bondingin orthodontics orthodontics 25.02.2015 dr.gyan p. singh, kgmu orthodontics&dentofacial...

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BONDINGIN ORTHODONTICS ORTHODONTICS 25.02.2015 Dr.Gyan P. Singh, KGMU Orthodontics&Dentofacial Orthopedics Slide 2 Fixed orthodontic Appliance BANDING BANDING The chief parts of modern fixed appliances are tooth bands,brackets and arch wires. 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. 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 bracketThe tooth moving forces derived from the arch wires are transmitted to the teeth through the bracket 2 Slide 3 MAGILL was the 1 st to use plain band MAGILL was the 1 st 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.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 1 st molars 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 1 st molars 3 Slide 4 Banding Technique: Separation Separation Selection of band material Selection of band material Fabrication and fitting Fabrication and fitting Cementation Cementation 4 Slide 5 Elastomeric separators;Elastomeric separators; which surrounds the contact point and squeeze the teeth apart over period of few days which surrounds the contact point and squeeze the teeth apart over period of few days 5 Slide 6 6 Slide 7 PrefabricationPrefabrication 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.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. 7 Slide 8 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. 8 Slide 9 History:History: Acid etching M. G. Buonocore in 1955 using 85% phosphoric acid for 30 sec Acid etching M. G. Buonocore in 1955 using 85% phosphoric acid for 30 sec Newman (1965) was the first to apply bonded orthodontic brackets Newman (1965) was the first to apply bonded orthodontic brackets Smith (1968) - zinc polyacrylate and bracket bonding with this cement Smith (1968) - zinc polyacrylate and bracket bonding with this cement 9 Slide 10 . Advantages over bonding Advantages over bonding It is esthetically superior.It is esthetically superior. It is faster and simple.It is faster and simple. There is less discomfort for the patientThere is less discomfort for the patient Arch length is not increased by band material.Arch length is not increased by band material. 10 Slide 11 It allows more precise bracket placement.It allows more precise bracket placement. Bonds are more hygienic than bands Partially erupted teeth can be controlled.Bonds are more hygienic than bands Partially erupted teeth can be controlled. Mesiodistal enamel reduction ( proximal reduction) is possible during treatment.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.Attachments may be bonded to artificial tooth surfaces (eg., amalgam, porcelain, gold) and to fixed bridge work. 11 Slide 12 Caries risk under loose bands is eliminated and interproximal caries can be detected and treated.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.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.Lingual brackets, invisible braces, can be used when patient rejects visible orthodontic appliance. 12 Slide 13 The protection against the inter proximal caries of well contoured cemented band is absent.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.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 cementDebonding is more time consuming than debanding, since removal of adhesive is more difficult than removal of cement 13 Slide 14 Bonding procedures can be performed in 2 waysBonding procedures can be performed in 2 ways Direct bonding Direct bonding Indirect bonding Indirect bonding Direct bonding : Direct bonding : This procedure is quite simple and involves following steps This procedure is quite simple and involves following steps CLEANING CLEANING ENAMEL CONDITIONING ENAMEL CONDITIONING SEALING SEALING BONDING BONDING 14 Slide 15 15 Slide 16 Cleaning Cleaning This requires rotary instruments, either a rubber cup or a polishing brush. This requires rotary instruments, either a rubber cup or a polishing brush. Studies have shown enamel loss due to prophylaxis. Studies have shown enamel loss due to prophylaxis. Mark Daniel pus et al ( AJO 1980) showed that 10.7m of enamel loss during initial prophylaxis with bristle brush was greater than the 5.0m lost when a rubber cup as used and the difference was statistically significant.Mark Daniel pus et al ( AJO 1980) showed that 10.7m of enamel loss during initial prophylaxis with bristle brush was greater than the 5.0m lost when a rubber cup as used and the difference was statistically significant. 16 Slide 17 Enamel conditioning:Enamel conditioning: Moisture control Moisture control Enamel pretreatment Enamel pretreatment MOISTURE CONTROL : 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 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 17 Slide 18 Enamel pretreatmentEnamel 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.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.When etching solutions are used, the surface must be kept moist by repeated applications. 18 Slide 19 Is etching time is different for young and old teeth?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.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 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.For young permanent teeth, 15 seconds of etching created more retentive conditions than 60 seconds. 19 Slide 20 How much enamel is removed by etching and how deep are the histological alterations?How much enamel is removed by etching and how deep are the histological alterations? Are they reversible? Is etching is harmful? Are they reversible? Is etching is harmful? A routine etching removes 3 to 10 m of surface enamel. Another 25 m reveals subtle histological alterations creating necessary mechanical interlocks. A routine etching removes 3 to 10 m of surface enamel. Another 25 m reveals subtle histological alterations creating necessary mechanical interlocks. Deeper localized dissolutions will generally cause penetration to a depth of about 100m or more. Deeper localized dissolutions will generally cause penetration to a depth of about 100m or more. 20 Slide 21 Bonding Bonding Direct technique in which the brackets are placed directly on the enamel surface by the operator, as was initially described by Newman. 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 alThe 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 1.TRANSFER 2.POSITIONING 2.POSITIONING 3.FITTING 3.FITTING 4.REMOVAL OF EXCESS 4.REMOVAL OF EXCESS 21 Slide 22 TRANSFER: 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