BONDING

IN
ORTHODONTICS

25.02.2015
Dr.Gyan P. Singh, KGMU
Orthodontics&Dentofacial Orthopedics
 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
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• 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

•
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Banding Technique:

Separation
Selection of band material
Fabrication and fitting
Cementation

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

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• 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.

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 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.

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• 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

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 .

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.

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• 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.
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• 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.

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• 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

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• 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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 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.
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• 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

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• 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.

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• 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.

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• 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.

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 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
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 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.

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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.
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FITTING

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• REMOVAL OF EXCESS

• Excess must be removed with the scaler before

the adhesive has set or it must be removed
with bur after setting.

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 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.

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 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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 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
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• 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

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DEBONDING

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• 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.

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 Clinical Procedures
• Mainly divided into 2 stages

-- Bracket removal
-- Removal of residual adhesive

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 Bracket removal
• Metal brackets
-- Debonding pliers

• Ceramic brackets
-- Pliers
-- Separation at bracket adhesive
interface (Bishara)
-- Thermal debonding
-- Lasers

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 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

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 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,elsevier,2001

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MCQs:
1. Complicated cases are most often treated by fixed appliances
than removal appliance because
(A)They apply heavy forces
(B)Wide range of tooth movements possible
(C)Require less anchorage
(D)They cannot be removed by the patients

2. Which of the following are examples of fixed active appliances

(A)Standard Edgewise and straight wire
(B)Begg and Herbst
(C) Activator and Herbst
(D) Bionator and twin-block 41
3.All of the following can be classified as myofunctional
appliances except
(A)An anterior bite plane
(B)Andresen appliance
(C)Begg appliance
(D)Oral screen

4. Rotation of teeth is best corrected by

(A)Hawley appliance
(B)Buccal retractor
(C) Fixed appliance
(D) All of the above 42
5.Which of the following is not true of an fixed appliance
(A)Economical
(B)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

(A)Brackets
(B)Arch-wire
(C)Springs
(D)Elastics
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7.Which of the following components of the fixed appliance holds the arch-
wire on the teeth except for that molars
(A)Cleats
(B)Brackets
(C)Bands
(D)Lock springs

8. The direct bonded orthodontic stainless steel brackets device retention

with composite because of
(A)The mechanical interlock with mesh at the bracket base
(B)The chemical interlock of composite with bracket base
(C)Both mechanical and chemical interlock of composite with the bracket
base
(D)Biological interlock between the tooth and the brackets.

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9. Use of light cure in orthodontics is done in case of
(A)Bonded retainer
(B)Fixing the brackets
(C)Correction of 1 mm midline
(D)All of the above

10. A first order bend in an orthodontic wire is

(A)A twist in the wire
(B)In the vertical plane
(C)In the horizontal plane
(D)A horizontal bend with a twist
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