Clinical Procedures for Seating, Bonding, 
and Removing DIBS 3D-Printed Bonding Trays

 

Please click here for a printable version of this information.

 

 

Our Bonding Product Recommendations

 

Option 1: Opal Orthodontics

 

Pumice

Recommended: Opal Consepsis.  Preferred alternative to traditional pumice.  Also works as a good antibacterial solution.

 

Etch

Recommended: Opal Etch.  Unique self-limiting properties to prevent over-etching.

 

Primer (and Sealant) 

Recommended:  Opal Seal.  Works as a good primer and sealant, reducing decalcification, and acts as a bonding enhancer.

 

Adhesive

Recommended:  Opal bond Flow.  Easy delivery and placement.  Prevents slumping.

 

 

Option 2: 3M Unitek

 

Pumice
Recommended: Nada Pumice Paste (Patterson Dental Supply). Blend of polishing and cleaning agents to prepare tooth surfaces prior to bonding.

Self-Etching Primer (SEP)
Recommended: Transbond Plus Self-Etching Primer.  Eliminates costly errors normally associated with the bonding process.

Adhesive
Recommended: Transbond Supreme LV.  Excellent strength, flow, and wear properties.

 

 

General Procedure

 

1.      Clean teeth with pumice, rinse off.

2.      Acid etch, rinse, dry teeth.

3.      Add a bonding primer to teeth.

a.      Many doctors combine steps 2 and 3 into one by using a SEP (Self Etching Primer).

4.      Bonding adhesive is added to the bracket pads in the tray. Only a very thin layer is required. Ensure the agent covers the whole pad up into the corners.

 

When bonding with our 3D-printed trays, it is important to remember that DIBS trays have some unique properties, so please read and follow these tips carefully.

It would be beneficial to first watch our Clinical Procedures video. 
Another helpful video, recommended for both doctor and staff, demonstrates good technique for using tweezers to correctly insert brackets into your DIBS trays: Inserting Brackets

 

1. Seat the tray over the teeth, placing enough finger pressure on the occlusal of the tray near each bracket to completely seat the tray. Once seated on the patient’s teeth, the tray will maintain its position with moderate finger pressure. Maintain steady moderate pressure during the light curing process.

2. While curing, apply slight pressure (with the light cure stem) against the facial/buccal side of the tray on the bracket. This will ensure there are no potential gaps between the surface of the tooth and the bracket pad. 

3. Light cure once, directly on the facial/buccal side; then a second time from the incisal edge/buccal cusp ridge. This helps penetrate through the tray and create a complete bond, with better resistance to bond failure. After removal of the trays, again light cure each bracket from the gingival side.

Some important notes: The curing light intensity is reduced by almost half when curing through an IDB tray; so you should double either the light intensity (turbo setting) or cure time.

When using a light-cure primer or bond enhancer, e.g. Assure Plus from Reliance, Self-Etching Primer from 3M or Opal Seal, be careful to apply it to the specific area where the bracket will bond. If the primer or enhancer is applied to a broad area on the tooth surface, the tray may adhere to the tooth, resulting in unnecessary cleanup. Another option is to light cure the primer or bond enhancer before proceeding with the bonding agent. Be sure to follow the instructions of your bonding agents and cure light.


4. Please avoid placing bands on the teeth after you have taken the scan or impression that will be used in creating your DIBS trays. Movement of teeth in the interim could adversely affect the proper fit of the trays at bonding time.

 

5. Self-ligating brackets: If you will be inserting self-ligating brackets into your DIBS trays, please make sure that the gates/doors are closed. Failure to do this will result in incorrect positioning.

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6. The gripping property of the trays is important for holding brackets in their precise position and for seating tightly on a patient's teeth. It's also the reason a little technique can help make removal quick and simple. Here are some recommended methods for removing DIBS trays easily without ripping: 

  • For trays sectioned in thirds, the posterior sections can be gently pulled/lifted from the lingual and rolled toward the buccal.  

  • A scaler or other instrument helps to gently lift the tray off, little by little along the entire tray until it is completely removed. This works well for the anteriors, where the curvature of the tray section can sometimes impede rolling from the lingual to the facial.

  • Another helpful method is to lift a section of the tray with your fingers, by gently wiggling it back and forth.

7. After curing, have the patient gently close and stop if they are about to touch a bracket. Consider bite opening measures such as bite turbos on the lingual of teeth #8 and #9, or composite build-ups on the occlusal surfaces of posterior teeth to prevent any occlusion on the lower brackets.

 

 

Doctor Recommendations

 

We asked DIBS users to share their recommended methods and products. Here are some of the replies we received:

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1. Reliance Flowtain LV, based on your recommendation

 

and others.

         Dr. Steven Gajda


2. We are using Reliance thin viscosity Light Bond for our DIBS cases, so far. We are still trying to refine our technique to reduce composite flash. I will be happy to share any practical pearls as we increase our skills with the DIBS. 

         Dr. Todd Curtis



3. We use two types of brackets with our OrthoSelect cases, either Clarity Advanced Flash Free by 3M or unpasted SmartClip SL3 from 3M. The Clarity Advanced are pre-pasted with an attached fiber mesh that’s been impregnated with thin layer of adhesive. When bonding these brackets, we condition the teeth with a 35% phosphoric acid etchant for 20 seconds, rinse, follow with an application of 3M Self Etching Primer, then seat the trays/cure brackets. When using the SmartClip brackets, we prepare the teeth in the same way, but Dr. Alvetro will then apply a very thin layer of 3M’s Transbond Supreme LV low viscosity light cure adhesive to the bracket bases just before seating the trays. Using a very thin layer is key, ensuring little to no flash during bonding. 

After curing and removing trays, we seal all around the brackets with Vanish XT light cured glass ionomer, also from 3M. 

Summary:
3M gel etch, 35% phosphoric acid
3M Transbond SEP self etching primer
3M Transbond Supreme LV low viscosity flowable composite. 
Seal all around the brackets with Vanish XT light cured glass ionomer, also from 3M. 

          Leighann Jones, COA,  Alvetro Orthodontics


4. The composite that we recommend is 3m Transbond Supreme LV with OrthoSolo universal bond enhancer. Suggestions: Divide the trays before trying them in the patient.

          Deanna Brown I Office Manager / Ortho Certified CDA II , Dr. Baby & Rojas, Specialists in Orthodontics


5. We use transbond by unitek, no flowable cements because there is no custom base. Hope this helps!

          Dr. Christine Ferrell, West Chester Orthodontics


6. Used Transbond LR on first case and got little or no flash.

          Dr. Bryn Cooper


7.  I used 3M Unitek Transbond supreme LV Flowable. I also used Flowtain from Reliance.
I found that I like the flowable composites much more than the thicker composite. The thicker composite gave too much flash. I did like the 3M Transbond Supreme LV the best. I felt I could see the composite on the pad better before placing the tray.

           Cassie Vazquez, Clinical Consultant, Hummingbird Associates


8. I didn’t use a flowable. I just used my regular GAC neobond composite and used a very little bit. I cured it buccal/facial 10 seconds then gingival/incisal 5 seconds each. 

         Jordan Sanabria, Treatment Coordinator, Wesley Hills Orthodontics


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