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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 men- brackets could not be exposed to this heat. This
T tioned in the literature during the mid- to
late 1970s, and various manifestations of the pro-
necessitated placing the brackets separately on
the models after the metal brackets had been
cess have since been reported.1-6 In the initial heat cured and resulted in a more cumbersome
trials of indirect bonding softened candy was procedure. When the bracket bases are fabri-
used to position brackets on the teeth, and cated with heat-cured resin, bonding of the
chemically cured filled resins were used to bond brackets on the teeth is generally accomplished
the brackets to the teeth. Although the method with chemically cured sealants or bonding res-
was effective, it resulted in a significant amount ins. However, if a transparent tray is used, a
of excessive bonding material or flash remaining light-cured resin, with cure-on-demand benefits,
around the bracket, and the cleanup of the resin can be used.7
presented a significant problem. This technique
was also cumbersome and involved significant
amount of doctor and laboratory time. Alterna-
tive adhesives have been used over the years, but Resins Previously
most have proved to be only moderately success- Used in Indirect Bonding
ful. With the increasing popularity of indirect bond-
The next major improvement in the indirect ing over the past two decades, different methods
methodology occurred during the 1980s. This of bonding the brackets to the teeth have been
occurred when heat-cured resins entered the developed. When brackets had been posi-
market. However, there were reports of clini- tioned on the models with softened candy or
cians experiencing problems with the brackets various glues, the bonding of the brackets to
drifting on the working models during the time the teeth was accomplished with a filled resin,
required to heat cure the resin. The transfer such as Concise (3M Unitek). The indirect
model with the brackets attached had to be transfer trays were usually formed with silicone
heated to 250°F to 300°F for approximately 15 to tray materials. Although the bond strength with
20 minutes as a means of curing the resin (Ther- the filled resins was adequate, the technique was
macure; Reliance Orthodontic Products, Itasca, cumbersome, and the excessive amount of flash
IL). Furthermore, some nonceramic esthetic around the bracket bases was difficult to remove.
With heat-cured resin bases, different sealants,
From the private practice of Dr. Anoop Sondhi, Indianapolis, and mixtures of sealants and resins, have been
IN. attempted over the years. It became increasingly
Address correspondence to Anoop Sondhi, DDS, MS, 9333 N. evident that one of the deficiencies in the avail-
Meridian Street, Ste. 301, Indianapolis, IN 46260. Phone: 317- able systems came from the fact that all the
846-1455; E-mail: sondhi@indyortho.com
© 2007 Elsevier Inc. All rights reserved.
resins and procedures had been originally de-
1073-8746/07/1301-0$30.00/0 signed for direct bonding and had subsequently
doi:10.1053/j.sodo.2006.11.006 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 A New Indirect Bonding Resin


resin designed for direct bonding is a generous
As discussed earlier, there are significant disad-
window of working time. The latter property is a
vantages in indirect bonding with a resin
distinct disadvantage in indirect bonding be-
that had originally been designed for direct
cause an extended cure time is not required
once the tray has been placed. An effort was bonding. It became evident that a new resin was
therefore made to develop a resin designed spe- required specifically for indirect bonding. This
cifically for indirect bonding. Following labora- resin was developed with the aid of 3M Unitek
tory testing and clinical trials, an efficient and (Sondhi Rapid Set, 3M Unitek). The material
effective indirect bonding procedure has been was designed with several objectives in mind.
developed.8,9 Among the benefits of the newly First, although an unfilled resin is not very vis-
developed process is the elimination of the ther- cous, it does not have the property of being able
mally cured resin on the working models, since to fill imperfections in the custom base formed
a custom base of the bracket is fabricated using with a light-cured resin, or imperfections in the
a light-cured resin. fit of the tray, without compromising bond
strength. The viscosity of the new resin was in-
creased with the use of a fine-particle-fumed
Developing a Customized Resin Base silica filler (approximately 5%), so that it would
In an effort to determine the best method for have the ability of filling any such voids without
preparing a custom resin base, a number of compromising bond strength. Second, because
clinical trials were undertaken. It was found that there is no need for increased working time
a light-cured resin was an ideal material for plac- once the trays have been placed, the new resin
ing brackets on models, and it was also ideal for was developed with a quick-set time of 30 sec-
forming a custom resin base. Using Adhesive onds. The latter significantly decreases the time
Precoated Brackets (3M Unitek), contamination needed to hold the bonding tray in place during
was eliminated and laboratory time reduced to a curing. The resin is completely cured in 2 min-
minimum because individual brackets do not utes, which allows for rapid removal of the bond-
need to be sorted and resin does not need to ing tray.10 This new resin has been specifically
be applied to the base before placing the brack- designed for indirect bonding and would not be
ets on the model. If precoated brackets are not useful for direct bonding.
used, then Transbond XT (3M Unitek) is rec- The complete indirect bonding procedure,
ommended as the material of choice for prepar- from the laboratory process to clinical delivery
ing the custom resin bases. Other resins with of the appliances, is described herein. The
lighter viscosities have proven to be ineffective process is demonstrated on a patient who had a
because of bracket drift on the working models. Class I malocclusion, with a distinct Class III ten-
For the current indirect bonding procedure, dency (Fig 1A-E). A minor maxillary and mandib-
the author now uses a new indirect bonding ular arch length deficiency is noted. Most often,
resin10 in conjunction with APC brackets (or in a typical Class I malocclusion, bracket place-
Transbond XT adhesive applied in the labora- ment is performed according to the prescription
tory) for the custom base. This article provides a selected by the orthodontist (Fig 2A and B).
step-by-step explanation of the indirect bonding However, this patient had a distinct anterior
procedure recommended. 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 45

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.) Figure 5. (A and B) Anterior and occlusal views of
the maxillary working models. Note the detail of den-
tal and soft tissue structures, and an absence of any
bracket locations for this patient were deliber- bubbles or voids in the pour-up. (Color version of
ately atypical to address the vertical discrepancy figure is available online.)
(Fig 3A and B). In patients who have a deep
anterior overbite the bracket placement would should be removed and the position of the
be reversed as a method of effecting the desired bracket carefully checked with a bracket
vertical changes (Fig 4A and B). gauge. If noncoated brackets are used, then
Transbond XT Light Cure Adhesive should
Laboratory Procedure: be placed on the mesh pad of individual
Preparation of the Bonding Trays brackets before they are positioned on the
1. Working models are made from orthodontic model (Fig 7A and B).
stone, prepared from accurate alginate im- 4. After all brackets have been placed, a final
pressions. Care should be taken to ensure check of the bracket positions is done and the
that there is no distortion of the impres- excess resin removed. The models should be
sions. The working models should be pre- placed in the black plastic box that is provided
pared with careful trimming, removal of bub-
bles, 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 In-
ternational, Inc., York, PA) separating me-
dium (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

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 Figure 7. (A and B) Brackets being applied on the
placement to address a malocclusion with a deep mandibular and maxillary models. (Color version of
overbite. (Color version of figure is available online.) 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 light-


free 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 Figure 10. Brackets being sprayed with PAMTM be-
is obviously more time consuming and cum- fore forming the indirect bonding tray. This permits
bersome. The amount of time for light cur- easier tray removal following bonding of the brackets.
(Color version of figure is available online.)
ing is substantially reduced with clear es-
thetic 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 Cham-


ber. (B) Maxillary and mandibular indirect bonding
models placed in the Triad 2000 Light Curing Cham-
ber. The rotating tray table permits exposure of light
to bracket bases from all directions. (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 Figure 14. BiocrylTM layer, vacu-formed over the Bio-
from the model. (Color version of figure is available plastTM layer. The outer, hard shell of Biocryl pro-
online.) vides rigidity to the tray.

spray be used to facilitate easy removal of be sprayed lightly; the spray should be for
the tray from the brackets. A silicone spray less than 1 second (Fig 10).
may be used. Alternatively, a light cooking 7. The indirect bonding trays can now be placed
spray, such as PAM (International Home over the brackets. The author uses a Biostar
Foods, Inc., Parsippany, NJ), may be used (Great Lakes Orthodontics, Tonawanda, NY)
and is quite effective. The brackets should unit to vacu-form a 1.5-mm-thick layer of Bio-
plast, overlayed with a 0.75-mm-thick layer of
Biocryl (Great Lakes Orthodontics). The Bio-
plast (Great Lakes Orthodontics) layer is vacu-
formed 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 Figure 15. Occlusal view of a silicone transfer tray,
PAMTM before the BiocrylTM is adapted, to permit demonstrating bracket bases that can be coated with
easier separation of the two layers. (Color version of resin for the indirect bonding process. (Color version
figure is available online.) 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 lat- Figure 18. Vacu-formed indirect bonding tray being
ter permits easier separation of the two tray removed from the model. (Color version of figure is
materials (Fig 13). The outer layer of 0.75- available online.)
mm-thick Biocryl can then be vacu-formed
(Fig 14). The outer hard shell should be 8. If it is the clinician’s preference to use a
trimmed away from all heights of contour, bonding tray made with a silicone transfer
since its purpose is only to permit firm seat- material (Figs 15 and 16), the Biostar unit
ing of the soft inner tray. The hard outer is not necessary. A bonding tray can be
layer provides rigidity to the bonding tray, made with a suitable silicone transfer mate-
and the soft inner layer permits easy separa- rial. Once the putty has been mixed with the
tion from the brackets. activating agent, a small button of the sili-
cone 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

Figure 17. The bonding tray being sectioned for re- Figure 19. Excess tray material being trimmed with
moval from the model. (Color version of figure is crown and bridge scissors. (Color version of figure is
available online.) available online.)
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 en-
sure complete polymerization of the resin base.
(Color version of figure is available online.)

of the teeth should also be covered with the Figure 23. Custom resin bases being micro-etched
tray material. This technique has been pre- with 50-␮m aluminum oxide particles. (Color version
viously described by Kalange.8 of figure is available online.)
9. Soaking the model for approximately 1 hour
is recommended to permit the separating
medium to dissolve. This allows for easier

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 25. Teeth being polished with a pumice paste


Figure 22. (A and B) External and internal views of before etching. A nonfluoridated paste should be
the maxillary bonding tray. used. (Color version of figure is available online.)
50 A. Sondhi

Figure 26. (A and B) The patient isolated with a Figure 28. (A and B) Etching gel being applied to the
NolaTM dry field system in preparation for bonding. maxillary arch. (Color version of figure is available
(Color version of figure is available online.) online.)

separation of the bonding trays. The bond- 11. The trays are then carefully examined for
ing trays are then removed from the models, any remaining separator or tray material
and should be sectioned with a bur (Fig 17). covering the adhesive custom base on the
It is usually necessary to tease the tray off bracket. A micro-etching unit is then used
with a plaster knife (Fig 18). Any excess to lightly sandblast the adhesive custom
material should be trimmed with crown and bases (Fig 23). A fine aluminum oxide par-
bridge scissors or a scalpel (Fig 19). After ticle (50 ␮m) is recommended. Care is
the bonding trays have been trimmed, they taken not to abrade the resin base. If there is
should be placed in the Triad 2000 unit for any contamination of the adhesive custom
an additional minute to ensure that any un- bases, especially if touched with your finger-
cured resin is cured (Fig 20). tips, the trays should be cleaned with a de-
10. The bonding trays can now be examined. tergent, rinsed, and dried. The author does
The trays should now be cleaned in an not recommend the application of acetone
ultrasonic cleaner with a dishwashing deter- to adhesive bases, since recent information
gent, for example, Dawn (Procter and has indicated that this may result in degra-
Gamble, Cincinnati, OH) for 10 minutes dation of the resin. Figure 24 demonstrates
(Fig 21). The trays are then placed in the appearance of properly formed custom
an ultrasonic machine, in water only, for an resin bases for an indirect bonding case.
additional 5 minutes. The trays are then
rinsed and dried thoroughly. Figure 22A Clinical Procedure: Indirect Bonding
and B show a view of the bonding trays from
the Bioplast surface, as well as the Biocryl Preparation of the Patient
surface. 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 Propan-
theline. The patient should be instructed to
remove any contact lenses when they take the
antisialagogue tablet.

Figure 27. Teeth being air dried before placement of Figure 29. (A) Etching gel being suctioned off the
the etching gel. (Color version of figure is available teeth. (B) Etching gel being rinsed from the maxillary
online.) 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 Figure 32. Resin A being applied to the teeth. (Color
this is one of several procedures in prepara- version of figure is available online.)
tion for bonding (Fig 25).
3. Rinse and suction well with water.
position and forming the tray. It is important
4. Show the bonding trays to the patient and
to stress the time the orthodontist spends
explain the procedure—from taking the im-
positioning the brackets and supervising the
pressions to placing the brackets in proper
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 proce-
dure 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 Figure 33. Resin B being painted on the resin pads in
should be placed in the well with the bracket icon. the indirect bonding tray. (Color version of figure is
(Color version of figure is available online.) available online.)
52 A. Sondhi

the teeth that is feasible. If there is signifi-


cant 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 adhe-
sive 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 per-
mit easier bonding. On rare occasions, it
may be advisable to consider sectioning the Figure 35. The maxillary bonding tray in place.
tray into thirds, in which case the trays may (Color version of figure is available online.)
be sectioned as follows:
a. Cuspid to cuspid (3-3):
anterior segments into the interproximal contacts to ensure
b. Second molar to first bicuspid (4-7): easier cleanup (Fig 28A and B).
posterior segments 6. After 15 seconds, the etching gel can be
2. The patient described in this article was suctioned off the tooth (Fig 29A). Rinse with
bonded with a single tray in each of the a steady stream of water for another 15 sec-
maxillary and mandibular arches. onds (Fig 29B). Rinse with a steady spray of
3. Isolate the teeth that are to be bonded with water and air for another 30 seconds. Suc-
the Nola (Nola Specialties, Hilton Head, tion excess water and be careful to avoid
SC) dry-field system (Fig 26A and B). Occa- saliva contamination of the etched enamel.
sionally, plastic cheek retractors, Tongue The teeth should now be air dried to ensure
Away (TP Orthodontics, LaPorte, IN), cot- complete desiccation (Fig 30A and B).
ton rolls, and Dri-Angles (Young Dental, 7. Replace cotton rolls and Dri-Angles—again,
Earth City, MO) may be used. making sure that saliva does not contact the
4. Using an air syringe, dry the teeth thor- etched enamel.
oughly (Fig 27). 8. (A) If the clinician chooses to use a mois-
5. Dab— do not rub— etching solution onto ture-insensitive primer, such as Transbond
teeth and set a stopwatch for 15 seconds. MIP (3M Unitek), on the enamel surface for
Note: Etching solution should be applied the bonding procedure, the air syringe
with extreme care. Do not allow etch to should be used to remove excess moisture.
contact skin or gingiva. Complete desiccation of the teeth is op-
The etchant should be applied in the tional. A liberal coat of Transbond MIP
general area that is to be covered by the should be painted onto the enamel surface.
bracket. Do not allow the etchant to flow 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 34. (A and B) The maxillary bonding tray


being positioned. It should be held in place with firm Figure 36. (A and B) Gel etching material being
finger pressure for 30 seconds. (Color version of fig- applied to the mandibular teeth. (Color version of
ure is available online.) 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 mois-
ture 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 42. The maxillary BiocrylTM layer being re-


Figure 39. (A and B) The mandibular bracket bases moved with a scaler. (Color version of figure is avail-
being painted with resin B. (Color version of figure is able online.)
available online.)

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


being placed on the mandibular teeth. The tray Figure 43. (A and B) The inner BioplastTM layer
should be held with firm finger pressure for 30 sec- being removed with scaler and fingers. (Color version
onds. (Color version of figure is available online.) 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 brack-


ets in place. (Color version of figure is available on-
line.)

ance is not apparent, repeat the etching


process for 15 seconds.
9. Small amounts of the indirect bonding resin
A and B liquids should be poured into wells
(Fig 31). Take care to keep the liquids sep-
arate. 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).
10. 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.
11. 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.
12. 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.
13. 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 Figure 45. (A-C) The mandibular tray can be re-
teeth (Fig 40A and B). Figure 41 shows both moved with the same procedure as the maxillary tray.
bonding trays in place. (Color version of figure is available online.)
The Sondhi Method 55

16. This patient was seen 8 weeks following


the initial bonding, and early correction of
the vertical discrepancy was already evi-
dent. The resin-reinforced glass-ionomer
cement has been reduced by the orthodon-
tist on the occlusal surface of the maxillary
Figure 46. (A) A scaler being used to remove the molars, and the open bite was reduced
excess resin around the brackets. (B) Dental floss (Fig 49A-E).
being used to check that all contacts are open. (Color
version of figure is available online.)

Results
This system has been used by clinicians in many
countries, and treatment on numerous patients
has indicated the effectiveness. Many orthodon-
tists 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 im-
proper technique. In instances where bond fail-
ures occur, it is a simple matter to section the
Figure 47. The maxillary and mandibular bonded bonding tray, reapply the adhesive, and reseat
appliance in place. (Color version of figure is avail- the transfer tray.
able online.) Bond strength tests have also indicated the
efficacy of the resin. Bond strength compares
similar manner (Fig 45A-C). Scale the excess favorably with indirect bonding using Concise
resin from around the brackets and floss the Enamel Bond (3M Unitek) and Custom IQ (Reli-
interproximal contacts (Fig 46A). Use den- ance Orthodontic Products, Itasca, IL). Figure 50A
tal floss to check that all contacts are open and B provide important data, since the bond
(Fig 46B). Figure 47 shows the bonded ap- strength immediately after curing is of critical
pliances in place. importance during tray removal, and initial
15. The initial archwires can now be inserted. archwire insertion. Results of the study indicated
Please note the immediate and complete that the new indirect resin had substantially
engagement of all teeth, including second greater bond strength than the other resins at
molars at this bonding appointment (Fig the time of initial curing. Although the final
48A-E). Resin-reinforced glass-ionomer ce- bond strength was not statistically different, the
ment has been placed on the occlusal sur- clinical efficiency of this resin is greatly en-
faces of maxillary first molar teeth to permit hanced by the higher bond strength when tested
disclusion to protect the second molars 5 minutes following bonding, since that is the
brackets, and also to permit early correction time when the indirect bonding tray would be
of the vertical discrepancy. 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 bases showed significantly lower bond strengths
that compared different indirect bonding tech- when compared with light cured custom bases.”
niques was published by Klocke and cowork- The other system that demonstrated bond
ers.11 They concluded that indirect bonding strengths comparable to the Transbond/Rapid-
with the Rapid Set resin achieved bond strengths Set resin system required trays to remain in
comparable with direct bonding techniques. “In- place for 7 minutes, compared with the 2 min-
direct bonding with thermally cured custom utes required for the Rapid Set resin.

Discussion
A new method for effective and efficient indirect
bonding of orthodontic brackets has been pre-
sented. 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 au-
thor and others have used this system for the indi-
rect bonding of complete dental arches, from sec-
ond molar to second molar, on pediatric, adult,
and orthognathic patients.
Bond strength tests have also proven the effi-
cacy 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 there-
fore possible within 2 minutes, and archwire inser-
tion can be immediately carried out.12,13

References

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
Figure 50. (A and B) Bond strength 5 minutes after 3. Simmons M: Improved laboratory procedure for indirect
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