Frequently Asked Questions
Indirect Bonding

Q: What type of models do I need to send to Specialty for Indirect Bonding?
A: We recommend using orthodontic stone instead of plaster whenever possible. We find that stone gives an added level of accuracy in the model pour-up and is more durable to work with in the laboratory. The precision necessary with Indirect Bonding is directly related to the fit of the custom pads to the dental model and teeth, and the best results are achieved by the use of the best practices and materials. We also recommend using a premium-grade alginate such as Kromopan for taking all Indirect Bonding impressions. Kromopan is especially desirable for impressions that cannot be poured immediately; it is accurate and stable if poured within seventy-two hours. Make sure to follow the manufacturer’s recommendation regarding the proper water-to-powder ratio when mixing the stone. For consistency, a power mixer with a vacuum attachment is also recommended.

Q: Do I need to send my brackets with the case?
A: Specialty Appliances will place any manufacturer’s brackets with our Indirect Bonding service. If you maintain your own bracket inventory, please enclose with each case the brackets required for that particular Indirect Bonding setup. Please use a sticky card or some kind of bracket-carrying tray.

Q: Can you use any type of brackets with this service?
A: We have worked with all types of appliances from all manufacturers, and have had success with all of the ceramic brackets and the standard metal appliances. Recently, we have experienced an increased demand for the self-ligating appliances, such as the TIME bracket from American Orthodontics, the Damon Appliance from Ormco, and the GAC Innovation. Although they require special handling, there are no limitations on their use with Indirect Bonding.

Q: How do you determine bracket placement at Specialty Appliances?
A: We begin with the long axis mark on each tooth, which some orthodontists prefer to do on the cast before sending it to Specialty. Then we mark the proper vertical height for bracket placement. The location of vertical height lines depends on the overall size of the teeth. We encourage our customers to provide additional bracket placement information, either as a standard instruction file to be followed on all cases or as special instructions for individual cases. For example, an orthodontist might ask us to place the brackets one millimeter more gingival on an open-bite case, or request over-corrections on certain types of rotations.

Q: How are the molars treated when Indirect Bonding is used?
A: Over 75% of our Indirect Bonding customers now include bonded molars in their Indirect setups. The NOLA dry-field apparatus and today’s excellent adhesives have made molar-bonding with the Indirect technique a routine procedure. Because the anatomy of molars varies so widely, many orthodontists believe the bracket positioning of Indirect is far superior to banding for these teeth. This is especially true when using some of the smaller mini-tubes on the second molars. Another advantage of bonding molars with Indirect is the elimination of spacers at the beginning of treatment and band space at the end. When bands are placed on the posterior teeth, we recommend that they be placed after the Indirect Bonding trays have been delivered. Any movement ofthe teeth while the trays are being fabricated could create discrepancies between the construction model and the patient’s teeth, and prevent the trays from fitting properly.

Q: What material do you use to place brackets in the laboratory?
A: Many methods have been suggested for placing brackets in the laboratory, including caramel candy—one of the temporary materials used in the early years of indirect bonding. The custom-base method has been demonstrated using auto-cure, thermal-set, and light-cure material.
At Specialty we use Phase II, an auto-cure material from Reliance Orthodontic Products, and a thermal-set adhesive, also from Reliance. These products have excellent working characteristics in the laboratory, and produce extremely accurate custom pads in the final product.

Q: What adhesives do most doctors use in the clinic with Indirect Bonding?
A: With the custom-base method there are two basic choices for clinical bonding: light cure or auto cure. In either system, because of the precise fit of the custom bases to the teeth, only a sealant is required for clinical bonding. Some practices also elect to use a very small amount of paste in the interface between the custom base and the tooth surfaces. This can be done with either the light cure or the chemical cure. For all clinical bonding, we recommend the family of adhesives from Reliance Orthodontic Products. Reliance offers high-quality adhesives and outstanding customer support. Many other adhesives will work with the Indirect technique; we suggest that practices discuss the specifics of each adhesive system with the manufacturer and ask for directions on their use with Indirect. The Specialty Appliances Indirect Bonding Manual illustrates each of the clinical bonding techniques. Specialty also offers, free of charge, a video tape featuring Dr. Terry Dischinger and his staff as they demonstrate two of the most popular clinical techniques.

Q: How are the Indirect Bonding trays fabricated and used?
A: There is a soft inner tray made from 1.5-millimeter flexible Bioplast (from Great Lakes Orthodontic Products) with a hard outer shell made from 1.0-millimeter Biocryl. The hard tray fits precisely over the inner tray. An important step in our laboratory is the block-out applied to the brackets before the trays are formed on the Biostar machine. The block-out is used around the hooks, wings, and undercut areas; brackets are held firmly, but easily disengage when the trays are removed after the bonding process. The outer tray provides rigidity to the overall system after the trays have been seated in the mouth. Most practices are using the trays in a complete-arch segment; the trays are not split into sections or quadrants. If your practice prefers to have the trays sectioned, specify that in your standing instruction file. Another option available for practices using the clean-base technique is the original silicone-putty trays. If your practice prefers to use them, indicate that on the prescription form.

Q: How long does it take to get an Indirect Bonding case from Specialty Appliances?
A: On average Indirect Bonding cases are processed in our laboratory in three to five working days. We typically estimate two to three days each way for shipping and receiving for a total turn-around time of approximately ten working days. We are able to expedite cases upon request and also utilize a rapid return service for situations where your patient must have brackets placed immediately.