3A. Band and Bond

Question 1

‘adjunct’

DEFINITION: something added to another thing but not essentially a ____ of it (American College Dictionary)

Answer 1

part

Question 2

Examples of Adjunctive Orthodontic Treatment
____ Uprighting
____ Tooth Movement
n e.g. forced tooth extrusion

Answer 2

molar

minor

Question 3

These are like the bands that we fit on our typodont, our molars and premolars.

In the past days of ortho (1920’s), this was typical to place bands on all teeth, place on anteriors as well as posteriors. Now, with the superior bond strength that we have, many ortho cases that you see in the clinic upstairs and in private practice are done without ____ at all. Sometimes it is necessary, as we will discuss, to band teeth that we need to place stronger traction mechanisms to (head devices, palatal expanders). But because of better composite materials, we’ve been able to avoid having to band all teeth like we have in the past.

Answer 3

banding

Question 4

Our typical bracket is a “____” bracket or “____” bracket.
It has mesial and distal side wings which help with movement control. Created by a faculty member here at Penn!
See this in 90+% of ortho treatment used.
It is NOT the original bracket, that was a ____ bracket with just one tie wing across the center. Rant about faculty inventing brackets….

Answer 4

siamese
dual winged
mono-winged

Question 5

Orthodontic Bracket (Components)
____
____
____ Wings

Answer 5

base
slot
tie

Question 6

The base itself like the brackets that we use for our typodont exercises, etc. On the back side of the bracket base is a ____ backing. The point is to create the best bond strength between the band and the tooth itself.

Answer 6

mesh

Question 7

Bracket Base Mesh-backed

PURPOSE: create a ____ interface between the bracket and the tooth surface

Answer 7

mechanical

Question 8

Most brackets regardless of design, have this mesh back base.

If a bracket debunks from a tooth, you can’t place the ____ bracket back on! You won’t get the same bond strength. Have to place a new bracket. We lose that mechanical interlocking. You could also ____ back of the bracket itself to remove the composite and get that interface back and create the mechanical interlocking.

Answer 8

same

micro etch

Question 9

Bracket Slot
PURPOSE: translate \_\_\_\_-dimensional control of archwire to tooth
BASIC SLOT DIMENSIONS 
n height \_\_\_\_”
n depth \_\_\_\_”

Answer 9

3

0. 022
1. 028

Question 10

If you look at dimension, when we place our 016 (round) wire into the slot, there is a lot of interplay between the slot and the wire itself.

1. If you were to place a stronger heavier wire, the 1825 wire, the rectangular wire, that we used for the uprighting spring, we would be filling that slot a little more fully and we would have best ____ control.
2. SO the thinner the wire, the rounder the wire, the ____ control we have. As we progress from round to ____ wire, we are filling that slot more completely and thus really enhancing the 3D control that is built into the bracket itself.

Answer 10

3D
lesser
rectangular

Question 11

Bracket Wings
____ wings
PURPOSE: ligating ____ into bracket slot

Answer 11

4

archwire

Question 12

Orthodontic Brackets (Materials)

____ (stainless steel) Ceramic/Porcelain
____
Plastic/Polycarbonate
Combination (i.e. ____ bracket; ____ base/wings with a ____ slot)

Answer 12

metal
polycrystalline alumina
unitek clarity
porcelain
stainless steel

Question 13

The bracket itself acts as a handle on each tooth, but what actually dictates ____ is the arch wire. The bracket gives us tooth control. The arch wire translates movement to the bracket.

Answer 13

movement

Question 14

This is the CLARITY BRACKET. These are ____ brackets (full ceramic, ceramic base, tie wings, and slot). It gives us the best aesthetic superiority.

Answer 14

ceramic

Question 15

This is the ORIGINAL CLARITY bracket. A \_\_\_\_ base and tie wings, but a \_\_\_\_ slot. This is a hybrid bracket, metal and porcelain. What is the advantage of this type of bracket? ANSWER:
1. you can \_\_\_\_ it better. Porcelain is very tough to see, so we add a blue tint to the
clarity brackets (slide above). This blue tint will wash off after patient brushes so that they look crystal clear, but the tint is useful for placing the bracket. That is one advantage to the original steel slot.
2. How about a mechanical advantage? It is not more rigid... there is less \_\_\_\_! There is more binding between the porcelain bracket and the metal arch wire. If you are talking about \_\_\_\_ wires and a \_\_\_\_ slot, there is better sliding mechanics, there is less friction.
3. So the advantage of this bracket is \_\_\_\_ and better \_\_\_\_ mechanics (which is a downside to the consideration of porcelain brackets). Of course, any friction in the system slows down and impedes tooth movement.

Answer 15

porcelain
metal
visualize
friction
stainless steel
stainless steel
aesthetic
sliding

Question 16

Orthodontic Brackets (Design)
Horizontal slot (\_\_\_\_ v. non-Rx) 
Vertical slot (\_\_\_\_ technique)
Self-ligating (i.e. \_\_\_\_, In-Ovation, \_\_\_\_)

Answer 16

rx
begg
speed
damon

Question 17

Horizontal slot

Our horizontal brackets have our typical component like we talked about. Our base, tie wings, and wire slot.
The wire is set in the wires slot, and ligated in with ____.

Answer 17

elastics

Question 18

Horizontal slot (lingual)

Also in the category of horizontal slots are our ____ appliances.

These work in the same fashion except instead of the brackets themselves being bonded to labial and buccal surfaces they are bonded to lingual and palate surfaces of the teeth.

Answer 18

lingual

Question 19

The ligation is similar.
We have an arch wire itself, but instead of going on outer perimeter of dentition, it goes on the inner perimeter of the dentition.
It is held with elastic ligatures.

1. What is the advantage of lingual appliances? A. ____ (hides discoloration, etc).
2. What are the disadvantages?
   A. ____, disability in speech (tongue space), and less ____ tooth movement. It is not as fast because we are working within a ____ perimeter so tooth movement is less efficient.
   We have more concerns about ____, lost brackets and tongue irritation, etc.
   This was fairly popular a couple years ago, but with Invisalign etc we don’t see this as much anymore.

Answer 19

esthetic
discomfort
efficient
smaller
emergencies

Question 20

Vertical slot

Veritically slotted brackets are called the “____ appliance”.

Answer 20

Begg

Question 21

Vertical slot

Instead of having the individual slot in the center of the bracket itself, the vertically slotted bracket has an arch wire thats going to slide into a gingival slot, then we have these little brass pins that are going to hold it in place, and then are bent up a the incision edge.

Place the wire itself into they vertical slot, place a brass pin to hold it in place, then turn up the brass pin on the incised edge to hold the wire in.

This is the BEG SYSTEM. We use this in clinic.
Advantage: Superior ____ mechanics. Great for closing ____ if you have an extraction, etc.
Disadvantage: Difficulty in ____ control. Usually this uses ____ wire, and it is harder to use rectangular wire if you want tip control, etc.

Answer 21

sliding
space
round

Question 22

Self-ligating (SPEED)

This is probably the most latest and best in ortho rn.

No need for ____ ligature or elastics.

Answer 22

stainless steel

Question 23

Self-ligating (SPEED)

You open the specialized clip, then to close it down, you put pressure on the upper aspect, it clips into place and ligates the wire in place.
The clip is a ____, so you have some control. (However, some are stainless steel, some are titanium alloy, so it is going to vary.)

Answer 23

titanium alloy

Question 24

Self-ligating (Damon)

The most popular self ligating bracket in the US is the ____ bracket.

Similar specialized clip, but the bracket looks more like a ____ bracket, versus the SPEED bracket, which looks more like a ____ bracket.

All the self-ligating ones have a clip that opens up and down like this and then you close it and lock the arch wires in place. It is ____ in a sense that you open it up and down.

The clips don’t open ____ because it could be painful for the patient.

Answer 24

damon
siamese
mono-wing
vertical
outward

Question 25

Self-ligating (DamonClear)

Just like we talked about different materials, the DAMON can be make in ____. The DamonClear is made out of “poly-crystal aluminum” (I think thats what he said).

Answer 25

clear

Question 26

Self-ligating (Damon)

With regard to that, the big advantage of the DamonClear (vs even the 3M Clarity bracket we talked bout before, where we would still have an elastic that holds it in place), the big advantage is we have a ____ cover slip that is going to hold that wire in place (bc esthetics)

Left are standard siamese brackets, vs Right (top) : DamonClear and Right (bottom): regular Damon.

Answer 26

polycrystal aluminum

Question 27

Self-ligating (In-Ovation C)

What’s the advantage of self-ligating brackets?
Why have bracket companies spent so much in designing these new brackets?

1. Less ____ (a main advantage). Because the time it takes to place the wire, and elastics, takes double maybe even triple the chair time for an individual patient. You could maybe see double the patients in that time period. (However, the brackets are maybe twice as expensive).
2. Some say there is less ____ in the system than if you had elastics. because there is less binding. Although this is ____.
   The point of this slide;
   In-Ovation makes clear brackets but that have a ____ coverslip (so you’ll still notice arch wire and metal coverslip, unlike the Damon clear bracket which is entirely ____).

Answer 27

chair time
friction
unproven

metal
clear

Question 28

Prescription v. Non-Rx
Prescription also known as ‘____ Appliance’
Non-Rx known as ‘____ Appliance’
Non-Rx requires ____ wire bending to maintain teeth in 3 planes of space

Answer 28

straight wire
edgewise
more

Question 29

The brackets that we’ve placed on our typodont.
On the right we have prescription, on the left we have non-rX

The dot on the bracket itself, for orientation of the bracket, is on the ____ and the ____. It is very important for brackets that we orient them correctly.

This is especially importtant for prescription brackets, why?

If we placed prescription brackets upside down, all the values of tip, torque etc are now ____.
If we placed a Non-RX bracket upside down, what will happen?
____ (because the bracket is just a slot). All the values of tip and torque, we place on the wire itself.

Answer 29

distal
gingival
reversed
nothing

Question 30

We can get a better idea of the torque values of the teeth as well. The advantage of CBC technology is a ____ evaluation, which is better than we’ve had in the past with 2D radiology.

Answer 30

3D

Question 31

3 Planes of Space Considered in Tooth Position

Mesiodistal Angulation (\_\_\_\_) Buccolingual Angulation (\_\_\_\_) 
Buccolingual Bodily Position (\_\_\_\_)

Buccolingual Bodily position is because of the difference of ____ of individual teeth.
So the individual width of central incisor vs lateral incisors, requires some bends to have in/out. This is in essence why the nonprescription bracket needs an ____ bend on the lateral, to make it align well, because of the difference in ____ values.

Answer 31

tip
torque
in/out
width
inset
in/out

Question 32

Prescription v. Non-Rx Lab Exercise

Maxillary Left lateral incisor
____ Torque
____ Angulation

Maxillary Right lateral incisor (Roth Rx)
____ Torque
____ Angulation

If we look at the position of the lateral incisor itself, for a non-RX, it is cut at 0 torque and 0 angulation, but in a prescription bracket, we have 7 and 8 torque and angulation. That means that the tooth itself is tipped a bit ____, 7 degrees, and the root tip itself is tipped a bit ____ 8 degrees.

So torque applies to bucco-lingual angulation, and the tip value, the angulation, has to do with mesio-distal tip. The 7 degrees torque means the root is tipped palatelly by 7 degrees, and the root is tipped a tiny bit distally 8 degrees to the distal.

Answer 32

0
0

7
8

palatally
distally

Question 33

The slight offset for the canine and inset for the lateral incisor show the need for wire bending. If we were to get the true torque / tip values of 7 and 8, we would need a ____ wire. (couldn’t do with a 016 round wire)

Answer 33

heavier rectangular

Question 34

ADHESIVES
____-cured resin
____-cured resin
Creates a ____ Bond interface between bracket and enamel surface

We have an ____, ____, and ____ material.

Answer 34

chemical
light
mechanical

etchant
sealant
composite

Question 35

The first step in placing brackets clinically is cleaning the tooth itself.
Use a ____.

Instead of a typical prophy paste that we use clinically, we use something different (no dyes or flavoring).

The ____ would impede bond strength and flavoring agent has an ____ to it, good for shine, but bad for bonding brackets.

So we use plain old flower pumice to clean the entire tooth surface (not just where we place the bracket).

not applying it only in the center of the tooth - all ____ the tooth -> maximize bonding capability!

Answer 35

non-fluoridated pumice
fluoride
oil
over

Question 36

After we clean the tooth surface, we isolate the teeth and use isolation with cheek ____, a tongue
block, suction tube and saliva ejector built right into tongue blocks.
This gives us a buccal and labial retraction from cheek retractors, keeps the tongue back, and removes as much moisture as possible. With composite materials, our biggest enemy is moisture.

Answer 36

retractors

Question 37

ETCHING
\_\_\_\_ Acid 
\_\_\_\_ seconds
Rinse liberally with \_\_\_\_ 
Air \_\_\_\_

For composite, we like to see ____ of enamel exposed, and ____ appearance of teeth. Micropores give us that ____ interlocking.

Answer 37

37% phosphoric
30-60
water
dry

microspores
frosted
mechanical

Question 38

SEALING

• ____-cured
• ____-cured
• interface between bonding resin and etched enamel

As far as sealing, we can use chem-cured or light-cured. It creates an interface (reads)…

This product, AsurePlus, is a ____ resin that is beneficial on a lot of different ____. Can utilize for bonding onto etched enamel, an acrylic temporary, or porcelain surface.

Answer 38

chemical
light
hydrophilic
surfaces

Question 39

Place our coating of sealant on the surface. Then give it a quick blast of ____ (because we only want a thin coating on the surface).

Want it to ____ as well as possible into the micro pores on the etched enamel to give it that interface between composite material and the surface.

Answer 39

air

flow

Question 40

Some are light cured, and some (____), are not.

Answer 40

asureplus

Question 41

This is a 3M curing light.

Consider a short, ____ seconds of curing, just for the ____ surface of the tooth. (It is longer for the ____ itself).

Answer 41

10
sealant
bracket

Question 42

Porcelain bonding

Can we place sealant on porcelain material?
Because we treat so many adult patients now, our adolescent patients usually just have enamel, but many times for adults patients we bind onto porcelain crowns and posterior restorations.

Is there a different system for that? Yes.
Our conventional 3% hydrofluoric acid solution is NOT good enough for porcelain. We use something more potent. “Porc-Etch” is ____ acid solution. Have to use a ____ because it has such a high acid content. If you’re going to bond a bracket onto a permanent maxillary first molar, before we place the 47% etch, use a ____ gel, and place it on ____. That helps with leaching of the hydrofluoric acid, which would burn away gingival surface.

We also have a special ____ for bonding to porcelain. There are a variety of different materials that we use.

Answer 42

4% hydrofluoric
rubber dam
barrier
gingival margin

Question 43

Self-etching primer

Other systems instead of a two step etch and sealant we can use a ____ step. We can use a self-etch primer which is a one step.

We isolate the same way, but instead of placing etchant, rinsing, then placing sealant, we use a one step self etch primer.

Answer 43

one

Question 44

This is a well system. One step.

Clean the tooth surface, isolate, then use this.
Have an “AB component” (?)
You exude the material from well 1 into well 2, then fold it into well 3.
Once the material is mixed, it goes into well C (3?), which is where you place the microbrush.
Place it on the tooth for ____ seconds, air dry for ten seconds, then place composite.
What is the advantage of the self etch primer?

What is the advantage of the self etch primer? It saves time ____.

Answer 44

30

chair side