Date: Thu, 12 Oct 2006 00:18:41 -0500
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 9 Oct 2006 to 11 Oct 2006 (#2006-33)

There is 1 message totalling 201 lines in this issue.

Topics of the day: 1. Re: indirect bonding


Date: Tue, 10 Oct 2006 07:15:24 -0400
From: "charles ruff" <orthodmd@MAC.COM>
Subject: Re: indirect bonding

Dear Charlie,

Nice to hear from you.  We remain very enthusiastic about the overall concept of Indirect Bonding.  And we continue to use the Thermacure (Reliance Corp.) as we believe that the benefits outweigh any perceived disadvantages.  No doubt, rotations of individual teeth, as you have noted, place greater demands on bracket placement, whether an indirect or direct placement technique is utilized.  Mild to moderate rotations do not seem to present much of a problem as we aim to place the brackets in their “correct” mesio-distal positions, rather than “overcorrect” individual brackets, as we might have done a long time ago with either the Begg technique or non-preadjusted appliances. This objective is mainly related to the fundamental and somewhat generic principles of “pre-adjusted or straightwire” principles.  However, for severe rotations of individual teeth, I instruct our “in-house” lab staff to simply place the bracket in the “best” position possible, knowing that after some degree of rotation during the initial treatment period, the bracket would have to be removed and then placed in its ideal position chairside using a direct technique.  Not much different than if we were using a direct technique from the very beginning.  I suppose the same can be said for teeth that have not quite erupted enough to place a bracket in its correct inciso-gingival position.  One has the option of simply waiting for such teeth to erupt more or perhaps helping it along by first bonding it and then placing the initial archwire gingival to the actual bracket for a visit or so (thereby supra-erupting the tooth), only to rebond such a bracket about one visit later in a correct inciso-gingival position. I think that the important message here (and I know that you would agree) is that the entire specialty (and especially post-graduate residency programs) should include indirect bonding as an important training and clinical pedagogical exercise.  Bracket position on typodonts (that do not have the teeth ideally positioned) can be carefully scrutinized by peers and faculty before the residents begin their clinical encounters with individual patients.  If I recall, we used typodonts in operative dentistry before we actually made a preparation on teeth of actual patients.  And with good reason.  Precise bracket position does not receive enough serious attention and this type of mentality sews the seeds of “sloppiness” and imprecise finishing of individual orthodontic cases.  The fundamental principles of Edgewise do not suddenly change because of the “Bracket Du Jour” of Orthodontic manufacturing companies.  Precise and accurate bracket placement still remains a continual challenge to all of us.  If you want to see where we seem to be going with all of this, just take a look at the directions of some forward thinking Orthodontic Manufacturers.  The day will come where each tooth for each patient will be customized.  And when that day arrives, I can assure everyone that the only technique that will be appropriate will be a sophisticated indirect system.  Orthodontists will have to become as “Smart” as the “Smart Orthodontic Appliances” advocated by our Orthodontic manufacturers.  That is the future!

Elliott M. Moskowitz, D.D.S.,M.Sd NYC

I loved your comment about using a typodont first in dental school.  Absolutely right on.  The residents are always talking about "learning how to finish a case."  In fact, they should be worried about "learning to start a case."   As far as the rotation issue, I'm not trying to overcorrect but fully correct.  I hate to rebond respecially bicuspids so I guess I will stay with the Transbond and grind brackets to help with that issue.  Obviously, that is a small point.  the issue is indirect bonding and hopefully more and more orthos will move in that direction.

best wishes
charlie ruff