Other previous entries such as Bracket placement: 2 basic methods and Bracket placement: direct bonding already discussed the different bracket placement methods that there are and presented a rough outline of the differences between them. This entry will focus on the advantages of and procedure for bracket placement with indirect bonding.
The faster and more precise method of bracket placement
Indirect placement or indirect bonding of brackets is the technique that I currently use in 100% of patients. In this placement technique, the brackets are first placed in the patient’s moulds and then transferred to the mouth.
The advantages of indirect bonding can be summed up as follows:
- Bracket placement in models is easier because the absence of the tongue, saliva, cheeks, etc.; therefore, it increases precision.
- In models, unlike in the mouth, the teeth can be seen from all angles, especially the back teeth; therefore, it also increases precision compared to direct bonding.
- It is a much more convenient technique for the patient since the procedure in the mouth is very quick — nearly 3 times faster — and less uncomfortable.
- A major advantage for the professional is the decrease in chair time for each patient.
This technique benefits everybody in terms of precision, speed and convenience.
“In-mouth bonding” procedure
A step to prepare the models and the brackets must be completed before the brackets can be placed in the mouth.
The patient’s models are measured and the proper position for each bracket is marked, the brackets are bonded to the moulds and then splints are prepared with the brackets inside of the splint, with each bracket in the position in which it has to be.
The procedure in the mouth is quick and simple: the teeth are cleaned, prepared with an acid gel that opens up the pores of the tooth enamel for 30 seconds, rinsed with plenty of water and dried. Meanwhile, the splint is prepared by cleaning it with a solvent and placing one adhesive ingredient (the adhesive consists of 2 parts, and it sets and hardens when they come into contact with each other).
Once the teeth are dry, the other adhesive ingredient is placed on the teeth, it is ensured that it saturates the entire prepared surface of the tooth and the splint is placed in the mouth. When the two ingredients come into contact with each other, the adhesive starts to set, and around 30 seconds later, it is already set. Next, the splint is carefully removed from the mouth and the brackets remain bonded to the teeth. Excess cement is removed and wires are placed.
The bonding procedure at the clinic takes around 15 minutes for each dental arch, regardless of whether it involves self-ligating, aesthetic or incognito invisible lingual braces. For placement on both dental arches, with hygiene and placement of wire, I tend to take more or less 1 hour and 15 minutes.
After placement we give instructions on hygiene, diet and potential emergencies and make arrangements with the patient for the next visit.
Summary of the process: Indirect Bonding
- We take measurements of the mouth with alginate moulds.
- We prepare plaster models.
- We bond (glue)the brackets to the models.
- We make the transfer splints for the brackets.
- We bond the brackets to the patient’s teeth by means of indirect bonding.
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