By Marcel Korn, DMD
Figure 1Many materials and methods for bracket bonding and placement are available in the marketplace. At the start of the bonding era, orthodontists relied on direct bonding with two-paste systems. This was followed over time by no-mix, hydrophilic, light cured, and indirect bonding systems.
Eventually, prepasted brackets came onto the scene. This both excited the profession and offered a new and innovative approach to the bonding of brackets. The first prepasted system was prepackaged and the light-cure bonding material it utilized had much flow, but the operator had to stay at the chair with the assistant to prevent bracket drifting.
The “Pre-Paste, Orange Box System” we use in our office maximizes practice downtime, allowing us to first study the cases and then prepaste the brackets chosen for cases. The Pre-Paste System increases office productivity while keeping control in hand by using downtime to paste and store brackets.
The Pre-Paste System with the “Orange Box Parts” offers many advantages to the practitioner, including:
- Use of any bracket available in the practice’s inventory. Use is not limited to commercially available prepasted brackets.
- Use of high-viscosity adhesive, which eliminates bracket drift after placement and prior to curing, and allows time for very accurate bracket placement. Moreover, brackets can be prepasted and stored for up to 2 weeks using the Pre-Paste System, or pasted at chairside. Additionally, the thicker consistency requires adhesive to be pressed firmly into mesh at the time of prepasting to achieve optimal bond-bracket locking.
- Prepasting of brackets can be done during practice downtime, not only at the chair.
- Accuracy, quality, and adequate time for bracket placement, which reduces the need for costly and time-consuming indirect bonding, saving doctor time, chairtime, and assistant time.
- Substantial savings in cost.
Figure 2What You Will Need:
- Work Box: The orange-colored plastic prevents polymerization, creating a safe zone for prepasting brackets.
- Storage Box: Protects six prepasted cases for up to 2 weeks before bonding.
- A high-viscosity adhesive, like Eagle No Drift™ from American Orthodontics: Eliminates bracket drift prior to curing and allows time for accurate bracket placement.
- Chairside Cover: Protects one prepasted case at chairside until ready for bonding.
- Mouth Shield: The patient holds the mouth shield during bonding. It helps prevent ambient light from prematurely polymerizing brackets after they are positioned, but prior to curing. Helpful whenever curing is delayed after positioning.
- Slippery Bond Card: For organizing prepasted brackets base-side down. Fits in Storage Box and Chairside Cover.
Figure 3Steps in Bonding a Full Case
Step One: Prepasting (Figure 1). Utilizing office downtime, prepaste any bracket setups working inside the orange Work Box. Use Eagle No Drift High Viscosity Adhesive, and place prepasted brackets base-side down on specially coated Slippery Bond Cards.
Step Two: Storage (Figure 2). Store prepasted Slippery Bond Card bracket setups in the orange Storage Box. Prepasted brackets can be stored for up to 2 weeks.
Step Three: Chairside Prep and Preplanning (Figure 3). Select prepasted Slippery Bond Card, transfer to chairside for bonding, and protect from ambient light with the Chairside Cover.
Figure 4
Step Four: Preparing the Mouth and Dentition (Figure 4). Select the appropriate retractors and bite block-tongue guards for proper isolation and salivary control. Maxillary and mandibular segments will now be etched and brackets bonded.
Prepare the dentition one side at a time, tipping the head to the right and etching from right lateral to left second molar. Tipping the head to one side will allow for fluid accumulation away from the teeth being bonded.
The process in this step includes pumicing and etching, or micro-etching one segment at a time; applying Reliance Orthodontic Products’ Assure hydrophilic coating; and placing Eagle No Drift High Viscosity Adhesive over the Assure coating.
Figure 5
Step Five: Initial Bracket Placement. Take brackets one at a time from beneath the Chairside Cover (Figure 5), and place them on the prepared teeth. Once the first side is bonded, the head is then tipped to the opposite side for fluid accumulation, and the process is repeated as the dentition from right canine to right second molar is etched and prepared.
Figure 6
Patient holds mouth shield over mouth (Figure 6), protecting it from ambient light. Meanwhile, continue to take brackets one at a time from the Slippery Bond Card under the Chairside Cover, and place brackets on teeth in their proper location. Press hard to ensure material-bracket locking. This is done one side at a time, according to Step Four preparation.
Figure 7
Step Six: Final Bracket Placement and Checking (Figure 7). The doctor is now called to check bracket placement and to finalize positions, one side at a time with head still tipped to one side for fluid control.
Figure 8
Step Seven: Bracket Light Curing (Figure 8). Whatever you do now to cure, you can do the same with this process.
This method of bonding is technique sensitive but has a very short and direct learning curve. The savings in time, accuracy, and cost are substantial. The clinician will be rewarded after going through the learning process and arriving at the end with a most rewarding and satisfying method of initiating orthodontic treatment. OP
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Marcel Korn, DMD, is a diplomate of the American Board of Orthodontics (ABO), a member of the College of Diplomates of the ABO and the Angle Society of Orthodontists (president of the Eastern Component), and a fellow in the International College of Dentists. He has developed and has patents on many orthodontic appliances. He lectures worldwide on many subjects with an emphasis on “Early Treatment for Children” and “Postural Orthodontics for Adults.” He has practiced for 43 years and maintains a private practice in Boston. He is on the faculty at Tufts University School of Dental Medicine in the Department of Postgraduate Orthodonics. |
