Orthotown November 2017 - 36

Fig. 5

Composite, gold, amalgam,
stainless steel and acrylic

Silane

Silane coupling agents
are an integral part of bonding chemically to the glass
1. Prophy, rinse and dry.
fi ller contained in porcelain
2. Sandblast, rinse and dry.
a nd lit hiu m d isi lic ates.
3. Apply one coat of Assure Plus,
Hydrolyzed silane has one
air-dry and light-cure.
major benefit and one major
4. Proceed with bracket
disadvantage. It has reduced
placement.
the headache of diagnosing
a glass-containing porcelain
surface from a glass-free
Porcelain, lithium disilicate
zirconium surface. Because
and zirconia
of accelerated evaporation,
hydrolyzed silane will evap1. Prophy, rinse and dry.
orate off a zirconia crown in
2. Sandblast, rinse and dry.
60 seconds without inter3. Apply one coat of hydrolyzed
fering with the subsequent
priming steps. Because this
silane; wait 60 seconds.
chemical is volatile, porcelain
4. Apply one coat of Assure Plus;
conditioners must be stored
air-dry and light-cure.
in refrigeration and used
5. Proceed with bracket
within the dated expiration.
placement.
Finally, a warm air dryer
is a great addition to any
bonding protocol to elimA condensed set of steps for priming
artificial surfaces with only two protocols.
inate contamination from
a water/air syringe. Tooth
dryers are also very effective
in exciting hydrolyzed silane, resulting in optimal bond
strength.

Artificial primers
In the past, several different primers were needed to
have a complete toolbox for bonding to various non-enamel

NOVEMBER 2017 // orthotown.com

surfaces found in the mouth. Metal primers utilize the
monomer 4-meta in bonding to metal surfaces. Monomer,
or methyl methacrylate, is effective in placing attachments
on plastic- or resin-based composite surfaces. Silane couples
with glass and reduces loss of brackets on porcelain and
lithium disilicate. Zirconia-dedicated primers, often
borrowed from restorative dentistry (at a significant price
increase), provide clinically acceptable strength.
All the products above need an additional coat of
sealant to finalize the priming step. Non-enamel priming
technology has seen a revolution with breakthroughs
from manufacturers releasing products that combine
not only the prime and seal step but multiple primers in
the same bottle.

Debond
Similar to debonding a case from enamel, the mechanical steps to debonding an appliance from an artificial
substrate are very similar. Most clinicians will use
bracket-removing pliers to initially break the bracket free
from the tooth. Next, a high-speed carbide bur is used
to remove the bulk majority of composite, yet leaving a
thin layer. Finally, a rubberized point is used to not only
remove the residual composite film, but also to initiate the
restoration polishing process. For artificial substrates, a
diamond polishing paste can be prophied onto the tooth
with a rubber cup as a finishing touch to restore a natural
look to that tooth (Fig. 5).
Although there have been multiple chemical breakthroughs in the bonding world, technique is still the
most important aspect for case-long success. The basics
of bonding-starting with clean surfaces, isolation,
uniformity and attention to detail-are invaluable to any
surface preparation. Once these simple steps are followed,
clinicians now have the convenience of relying heavily
on the primer technology available today. ■

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Table of Contents for the Digital Edition of Orthotown November 2017