Prophy - A Foundation for Success
One of the primary reasons clinicians struggle with bonding to artificial surfaces is as simple as the need to begin with a clean surface. A thorough prophylaxis is vitally important to any intraoral bonding sequence, but particularly important when bonding to difficult surfaces that yield compromised strengths in the best of circumstances. There are two reasons practitioners tend not to prophy teeth prior to bracket bonding:
Oversight. It's a common misconception that when an intraoral microetcher is used to mechanically prepare substrates, subsequent prophylaxis of teeth isn't necessary because the abrasive powder will remove any bulk material. This belief couldn't be further from the truth, especially when there's soft material present on the tooth. All debris must be removed before using a microetcher to allow the blast media to reach the substrate itself. Any soft material present will absorb much of the aluminum oxide powder, inhibiting the mechanical preparation that's so crucial to clinically acceptable bond strength.
Overcomplication. It's no secret that a clean surface free of debris, mature pellicle or plaque will generate superior bond strength compared to a contaminated surface. Orthodontic bonding is complicated process; skipping this simple reality will only make the operator's job more difficult.
A thorough prophylaxis achieved by using a rubber-cup rotary instrument or bristle brush is the foundation for the successful bonding of orthodontic brackets. Excessive oral fluid or gingival bleeding may occur from this prophylaxis if clinicians are not careful when cleaning next to the soft tissue margins. Caution, precision and attention to detail are imperative when using a prophylaxis technique. A small-diameter rubber cup provides the most precise pumice application, resulting in less nuisance oral fluids.
Because of the risk of increased oral fluids, some clinicians will forgo the prophylaxis of teeth prior to bonding. Although possible contamination is reduced, this practice does not address the bulk material present on the tooth, that when left unaddressed, may reduce the likelihood of a successful long-term bond.
Paul Gange Jr.
Vice President of Sales