Indirect bonding: why are we so reluctant?


In the last issue of VJO you will find a clinical article on Indirect Bonding. We tested a new improved adhesive made by 3M Unitek tm. Though resins and adhesives are constantly improving, there is no consensus on the indirect bonding technique. It is safe to say that many orthodontists think that this is a terrific technique but only a few of them actually use it.

The question is why?

Indirect bonding allows precise bracket placement. Positioning brackets on a model is obviously easier since the crown inclination or rotations can easily be checked without bothering the patient. It is a lot more convenient to control roots looking at X rays in one hand and models on the other hand. Everyone can  visualize perfect bracket placement even on first or second molars. Cleaning of resin is easier around the brackets and one can use the correct amount of composite on casts without wasting one’s time with scalers or handpieces in the patient’s mouth.

Finally it is possible to do a full bonding in 10 minutes.

Orthodontists who are reluctant say that they can place brackets with speed using direct bonding and therefore do not need a speedier procedure. This statement can be true, but everyone knows that human attention decreases during the day, especially when you have been performing the same procedure for hours. Placing a bracket in a wrong position means that it needs to be repositioned at the next appointment, thus wasting valuable time.

Some orthodontists say that indirect bonding is expensive because you need more materials (Silicone trays, resins, trays etc.). If a thermoform tray is used, you will spend only a few dollars for each patient. Because a chair assistant can prepare indirect bonding, you can save the doctor’s time. And this is a real saving!

I believe that indirect bonding is a new way to approach patient’s care: better placement, better hygiene, and faster placement. If you are looking at the future of orthodontic clinical practices, do consider it!

Alberto Mazzocchi
VJO associate editor