Orthotown Jan/Feb 2016 - (Page 18)

clinical orthodontics // message board Best Direct Bonding Protocol Townies discuss different direct bonding techniques. Orthotown.com > Message Boards > Clinical Topic > Clinical Orthodontics > Best Direct Bonding Protocol Jon OC Member Since: 06/25/09 Post: 1 of 30 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 chairsides 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 percent phosphoric acid etch for 30 seconds, rinse thoroughly and dry, Assure, dry, apply Pad Lock 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! ■ AUG 28 2012 vacuefactor Member Since: 06/13/10 Post: 3 of 30 Related Message Boards Direct Bonding Dr. Time? Direct Bonding Seeking the Optimal Direct Bonding Protocol Optimal Direct 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 identical protocol I do, except I pumice first (assumed you were doing this), then Ortho Solo vs. Assure (don't really see a difference here), and Light Bond vs. Pad Lock. Bracket failures are very, very minimal in our office except when patients do dumb things (eat ice, pencils, etc.). If you are going to use Pad Lock, 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. ■ AUG 28 2012 andrew777 Member Since: 04/18/11 Post: 4 of 30 It is likely 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. ■ AUG 28 2012 thomasgessel Member Since: 11/21/08 Post: 5 of 30 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 that, "In order to keep costs down, we need to charge for replacement braces. After all, some patients never break a brace, and some break a lot." This makes sense to our patients. At the start of treatment they wouldn't imagine that they'll ever break the rules and eat an apple/carrot/mint. ■ AUG 28 2012 Continued on p. 20 18 JANUARY/FEBRUARY 2016 // orthotown.com http://www.Orthotown.com http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=693&t=202956&g=1 http://www.orthotown.com/MessageBoard/thread.aspx?a=11&s=6&f=693&t=201565&g=1 http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown Jan/Feb 2016

Orthotown.com Highlights
Embrace Progress: You Can’t Fight Mother Nature
Transfer Case: Can I Finish Without Surgery?
Best Direct Bonding Protocol
Class III Treatment in 15 Months
Go Beyond Accommodating: Working with Extra-Needs Patients
Treatment of Open-Bite with Mini-Screws and Segmental Mechanics
Cali Orthodontist an Engineer of New Smiles
Poll
Serendipity and the Right Technology: One Orthodontist’s Story
Townie Choice Awards 2015: Townies Have Spoken!
12 Marketing Tips for Orthodontists in 2016
Ad Index

Orthotown Jan/Feb 2016