One of the scariest experiences in the dental office is the bonding appointment. This is the point in the treatment the braces are attached to the teeth and bands may be placed on the molars predicated on what treatments are required. This experience can be less than enjoyable and is often a discussion point of our younger patients. There are tales they hear from their friends and classmates, about their mouth being pulled and forced open. There are chemicals placed on the teeth and washed off only to be replaced. These applications are often placed a few teeth at a time. All the while the patient is ordered to stay open, don’t get saliva on the treated teeth, and put “your” head into an uncomfortable position. This is repeated multiple times during the bracket placement appointment.
I feel there is a better way to provide that case. That is INDIRECT BONDING. With indirect bonding the procedure is as follows: First, we take impressions of the teeth. Second, the impressions are poured in cast stone. Third, models are trimmed, cleaned and treated with a separating solution. Fourth, the assistant then places the appropriate bracket on the teeth (these are placed with bonding cement). Fifth, the orthodontist adjusts the brackets into the proper treatment position (this is done while reviewing the case and checking the X-rays). Then the braces are prepared for placement on the teeth. Sixth, the assistant completes the process by placing a mouth guard material and a hard tray over the patients mouth. Upon the completion of the laboratory procedure the brackets and trays are scrubbed with soap and water and set aside for placement into the patients mouth. The patient is appointed for the placement of the brackets into their mouth.
What are the benefits of this approach?
The trays can be used to place the brackets on the patient’s teeth either as a single tray for each arch or the trays can be halved, and the brackets can be placed on an individual quarter of the mouth.
The braces are not placed individually on each tooth but rather 6-12 at a time.
The brackets are placed using the lollipop technique which allows us to use a bonding solution that does not have to be washed off and retreated.
The accuracy of the brace placement is improved as it is not necessary to try and accurately place a brace on a moving target and in an extreme environment,(the analogy is cutting a diamond under a waterfall)
Using this methodology allows us to place the braces, with the wire in place, in under an hour. This is much more accurate and quicker than the traditional approach.
What does this mean?
Less time in the chair
Much less discomfort
Greater accuracy of bracket placement
Upon the completion of the appointment, there is almost universal agreement, there was little discomfort, and it was completed in much less time than expected. Most of the juvenile patients advise is that the expectations they were led to expect did not occur. The statements about the bond appointment were from one of two sources. Someone who had their braces placed at another office, or a sibling who wants to torture their brother or sister.