Bonding Rituals by Paul Gange Jr.

Chairside insights for digitally guided orthodontics

by Paul Gange Jr.

1. After a thorough prophylaxis, etch the full buccal and lingual from gingivae to cusp tips (Figs. 1–3). Do not etch any occlusal surface that is not covered by the appliance. (A gel etch makes this process easier.)
2. Apply a hydrophilic primer to only the buccal surface (Fig. 4)—priming the lingual makes removal significantly more difficult—and air-dry.
3. Apply a thin bead of a dual-cure compomer around the interior circumference of the appliance (Figs. 5a and 5b), then seat it.
4. Tack-cure flash with a curing light for one second, then remove all flash as one cohesive piece (Figs. 6–8).
5. Cure from the occlusal, touching the appliance for 30 seconds per tooth (Fig. 9).

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• Area-specific etching. Advise clinicians to reference the digital view of the bracket location and etch that specific area accordingly. This can be tricky because the arch needs to be rotated on the media screen as the team member works from one quadrant to the next.
• Entire surface etching. Advise clinicians to etch the entire facial tooth surface, similar to the etch process for application of decalcification-preventing sealants. The risk involved with this technique is that the “decal” process begins on any etched areas not covered by a primer. If primer (filled or unfilled) is subsequently applied to the entire etched surface, decal concerns from the exposed etched surface are null.

1. Etch both arches and isolate diligently.
2. Desiccate only the teeth involved in the jig (anterior sextant jig, posterior jig, quadrant jig, full-arch jig, etc.).
3. Apply hydrophilic primer to only the involved teeth; air-dry and tack-cure.
4. Insert jig with preloaded composite and tack-cure from the exposed gingivae to all brackets.
5. Revisit first bracket and full cure from gingivae.
6. Remove trays and full cure again from incisal.

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Paul Gange Jr. is the vice president of sales and operations at Reliance Orthodontic Products. He has become a leader in resolving difficult technical bonding issues through countless chairside hours training clinical staff. His passion for research and development has influenced many new Reliance products and aided numerous research projects. Gange, a published author, lectures domestically and internationally at numerous universities, study clubs and constituent meetings, as well as for the American Association of Orthodontists.

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