Orthotown October 2012 - (Page 16)

orthotown.com // message board Best Direct Bonding Protocol What’s the best direct bonding protocol? A Townie with many bond failures wants to know. » t Orthotown.com > Message Boards > Clinical Topics > Clinical Orthodontics > Best Direct Bonding Protocol Jon OC Member Since: 06/25/09 Post: 1 of 17 I am searching for the best direct bonding protocol. I have been in practice for a decade and have more bond failures now than ever. Granted, I have gradually increased the duties of the assistants to include bonding preparation, however, they seem to all have a handle on what we look for in ideal tooth prep. I currently use traditional 37% phosphoric acid etch for 30 seconds, rinse thoroughly and dry, Assure, dry, apply Pad-Lok paste (Reliance) to the In-ovation R bracket and position. For bond failures, I micro-etch the teeth with 50 micron aluminum oxide for three to four seconds and repeat the above protocol. Bond failure is common in the practice and is a real disruption on a day-to-day basis. I am searching for a better technique. All suggestions welcome! n Jon AUG 28 2012 swamp fox Member Since: 06/17/10 Post: 2 of 17 Hi Jon, type in questions for indirect bonding and search this site – a lot of info there. Cheers. n Ray AUG 28 2012 vacuefactor Member Since: 06/13/10 Post: 3 of 17 Where are the failures? Bracket/adhesive or adhesive/tooth interface? Make sure you see where these are happening so you know what you need to focus on correcting. You follow the same protocol I do, except I pumice first (assumed you were doing this), Solo vs. Assure (don’t really see a difference here), and Light Bond vs. Pad-Lok. Bracket failures are very, very minimal in our office except for when patients do dumb things like eat ice, pencils, etc. If you are going to use Pad-Lok, make sure you are really pushing the material into the mesh since it’s quite viscous. I switched to Light Bond for that reason but it is still viscous enough to stay put on the tooth and not run around (wasn’t a fan of Transbond for that reason). I still push it into the base with the back of the mirror handle or a spatula before bonding, but it’s easy to do. For failures and rebonds, I etch with 90 micron until all the material is removed from the base of the bracket. Then just rebond as usual. n AUG 28 2012 andrew777 Member Since: 04/18/11 Post: 4 of 17 Failure is likely due to technique issues rather than your materials. Anything you can do to reduce the amount of time from tooth preparation to curing will make a difference in your practice. Here’s our SOP: 1. Pumice/etch entire dentition with phosphoric acid, rinse, dry. 2. 3M L-Pop lower arch only, dry and place lower appliances only, cure. 3. Re-dry the upper arch, L-Pop upper arch, dry and place upper appliances, cure. This requires you to see the patient twice instead of once during appliance placement, but it is well worth it. I have almost zero debonds. n AUG 28 2012 thomasgessel Member Since: 11/21/08 Post: 5 of 17 One of the best things we’ve done in our practice to increase bond strength is to charge patients for replacement braces. It works like magic! I simply explain to patients and parents 16 OCTOBER 2012 // orthotown.com http://www.orthotown.com http://www.Orthotown.com http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown October 2012

Front Cover
Orthotown.com Highlights
Wired for Success
Townie Clinical: Phase I Decisions
Best Direct Bonding Protocol
AAO Dues
Corporate Profile: Ortho Classic
New Products
Office Visit: One in a Million
Insurance: We Love to Hate It… But Should We? (Part 2)
You Should Know: G&H Orthodontics
Industry News
Have You Really Thought About Your Schedule Lately?
“Go Mobile…”
Speeding Up Orthodontic Treatment with OrthoAccel’s AcceleDent System
Advantages of Self-Ligating Brackets
Adult Clinical Cases with Pathological Problems Treated with Lingual Orthodontics
Ad Index

Orthotown October 2012