If we look back to our workflow in February before the apocalypse began, it’s borderline cringeworthy to think about using a rotary instrument in a confined space (not to mention the patient’s maskless parent inquisitively gazing chairside, shaking hands as they leave). Fast-forward to our current situation: We have been tasked with the daunting situation of exploring our comfort with different degrees of aerosol production versus one of the most important parts of treatment—keeping the brackets on the teeth.
Below you will find “A,” “B” and “C” options for many steps: “A” steps will produce the least amount of aerosols, “B” steps have the potential for increased aerosols and “C” steps are the traditional bonding steps with the highest amount of aerosols. Included are three protocols: utilization of traditional phosphoric acid etchant, self-etching primers, and bonding to a tooth with residual composite.
Before the COVID era, self-etch techniques were traditionally producing a 10–20% reduction in strength, compared with phosphoric acid etching. If clinicians are focused on the least amount of aerosol production (utilizing “A” steps), it should be noted that the same reduction in strength is maintained when utilizing a self-etch versus traditional etch process with these steps.
These procedures were developed as a response to the concerns about forced air and water spray. Every step in these protocols is intentional and vital to a successful bond. Because of the slight (10–15%) decrease in strength and extreme technique sensitivity, these protocols should not be utilized when we are past the COVID-19 crisis.