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BONDING

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Title: BANDING AND BONDING Author: Administrator Last modified by: oem Created Date: 9/16/2005 5:24:11 AM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: BONDING


1
  • BONDING
  • IN
  • ORTHODONTICS

25.02.2015Dr.Gyan P. Singh,
KGMUOrthodonticsDentofacial Orthopedics
2
Fixed orthodontic Appliance
  • BANDING
  • The chief parts of modern fixed appliances are
    tooth bands,brackets and arch wires.
  • Tooth bands are made up of metals and cemented
    to the teeth and provides place for attachment of
    other auxiliaries like brackets, buccal tubes,
    lingual buttons etc.
  • The tooth moving forces derived from the arch
    wires are transmitted to the teeth through the
    bracket


3
  • MAGILL was the 1st to use plain band
  • Preformed steel bands came into widespread use
    during the 1960s and are now available in
    anatomically correct shapes for all the teeth.
  • Teeth that will receive heavy intermittent
    forces ( for the anchorage purpose-extraction
    cases) against the attachments for the extra oral
    force like Head gear. E.g. upper 1st molars

4
Banding Technique
  • Separation
  • Selection of band
    material
  • Fabrication and
    fitting
  • Cementation

5
  • Elastomeric separators
  • which surrounds the contact point and
    squeeze the teeth apart over period of few days

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7
  • Prefabrication
  • Lower molar bands are designed to be seated
    initially with hand pressure on the proximal
    surface and then heavy biting force along the
    buccal but not the lingual margins.

8
BONDING
  • For the patient to whom esthetics being the prime
    consideration even during the treatment, the
    metallic look of the orthodontic appliance has
    always been the bone of contention.

9
  • History
  • Acid etching M. G. Buonocore in 1955 using
    85 phosphoric acid for 30 sec
  • Newman (1965) was the first to apply
    bonded orthodontic brackets
  • Smith (1968) - zinc polyacrylate and
    bracket bonding with this cement

10
.
  • Advantages over bonding
  • It is esthetically superior.
  • It is faster and simple.
  • There is less discomfort for the patient
  • Arch length is not increased by band material.

11
  • It allows more precise bracket placement.
  • Bonds are more hygienic than bands Partially
    erupted teeth can be controlled.
  • Mesiodistal enamel reduction ( proximal
    reduction) is possible during treatment.
  • Attachments may be bonded to artificial tooth
    surfaces (eg., amalgam, porcelain, gold) and to
    fixed bridge work.

12
  • Caries risk under loose bands is eliminated and
    interproximal caries can be detected and treated.
  • No band spaces are present to close at the end of
    treatment.
  • Lingual brackets, invisible braces, can be used
    when patient rejects visible orthodontic
    appliance.

13
  • The protection against the inter proximal caries
    of well contoured cemented band is absent.
  • Bonding is more complicated when lingual
    auxiliaries are required or where headgears are
    attached.
  • Debonding is more time consuming than debanding,
    since removal of adhesive is more difficult than
    removal of cement

14
  • Bonding procedures can be performed in 2 ways
  • Direct bonding
  • Indirect bonding
  • Direct bonding
  • This procedure is quite simple and
    involves following steps
  • CLEANING
  • ENAMEL CONDITIONING
  • SEALING
  • BONDING

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16
  • Cleaning
  • This requires rotary instruments, either a
    rubber cup or a polishing brush.
  • Studies have shown enamel loss due to
    prophylaxis.
  • Mark Daniel pus et al ( AJO 1980) showed that
    10.7µm of enamel loss during initial prophylaxis
    with bristle brush was greater than the 5.0µm
    lost when a rubber cup as used and the difference
    was statistically significant.

17
  • Enamel conditioning
  • Moisture
    control
  • Enamel
    pretreatment
  • MOISTURE CONTROL
  • After the rinse, salivary
    control and maintenance of a completely dry
    working field is absolutely essential. Its
    presence may prevent the good bond between the
    sealant and bonding agent

18
  • Enamel pretreatment
  • The conditioning solution or gel (usually 37
    phosphoric acid ) is then lightly applied over
    the enamel surface with a foam pellet or brush
    for 15 to 30 sec.
  • When etching solutions are used, the surface must
    be kept moist by repeated applications.

19
  • Is etching time is different for young and old
    teeth?
  • K J. Nordenvall et al (AJO 1980) did a
    comparison between the effects of 15 and 60
    seconds of etching with a 37 percent phosphoric
    acid solution on enamel surfaces of deciduous and
    young and old permanent teeth.
  • For deciduous teeth, no difference was found in
    effect between the etching periods.
  • For young permanent teeth, 15 seconds of etching
    created more retentive conditions than 60
    seconds.

20
  • How much enamel is removed by etching and how
    deep are the histological alterations?
  • Are they reversible? Is etching is harmful?
  • A routine etching removes 3 to 10 µm
    of surface enamel. Another 25 µm reveals subtle
    histological alterations creating necessary
    mechanical interlocks.
  • Deeper localized dissolutions will
    generally cause penetration to a depth of about
    100µm or more.

21
  • Bonding
  • Direct technique in which the brackets are
    placed directly on the enamel surface by the
    operator, as was initially described by Newman.
  • The second method of bracket placement is the
    indirect technique, which was first described by
    Silverman et al
  • The recommended bracket bonding procedure
    consists of the following steps
  • 1.TRANSFER
  • 2.POSITIONING
  • 3.FITTING
  • 4.REMOVAL OF EXCESS

22
  • TRANSFER
  • The bracket is gripped with a pair of cotton
    pliers or a reverse action tweezer (bracket
    holding forceps) and the mixed adhesive is
    applied to the back of the bonding base.

23
  • POSITIONING
  • A placement scaler, such as the RM 349 or one
    with parallel edges is used to position the
    brackets mesiodistally and incisogingivilly and
    angulate them accurately.
  • The placement scaler with parallel edges allows
    visualization of the bracket slot relative to the
    incisal edge and long axis of the teeth, with the
    scaler seated in slot.

24
  • FITTING

25
  • REMOVAL OF EXCESS
  • Excess must be removed with the scaler before the
    adhesive has set or it must be removed with bur
    after setting.

26
  • INDIRECT BONDING
  • Several techniques for indirect bonding are
    available. Most are based on the procedures
    described by Silverman and Cohen ( JCO 1976).
  • H. Stuart ( Jco 2003 ) suggested most indirect
    bonding techniques are successful in accurately
    placing brackets but can be expensive, he
    introduced a simplified method that has reduced
    lab cost and chair time.

27
Indirect bonding with silicone impression tray
  • Take an impression and pour up a stone model
  • Select brackets for each tooth
  • Apply a small portion of water soluble adhesive
    on each tooth
  • Position the brackets on the model, check all the
    measurements and allignments, reposition if
    needed

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29
  • Indirect bonding
  • In this technique temporary adhesive is used
    to attach the brackets to the patients stone
    model
  • The bracket is placed on the model and excess
    adhesive is removed from the periphery of the
    base
  • Before forming the indirect bonding tray use of
    light separating spray is recommended to
    facilitate the easy removal of the tray from the
    brackets.
  • After 10 min placement tray is vacuum formed for
    each arch

30
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32
  • Tray is removed by peeling from the lingual
    towads the buccal
  • Excess flash of sealant is carefully removed from
    the gingival contact areas of the tooth
  • Advantages
  • clean up is simple because little flash is
    present

33
DEBONDING
34
  • Definition/Objective of debonding -
  • --To remove the attachment and all the
    adhesive resin from the tooth and restore the
    surface as closely as possible to its
    Pre-treatment condition without inducing
    iatrogenic damage.

35
Clinical Procedures
  • Mainly divided into 2 stages
  • -- Bracket removal
  • -- Removal of residual adhesive

36
Bracket removal
  • Metal brackets
  • -- Debonding pliers
  • Ceramic brackets
  • -- Pliers
  • -- Separation at bracket adhesive
  • interface (Bishara)
  • -- Thermal debonding
  • -- Lasers

37
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38
Removal of residual adhesive
  • Scaler
  • Scraping with a sharp band or bond removing plier
  • Burs
  • -- Dome shaped TC bur
  • -- Ultrafine diamond bur
  • -- White stone finishing bur

39
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40
  • REFERENCES
  • William R Proffit ,Contemporary orthodontics
    Third Edition ,2002
  • Thomas M Graber , Robert L, Vanarsdall ,
    Orthodontics Current Principles and Technique
    Fourth Edition,2003
  • Robert E Moyers Handbook of orthodontics Fourth
    Edition,1988
  • Kharbanda.Diagnosis and Management of
    Malocclusion and Dentofacial deformities.Mosby,els
    evier,2001

41
  • MCQs
  • Complicated cases are most often treated by fixed
    appliances than removal appliance because
  • They apply heavy forces
  • Wide range of tooth movements possible
  • Require less anchorage
  • They cannot be removed by the patients
  • 2. Which of the following are examples of fixed
    active appliances
  • Standard Edgewise and straight wire
  • Begg and Herbst
  • (C) Activator and Herbst
  • (D) Bionator and twin-block

42
  • 3.All of the following can be classified as
    myofunctional appliances except
  • An anterior bite plane
  • Andresen appliance
  • Begg appliance
  • Oral screen
  • 4. Rotation of teeth is best corrected by
  • Hawley appliance
  • Buccal retractor
  • (C) Fixed appliance
  • (D) All of the above

43
  • 5.Which of the following is not true of an fixed
    appliance
  • Economical
  • Rotation and extrusion movement are possible
  • (C)Patient cooperation is not required
  • (D)Tipping and bodily movement is possible
  • 6. Passive component of fixed appliance
  • Brackets
  • Arch-wire
  • Springs
  • Elastics

44
  • 7.Which of the following components of the fixed
    appliance holds the arch-wire on the teeth except
    for that molars
  • Cleats
  • Brackets
  • Bands
  • Lock springs
  • 8. The direct bonded orthodontic stainless steel
    brackets device retention with composite because
    of
  • The mechanical interlock with mesh at the bracket
    base
  • The chemical interlock of composite with bracket
    base
  • Both mechanical and chemical interlock of
    composite with the bracket base
  • Biological interlock between the tooth and the
    brackets.

45
  • 9. Use of light cure in orthodontics is done in
    case of
  • Bonded retainer
  • Fixing the brackets
  • Correction of 1 mm midline
  • All of the above
  • 10. A first order bend in an orthodontic wire is
  • A twist in the wire
  • In the vertical plane
  • In the horizontal plane
  • A horizontal bend with a twist

46
Thank you
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