Orthotown October 2016 - 40


INDIRECT
BONDING:
A CLOSER LOOK

The introduction of pre-torqued and preangulated brackets ushered in the era of straight-wire
appliances-and the concept of finishing treatment
using a wire with no finishing bends has spawned a
number of innovations in orthodontic appliances.
Torque-in-base versus torque-in-face, angulated
and offset bracket pads, and numerous visual cues
have all contributed to achieving the goal of having
a final wire with no bends to achieve the ideal final
positioning of the teeth.
Over the past 40 years, numerous variations in
torque and angulation have been proposed, each
with claims of superiority in achieving optimal
final tooth positon and interarch occlusion. To that
end, all the innovations in bracket design become
irrelevant if the bracket isn't positioned ideally on
each individual tooth. The ideal positioning of
each bracket must align the individual tooth in
relation to each of the neighboring teeth, and also in
relation to the entire arch, to achieve arch leveling.
Coordination of the arch forms, along with tip and
angulation of the teeth in each arch, ultimately
achieves the final occlusal result. Easy, huh?

The direct effect
Positioning brackets can be done directly at
chairside-the challenge is to place the bracket
and cure the adhesive, often in adverse conditions.

Isolating the teeth, positioning the patient, and
having adequate access and lighting to evaluate
the bracket position is always difficult, even in the
best of circumstances. Most orthodontists have
mastered this skill through years of practice, and
it's still the preferred method of placing brackets.
There are two pitfalls to placing brackets directly:
The time required. The amount of time required
to place and cure brackets can vary widely, but a
conservative estimate is 20-30 minutes to bond
both upper and lower arches, including all second
molars. Even with chairside technicians making the
initial placement, considerable doctor time is still
required to adjust and cure each bracket.
Many doctors split this procedure into more
than one appointment, doing partial bonding at
one appointment and the remainder at a subsequent
visit. The rationale is to limit the amount of doctor
time or patient time required at any one visit, but
the downside is a lack of efficiency for both patient
and orthodontist. In a busy practice, having the
doctor sit at one chair for any length of time creates
a bottleneck in the schedule.
The consequences of improper bracket
placement. As treatment progresses, this will become
apparent and will require correction by means of
bracket repositioning or making detail bends to
compensate. Both repositioning and detail bends are

by Clark D. Colville, DDS, MS
Clark D. Colville, DDS, MS, maintains private practices in Seguin and San Marcos, Texas. Colville
is a diplomate of the American Board of Orthodontics and is active in the American Association of
Orthodontists and the Southwestern Society of Orthodontists. He is an assistant clinical professor in the
graduate orthodontic department at the University of Texas Health Science Center at Houston, School of
Dentistry, where his primary responsibility is teaching clear-aligner treatment to orthodontic residents.   

40

OCTOBER 2016 // orthotown.com


http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown October 2016

Orthotown.com Highlights
Embrace Progress: What’s In Your Records?
New Products
Poll
Message Boards: HSD/Invisalign/Adult
Message Boards: Phase 1: Anterior Crossbite and Crowding
Interdisciplinary Ortho-Perio Treatment of Excessive Gingival Display
Creating a Strong Scheduling Architecture
Indirect Bonding: A Closer Look
Indirect Bonding: The Tech Effect
Welcome to Digital Orthodontics
Good Vibrations
Ad Index
Orthotown October 2016 - Cover1
Orthotown October 2016 - Cover2
Orthotown October 2016 - 1
Orthotown October 2016 - 2
Orthotown October 2016 - 3
Orthotown October 2016 - 4
Orthotown October 2016 - 5
Orthotown October 2016 - Orthotown.com Highlights
Orthotown October 2016 - 7
Orthotown October 2016 - Embrace Progress: What’s In Your Records?
Orthotown October 2016 - 9
Orthotown October 2016 - New Products
Orthotown October 2016 - 11
Orthotown October 2016 - Poll
Orthotown October 2016 - 13
Orthotown October 2016 - Message Boards: HSD/Invisalign/Adult
Orthotown October 2016 - 15
Orthotown October 2016 - 16
Orthotown October 2016 - 17
Orthotown October 2016 - Message Boards: Phase 1: Anterior Crossbite and Crowding
Orthotown October 2016 - 19
Orthotown October 2016 - 20
Orthotown October 2016 - 21
Orthotown October 2016 - 22
Orthotown October 2016 - 23
Orthotown October 2016 - 24
Orthotown October 2016 - 25
Orthotown October 2016 - 26
Orthotown October 2016 - 27
Orthotown October 2016 - Interdisciplinary Ortho-Perio Treatment of Excessive Gingival Display
Orthotown October 2016 - 29
Orthotown October 2016 - 30
Orthotown October 2016 - 31
Orthotown October 2016 - 32
Orthotown October 2016 - 33
Orthotown October 2016 - 34
Orthotown October 2016 - 35
Orthotown October 2016 - Creating a Strong Scheduling Architecture
Orthotown October 2016 - 37
Orthotown October 2016 - 38
Orthotown October 2016 - 39
Orthotown October 2016 - Indirect Bonding: A Closer Look
Orthotown October 2016 - 41
Orthotown October 2016 - 42
Orthotown October 2016 - 43
Orthotown October 2016 - Indirect Bonding: The Tech Effect
Orthotown October 2016 - 45
Orthotown October 2016 - 46
Orthotown October 2016 - 47
Orthotown October 2016 - 48
Orthotown October 2016 - 49
Orthotown October 2016 - Welcome to Digital Orthodontics
Orthotown October 2016 - 51
Orthotown October 2016 - 52
Orthotown October 2016 - 53
Orthotown October 2016 - Good Vibrations
Orthotown October 2016 - 55
Orthotown October 2016 - 56
Orthotown October 2016 - 57
Orthotown October 2016 - 58
Orthotown October 2016 - 59
Orthotown October 2016 - 60
Orthotown October 2016 - Cover4
Orthotown October 2016 - Ad Index
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