I would want to be treated. I only use suction to evacuate the laser plume when doing surgeries. (My staff uses it for SureSmile scans.) I have gone months without turning on suction.

When rebonding or direct bonding, I sit down, hold the lip out of the way, air dry for a split second, grab the L-pop and rub for a couple of seconds, air dry for 2 seconds, place the brace, position the brace, then zap it. It takes … 30 seconds? 45? Why would I need the assistant to waste time cotton-rolling and retracting, acid-etching, drying, priming, placing the brace, then waiting for me?

I have read research that suggests curing your light-cured primer prior to placing the brace in order to decrease the amount of adhesive remnants left on the tooth after debonding. I think this is a good idea, but I have not found a difference clinically. Try it with your primer/adhesive and see if it helps on debonding day.

I micro-etch every band that is cemented. If nothing else, more adhesive comes off with the band when debonding, and that also makes for easier cleanup.

I love blue Ultra Band Lok from Reliance Orthodontics; it requires no mixing and is easy to clean up. I hate trying to find the tooth-colored band adhesive that transfers will have on their teeth. I love the question I sometimes get: “Are my teeth suffocating? They’re turning blue!” When Band Lok is not enough, I use the L-pop on the buccal surface as a primer and add a slight amount of my light-cured adhesive to the buccal bead of Ultra Band Lok.

I love Paul Gange from Reliance Orthodontics; he is accessible, prompt with a response, and knowledgeable about his products and his competition’s products. If you are having trouble with your bonding, he is the person to talk to.

Crystal Glass Nail Files

Phillip Parker, DDS, MS, PC

Phillip Parker, DDS, MS, PC
Norman, Okla

Being the “guy” that I am, I had no idea what a hit nail files would be as a gift for our referring offices and parents. I have grown to trust our marketing firm, Smile!, with innovative ideas for ways to promote our practice, and we can’t keep these in stock. The files are made of crystal glass, and ours have a green and cobalt fade with our logo imprinted on them. The ladies have told me that they no longer need disposable files and that these are permanent residents in their purses and gym bags. Additionally, the files are hygienic because they are not porous so they are not likely to be thrown away. That is pretty powerful to know our practice brand is in the hands of those we appreciate most and going places we may never have been.