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without the consent of Dr. Higgins.
Inner silicone tray after removal (made with Template Clear TM from Clinicians’ Choice (Orthodontic Essentials in Canada 1-866-388-1851)
This new silicone flows like light body without slumping and has high tear strength so it removes in one piece.
______________Precision bracket placement on patient's model________________
The more scribe lines the easier it is to get precision bracket placement.
_________________Template Clear/ 0.5mm Splint Biocryl Tray_____________________
Valo light from Opal. 3200 mW. We use two passes of 3 seconds per tooth for a total of 6 seconds per tooth.
The corded model is about the size of a handpiece. There is no light guide so the patient does not have to open as far.
There is no fan vent so it is easy to wipe down. There are four models, two corded and two cordless.
The "Ortho" model has an indirect bonding mode that gives 5 X 3 second high power bursts with one push of the button.
I am now using Opal Etch and Opal Seal for indirect bonding. We do not air thin the Opal Seal as it is not cured
before we place the tray. We still use 3M Unitek Transbond XT Light Cure Adhesive for the custom base.
Transbond Supreme LV Low Viscosity Light Cure Adhesive ("Filtek" in the article below) is spread as thinly as
possible on the custom base just before placing the tray in the mouth over the uncured Opal Seal.
The flowable resin fills in the gaps due to voids in the custom bases that occur when positioning the brackets
on the models.We also use Transbond LV for the pads and adhesive for indirect bonded lingual retainers.
I do not use self-etching primers due to experience with higher bracket bond failures and the increased chance of decalcification.
Indirect bonding trays for buccal segments when anterior brackets were previously placed for phase one Xbow treatment
The following is from an unpublished master's thesis.
In-Vitro Comparison of Three Indirect Bonding Adhesive Systems
Dr. M. Miller, Dr. T. Foley, Dr. A. Rizkalla, Dr. D. Banting
Division of Graduate Orthodontics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Canada
Taken from Summary and Conclusions:
"Based on the data obtained in this in-vitro study, it thus appears that the modified Higgins indirect bonding system is superior to
both the auto-cure (A-B) system and the Thermacure system. The modified Higgins indirect bonding system yielded SPBS
(Shear-peel bond strength) values comparable to directly bonded brackets, without any apparent increased risk of enamel damage at debonding."
In another unpublished study by a major orthodontic manufacturer, five indirect bonding tray designs were tested for bracket transfer error.
The author's tray design was the most accurate of the five. The trays without a hard occlusal stop all caused the brackets to be bonded
approximately 0.25 mm more gingivally than intended. The trays tested were: 1. PVS over brackets and occlusal surface,
1.5 mm polycarbonate outer shell, 2. Emiluma PVS bead over brackets, Memosil 2 PVS outer shell,
3. Affinity Crystal PVS bead over brackets, 0.5 mm Biocryl outer shell (author's tray design),
4. 1.5 mm Bioplast inner shell, 0.75 mm Biocryl outer shell, 5. Affinity Crystal PVS bead over brackets, 0.75 mm Biocryl outer shell.
Lingual retainers indirect bonded before debond
Lingual retainer on model and in transfer tray
Full coverage Essix retainers are made for all patients to be worn at night, even if they have bonded lingual retainers.
This is to retain posterior teeth and closed extraction sites. If a bond fails on a fixed lingual retainer (and they do) the Essix retainer is worn full time
to maintain tooth positions until a new lingual retainer is bonded indirectly. We always use both upper and lower Essix so that we have plastic against
plastic instead of tooth against plastic which wears too quickly.
The following is copied from that article.
Indirect Bonding with a Light Cured Adhesive and a Hybrid Transfer Tray