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
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