eXceed Bonding Principles and Chair-­Side Guide eXceed offers two types of bonding protocols – clean or pad-­adjusted. The former type, also referred to as flush bonding, is utilized in both eXceed Rx and Tx orders. In this scenario, the bracket pad is positioned virtually (and later, in the delivery trays) at a distance of 0.1mm from the tooth, leaving just enough space for the adhesive agent to be applied chairside. This method guarantees maximum bonding strength between the bracket and the tooth. Clean bonding in eXceed RX. Note minimal gap between the brackets and the teeth The 2nd type, pad-­adjusted, is employed in eXceed Tx orders only whenever the effective bracket torque has to be compensated to bring about a desired post-­treatment outcome. Torque compensation is facilitated by maintaining a gap of 0.1 to 1.5mm between the bracket base and the tooth in the digital bracketing plan and the resulting transfer trays. Prior to seating, a thicker layer of bonding agent has to be applied in order to completely fill the void between the pad and the tooth. eXceed Tx features a combination of clean and pad-­adjusted bonding 1
Whenever possible, eXceed bracketing plans are generated with a preference to clean bonding. However, in eXceed Tx, it is common to find at least one tooth (typically, a posterior) where pad adjustment is necessary. In such circumstances, the eXceed delivery container will display a message indicating which brackets require extra adhesive to facilitate the adjustment. eXceed container displaying information on brackets requiring pad adjustment Example: the case below calls for pad-­adjusted bonding for the UR4 and clean bonding for the UR3 and UR5 brackets. Accordingly, only a thin coat of adhesive is applied onto the UR3 and UR5, while a more generous portion is applied onto the UR4. 2
Following trays' seating and adhesive curing, the UR4 pad adjustment has been completed, in line with the eXceed bracketing plan. Chair-­side Guide For best results: 1) bonding, either of a single arch or both arches, should be performed within 4 (four) weeks from the date of impression-­taking/scan;; 2) If the two arches are bonded separately, the 2nd bonding appointments should be within 2(two) weeks from the first. 1. Have the necessary materials ready: a) Bonding agent – Adper Single Bond 2 (3M Unitek) or OptiBond Solo Plus (Kerr);; b) 37% phosphoric acid (3M Unitek, Ormco, Kerr);; c) Adhesive – Transbond Supreme Low Viscosity (3M Unitek)* OR BluGloo (Ormco) for aesthetic braces OR GreenGloo (Ormco) for metal braces;; * Transbond Supreme LV is highly recommended 3
2. Check patient’s hygiene and cleanse thoroughly. Pumice, if necessary, to remove any build-­up, paying special attention to the molars. 3. Apply Dri-­Angles and cheek retractors to prevent moisture. 4. Apply phosphoric acid onto each of the patient’s teeth for 30-­60 seconds (please consult manufacturer’s instructions). 5. Rinse with water, directing the stream at each tooth for at least 10 seconds. 6. Dry the surface of the tooth using an air-­dryer. 7. Apply the bonding agent on each tooth and remove any excess. 8. Apply alcohol on the bases of the brackets and dry. 9. Evenly distribute the adhesive on the pad of the bracket. Unless pad adjustment is required, use only a small amount, half of what’s required for direct bonding. Work the adhesive into the mesh pad. Only with pad-­adjusted brackets, apply more adhesive. To minimize moisture build-­up, try performing steps 8-­9 in parallel with steps 3-­7. 4
10. Place the first tray in place and press firmly with middle and index finger, applying consistent pressure to the whole arch. Make sure that the tray sits tightly on the occlusal surfaces of the teeth 11. Moving from the 2nd molar forward, light-­cure the tray for at least 20 seconds per tooth, 10 seconds from the gingival side and 10 seconds from the occlusal side*. Repeat steps 6-­11 for the opposing arch. 12. Remove the dry angles and cheek retractors. 13. Using a scaler or index finger, grab the the inside grip point and remove only the hard tray. Repeat step 13 for the opposing arch. 14. Light-­cure again the 1st and 2nd molars for at least 20 seconds, 10 seconds from the gingival side and 10 seconds from the occlusal side* 15. Moving from the 2nd molar forward, gently peel off the soft tray with a scaler. *Curing times may vary based on light and intensity;; Please consult the curing lamp’s manual. 5
16. Check each bracket for bond strength. Repeat steps 14-­16 for the opposing arch 17. Remove excess bonding material using a polishing burr. 6