In my most recent blog entry, I explained the two basic ways of placing brackets. This entry will review the clinical procedures that we do in the office when bonding the brackets using direct bonding, that is to say, placing the brackets directly on the teeth.
The first step is to clean the teeth with a brush with or without polishing paste, to etch the surface of the teeth with a blue acid gel and then to use suction to remove this acid. This is one of the most important parts, since if the brackets were to be placed on teeth that were not perfectly clean, they would fall off. Sometimes the teeth appear to be clean but have a thin layer of so-called bacterial plaque. Before the brackets are placed, it must be ensured that this plaque has been completely removed.
Orthophosphoric acid gel is a gel that does not damage the teeth or the enamel. It serves to open up the small pores on the surface of the teeth so that the brackets adhere to the teeth better.
The second step consists of rinsing the excess gel from the teeth with plenty of water and drying the surface of the teeth where the brackets are going to be placed. It can be seen that the tooth enamel turns a dull, chalky white. This indicates that it has been properly etched with the acid gel. A special adhesive for brackets is applied to the clean, etched surface with a small paintbrush, and the surface is dried with a little air.
The third step is placing the brackets. This is the most important part for the success of treatment. The position of the brackets is one of the most important parts of orthodontic treatment. If a bracket is positioned slightly out of its ideal place, the tooth will not end up straight and aligned. Once positioned in place, the excess cement or composite must be cleaned (in the middle image). Leaving excess composite could cause bacterial plaque and bits of food to be retained and lead to inflammation of the gums. When it is very certain that the bracket is in place, ultraviolet light is used to make the composite (adhesive) harden.
In direct bonding, it is very difficult to properly cement the brackets on the back teeth, because they are hard to access, not only to place the brackets but also to properly see where the brackets have been placed. As the brackets are placed one by one, the procedure is long and causes more discomfort. Therefore, I personally no longer use this procedure. Instead, I use indirect bonding.
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