Indirect Bonding in Orthodontics

Indirect Bonding is technique in which orthodontic brackets and other attachments are transferred from dental casts (working models) and placed on to the dentition using a transfer device
This presentation covers the methods of indirect bonding, limitations and also compares direct and indirect bonding

1. 1 INDIRECT BONDING DR. ANJU SARAH JACOB

2. CONTENTS INDIRECT BONDING LIMITATIONS OF DIRECT BONDING METHODS OF INDIRECT BONDING STUDIES (DIRECT VS INDIRECT BONDING) REFERENCES 2 DR. ANJU JACOB

3. Indirect Bonding DR. ANJU JACOB

4. 4 WHAT IS INDIRECT BONDING? Kalange JT, Thomas RG. Indirect bonding: a comprehensive review of the literature. Semin Orthod . 2007;13:3-10 “ Indirect Bonding is technique in which orthodontic brackets and other attachments are transferred from dental casts (working models) and placed on to the dentition using a transfer device ”

5. 5 LIMITATIONS OF DIRECT BONDING Zachrisson B, Büyükyılmaz T. Bonding in orthodontics. In: Graber TM, Vanarsdall R, Vig K, eds. Orthodontics: Current Principles and Techniques. 6th ed. St. Louis: Mosby; 2017:812–867

6. 6 METHODS OF INDIRECT BONDING

7. 7 METHODS OF INDIRECT BONDING

8. A UNIVERSAL DIRECT BONDING SYSTEM FOR BOTH METAL & PLASTIC BRACKETS – SILVERMAN ET AL, 1972 Silverman E, Cohen M, Gianelly AA, Dietz VS. A universal direct bonding system for both metal and plastic brackets. Am J Orthod . 1972;62:3. 8 Bisphenol A + Glycidal methacrylate (3 parts) Methyl methacrylate monomer (1 part) 5 parts liquid 2 parts powder Pit and fissure sealant ( Buonocore ) Experimental adhesive (GAC)

9. Silverman E, Cohen M, Gianelly AA, Dietz VS. A universal direct bonding system for both metal and plastic brackets. Am J Orthod . 1972;62:3. 9 2 sets of casts prepared B rackets are tacked to the teeth, using the bracket adhesive cement (1 drop / bracket) Each cast is placed in a Vanguard unit, and a plastic wafer is centered over the model The plastic tray is then carefully removed from the cast A UNIVERSAL DIRECT BONDING SYSTEM FOR BOTH METAL & PLASTIC BRACKETS – SILVERMAN ET AL, 1972

10. Silverman E, Cohen M, Gianelly AA, Dietz VS. A universal direct bonding system for both metal and plastic brackets. Am J Orthod . 1972;62:3. 10 Isolation, etching of teeth is done & sealant painted (Prevent bridging of teeth) The NuvaSeal gun, with its ultraviolet light waves (30 seconds for each tooth ) The bonding cement is mixed to a syrupy consistency & placed on each bracket Tray i nserted into mouth and held for 5 minutes to ensure setting of the cement . A UNIVERSAL DIRECT BONDING SYSTEM FOR BOTH METAL & PLASTIC BRACKETS – SILVERMAN ET AL, 1972

11. IMPROVED LABORATORY PROCEDURE FOR INDIRECT BONDING OF ATTACHMENTS - MICHAEL D. SIMMONS, 1978 Simmons MD. Improved laboratory procedure for indirect bonding of attachments. J Clin Orthod . 1978;12(4):300‐302. 11 Uses caramel candy softened and preloaded into syringe Small amount of caramel is warmed (50 ⁰ C) & loaded into syringe Preloaded syringe is warmed to 50 ⁰ C for 5 min (Soften caramel) Caramel holds bracket in place Impression made with brackets positioned Syringe loaded with adhesive, applied to bracket bases Impression removed with brackets bonded

12. INDIRECT BONDING: SIMPLICITY IN ACTION – ROYCE G. THOMAS, 1979 12 Modification of Silverman & Cohen Technique Determine bracket position on model: Mix each bonding resin paste - Catalyst (B) and Universal (A ) and apply to the bracket Place bracket in desired position Allow bonding material to set at least 10 minutes before forming tray Tray formation: 5 " square sheets of bioplast used Model is dipped into water (3-5 seconds ) & placed under a dry heat source with the arch blank on top (drapes down) Vacuum is applied till good adaptation occurs The tray removed, trimmed & backs of the bases are lightly abraded Thomas RG. Indirect bonding: simplicity in action. J Clin Orthod . 1979;13(2): 93‐106

13. INDIRECT BONDING: SIMPLICITY IN ACTION – ROYCE G. THOMAS, 1979 Thomas RG. Indirect bonding: simplicity in action. J Clin Orthod . 1979;13(2): 93‐106 13 Clinical Procedure All teeth that are to receive brackets are polished, isolated, etched and dried Inside of the tray  Concise Enamel Bond Catalyst (Part B) liquid Teeth  Concise Enamel Bond Universal (Part A) liquid The tray is inserted into the mouth, seated fully and held to place for 1½ minutes The tray is then removed from the lingual toward the buccal Advantages: Accurate Chairside time greatly reduced

14. A NEW INDIRECT BONDING TECHNIQUE – RAJAGOPAL, 2004 Rajagopal R, Vankatesan A, Gnanashanmugham K, Harish Babu S. A new indirect bonding technique. J Clin Orthod . 2004;38(11):600‐602 14 Existing systems attached brackets to working cast If adhesive mesh not removed  Bond strength is compromised Reason for development : Leaves an adhesive-free mesh prior to bonding Uses readily available materials for bonding Long axes and bracket height scribed Brackets affixed to adhesive side of tape Tape cut around each bracket

15. Rajagopal R, Vankatesan A, Gnanashanmugham K, Harish Babu S. A new indirect bonding technique. J Clin Orthod . 2004;38(11):600‐602 15 Tray placed Cyanoacrylate glue applied to non adhesive side of tape Result after indirect bonding Brackets placed on cast Brackets with adhesive free mesh embedded in tray material A NEW INDIRECT BONDING TECHNIQUE – RAJAGOPAL, 2004

16. EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi , Anoop . (2007). Effective and Efficient Indirect Bonding: The Sondhi Method. Seminars in Orthodontics. 13. 43-57 16 New indirect bonding resin introduced ( 3M Unitek ) Advantages of new indirect resin The viscosity of resin increased  F ill voids in the custom base without compromising bond strength Quick set time (30 seconds)

17. EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi , Anoop . (2007). Effective and Efficient Indirect Bonding: The Sondhi Method. Seminars in Orthodontics. 13. 43-57 17 LABORATORY PROCEDURE : Working models Al Cote separating medium Brackets placed Light curing chamber (10 minutes)

18. EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi , Anoop . (2007). Effective and Efficient Indirect Bonding: The Sondhi Method. Seminars in Orthodontics. 13. 43-57 18 Preparation Of Bonding Trays: Biostar tray (1.5mm Bioplast + 0.75mm Biocryl ) First layer – Bioplast & trimmed Additional curing of trimmed trays Silicone transfer tray Maxillary bonding tray Biocryl formed over Bioplast Excess material trimmed

19. EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi , Anoop . (2007). Effective and Efficient Indirect Bonding: The Sondhi Method. Seminars in Orthodontics. 13. 43-57 19 CLINICAL PROCEDURE : Preparation Of Patient Pumicing done Adhesive application Resin B applied to tray Resin A applied to teeth Etchant applied Etched tooth surfaces

20. EFFECTIVE AND EFFICIENT INDIRECT BONDING: THE SONDHI METHOD – SONDHI, 2007 Sondhi , Anoop . (2007). Effective and Efficient Indirect Bonding: The Sondhi Method. Seminars in Orthodontics. 13. 43-57 20 Insertion of trays: Tray placed Excess removed Removal of tray

21. PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHN T. KALANGE, 2007 Kalange , John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars in Orthodontics. 13. 19-42 21 Advantages Over Other Techniques Horizontal & Vertical lines drawn (Template) Quick, efficient, accurate & reliable Bonding time reduced Enhances patient comfort R econtour the incisal edges of the anterior teeth Working models

22. PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHN T. KALANGE, 2007 Kalange , John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars in Orthodontics. 13. 19-42 22 Armamentarium Used Horizontal & vertical reference lines Horizontal line (Red) : Marginal ridge lines Vertical line : Long axis of teeth Slot line 1:3 (separating medium: water) applied in two light coats

23. PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHN T. KALANGE, 2007 Kalange , John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars in Orthodontics. 13. 19-42 23 Brackets are placed in pairs Excess removed Light Cured Bracket positioning verified

24. PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHN T. KALANGE, 2007 Kalange , John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars in Orthodontics. 13. 19-42 24 Polyvinyl siloxane (PVS) mixed in equal parts PVS material adapted to the brackets and models Trays are cleaned with distilled water and a clean toothbrush Final trays trimmed

25. PRESCRIPTION - BASED PRECISION FULL ARCH INDIRECT BONDING - JOHN T. KALANGE, 2007 Kalange , John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars in Orthodontics. 13. 19-42 25 Etchant applied Bonding agent applied to teeth & custom resin base Trays inserted Trays removed Excess material removed

26. QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada & Watanabe, Kazuya & Koga, Takako . (2007). Quick Indirect Bonding System (Quick IDBS): An Indirect Bonding Technique Using a Double-Silicone Bracket Transfer Tray. Seminars in Orthodontics. 13. 11-18 26 Uses a double silicone bracket transfer tray Working models Reference lines are marked Brackets are placed Light curing

27. QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada & Watanabe, Kazuya & Koga, Takako . (2007). Quick Indirect Bonding System (Quick IDBS): An Indirect Bonding Technique Using a Double-Silicone Bracket Transfer Tray. Seminars in Orthodontics. 13. 11-18 27 Attach white wax 2-3mm gingival to facial side & cervical areas on palatal / lingual surfaces Injection of soft silicone followed by hard silicone The plastic film surrounds the model and serves to forms the facial wall of the tray

28. QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada & Watanabe, Kazuya & Koga, Takako . (2007). Quick Indirect Bonding System (Quick IDBS): An Indirect Bonding Technique Using a Double-Silicone Bracket Transfer Tray. Seminars in Orthodontics. 13. 11-18 28 Once silicone has set, remove plastic film and white wax Detach the tray beginning from the posterior end Final seating of tray Initial archwire inserted

29. QUICK INDIRECT BONDING SYSTEM – MASTADA KOGA, 2007 Koga, Masatada & Watanabe, Kazuya & Koga, Takako . (2007). Quick Indirect Bonding System (Quick IDBS): An Indirect Bonding Technique Using a Double-Silicone Bracket Transfer Tray. Seminars in Orthodontics. 13. 11-18 29 ADVANTAGES: Firm, dimensionally stable Easy to check bracket position Esthetic DISADVANTAGES: Technique sensitive Silicone begins to set at room temperature and must be handled carefully. The high cost of the silicone.

30. INDIRECT BONDING WITH A THERMAL CURED COMPOSITE ( MOSKOWITZ, 2007) Moskowitz, Elliott. (2007). Indirect Bonding with a Thermal Cured Composite. Seminars in Orthodontics. 13. 69-74. 30 Modification of Thomas Technique It uses Thermally cured composite material. Reprosil - vinyl polysiloxane impression material (PVS) Vacuum-form Essix 0.020 inch (0.5 mm) clear material tray

31. INDIRECT BONDING WITH A THERMAL CURED COMPOSITE ( MOSKOWITZ, 2007) Moskowitz, Elliott. (2007). Indirect Bonding with a Thermal Cured Composite. Seminars in Orthodontics. 13. 69-74. 31 Light bodied polyvinylsiloxane (PVS) impression material applied over all brackets, extending onto occlusal or incisal surfaces and onto lingual surfaces Essix tray formed Trays separated and trimmed Inside of bracket-tray complex after washing and lightly abrading composite surfaces

32. INDIRECT BONDING WITH A THERMAL CURED COMPOSITE ( MOSKOWITZ, 2007) Moskowitz, Elliott. (2007). Indirect Bonding with a Thermal Cured Composite. Seminars in Orthodontics. 13. 69-74. 32 Enamel surfaces etched Unfilled bonding resin mixed and applied to the composite bases of brackets and teeth The trays are seated & held in place for approx 1 minute. Kept in place for 4 more minutes Excess material can be removed with scaler / floss

33. THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern , Michael & Primus, Carolyn & Alpern , Ada. (2009). The AccuBond system for indirect orthodontic bonding. Journal of clinical orthodontics : JCO. 43. 572-6 ; 33 Uses 2 adhesives to create a customised base for each bracket Ultrafluid material which interlocks with the retentive elements in bracket base A polymer covers this to form custom base

34. THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern , Michael & Primus, Carolyn & Alpern , Ada. (2009). The AccuBond system for indirect orthodontic bonding. Journal of clinical orthodontics : JCO. 43. 572-6 ; 34 LABORATORY PROCEDURE: Using a 10-megapixel digital camera and a macro lens, the lab takes close-up images of each bracket from three angles and posts them on a secure website Each view includes a millimeter gauge to facilitate adjustments O rthodontist must view the brackets and approve the positions Polyvinyl siloxane full arch impression Brackets placed with reference lines

35. THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern , Michael & Primus, Carolyn & Alpern , Ada. (2009). The AccuBond system for indirect orthodontic bonding. Journal of clinical orthodontics : JCO. 43. 572-6 ; 35 CLINICAL PROCEDURE: Cleaning, polishing, etching & drying is done AccuBond primer/sealant to the inner surfaces of each mandibular custom bases & the teeth & Light cure them

36. THE ACCUBOND SYSTEM FOR INDIRECT ORTHODONTIC BONDING (MICHAEL C. ALPERN, 2009) Alpern , Michael & Primus, Carolyn & Alpern , Ada. (2009). The AccuBond system for indirect orthodontic bonding. Journal of clinical orthodontics : JCO. 43. 572-6 ; 36 CLINICAL PROCEDURE: Final tray removal Removal of blue inner liner with scaler Bioforce wire placed immediately with full bracket slots

37. A NEW APPROACH TO INDIRECT BONDING (AKHTER HUSAIN, 2009) Husain, Akhter & Ansari, Tariq & Mascarenhas , Rohan & Shetty, Sandeep. (2009). A new approach to indirect bonding. Journal of clinical orthodontics : JCO. 43. 652-4. 37 DRAWBACKS OF INDIRECT TECHNIQUES: O cclusogingival insertion of a transfer tray causes the adhesive-coated bracket to scrape along the long axis of each tooth When opaque transfer trays are used  P revents light-curing from palatal / occlusal PROCEDURE Brackets placed on working cast with water-soluble adhesive. Working cast centered on flat, horseshoe- shaped platform . Putty applied over buccal surface of cast .

38. Husain, Akhter & Ansari, Tariq & Mascarenhas , Rohan & Shetty, Sandeep. (2009). A new approach to indirect bonding. Journal of clinical orthodontics : JCO. 43. 652-4. 38 Two sticks of acrylic bent at 90 ° angles and attached to form handles Tray tried in patient’s mouth Midline marked on transfer tray Bracket bases cleaned with brush Primer applied to bracket bases Brackets after curing A NEW APPROACH TO INDIRECT BONDING (AKHTER HUSSAIN, 2009)

39. DIRECT VS INDIRECT BONDING 39 DR. ANJU JACOB

40. SHEAR BOND STRENGTH COMPARISON BETWEEN DIRECT AND INDIRECT BONDED ORTHODONTIC BRACKETS Yi GK, Dunn WJ, Taloumis LJ. Shear bond strength comparison between direct and indirect bonded orthodontic brackets. Am J Orthod Dentofacial Orthop . 2003;124(5): 577‐581 40 54 extracted premolars were mounted & randomly divided into 2 groups . Orthodontic brackets bonded to premolars with an indirect bonding adhesive system B rackets were bonded with the direct method The mean shear bond strengths were Indirect group – 11.2 MPa Direct group – 10.9 Mpa Both exceeding the minimum shear bond strength range of 5.9 to 7.8 MPa often cited in the literature for clinical success.

41. ASSESSMENT OF BRACKET PLACEMENT AND BOND STRENGTH WHEN COMPARING DIRECT TO INDIRECT BONDING TECHNIQUES Aguirre MJ, King GJ, Waldron JM. Assessment of bracket placement and bond strength when comparing direct bonding to indirect bonding techniques. Am J Orthod . 1982;82(4):269‐276 41 The techniques were compared with respect to 4 factors: B racket placement Vertical bracket placement : No statistically significant differences. Maxillary canines  indirect technique yielded better results Mandibular 2nd premolars  direct-bonded brackets placed closer to ideal Angular bracket placement : Statistically significant differences M axillary & mandibular canines  Indirect bonds more accurate. Bond strength Great variability

42. ASSESSMENT OF BRACKET PLACEMENT AND BOND STRENGTH WHEN COMPARING DIRECT TO INDIRECT BONDING TECHNIQUES Aguirre MJ, King GJ, Waldron JM. Assessment of bracket placement and bond strength when comparing direct bonding to indirect bonding techniques. Am J Orthod . 1982;82(4):269‐276 42 Rate of failure Bracket failures (3 months after appliance placement)  4.5% (indirect technique) 5.3 % (direct technique) Clinical & Laboratory time Direct bonding technique  42.18 minutes I ndirect bonding technique  53.73 minutes (23.91 minutes - actual clinical time)

43. COMPARISON OF THE ACCURACY OF BRACKET PLACEMENT BETWEEN DIRECT & INDIRECT BONDING TECHNIQUES Koo BC, Chung CH, Vanarsdall RL. Comparison of the accuracy of bracket placement between direct and indirect bonding techniques. Am J Orthod Dentofacial Orthop . 1999;116(3):346‐351 43 19 sets of duplicated Class II malocclusion models were divided into 3 groups Ideal bracket placement (1 set) Direct bonding on mannequins (9 sets) Indirect bonding (9 sets ) Overall , indirect bonding showed better bracket placement in bracket height whereas , no statistically significant difference was found regarding the angulation and mesiodistal position .

44. Anusavice , K. J., Phillips, R. W., Shen, C., & Rawls, H. R. (2013). Phillips' science of dental materials. St. Louis, Mo: Elsevier/Saunders Graber TM, Vanarsdall R, Vig K, eds. Orthodontics: Current Principles and Techniques. 6th ed. St. Louis: Mosby Schmage P, Nergiz I, Herrmann W, Ozcan M. Influence of various surface-conditioning methods on the bond strength of metal brackets to ceramic surfaces. Am J Orthod Dentofacial Orthop . 2003;123(5):540‐546 Kalange JT, Thomas RG. Indirect bonding: a comprehensive review of the literature. Semin Orthod . 2007;13:3-10 Silverman E, Cohen M, Gianelly AA, Dietz VS. A universal direct bonding system for both metal and plastic brackets. Am J Orthod . 1972;62:3 . Simmons MD. Improved laboratory procedure for indirect bonding of attachments. J Clin Orthod . 1978;12(4):300‐302 . Rajagopal R, Vankatesan A, Gnanashanmugham K, Harish Babu S. A new indirect bonding technique. J Clin Orthod . 2004;38(11): 600‐602 Koo BC, Chung CH, Vanarsdall RL. Comparison of the accuracy of bracket placement between direct and indirect bonding techniques. Am J Orthod Dentofacial Orthop . 1999;116(3):346‐351 44 REFERENCES

45. Thomas RG. Indirect bonding: simplicity in action. J Clin Orthod . 1979;13(2):93‐106 Sondhi , Anoop . (2007). Effective and Efficient Indirect Bonding: The Sondhi Method. Seminars in Orthodontics. 13. 43-57 Kalange , John. (2007). Prescription-Based Precision Full Arch Indirect Bonding. Seminars in Orthodontics. 13. 19-42 Koga , Masatada & Watanabe, Kazuya & Koga, Takako . (2007). Quick Indirect Bonding System (Quick IDBS): An Indirect Bonding Technique Using a Double-Silicone Bracket Transfer Tray. Seminars in Orthodontics. 13. 11-18 Moskowitz, Elliott. (2007). Indirect Bonding with a Thermal Cured Composite. Seminars in Orthodontics. 13. 69-74 . Alpern , Michael & Primus, Carolyn & Alpern , Ada. (2009). The AccuBond system for indirect orthodontic bonding. Journal of clinical orthodontics : JCO. 43. 572-6 ; Husain, Akhter & Ansari, Tariq & Mascarenhas , Rohan & Shetty, Sandeep. (2009). A new approach to indirect bonding. Journal of clinical orthodontics : JCO. 43. 652-4 . Aguirre MJ, King GJ, Waldron JM. Assessment of bracket placement and bond strength when comparing direct bonding to indirect bonding techniques. Am J Orthod . 1982;82(4): 269‐276 Yi GK, Dunn WJ, Taloumis LJ. Shear bond strength comparison between direct and indirect bonded orthodontic brackets. Am J Orthod Dentofacial Orthop . 2003;124(5):577‐581 45 REFERENCES

46. Thank You!