Bracketing: A Basic Teaching Module for Dental

Assistants

Dr Jean Marc Retrouvey

McGill University, Faculty of Dentistry

General steps in bracket bonding

Prophylaxis

• Pre-bonding prophylaxis procedure – Using oil-free pumice mixed with water: tooth surfaces where the brackets are to be bonded must be cleaned.

Isolation of teeth (Cheek retractors)

Acid Etching

Proceed by quadrants

Apply a light coat of resin

Select the proper bracket

Position the bracket as precisely as possible

Use a mirror to verify if the bracket is centered on the crown

Excess composite

Remove excess composite around the bracket with a scaler or an explorer before light curing. If not, it will encourage plaque accumulation.

Use height gage properly

In the canine, premolar and molar regions, the gauge is placed parallel with the occlusal plane

Verify bracket positioning

Tip and Torque in the position of incisors

GENERAL ORTHODONTIC INSTRUMENTATION FOR FIXED

APPLIANCES

Examination kit

• Cotton pliers. This instrument is used to hold brackets securely when placing them onto the tooth surface.

• Explorer. In orthodontics, this is commonly used to remove elastics, in place of a scaler. In addition, it can be used to remove excess resin after bracket placement.

• Mouth mirror. This is used to verify the MD position of the bracket

Bidirectional ligature director. This instrument is used to tuck metal ligatures under the archwire, to keep the ends free from irritating the soft tissue.

Bracket height gauge. This is used to measure the distance from the occlusal/incisal surface to the bracket slot.

Distal-end cutter. This instrument cuts the distal end of archwire while holding the cut end. Therefore, this can be used in an intraoral setting.

Mathieu plier. This is an instrument that locks (like a haemostat) and braces small metal parts. In general, they are used to hold and twist the ends of metal ligatures, and also to place elastic ligatures.

Ligature-cutting plier. To avoid damage to the instrument, these pliers must only be used to cut small gauges of “dead soft” stainless steel ligature wire (<0.014”) intra orally.

Hard wire cutter. This instrument is designed to cut thick wire (> 0.014”) extraorally.

Ladmore composite instrument. This non-stick instrument is used to place resin onto the base of the bracket.

Cheek and lip retractor. This is an adjustable device that retracts away the lips and cheeks to maximize visibility and to minimize salivary contamination.

Debonding plier. This instrument is used to remove brackets by holding the bracket mesio-distally and applying slight pressure by torquing or turning in a clockwise motion.