Indirect Bonding with Light-Cured Adhesive and a …

1 Indirect Bonding with Light-Cured Adhesiveand a Hybrid Transfer TrayDuncan W. HigginsIndirect Bonding has evolved concurrent with the improvements in dentalmaterials. Light-Cured adhesives allow additional time for tray placement,and adequate bond strength that allows for rapid tray removal and imme-diate archwire placement. Flowable restorative composite resins haveproven to be an ideal Indirect Bonding Adhesive . The tray system combinesclear vinyl polysiloxane to capture the brackets and a thin thermoplasticouter tray. The primary advantage of this technique is the reduction inlaboratory time needed to fabricate the hard outer tray. (Semin Orthod 2007;13:64-68.) 2007 Elsevier Inc. All rights beginning practice in 1981 the tech-nique used by the author involved placingthe brackets on working models with toffee. Thetransfer trays were then made from siliconeputty, and the Adhesive was a two-paste compos-ite resin.

2 A problem with this technique involvedthe possibility of Adhesive flash remainingaround the base of the brackets, which requiredremoval with a round bur and a hand problem involved the requirement ofwaiting long enough for the Adhesive to gainenough bond strength to allow tray the advent of lingual orthodontics camethe custom base Indirect Bonding brackets were placed on the model with aheat-cured composite resin and the flash re-moved. After the bracket position was adjusted,the model was placed in an oven to cure the tray was made and the model wasplaced in warm water to dissolve the separatingmedium and release the brackets from themodel, the cured composite resin had formed acustom base on the brackets. This custom basewould adapt so closely to the tooth that it wasonly necessary to use a thin film of self-curedcomposite resin to act as the Adhesive betweenthe custom base resin and the etched , Concise (3M Unitek, Monrovia, CA)restorative unfilled enamel sealant was used asthe Adhesive .

3 Some clinicians preferred to sim-ply place part A of the sealant on the custombase and part B on the enamel. When the traywas placed on the prepared teeth, the two partswould meet and cure. This became known as the A-B custom base Indirect Bonding adhesives were de-veloped for the A-B adding fillers for increased viscosityand bond strength, as well as adding acceler-ators to decrease the setting time and to de-crease the time the trays had to be held inplace before they could be removed from thebonded approximately the same time that Light-Cured restorative composite resins were intro-duced, orthodontists began experimentingwith clear transfer trays. These trays are madein the same manner that mouth guards aremade on the Biostar (Great Lakes Orthodon-tics, Tonawanda, NY). The clear trays allowedthe use of Light-Cured , nonfilled resins to beused as an Adhesive . Themain advantage of theuse of Light-Cured adhesives versus chemicallycured adhesives was the relatively high initialbond strength present at the critical time of trayFrom the private practice of Dr.

4 Duncan W. Higgins, DeltaOrthodontic Group, British Columbia, correspondence to Duncan W. Higgins, DDS, MSD,FRCD(C), #203, 7313 120 Street, Delta, BC, Canada V4C : 604-590-1172. 2007 Elsevier Inc. All rights $ in Orthodontics, Vol 13, No 1 (March), 2007: pp 64-68removal. Another advantage was the increasedworking time available to ensure that the traywas fully seated. Subsequently, the double traytechnique was introduced, which used an outerhard acrylic tray in addition to the soft innertray. This increased stability in the tray next step in the evolution of this pro-cess involved adding a filler to the resin inorder to increase the viscosity, as well as thebond strength. Fluorobond (Ormco, SybronDental Specialties, Orange, CA) was a lightlyfilled, Light-Cured orthodontic sealant used bythe author as an Indirect Bonding was replaced by Ortho Solo (Ormco,Sybron Dental Specialties, Orange, CA) whichadded some moisture tolerance to the lights became stronger, and curingtimes decreased.

5 When the argon laser wasintroduced, it decreased curing time and pro-vided a smaller and lighter wand. The use ofFigure 1.(A) Affinity Crystal Clear vinyl polysiloxane(VPS). (B) Application of VPS over brackets. (C) Modelwith VPS. (Color version of figure is available online.)Figure of the custom bases. (Colorversion of figure is available online.)Figure tray. (Color version of figure isavailable online.)65 Mouth Guard Transfer Trayan argon laser also decreases enamel Supreme Plus Flowable Restorative(3M ESPE, St. Paul, MN) acts as an intermediaryresin in our Indirect Bonding process. The use ofa flowable Light-Cured Adhesive with indirectbonding was first described by isviscous enough so that it stays where it is placedon the custom base; however, it flows under thepressure of seating the tray down to 10 microns,which is considered an ideal cement line thick-ness. Very little flash is present after Bonding , ifcare is taken to place a minimal amount of Filtekon the custom TechniqueThe Indirect Bonding technique combining aclear double transfer tray with an APC II (3 MUnitek, Monrovia, CA) custom base has beenpreviously described by followingare the modifications that the author has made:1.

6 Use a resin-reinforced model stone such asGC Fujirock EP (GC America Inc., Alsip,IL).2. Use a separating medium and place thebrackets on the models. A technique for pre-cision bracket placement using marginalridges, and functional and esthetic surfaces asa reference point, has been previously de-scribed by Cure the custom base resin in a Triad 2000 Visible light Curing Unit (Dentsply Interna-tional, York, PA) for 10 minutes from theocclusal and 10 minutes from the Lay down a bead of Affinity Crystal Cleartransparent vinyl polysiloxane or VPS (Clini-cians Choice, Inc., New Milford, CT) to capturethe brackets (Fig 1A-C). Use a small, yellow ( ) mixing tip. The bead should be approxi-mately the diameter of a pencil so that it can beremoved in one piece in the mouth. Hold themixing tip at a 45 degree angle to the bracketFigure and etching using the Nola DryField System. (Color version of figure is available on-line.)

7 Figure 5.(A) Dry Tips. (B) Dri-Angle. (Color versionof figure is available online.) Higginsface. Keep the VPS flowing ahead of the tip tosurround the Using a Biostar machine (Great Lakes Orth-odontics, Tonawanda, NY) and mm clearSplint Biocryl (Great Lakes Orthodontics,Tonawanda, NY; item #021-023) make anouter tray over the VPS using the lead Soak the working model with the customtransfer tray in warm water for a minimum ofone hour to dissolve the separating medium,and release the custom bases from the the tray from the model in onepiece. Do not separate the VPS from theouter Return the tray to the curing unit for oneminute to cure any soft spots .8. Trim the tray with scissors or a Micro-etch the custom bases with Ortho Pro-phyTMSA-85 abrasive (Danville Engineering,San Ramon, CA). This will clean the custombases without removing a significant amountof the resin (Fig 2).10. Rinse the tray well to remove all off the excess water and allow to airdry (Fig 3).

8 Clinical Procedure1. Apply the smallest amount of Filtek that willcover the custom base of each bracket, andspread the Adhesive with the end of the sy-ringe (Fig 6). Place the trays in the Isolate the oral cavity using a Nola Dry FieldSystem (Great Lakes Orthodontics,Tonawanda, NY) (Fig 4). Use Dry Tips (Molnlyke Health Care, Goteborg, Sweden)for maximum moisture control or the morerigid Dry Angles (Dental Health Products,Inc., Youngstown, NY) to hold the cheek awayfrom the second molars (Fig 5A and B).3. Etch the facial surface of all teeth to bebonded on one arch, rinse well, and dry witha tooth Apply a thin layer of Ortho Solo to the Seat the tray and cure each tooth for 10 sec-onds with either a high intensity halogen orLED curing light or 5 to 10 seconds with anargon laser (Fig 7).6. Repeat the procedure for the opposite Remove the outer Remove the Remove any interproximal Adhesive flash. Thepatient is now ready for archwire of Filtek.

9 (Color version of fig-ure is available online.)Figure of the composite with an argonlaser. (Color version of figure is available online.)Figure of the outer tray. (Color version offigure is available online.)67 Mouth Guard Transfer TraySummaryIndirect Bonding has undergone many improve-ments since its introduction in the 1970s and theinterest in this technique has increased; how-ever, it does not enjoy the popularity that itdeserves. Opponents of the technique equatethe complexity with crown and bridge fabrica-tion. The technique described in this articleserves to simplify tray fabrication. This is accom-plished by combining clear vinyl polysiloxane tocapture the brackets, with a thin thermoplasticouter tray. The resulting tray is easier to trim andless bulky than other Noel L, Rebellato J, Sheats RD: The effect of argon laserirradiation on demineralization resistance of humanenamel adjacent to orthodontic brackets: an in vitrostudy.

10 Angle Orthod 73:249-258, 20032. Miles PG: Indirect Bonding with a flowable light -curedadhesive. J Clin Orthod 36:646, 20023. Sondhi A: Efficient and effective Indirect Bonding . Am JOrthod Dentofacial Orthop 115:352-359, 19994. Kalange J: Ideal appliance placement with APC brackets andindirect Bonding . J Clin Orthod 33:516-526, 1999 Figure of the VPS. (Color version of fig-ure is available online.)Figure tray and VPS. (Color version offigure is available online.) Higgins