Lingual Indirect Bonding Techniques
As it would be impossible to describe the detail of all laboratory work in a limited space, we have concentrated on the differences between the fundamentals of the techniques. We believe that we are unique in the world by offering our clients the four major techniques in an advanced form. As a laboratory, we naturally concentrate on laboratory techniques and any clinical references in this outline are therefore based on advice from orthodontists who have applied the particular technique.
- Lingual indirect bonding with Traditional CLASS system,
- Lingual indirect bonding with ARCHFORM CLASS system
- Lingual indirect bonding with BEST system (Fillion technique)
- Lingual indirect bonding with TOP system (Weichmann technique)
- HIRO individual jigs system (Takemoto technique)
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Traditional CLASS system
Customised Lingual Appliance Set-up Service
This is one of the earliest systems still in use. We do not support it in this traditional form because, by applying the latest technology, we have developed a more accurate and capable version, which we call the "ARCHFORM CLASS system". We explain it under the next heading.
The CLASS system uses an ideal diagnostic set up model and a maloccluded model. Traditionally, brackets are positioned on the diagnostic set up model according to standard prescription values, using a flat horizontal plane to ensure that the brackets are in a horizontal line. This traditional method does not allow for individual prescriptions.
The brackets are then transferred manually, one by one, to the maloccluded model. As you will see from the next description, the ARCHFORM CLASS system removes opportunities for error in the process of matching the bracket positions on the maloccluded model to those on the diagnostic model.
The brackets are then encased in a soft inner tray with a hard outer tray, separated from the model and sent to the orthodontist. The soft inner tray allows for minor bracket movement and we have therefore eliminated that in the ARCHFORM CLASS system.
The bracket placements on the diagnostic set up model physically determine the archwires-bending templates supplied to the orthodontist with the bracket trays. The ARCHFORM CLASS system uses digital measurements and computer software to prepare the archwires-bending templates.
The orthodontist bends the archwires, using these templates as a guide. With the ARCHFORM CLASS system, we also offer a wire bending service.
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ARCHFORM CLASS system
Customised Lingual Appliance Set-up Service
We also use an ideal diagnostic set up model and a maloccluded model. However, we use modern technology and methods to place and transfer the brackets very accurately and make precise archwire-bending templates. We first determine the long tooth axis of each tooth on the diagnostic model, so that we can place each individual bracket according to its long tooth axis, rather than a standard prescription value. Then we duplicate these axes on the maloccluded model with Identical Line Transfer ("ILT") system we have developed for this purpose.
Using a sophisticated modified digital TARG machine called "PRO-TARG", we digitally measure the three-dimensional orientation of each tooth on the diagnostic set up model and accurately place the brackets in a horizontal line, each according to its individual long tooth axis. We make a record, called "protocol", of the digitally measured three-dimensional placement of each bracket and the mesial distal dimensions of its tooth.
By using the tooth axes on the maloccluded model and the PRO-TARG to apply the protocol values, we then very precisely transfer and bond each bracket to that model. With the PRO-TARG we then digitally measure the three-dimensional placement of each bracket and also record these values in the protocol. After bonding, we encase the brackets in a single tray and after separating the brackets from the model, deliver it to the orthodontist.
From the protocol data our computer software prepares very precise archwire-bending templates that we deliver with the bracket trays to the orthodontist. The orthodontist can use the templates to exactly bend the archwires. We also supply archwires, pre-bent according to the templates, upon request.
Before clinical bonding, the orthodontist cuts each tray into two or three sections, according to preference, and after the brackets have bonded, peels the tray sections away. If a bracket comes off during treatment, the orthodontist can reinsert it in the tray section to re-bond it in its proper position.
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BEST system - Fillion technique
Bonding with Equalised Specific Thickness
This technique uses only a maloccluded model. We use the PRO-TARG to position the brackets and bond them directly onto the maloccluded model with positioning thicknesses ("equalised thickness") that result in the bracket slots forming a perfect arch at the end of treatment.
Using the PRO-TARG enables us to prescribe tip and torque for each tooth, according to the patient's individual needs. It also makes it possible to position the brackets with equalised thickness to partially align the bracket slots and thus reduce the severity of the required bends in the archwires. During this process of bracket placement, we record the protocol of digital vertical, horizontal measurements of each bracket position on the maloccluded model also of its ideal position at treatment completion, as well as the mesial distal measurements of its tooth. We encase the brackets in a single tray, which we then separate from the model and deliver to the orthodontist.
Our computer software prepares precise archwire-bending templates from the protocol data. We deliver these templates with the bracket trays, for the orthodontist to make exact bends. Alternatively, we supply wires pre-bent according to the templates upon request.
Before clinical bonding, the orthodontist cuts each tray into sections and peels it away after the brackets have bonded. If a bracket comes off during treatment, the orthodontist can accurately re-bond it after reinserting it in the tray section.
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TOP system - Weichmann technique
Transfer Optimised Positioning
This exceptionally accurate technique in the laboratory uses an ideal diagnostic set-up model, a maloccluded model, and the PRO-TARG. We also use Archform ILT. While the position of each bracket is determined on the diagnostic set up model and digitally recorded, the brackets themselves are placed directly on the maloccluded model with minimal positioning thickness. A sophisticated robot makes exact archwire bends based on digital measurements.
We determine the long tooth axes on the diagnostic model and duplicate them on the maloccluded model with ILT. Using the PRO-TARG, we then measure the three-dimensional orientation of each individual tooth on the diagnostic set up model and determine - in digital three-dimensional measurements - each bracket placement according to its long tooth axis, the mesial distal dimensions of each tooth and its thickness. We record all measurements in the protocol.
Again using the PRO-TARG, we then precisely apply the protocol values for each bracket to accurately place and bond it - with minimal composite thickness - on the maloccluded model according to its long tooth axis, also adding to the protocol the digitally measured three-dimensional position of each bonded bracket. As with the techniques described above, we encase the brackets in a single tray, separate the brackets from the model and deliver to the orthodontist.
The minimal bracket positioning thickness places special demands on first order bends in the archwires. Therefore, instead of using the protocol values for our computer software to prepare archwire-bending templates, we use the protocol values (and the arch form) for a computer-controlled robot to accurately bend the archwires themselves. We deliver these pre-bent archwires to the orthodontist with the bracket trays.
The orthodontist cuts each tray into sections before bonding and peels them off afterwards. If a bracket comes off during treatment, the orthodontist can re-bond it very accurately after inserting it in the tray section. The digital precision in three-dimensional positioning of the brackets according to tooth axis and dimensions, the precision of robot archwire bending and the single-material tray make the laboratory portion of the TOP system extremely accurate.
Orthodontists who use the TOP system have advised us that positioning the brackets closer to the teeth allows the patient more tongue space and comfort, while reducing the opportunity for composite breakage.
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HIRO system - Takemoto technique
This technique uses only an ideal diagnostic set-up model for bracket positioning. It does not use a TARG machine for bracket positioning, but a stiff pre-bent archwire. The technique is unique not only in this regard, but also in its use of individual tooth jigs instead of a single tray.
We manually pre-bend a 0.018 x 0.025 stainless steel lingual archwire ("positioning archwire") and use this to position and bond the brackets on the diagnostic set-up model. We then encase each bracket in a hard individual jig and remove the jigs from the model. We deliver the bracket jigs with the archwire to the orthodontist.
The orthodontist bonds the brackets one at a time and then removes the jigs by cutting them with a high-speed burr. The orthodontist bends the archwires, or uses pre-bent archwires that we supply upon request.
If a bracket comes off during treatment, the orthodontist ties the (replacement) bracket into its place on the positioning archwire defined by the composite by which it was attached to the archwire, making a temporary jig to re-bond the bracket. Alternatively we can make a new jig after the orthodontist sends us the archwire.
If you would like more information, or discuss other laboratory aspects of these techniques, please contact us by email or call us on +61 3 9532 4266.
