Join me for a summary of Dalia El Bokle’s lecture exploring finishing in orthodontics. Part 3 focuses on digital indirect bonding, from scan to tray production

Introduction

Straight wire appliance – based on bracket placement will correct tooth in 3 planes of space

· Not true – evidenced by finishing bends

Ideal bracket placement through indirect bonding IDB

· Level marginal ridges posteriorly

· Constant smile arc anteriorly

Digital indirect bonding time saving

· Brackets placed Layman 2019

o Time saving

§ 21 minutes – digital indirect bonding Vs manual direct bonding

§ 8 minutes – clinical time indirect Vs direct bonding

Different methods of making an indirect digital bonding tray

Method 1:

· Printed model

· VFR transfer tray

· Transfer tray made from the model

Method 2

· Printer tray (not model)

· Cost $105

· Tray biocompatible tray

· Cover occlusal half of the teeth and lingual aspect

· Insert bracket into model

· Advantage

o No model printing

o Clean base technique

Method 3 –

· Key pads – digitally planned material between bracket base and tooth

o Customises the bracket base

o Advantage

§ Less flash

§ Accuracy of bracket position in on the keypad

§ Torque + in and out can be customised per tooth

· Models printed

· Lab place the brackets manually with composite onto the model with jigs

· Transfer tray made from the model

Case submission for DIDB

· Send STL file to lab

· Prescription for set up, e.g.

o Bracket selection customisation: Standard Damon Brackets, low torque lower incisors, high torque LL4.

o Teeth bonded: 7-7 Upper and lower

o Bracket positioning customisation: Smile arc – 0.5mm incisal U1s Vs U2s

· Clinician approval of set up

o Library of brackets – specify which type of bracket

Digital indirect bonding workflow overview

1. Scan patients

2. Orthodontist prescription

3. CAD –Software system to place bracket and customise base / bracket

4. Print model

5. Brackets placed on model: allowing for bracket base customisation through either keypads or jigs, customising bracket base with composite

6. CAM - Lab design indirect bonding tray (IBT)

a. VFR

b. Silicone transfer tray / Memosil material

7. Process IBT

8. Post processing chemical and UV light

9. Insert bracket into tray with key holes as guides

Advantages of DIDB

· Full digital pathway with scanning

· Less working time

· Fewer appointments

· Can alter prescription

Disadvantage

· Cost

· Learning curve

· Production waste