Effective and Efficient Indirect Bonding:

The Sondhi Method

Anoop Sondhi
A new and comprehensive system for indirect bonding has been developed
and refined by the author. Previous deficiencies with other indirect systems
have been addressed, and a new resin designed specifically for indirect
bonding is presented. (Semin Orthod 2007;13:43-57.) 2007 Elsevier Inc. All
rights reserved.

he concept of indirect bonding was first mentioned in the literature during the mid- to
late 1970s, and various manifestations of the process have since been reported.1-6 In the initial
trials of indirect bonding softened candy was
used to position brackets on the teeth, and
chemically cured filled resins were used to bond
the brackets to the teeth. Although the method
was effective, it resulted in a significant amount
of excessive bonding material or flash remaining
around the bracket, and the cleanup of the resin
presented a significant problem. This technique
was also cumbersome and involved significant
amount of doctor and laboratory time. Alternative adhesives have been used over the years, but
most have proved to be only moderately successful.
The next major improvement in the indirect
methodology occurred during the 1980s. This
occurred when heat-cured resins entered the
market. However, there were reports of clinicians experiencing problems with the brackets
drifting on the working models during the time
required to heat cure the resin. The transfer
model with the brackets attached had to be
heated to 250F to 300F for approximately 15 to
20 minutes as a means of curing the resin (Thermacure; Reliance Orthodontic Products, Itasca,
IL). Furthermore, some nonceramic esthetic

From the private practice of Dr. Anoop Sondhi, Indianapolis,

IN.
Address correspondence to Anoop Sondhi, DDS, MS, 9333 N.
Meridian Street, Ste. 301, Indianapolis, IN 46260. Phone: 317846-1455; E-mail: sondhi@indyortho.com
2007 Elsevier Inc. All rights reserved.
1073-8746/07/1301-0$30.00/0
doi:10.1053/j.sodo.2006.11.006

brackets could not be exposed to this heat. This

necessitated placing the brackets separately on
the models after the metal brackets had been
heat cured and resulted in a more cumbersome
procedure. When the bracket bases are fabricated with heat-cured resin, bonding of the
brackets on the teeth is generally accomplished
with chemically cured sealants or bonding resins. However, if a transparent tray is used, a
light-cured resin, with cure-on-demand benefits,
can be used.7

Resins Previously
Used in Indirect Bonding
With the increasing popularity of indirect bonding over the past two decades, different methods
of bonding the brackets to the teeth have been
developed. When brackets had been positioned on the models with softened candy or
various glues, the bonding of the brackets to
the teeth was accomplished with a filled resin,
such as Concise (3M Unitek). The indirect
transfer trays were usually formed with silicone
tray materials. Although the bond strength with
the filled resins was adequate, the technique was
cumbersome, and the excessive amount of flash
around the bracket bases was difficult to remove.
With heat-cured resin bases, different sealants,
and mixtures of sealants and resins, have been
attempted over the years. It became increasingly
evident that one of the deficiencies in the available systems came from the fact that all the
resins and procedures had been originally designed for direct bonding and had subsequently
been adapted for indirect bonding.

Seminars in Orthodontics, Vol 13, No 1 (March), 2007: pp 43-57

43

44

A. Sondhi

One of the important properties required of a

resin designed for direct bonding is a generous
window of working time. The latter property is a
distinct disadvantage in indirect bonding because an extended cure time is not required
once the tray has been placed. An effort was
therefore made to develop a resin designed specifically for indirect bonding. Following laboratory testing and clinical trials, an efficient and
effective indirect bonding procedure has been
developed.8,9 Among the benefits of the newly
developed process is the elimination of the thermally cured resin on the working models, since
a custom base of the bracket is fabricated using
a light-cured resin.

Developing a Customized Resin Base

In an effort to determine the best method for
preparing a custom resin base, a number of
clinical trials were undertaken. It was found that
a light-cured resin was an ideal material for placing brackets on models, and it was also ideal for
forming a custom resin base. Using Adhesive
Precoated Brackets (3M Unitek), contamination
was eliminated and laboratory time reduced to a
minimum because individual brackets do not
need to be sorted and resin does not need to
be applied to the base before placing the brackets on the model. If precoated brackets are not
used, then Transbond XT (3M Unitek) is recommended as the material of choice for preparing the custom resin bases. Other resins with
lighter viscosities have proven to be ineffective
because of bracket drift on the working models.
For the current indirect bonding procedure,
the author now uses a new indirect bonding
resin10 in conjunction with APC brackets (or
Transbond XT adhesive applied in the laboratory) for the custom base. This article provides a
step-by-step explanation of the indirect bonding
procedure recommended.

A New Indirect Bonding Resin

As discussed earlier, there are significant disadvantages in indirect bonding with a resin
that had originally been designed for direct
bonding. It became evident that a new resin was
required specifically for indirect bonding. This
resin was developed with the aid of 3M Unitek
(Sondhi Rapid Set, 3M Unitek). The material
was designed with several objectives in mind.
First, although an unfilled resin is not very viscous, it does not have the property of being able
to fill imperfections in the custom base formed
with a light-cured resin, or imperfections in the
fit of the tray, without compromising bond
strength. The viscosity of the new resin was increased with the use of a fine-particle-fumed
silica filler (approximately 5%), so that it would
have the ability of filling any such voids without
compromising bond strength. Second, because
there is no need for increased working time
once the trays have been placed, the new resin
was developed with a quick-set time of 30 seconds. The latter significantly decreases the time
needed to hold the bonding tray in place during
curing. The resin is completely cured in 2 minutes, which allows for rapid removal of the bonding tray.10 This new resin has been specifically
designed for indirect bonding and would not be
useful for direct bonding.
The complete indirect bonding procedure,
from the laboratory process to clinical delivery
of the appliances, is described herein. The
process is demonstrated on a patient who had a
Class I malocclusion, with a distinct Class III tendency (Fig 1A-E). A minor maxillary and mandibular arch length deficiency is noted. Most often,
in a typical Class I malocclusion, bracket placement is performed according to the prescription
selected by the orthodontist (Fig 2A and B).
However, this patient had a distinct anterior
open bite and a reversed curve of Spee. The

Figure 1. (A-E) Intraoral views of the pretreatment malocclusion. A Class I malocclusion is noted, with a distinct
Class III tendency, and minor maxillary and mandibular arch length deficiencies. (Color version of figure is
available online.)

The Sondhi Method

Figure 2. (A and B) Graphic depiction of standard

bracket placement for the prescription currently used
by the author. (Color version of figure is available
online.)

bracket locations for this patient were deliberately atypical to address the vertical discrepancy
(Fig 3A and B). In patients who have a deep
anterior overbite the bracket placement would
be reversed as a method of effecting the desired
vertical changes (Fig 4A and B).

Laboratory Procedure:
Preparation of the Bonding Trays
1. Working models are made from orthodontic
stone, prepared from accurate alginate impressions. Care should be taken to ensure
that there is no distortion of the impressions. The working models should be prepared with careful trimming, removal of bubbles, and filling of small voids. If there are
large bubbles or voids, it will adversely affect
the fit of the bonding tray (Fig 5A and B).
2. A thin layer of diluted Al-Cote (Densply International, Inc., York, PA) separating medium (1 part Al-Cote to 4 parts water)
should be applied to the model and allowed
to dry for approximately 1 hour (Fig 6).
3. If APC Adhesive Coated brackets are used,
the brackets that are preoriented may be
removed directly from the sealed blister
pack and positioned on the individual teeth
of the working model. The excess adhesive

45

Figure 5. (A and B) Anterior and occlusal views of

the maxillary working models. Note the detail of dental and soft tissue structures, and an absence of any
bubbles or voids in the pour-up. (Color version of
figure is available online.)

should be removed and the position of the

bracket carefully checked with a bracket
gauge. If noncoated brackets are used, then
Transbond XT Light Cure Adhesive should
be placed on the mesh pad of individual
brackets before they are positioned on the
model (Fig 7A and B).
4. After all brackets have been placed, a final
check of the bracket positions is done and the
excess resin removed. The models should be
placed in the black plastic box that is provided

Figure 6. Separating medium being applied to the

maxillary working model. (Color version of figure is
available online.)
Figure 3. (A and B) Atypical bracket placement to
address the open-bite discrepancy. (Color version of
figure is available online.)

Figure 4. (A and B) Illustration of atypical bracket

placement to address a malocclusion with a deep
overbite. (Color version of figure is available online.)

Figure 7. (A and B) Brackets being applied on the

mandibular and maxillary models. (Color version of
figure is available online.)

46

A. Sondhi

Figure 8. (A-D) Anterior and occlusal views of the maxillary and mandibular models, demonstrating final
bracket positioning for indirect bonding. (Color version of figure is available online.)

with the resin, or in another suitable lightfree location, and left for final approval and
positioning by the orthodontist (Fig 8A-D).
5. When all the bracket positions have been
checked, the upper and lower models
should be placed in the Triad 2000 (Densply
International) curing unit (Fig 9A and B)
and cured for 10 minutes. Although the
resin actually cures in less time, extra time is
allowed to ensure complete curing, since
the access to light between the plaster model
and the bracket base is limited. If a light
chamber is not available, curing can be
effected with a chairside light-curing unit.
However, using a chairside light-curing unit
is obviously more time consuming and cumbersome. The amount of time for light curing is substantially reduced with clear esthetic brackets, and 1 minute of exposure to
the light is adequate.
6. Before forming the indirect bonding trays,
it is recommended that a light separating

Figure 9. (A) The Triad 2000 Light Curing Chamber. (B) Maxillary and mandibular indirect bonding
models placed in the Triad 2000 Light Curing Chamber. The rotating tray table permits exposure of light
to bracket bases from all directions. (Color version of
figure is available online.)

Figure 10. Brackets being sprayed with PAMTM before forming the indirect bonding tray. This permits
easier tray removal following bonding of the brackets.
(Color version of figure is available online.)

Figure 11. Model with first layer of BioplastTM.

The Sondhi Method

47

Figure 12. Excess Bioplast material being trimmed

from the model. (Color version of figure is available
online.)

Figure 14. BiocrylTM layer, vacu-formed over the BioplastTM layer. The outer, hard shell of Biocryl provides rigidity to the tray.

spray be used to facilitate easy removal of

the tray from the brackets. A silicone spray
may be used. Alternatively, a light cooking
spray, such as PAM (International Home
Foods, Inc., Parsippany, NJ), may be used
and is quite effective. The brackets should

be sprayed lightly; the spray should be for

less than 1 second (Fig 10).
7. The indirect bonding trays can now be placed
over the brackets. The author uses a Biostar
(Great Lakes Orthodontics, Tonawanda, NY)
unit to vacu-form a 1.5-mm-thick layer of Bioplast, overlayed with a 0.75-mm-thick layer of
Biocryl (Great Lakes Orthodontics). The Bioplast (Great Lakes Orthodontics) layer is vacuformed onto the model first, and the excess
material is trimmed away (Figs 11 and 12).
The Bioplast surface should be sprayed with

Figure 13. The Bioplast layer being sprayed with

PAMTM before the BiocrylTM is adapted, to permit
easier separation of the two layers. (Color version of
figure is available online.)

Figure 15. Occlusal view of a silicone transfer tray,

demonstrating bracket bases that can be coated with
resin for the indirect bonding process. (Color version
of figure is available online.)

48

A. Sondhi

Figure 16. Superior view of an indirect bonding tray

formed with expressed silicone impression material. A
putty tray of this kind can be used if a vacu-formed
tray is not desired or a BiostarTM is not available.
(Color version of figure is available online.)

PAM before the Biocryl is adapted. The latter permits easier separation of the two tray
materials (Fig 13). The outer layer of 0.75mm-thick Biocryl can then be vacu-formed
(Fig 14). The outer hard shell should be
trimmed away from all heights of contour,
since its purpose is only to permit firm seating of the soft inner tray. The hard outer
layer provides rigidity to the bonding tray,
and the soft inner layer permits easy separation from the brackets.

Figure 18. Vacu-formed indirect bonding tray being

removed from the model. (Color version of figure is
available online.)

Figure 17. The bonding tray being sectioned for removal from the model. (Color version of figure is
available online.)

Figure 19. Excess tray material being trimmed with

crown and bridge scissors. (Color version of figure is
available online.)

8. If it is the clinicians preference to use a

bonding tray made with a silicone transfer
material (Figs 15 and 16), the Biostar unit
is not necessary. A bonding tray can be
made with a suitable silicone transfer material. Once the putty has been mixed with the
activating agent, a small button of the silicone material is placed around individual
brackets, followed by the placement of the
remaining material rolled into the shape of
a cylinder. The occlusal and lingual surfaces

The Sondhi Method

49

Figure 20. Trimmed indirect bonding trays placed

in the TriadTM chamber for additional curing. One
minute of additional curing is recommended to ensure complete polymerization of the resin base.
(Color version of figure is available online.)

of the teeth should also be covered with the

tray material. This technique has been previously described by Kalange.8
9. Soaking the model for approximately 1 hour
is recommended to permit the separating
medium to dissolve. This allows for easier

Figure 23. Custom resin bases being micro-etched

with 50-m aluminum oxide particles. (Color version
of figure is available online.)

Figure 24. Properly formed custom resin bases on an

indirect bonding case.
Figure 21. The trays being cleaned with a detergent
solution in an ultrasonic cleaner. (Color version of
figure is available online.)

Figure 22. (A and B) External and internal views of

the maxillary bonding tray.

Figure 25. Teeth being polished with a pumice paste

before etching. A nonfluoridated paste should be
used. (Color version of figure is available online.)

50

A. Sondhi

Figure 26. (A and B) The patient isolated with a

NolaTM dry field system in preparation for bonding.
(Color version of figure is available online.)

Figure 28. (A and B) Etching gel being applied to the

maxillary arch. (Color version of figure is available
online.)

separation of the bonding trays. The bonding trays are then removed from the models,
and should be sectioned with a bur (Fig 17).
It is usually necessary to tease the tray off
with a plaster knife (Fig 18). Any excess
material should be trimmed with crown and
bridge scissors or a scalpel (Fig 19). After
the bonding trays have been trimmed, they
should be placed in the Triad 2000 unit for
an additional minute to ensure that any uncured resin is cured (Fig 20).
10. The bonding trays can now be examined.
The trays should now be cleaned in an
ultrasonic cleaner with a dishwashing detergent, for example, Dawn (Procter and
Gamble, Cincinnati, OH) for 10 minutes
(Fig 21). The trays are then placed in
an ultrasonic machine, in water only, for an
additional 5 minutes. The trays are then
rinsed and dried thoroughly. Figure 22A
and B show a view of the bonding trays from
the Bioplast surface, as well as the Biocryl
surface.

11. The trays are then carefully examined for

any remaining separator or tray material
covering the adhesive custom base on the
bracket. A micro-etching unit is then used
to lightly sandblast the adhesive custom
bases (Fig 23). A fine aluminum oxide particle (50 m) is recommended. Care is
taken not to abrade the resin base. If there is
any contamination of the adhesive custom
bases, especially if touched with your fingertips, the trays should be cleaned with a detergent, rinsed, and dried. The author does
not recommend the application of acetone
to adhesive bases, since recent information
has indicated that this may result in degradation of the resin. Figure 24 demonstrates
the appearance of properly formed custom
resin bases for an indirect bonding case.

Figure 27. Teeth being air dried before placement of

the etching gel. (Color version of figure is available
online.)

Clinical Procedure: Indirect Bonding

Preparation of the Patient
1. Seat patient and place a napkin around the
neck. The author recommends the use of an
antisialagogue, such as Sal-Tropine (Hope
Pharmaceuticals, Scottsdale, AZ) or Propantheline. The patient should be instructed to
remove any contact lenses when they take the
antisialagogue tablet.

Figure 29. (A) Etching gel being suctioned off the

teeth. (B) Etching gel being rinsed from the maxillary
teeth. (Color version of figure is available online.)

The Sondhi Method

51

Figure 30. (A) The teeth being air dried to ensure

complete desiccation. (B) A view of the maxillary arch
following completion of the etching process. (Color
version of figure is available online.)

2. Pumice all teeth. Explain to the patient that

this is one of several procedures in preparation for bonding (Fig 25).
3. Rinse and suction well with water.
4. Show the bonding trays to the patient and
explain the procedurefrom taking the impressions to placing the brackets in proper

Figure 32. Resin A being applied to the teeth. (Color

version of figure is available online.)

position and forming the tray. It is important

to stress the time the orthodontist spends
positioning the brackets and supervising the
entire process. The author believes that there
is a significant value in emphasizing to the
patient the importance of proper bracket
placement and the role of the orthodontist in
appliance design.
5. If there are bands to be placed, this should be
completed after the indirect bonding procedure has been completed. Since the resin
used in this indirect bonding system has such
a fast set time, the band placement can be
started immediately following the indirect
bonding of the brackets.
Placement of Bonding Trays
1. The decision to use a single tray for an
entire arch, or whether sectional trays are
used, is based on the degree of isolation of

Figure 31. The dispensing wells supplied with the

indirect resin. Resin A is applied to the tooth surface
and should be placed in the well identified with the
tooth icon. Resin B is applied to the bracket base and
should be placed in the well with the bracket icon.
(Color version of figure is available online.)

Figure 33. Resin B being painted on the resin pads in

the indirect bonding tray. (Color version of figure is
available online.)

52

2.

3.

4.
5.

A. Sondhi

the teeth that is feasible. If there is significant crowding and imbrication of the teeth,
it may be easier to section the tray. Since the
working time with this indirect bonding
resin is virtually unlimited (since the adhesive does not need to be mixed and does not
set until the trays are seated), the degree of
isolation and ease of tray placement are the
determining factors on whether to section
the trays or not. If isolation is difficult, the
tray may be sectioned at the midline to permit easier bonding. On rare occasions, it
may be advisable to consider sectioning the
tray into thirds, in which case the trays may
be sectioned as follows:
a. Cuspid to cuspid (3-3):
anterior segments
b. Second molar to first bicuspid (4-7):
posterior segments
The patient described in this article was
bonded with a single tray in each of the
maxillary and mandibular arches.
Isolate the teeth that are to be bonded with
the Nola (Nola Specialties, Hilton Head,
SC) dry-field system (Fig 26A and B). Occasionally, plastic cheek retractors, Tongue
Away (TP Orthodontics, LaPorte, IN), cotton rolls, and Dri-Angles (Young Dental,
Earth City, MO) may be used.
Using an air syringe, dry the teeth thoroughly (Fig 27).
Dab do not rub etching solution onto
teeth and set a stopwatch for 15 seconds.
Note: Etching solution should be applied
with extreme care. Do not allow etch to
contact skin or gingiva.
The etchant should be applied in the
general area that is to be covered by the
bracket. Do not allow the etchant to flow

Figure 34. (A and B) The maxillary bonding tray

being positioned. It should be held in place with firm
finger pressure for 30 seconds. (Color version of figure is available online.)

Figure 35. The maxillary bonding tray in place.

(Color version of figure is available online.)

into the interproximal contacts to ensure

easier cleanup (Fig 28A and B).
6. After 15 seconds, the etching gel can be
suctioned off the tooth (Fig 29A). Rinse with
a steady stream of water for another 15 seconds (Fig 29B). Rinse with a steady spray of
water and air for another 30 seconds. Suction excess water and be careful to avoid
saliva contamination of the etched enamel.
The teeth should now be air dried to ensure
complete desiccation (Fig 30A and B).
7. Replace cotton rolls and Dri-Anglesagain,
making sure that saliva does not contact the
etched enamel.
8. (A) If the clinician chooses to use a moisture-insensitive primer, such as Transbond
MIP (3M Unitek), on the enamel surface for
the bonding procedure, the air syringe
should be used to remove excess moisture.
Complete desiccation of the teeth is optional. A liberal coat of Transbond MIP
should be painted onto the enamel surface.
Air-dry for approximately 2 seconds. Light
curing of this primer is not necessary for
indirect bonding. (B) If Transbond MIP
Moisture Insensitive Primer is not used,

Figure 36. (A and B) Gel etching material being

applied to the mandibular teeth. (Color version of
figure is available online.)

The Sondhi Method

53

Figure 37. (A-D) Removal of the etching material, followed by rinsing and drying of the mandibular teeth.
(Color version of figure is available online.)

and the bonding is accomplished with the

indirect bonding resin, then all visible moisture should be removed. The etched teeth
should have a frosty appearance, and be
completely desiccated. If a frosty appear-

Figure 41. The maxillary and mandibular bonding

trays in place. (Color version of figure is available
online.)

Figure 38. The mandibular teeth being painted with

resin A. (Color version of figure is available online.)

Figure 39. (A and B) The mandibular bracket bases

being painted with resin B. (Color version of figure is
available online.)

Figure 40. (A and B) The mandibular bonding tray

being placed on the mandibular teeth. The tray
should be held with firm finger pressure for 30 seconds. (Color version of figure is available online.)

Figure 42. The maxillary BiocrylTM layer being removed with a scaler. (Color version of figure is available online.)

Figure 43. (A and B) The inner BioplastTM layer

being removed with scaler and fingers. (Color version
of figure is available online.)

54

A. Sondhi

14. Since 2 minutes time has elapsed during

seating of the mandibular tray, the maxillary
tray can now be removed. Remove the outer
tray by using a scaling instrument (Fig 42).
The inner Bioplast layer can be removed by
using a scaler to peel that tray from the teeth
and the brackets. Use extreme care when
removing the tray from around bracket
wings (Fig 43A and B). Figure 44 shows the
bonded maxillary arch, with all brackets in
place. The mandibular tray is removed in a
Figure 44. The bonded maxillary arch, with all brackets in place. (Color version of figure is available online.)

9.

10.

11.

12.

13.

ance is not apparent, repeat the etching

process for 15 seconds.
Small amounts of the indirect bonding resin
A and B liquids should be poured into wells
(Fig 31). Take care to keep the liquids separate. Resin A can be painted onto the tooth
surface with a brush, and resin B can be
painted on the resin pads in the indirect
bonding tray (Figs 32 and 33).
If too much resin has been placed on the
enamel, gently remove the excess with a
brush. The overall method of painting the
resin on the enamel and the custom bases is
similar to painting one fingernails with nail
polish.
Position the tray over the teeth and seat the
tray with a hinge motion. With the fingers,
apply equal pressure to the occlusal, labial,
and buccal surfaces (Fig 34A and B). Hold
for a minimum of 30 seconds. Figure 35
shows the maxillary bonding tray in place.
In the additional 2 minutes required for
complete curing of the Rapid Set Resin, the
mandibular arch can be etched and
bonded. Figure 36A and B show placement
of the mandibular etch. Figure 37A-D show
removal of the etching material, followed by
rinsing and drying of the maxillary teeth.
The mandibular teeth can now be painted
with resin A (Fig 38), and the mandibular
bracket bases can be painted with resin B
(Fig 39A and B). The mandibular bonding
tray can now be placed on the mandibular
teeth (Fig 40A and B). Figure 41 shows both
bonding trays in place.

Figure 45. (A-C) The mandibular tray can be removed with the same procedure as the maxillary tray.
(Color version of figure is available online.)

The Sondhi Method

Figure 46. (A) A scaler being used to remove the

excess resin around the brackets. (B) Dental floss
being used to check that all contacts are open. (Color
version of figure is available online.)

55

16. This patient was seen 8 weeks following

the initial bonding, and early correction of
the vertical discrepancy was already evident. The resin-reinforced glass-ionomer
cement has been reduced by the orthodontist on the occlusal surface of the maxillary
molars, and the open bite was reduced
(Fig 49A-E).

Results

Figure 47. The maxillary and mandibular bonded

appliance in place. (Color version of figure is available online.)

similar manner (Fig 45A-C). Scale the excess

resin from around the brackets and floss the
interproximal contacts (Fig 46A). Use dental floss to check that all contacts are open
(Fig 46B). Figure 47 shows the bonded appliances in place.
15. The initial archwires can now be inserted.
Please note the immediate and complete
engagement of all teeth, including second
molars at this bonding appointment (Fig
48A-E). Resin-reinforced glass-ionomer cement has been placed on the occlusal surfaces of maxillary first molar teeth to permit
disclusion to protect the second molars
brackets, and also to permit early correction
of the vertical discrepancy.

This system has been used by clinicians in many

countries, and treatment on numerous patients
has indicated the effectiveness. Many orthodontists who have used this system report that the
bonding is consistent and efficient. Obviously
occasional bond failures do occur and are these
are usually related to contamination or an improper technique. In instances where bond failures occur, it is a simple matter to section the
bonding tray, reapply the adhesive, and reseat
the transfer tray.
Bond strength tests have also indicated the
efficacy of the resin. Bond strength compares
favorably with indirect bonding using Concise
Enamel Bond (3M Unitek) and Custom IQ (Reliance Orthodontic Products, Itasca, IL). Figure 50A
and B provide important data, since the bond
strength immediately after curing is of critical
importance during tray removal, and initial
archwire insertion. Results of the study indicated
that the new indirect resin had substantially
greater bond strength than the other resins at
the time of initial curing. Although the final
bond strength was not statistically different, the
clinical efficiency of this resin is greatly enhanced by the higher bond strength when tested
5 minutes following bonding, since that is the
time when the indirect bonding tray would be
removed, and the archwire inserted.

Figure 48. (A-E) Initial archwires engaged. Note the control over molar positioning with the initial leveling
archwire, as well as the vertical control introduced by precise bracket placement. Resin-reinforced glass-ionomer
cement has been placed on the occlusal surface of teeth Nos. 3 and 14 to permit disclusion for protection of
molar brackets. (Color version of figure is available online.)

56

A. Sondhi

Figure 49. (A-E) The same patient seen 8 weeks later, showing early correction of the vertical discrepancy. This
also permits removal of part of the resin-reinforced glass-ionomer cement from the occlusal surfaces of the
molars. (Color version of figure is available online.)

The first independent, university-based study

that compared different indirect bonding techniques was published by Klocke and coworkers.11 They concluded that indirect bonding
with the Rapid Set resin achieved bond strengths
comparable with direct bonding techniques. Indirect bonding with thermally cured custom

bases showed significantly lower bond strengths

when compared with light cured custom bases.
The other system that demonstrated bond
strengths comparable to the Transbond/RapidSet resin system required trays to remain in
place for 7 minutes, compared with the 2 minutes required for the Rapid Set resin.

Discussion
A new method for effective and efficient indirect
bonding of orthodontic brackets has been presented. The custom adhesive bases are easily
formed with Transbond XT or APC brackets, and
the indirect bonding is accomplished using a new
resin developed specifically for this purpose. Bond
strength has proven to be excellent, and the author and others have used this system for the indirect bonding of complete dental arches, from second molar to second molar, on pediatric, adult,
and orthognathic patients.
Bond strength tests have also proven the efficacy of this resin.9 Although the eventual bond
strength is comparable to other resins, the clinical
efficiency of this resin is greatly enhanced by the
higher bond strength developed within the first 2
minutes following bonding. Tray removal is therefore possible within 2 minutes, and archwire insertion can be immediately carried out.12,13

References

Figure 50. (A and B) Bond strength 5 minutes after

bracket placement. These data are of critical importance, since the immediate bond strength is important
during tray removal and initial archwire insertion.
(Color version of figure is available online.)

1. Thomas R: Indirect bonding: simplicity in action. J Clin

Orthod 13:93-106, 1979
2. Moin K, Dogon IL: Indirect bonding of orthodontic
attachments. Am J Orthod 72:261-275, 1977
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The Sondhi Method

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