clinical bonding protocol - american orthodonticsfollowing bonding protocols of other lingual...

CLINICAL BONDING PROTOCOL

www.myHARMONYsmile.com

IMPORTANT: Read this before bondingThe clinical bonding protocols for Harmony are very specific and are designed to ensure a consistently successful bonding experience.

The Harmony system has several unique features over other lingual systems, so strict adherence to these protocols is highly recommended. Changing or skipping any step(s) may affect the performance of the brackets, weaken bond strength, and slow down treatment.

Following bonding protocols of other lingual systems is not recommended.


11

Adhesive: DenMat® - Geristore® Dual-Cure Glass Ionomer Primer*: *Reliance - Assure™ or *Unitek - Transbond® MIP Etch: American Orthodontics - Acid Etch Gel (001-913) American Orthodontics - Porcelain Conditioner (001-966) *Ultradent - Ultra-Etch®

ReCOMMeNDeD MATeRIALS

*Available from your local distributor. Not available from American Orthodontics.

TRAY PRePARATION

BRACKeT PRePARATION (ALL SURFACeS)

B

B

A Bring recommended materials and instruments chairside. If adhesive is stored in a refrigerator, allow 45 minutes to return to room temperature.

B Assemble mixing tips and inspect adhesive syringe to ensure that it was stored properly and that there is sufficient glass ionomer for the bonding appointment. NOTE: The auto-mixing tip is designed for direct delivery to the bonding pads using the intra-oral tip, which snaps onto the auto-mixing tip.

A Check the transfer tray to ensure that all brackets are present and correctly positioned in the tray.

B Using a microbrush, apply a very thin layer of Reliance Assure or Transbond MIP on the bracket pads, which have been pre-treated with ROCATEC, a metal primer, at the Harmony Technical Center. Do not micro-etch pads before bonding.


12


01 Micro-etch (sandblast) the lingual surface of each tooth to be bonded for 1-3 seconds with 50 micron Aluminum Oxide media.

BONDING TO eNAMeL SURFACeS

eNAMeL SURFACeS

01

02

02 Rinse tooth surfaces thoroughly to remove any Aluminum Oxide particles. Check to confirm that the bonding surfaces are clean and without any residual bio-material (tartar) that would compromise the bond integrity.

NOTE: Micro-etch and rinse before inserting the NOLA System.

13

04 Etch the tooth surfaces to be bonded with 37% phosphoric acid for 60 seconds.

05 Use suction to remove the bulk of the etch and then rinse each tooth thoroughly for 30 seconds minimum. Dry tooth surfaces with an oil-free and moisture-free air supply until the surface of the enamel appears ‘frosty’ white.

14

eNAMeL SURFACeS

03

03 Place a cheek retractor and evacuator system - ‘NOLA’ is recommended - to establish a dry, accessible working environment.

NOTE: When bonding the mandibular arch, be sure to place 2 cotton rolls in the ‘NOLA’ retractor.


07

eNAMeL SURFACeS

15

06 Apply a thin layer of Reliance Assure or Transbond MIP to each etched tooth surface. IMPORTANT: Do not allow saliva to contaminate the etched surfaces before the primer is applied.

07 Apply a small amount of Max Cem Elite* dual-cure adhesive to the exposed bracket bases in the transfer tray.

06

NOTe: A. The application time should be less than 35 seconds to avoid

premature curing of the adhesive.

B. Reduce the level of ambient light exposure to the adhesive.

C. Be judicious in the amount of adhesive applied to avoid excess

flash around the bracket bases or self ligating clips.

*Max Cem elite is recommended but other dual-cure resins may be used. Contact American Orthodontics for a list of other approved dual cure resins.

08 Insert the tray in the mouth making sure it is completely seated on the teeth by pressing the tray with finger pressure on the occlusal and lingual surfaces. This ensures that the brackets are in intimate contact with the tooth surfaces. “Tack” each of the brackets in place with a 5 second light cure.

09 After all the brackets have been “tacked,” use an LED light to cure adhesive from the labial for 10 additional seconds per tooth to completely polymerize the adhesive. After the last tooth has been cured, wait 30 seconds before removing the tray. TIP: Use a second LED curing light to shorten the bonding time.

16

eNAMeL SURFACeS


10 After removing the transfer tray, remove any excess adhesive from the tooth surfaces, especially interproximal, with an appropriate instrument. Check contacts between teeth with dental floss to make sure there is no adhesive “bridging” of teeth.

11 Check the occlusal contacts with articulating paper for any bracket-tooth interferences. Place “shims” (posterior bite blocks for opening) as necessary to eliminate any interferences.

17

eNAMeL SURFACeS

11

BONDING TO MeTAL SURFACeS

01 Micro-etch (sandblast) the metal surfaces to be bonded for 4 seconds with 50 micron Aluminum Oxide media.

02 Rinse the micro-etched surfaces thoroughly and dry.

03 > 09 Follow Procedures 06-11 for Bonding to Enamel.

18

MeTAL & PORCeLAIN SURFACeS

01 Micro-etch (sandblast) the lingual surface of each tooth to be bonded with 50 micron Aluminum Oxide media for 3 seconds, each tooth.

02 Rinse the micro-etched surface thoroughly and dry.

03 Coat the surface of the porcelain with a thin layer of liquid etch — 37% phosphoric acid (American Orthodontics). DO NOT RINSE!

04 Leaving the layer of acid etch on the porcelain, apply a layer of Porcelain Primer (American Orthodontics) on top of the phosphoric acid. After a few seconds, apply a second layer of Porcelain Primer over the first and let sit for 60 seconds. Rinse thoroughly and dry completely.

05 > 10 Follow Procedures 06-11 for Bonding to Enamel.

BONDING TO PORCeLAIN SURFACeS

www.myHARMONYsmile.com 19

MIXeD SURFACeS

STeP-BY-STeP SeQUeNCe FOR MIXeD BONDING SURFACeS

01 Micro-etch (sandblast) the tooth surfaces of ALL teeth whether Enamel, Metal, or Porcelain for 4 seconds.

02 Rinse and dry as previously instructed.

03 Start with Porcelain teeth first.

04 Coat the surface of the porcelain with a thin layer of liquid etch — 37% phosphoric acid (American Orthodontics). DO NOT RINSE!

05 Leaving the layer of acid etch on the porcelain, apply a layer of Porcelain Primer (American Orthodontics) on top of the phosphoric acid.

06 Apply a second layer of Porcelain Primer over the first and let sit for 60 seconds.

20

MIXeD SURFACeS

07 Etch the remaining teeth with 37% phosphoric acid and wait for 60 seconds, as in Bonding to Enamel, above.

08 Rinse and dry all teeth (enamel, metal, porcelain).

09 Apply a thin coat of Reliance Assure primer to the metal surfaces. Leave undisturbed for 5 seconds. Dry with a gentle stream of air for 3 seconds and light cure (polymerize) for 3 seconds. REPEAT THIS STEP TWICE.

10 Apply a thin layer of Reliance Assure or Transbond MIP primer to the other teeth to be bonded.

11 Insert the tray in the mouth making sure it is completely seated on the teeth by pressing the tray with finger pressure on the occlusal and lingual surfaces. This ensures that the brackets are in intimate contact with the tooth surfaces. “Tack” each of the brackets in place with a 5 second light cure.


MIXeD SURFACeS

21

12 After all the brackets have been “tacked,” use an LED light to cure adhesive from the labial for 10 additional seconds per tooth to completely polymerize the adhesive. After the last tooth has been cured, wait 30 seconds before removing the tray.

13 Remove any excess adhesive from the tooth surfaces, especially interproximal, with an appropriate instrument.

Check contacts between teeth with dental floss to make sure there is no adhesive ”bridging” of teeth.

14 Check the occlusal contacts with articulating paper for any bracket-tooth interferences. Place “shims” (posterior bite blocks for opening) as necessary to eliminate any interferences.

22

14

ReBOND

01 Micro-etch (Sandblast) the base of the pad (bonding surface) of the de-bonded bracket, removing ALL adhesive from the pad. Clean the surface with a stream of oil-free and moisture-free air.

02 Prepare the tooth surface to be re-bonded, following the appropriate instructions for bonding to enamel, metal, or porcelain.

03 Apply a thin layer of Reliance Assure or Transbond MIP primer to the pad and leave undisturbed for 5 seconds. Dry for 3 seconds and light cure (polymerize) for 3 seconds.

04 Repeat Step 3.

ReBOND PROTOCOL

FOR ReBONDING ANTeRIOR TeeTH

05 Place the corresponding Positioning Jig on the tooth to be rebonded to ensure the correct jig has been selected. NOTE: Positioning Jigs provide a mechanical guide for direct bonding Harmony brackets to anterior teeth at any time during treatment.


ReBOND

23

06 Apply a small layer of Geristore adhesive on the pad of the debonded bracket. While holding the positioning jig in place, press the pad firmly against the tooth, remove the jig and clean excess flash. Place the jig on the tooth a second time to ensure accurate positioning. Light cure (polymerize) for 10 seconds. Check contacts between teeth and occlusal contacts.

FOR BONDING POSTeRIOR TeeTH

07 For posterior teeth, place the bracket on the tooth and press firmly to ensure a good fit with the enamel surface. Remove any excess flash. Light cure (polymerize) for 10 seconds. Check contacts between teeth and occlusal contacts.

clinical bonding protocol - american orthodonticsfollowing bonding protocols of other lingual...

Documents