17 INDIRECT BONDING OF SPEED ATTACHMENTS BY DR. FRANÇOIS BÉRUBÉ D.M.D. CERT. ORTHO One of the primary advantages of indirect bonding SPEED brackets is the accuracy of bracket positioning. The procedure below ensures full control by you and your auxiliary staff. The simplicity of this procedure allows for delegation of the laboratory procedure, and its flexibility permits you to check, and if necessary, adjust bracket positioning before finalizing the case. MATERIALS 1. Stone model from an accurate alginate impression 2. Panoramic x-ray 3. Treatment plan 4. SPEED brackets 5. Separating medium (Al-Cote, Dentsply International) 6. Phase II adhesive kit (Reliance Orthodontic Products) 7. Reprosil Low Viscosity (Dentsply International) 8. Cutter Sil Putty Plus (Heraeus Kulzer) 9. Cutter Sil Hardener Universal Paste (Heraeus Kulzer) 10. Fastray (Bosworth Company) 11. Acetone 12. Cheek retractor (Nola Specialties) 13. Dry Angles (Young Dental) 14. Instrumentation: Pencil .03 Bracket gauge Bracket tweezer (Ortho Pli) Lecron spatula Explorer Plastic spatula Mixing pad Heatless wheel Mixing spatula Scalpel knife LAB PROCEDURE • Dental stone working models prepared from an accurate alginate impression are necessary. After the treatment plan is established, and the patient’s model has been trimmed and dried for at least 24 hours, reference lines are drawn on the teeth using a very sharp pencil (.03 mm). Mark the long axis, the incisal edge and the marginal crest of each tooth. Determine and mark on each tooth the desired height of the archwire. • On the model, individually check each bracket’s bonding pad relative to its corresponding tooth to ensure proper “base-to-tooth” adaptation. Modify the contour of the bracket’s pad, if necessary, to ensure an exact fit. • Apply a thin coat of separating medium (Al–Cote, Dentsply International) to the models and allow to dry. • Mix Phase II Paste A and B (Reliance Orthodontics) and apply to the mesh bonding base of the bracket. Locate the bracket correctly on the model’s tooth and press firmly into place. Excess adhesive is removed and the position of the bracket is carefully checked and aligned relative to the pencil reference lines previously drawn on the model. The adhesive is allowed to set. • Once all brackets have been placed, the indirect bonding tray may be created. With self-ligating brackets such as SPEED, it is of paramount importance to prevent sealant or composite from obstructing the bracket’s moving components. Therefore the minute crevasses in the self-ligating bracket’s mechanism must be completely filled and a close fit must exist between the indirect bonding tray material and the bracket mesh pad. For this reason a hydrophilic vinyl polysiloxane impression material like Reprosil ‘Low Viscosity’ (Dentsply International) is used to cover each bracket. Let this set for approximately 5 minutes. • Mix the Cuttersil Putty Plus (Heraeus Kulzer), a very high viscosity Silicone Impression material, with the paste hardener and manually roll into a strip. Place the putty around the facial surfaces of the model pressing the putty onto the brackets. Carry the putty over the incisal, occlusal and at least all of the lingual surfaces for accurate indexing. Allow a thickness of at least 5 mm of putty for proper tray strength.
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