Orthotown March 2014 - (Page 22)
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Best Direct Bonding Protocol
How to get them to stick!
Orthotown.com > Message Boards > Clinical Topics > 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 chairside's 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 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 3-4 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
vacuefactor
Member Since: 06/13/10
Post: 3 of 30
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Where are the failures? Bracket and adhesive or adhesive and 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 as me except I pumice first (assumed you were doing
this), 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 for 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. n
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 standard operating procedure:
1. Pumice and etch entire dentition with phosphoric acid, rinse, dry.
2. 3M Lpop lower arch only, dry and place lower appliances only, cure.
3. Re-dry the upper arch, Lpop 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 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 or mint. n
AUG 28 2012
22
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