Orthotown October 2016 - 45

INDIRECT
BONDING:
THE TECH EFFECT

Thanks to 3-D scanning and printing, it's a
whole new era.
Implementation of indirect bonding isn't as
widespread as it could be. If many (even most)
orthodontists agree that it has the potential to
significantly improve bracket placement and shorten
treatment time, then why aren't they using indirect
bonding in their practices?
Perhaps they're not aware of the ease and accuracy
possible with today's technology. To gain the full
value of indirect bonding's ability to yield precise
bracket placement, it's important to examine the
entire process for variables that introduce error,
then to seek effective solutions.
This article proposes features of an indirect
bonding system that increases accuracy of results
not only in planning bracket positions but also
in the actual transfer of the brackets to the teeth.

Issues
Traditional manual methods of indirect
bonding can be time-consuming, tedious and
technique-sensitive.
* Meticulous measuring, scribing and placement of brackets on dental models can lead
to even slight mistakes that cost extra time,
money and materials later in the patient's
treatment.

For manual methods to provide reliable,
predictable results that the patient and
doctor can visualize before treatment starts,
the teeth of the dental model would need to
be reset in wax with full archwire expression
in brackets connected to the teeth.
* Design and production of the transfer tray
are intertwined-designing the spaces and
edges of the two-part transfer tray happens
during production.
* The brackets are covered with multiple
materials during production of the tray and
could be moved inadvertently. The doctor
cannot verify the final positioning of each
bracket until the tray is complete.
* When placing the finished tray of brackets
on the patient's teeth, finger pressure must
be applied to position the tray where the
brackets will not be too near, or far from, the
gingival tissue. The inherent flexibility of the
inner tray can lead to asymmetrical overseating of brackets when pressure is applied
unevenly at different places along the tray.
Drawbacks of traditional methods-including,
but not limited to, time needed, detailed hand
work, multiple opportunities for error and difficulty
previewing the outcome-also have contributed to
avoidance of indirect bonding.

by Jack C. Fisher, DMD
During three decades of experience, including private practice at Artistic Smiles Orthodontics in
Memphis, Tennessee, Jack C. Fisher, DMD, has taught residents at NYU and the University of Louisville,
and currently teaches at Vanderbilt University and the University of Tennessee. An inventor, he holds
several U.S. patents, with strong interest in skeletal anchorage devices. Fisher is also a pilot and loves
skiing. Whether lecturing, teaching or practicing, he's passionate about his profession and treats every
patient as family. His practice even has a patient-care dog, Smiley, who is trained to help alleviate patient anxiety.
orthotown.com \\ OCTOBER 2016

http://www.orthotown.com

Table of Contents for the Digital Edition of Orthotown October 2016