INSTRUCTIONS FOR BONDING/REBONDING BRACKETS FOR OJW PATIENTS

    Detached brackets (hyperlink to supplies) can occur because of unusual biting forces and because the patient goes off the liquid diet and begins snacking on crispy, crunchy and crusty foods during the 4-6 days they are unwired to allow for exercising their jaws.

    I prefer the direct bonding method and I use Begg brackets. Dentists who have light curing equipment may relish the light-cure method because it gives them the benefit of placing the brackets without fear of the adhesive setting prematurely resulting in a more accurate positioning of the bracket.

    SPECIAL NOTE: In recent years the major Orthodontic Companies have developed "Self-Ligating" brackets. So that wiring the jaw in to "Rothstein's OJW position of rest"© can be done in a way that enables the wire to be held in place with more certainty:  One such bracket is the Damon bracket by Ormco.   [See the bracket].  In fact the use of self-ligating brackets permits the OJW provider more flexibility in the height at which s(he) decides to suspend the lower jaw from the upper jaw. He could choose to have a leeway as much as 2.5-3.5 mm which in some cases may well be in the patient's best interest. I believe that one drawback would be that that the wire may tend to break more frequently since wider arcs of movement may tend to "work harden" the wire. On the other hand the more movement the TM joint is allowed the less likely stiffening may occur.  It should be noted that these brackets CAN ONLY BE USED WHEN THE DENTIST HIMSELF INTENDS TO DO THE WIRING/REWIRING SINCE THE PATIENT COULD NEVER DO THE REWIRING BY HIM/HERSELF.

    In most cases the brackets are bonded on the premolars and canines. In some situations where the dentist encounters missing teeth the molars are sometimes used. If the tooth is rotated place the bracket as though the tooth were not rotated.

    Before placing brackets on the lower teeth make certain you have an appreciation of the overhang of the upper buccal cusp tips over the lower buccal surfaces. You must be certain the bracket is bonded sufficiently close to the mandibular gingiva to avoid the problem of a detached bracket resulting from the occlusal forces of the upper teeth striking the lower brackets.  The Begg bracket mounted on its screen allows the dentist to remove its bottom third thereby allowing the bracket to be positioned even closer to the gingiva when need be.

    I bond the brackets in the in the middle 1/3 of the tooth and in most cased tilted distally about 10 degrees distally. One cosmetic enhancement that you can do is to provide the patient with clear brackets on the upper canines.

Ps.  The brackets were bonded on to the teeth differently than in all previous patients in that they "more inclined" rather than vertically placed on the surface of the teeth.  It seemed that this innovation was more suitably matched to the direction of the path of the wiring...see pics below:

Skip steps one and two if you are bonding the brackets for the first time.  

1.  Remove all tags of residual bonding adhesive with the help of the hand instrument.

2. Dry the tooth you are going to rebond (hair dryer or canned air best).

3. Paint the surface of the tooth with "acid etch" (37% phosphoric acid) and allow the acid etch to remain on the tooth for 60 seconds. Do not allow the etch to smear on to soft tissue.

Note: When the teeth to be bonded with brackets bear a porcelain surface I recommend micro etching the tooth for three seconds, and then acid etching the tooth for 5 minutes with hydrofluoric acid. Some operators go even farther by painting the surface with a porcelain primer thus insuring the maximum adhesiveness possible.

4. Have patient rinse 30 Seconds to remove the acid etch.  Rinse until sour taste is gone.

5. Dry the tooth (hair dryer, etc.). You will see that the surface is "frosty." It is now etched. Etching cleans and prepares the tooth surface. It does not harm tooth structure. If tooth is not frosty, etch again for 30 seconds. From this point on you must be careful not to allow the surface of the tooth to be contaminated with saliva lest the bracket not adhere. Adept use of cotton rolls will be very helpful toward that goal.

6. Paint the surface of the tooth with catalyst/primer. Do not apply in excess.

7. Using a new brush paint the "screen" surface of the bracket with catalyst/primer. I have experienced failed bracket adhesion for lack of sufficient care in inadvertently using the acid etch brush to pain on the catalyst.

8. Squeeze out of the syringe enough adhesive to cover about 3/4 of the surface of the bracket. If you make an error it is better to err on the side of excessive material. Be absolutely certain you do not allow adhesive to clog up the bracket slot where the wire is going to pass through. An optional approach is to squeeze the adhesive on to the tooth.

9. Practice placing the bracket at least 2-3 times in the position you plan/intend it to go.

10. From the time you place the bracket with adhesive on the tooth you have about 13 seconds to adjust its final position. (That is not a lot of time.)

11. Make certain that if you are putting a bracket on an upper tooth that the "slot" of the bracket “points up” (toward the gums) and if you are putting the bracket on a lower tooth that the slot of the bracket points down. When you place the bracket on to the tooth hold it in position while pressing it firmly but gently on to the tooth. You can let go after about 20 seconds. Don't rinse for three more minutes. Bite gently on a cotton roll during the three minutes

12. After 3 minutes rinse the residual adhesive/catalyst from the mouth.

13. Allow the adhesive to cure/set for another 10 minutes.

14. Test with floss to be certain that all adhesive in the interproximals has been removed.

15. Test that the maxillary cusps are not striking the mandibular cusps by using blue articulating carbon paper.

14. You can now rewire the lower jaw in "Rothstein's OJW position of rest"©.  Use the .014 or .016 dead soft wire.

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