Printed 3D Indirect Bonding

We recommend using orthodontic stone instead of plaster whenever possible. We find that stone gives an added level of accuracy in the model pour-up and is more durable to work with in our laboratory.

The precision necessary with indirect bonding is directly related to the fit of the custom pads to the dental model and teeth, and the best results are achieved by the use of the best practices and materials. We also recommend using premium-grade alginate such as Kromopan to take all indirect bonding impressions.

Kromopan is especially desirable for impressions that cannot be poured immediately; it's accurate and stable if poured within 72 hours.

Make sure to follow the manufacturer's recommendation regarding the proper water-to-powder ratio when mixing the stone.

For consistency, a power mixer with a vacuum attachment is also recommended.

Specialty Appliances™ will place any manufacturer's brackets with our indirect bonding service. If you maintain your own bracket inventory, please enclose with each case the brackets required for that particular indirect bonding.

Please use a sticky card or some kind of bracket-carrying tray.

We have worked with all types of appliances from all manufacturers and have had success with all of the ceramic brackets and the standard metal appliances.

Recently, we have experienced an increased demand for self-ligating appliances, such as the TIME bracket from American Orthodontics, the Damon Appliance from Ormco, and the GAC Innovation.

Although they require special handling, there are no limitations on their use with indirect bonding.

We begin with the long axis mark on each tooth, which some orthodontists prefer to do on the cast before sending it to Specialty. Then, we mark the proper vertical height for bracket placement.

The location of vertical height lines depends on the overall size of the teeth. We encourage you to provide additional bracket placement information, either as a standard instruction file to be followed on all cases or as special instructions for individual cases.

For example, an orthodontist might ask us to place the brackets one millimeter more gingival on an open-bite case or request over-corrections on certain types of rotations.

Over 75% of our indirect bonding customers now include bonded molars in their Indirect setups. The NOLA dry-field apparatus and today's excellent adhesives have made molar bonding with the indirect technique a routine procedure.

Because the anatomy of molars varies so widely, many orthodontists believe the bracket positioning of indirect is far superior to banding for these teeth. This is especially true when using some of the smaller mini-tubes on the second molars.

Another advantage of bonding molars with indirect is the elimination of spacers at the beginning of treatment and band space at the end. When bands are placed on the posterior teeth, we recommend that they be placed after the indirect bonding trays have been delivered.

Any movement of the teeth, while the trays are being fabricated, could create discrepancies between the construction model and the patient's teeth and prevent the trays from fitting properly.

Many methods have been suggested for placing brackets in the laboratory, including caramel candy, one of the temporary materials used in the early years of indirect bonding. The custom-base method has been demonstrated using auto-cure, thermal-set, and light-cure material.

At Specialty Appliances, we use Phase II, an auto-cure material from Reliance Orthodontic Products, and a thermal-set adhesive from Reliance. These products have excellent working characteristics in the laboratory and produce extremely accurate custom pads in the final product.

With the custom-based method, there are two basic choices for clinical bonding: light cure or auto cure. In either system, only a sealant is required for clinical bonding because of the precise fit of the custom bases to the teeth.

Some practices also elect to use a very small amount of paste in the interface between the custom base and the tooth surfaces. This can be done with either the light cure or the chemical cure.

We recommend the family of adhesives from Reliance Orthodontic Products for all clinical bonding. Reliance offers high-quality adhesives and outstanding customer support.

Many other adhesives will work with the indirect technique; we suggest that practices discuss the specifics of each adhesive system with the manufacturer and ask for directions on their use with indirect. The Specialty Appliances™ indirect bonding manual illustrates each of the clinical bonding techniques.

There is a soft inner tray made from a 1.5-millimeter flexible Bioplast (from Great Lakes Orthodontic Products) with a hard outer shell made from 1.0-millimeter Biocryl. The hard tray fits precisely over the inner tray.

An important step in our laboratory is the block-out applied to the brackets before the Biostar machine forms the trays. The block-out is used around the hooks, wings, and undercut areas; brackets are held firmly but easily disengage when the trays are removed after bonding.

The outer tray provides rigidity to the overall system after the trays have been seated in the mouth. Most practices use the trays in a complete-arch segment; the trays aren't split into sections or quadrants. If you prefer to section the trays, simply specify that on your prescription form.

Another option available for practices using the clean-base technique is the original silicone-putty trays. Please indicate if your practice prefers to use them on the prescription form.

On average, we process indirect bonding cases in our laboratory in three to five working days. We typically estimate two to three days each way for shipping and receiving for a total turn-around time of approximately ten working days.

We can expedite cases upon request and utilize a rapid return service for situations where your patient must have brackets placed immediately.

Access the upload portal at suresmile.com. All fusion cases go through the SureSmile upload portal.