protocol handbook - american orthodontics

PROTOCOL HANDBOOK

www.myHARMONYsmile.com

TABLE OF CONTENTS

IMPRESSION SPECIFICATIONS 1 - 3

RECOMMENDED INSTRUMENTS 5 - 9

CLINICAL BONDING PROTOCOL 11 - 24 ENAMEL SURFACES 13 - 17 METAL SURFACES 18 PORCELAIN SURFACES 19 MIXED SURFACES 20 - 22 REBONDING 23 - 24

OPEN/CLOSE INSTRUCTIONS 25 - 30

NOTES 31 - 34

IMPRESSION SPECIFICATIONS


FOR ARCHES TREATED WITH HARMONY:Send PVS (Silicone) impressions.

FOR ARCHES NOT TREATED WITH HARMONY:Send plaster model or PVS impression for reference.

PVS (SILICONE)IMPRESSIONTWO-STEP TECHNIQUE

INSPECT FOR IMPERFECTIONS

NOALGINATE

OR

PLASTERMODEL

NOALGINATE


1

PVS TWO-STEPTECHNIQUE REQUIRED

RECOMMENDED HEAVY PVS (FOR BASE)

Example:Bisico S1

Plicafol

RECOMMENDED LIGHT PVS (FOR TWO-STEP)

Example:Bisico S4 Suhy


2

TWO-STEP TECHNIQUE


IMPRESSION TRAYSSend Impressions in Rigid PerforatedPlastic or Metal Trays.(AO sample kit 861-121)

NOTE: Impression Trays are returned with the finished case.

BEFORE SENDING: CHECK IMPRESSIONS FOR ANY FLAWS, VOIDS OR TEARS - Retake if necessary

3

RECOMMENDED INSTRUMENTS


REF 010-300 Open/Close InstrumentDesigned specifically for Harmony self ligating brackets, the 90˚ tip opens/closes anterior brackets and the 145˚ tip opens/closes posterior brackets.

RECOMMENDED INSTRUMENTS

5

opens/closes posterior brackets.

145˚ tip(Posterior)

90˚ tip(Anterior)

REF FE/LD Hu-Friedy® Explorer/Lig DirectorIdeal for directing arch wires and elastic chain with Harmony brackets.

6

INSTRUMENTS


REF 010-301 Scaler/Band PusherThe serrations of the band pusher are patterned perfectly for directing the arch wire. The scaler tip is a useful tool for holding the arch wire in the slot to assist with clip closing.

7

INSTRUMENTS

REF 001-E345RT - NarrowREF 001-E346RT - WideDirect Bond Bracket RemoverThese pliers are recommended for quick and comfortable removal of posterior lingual brackets. Dual chisel tips wedge between bracket base and tooth, lifting the bracket off with no stress on the tooth. May be used mesial-distally or incisal-gingivally.

REF 001-E346RT REF 001-E345RT

8

INSTRUMENTS

www.myHARMONYsmile.com 9

INSTRUMENTS

REF 001-302 Lingual Debonding PliersDesigned to remove anterior lingual brackets and bite blocks. The swing arm is positioned under the gingival tie wing and the beveled tip is placed at the enamel/pad interface. A gentle squeeze debonds anterior brackets.

REF 001-006 45� Pin and Lig Cutter45˚ angle allows easier access for cutting ligature wires. Maximum cutting capacity: .012 soft wire

Designed to remove anterior lingual brackets and bite blocks. The swing arm is positioned under the gingival tie wing and the beveled tip is placed at the enamel/pad interface. A gentle

CLINICAL BONDING PROTOCOL


IMPORTANT: Read this before bondingThe clinical bonding protocols for Harmony are very specific and are designed to ensure a consistently successful bonding experience.

The Harmony system has several unique features over other lingual systems, so strict adherence to these protocols is highly recommended. Changing or skipping any step(s) may affect the performance of the brackets, weaken bond strength, and slow down treatment.

Following bonding protocols of other lingual systems is not recommended.


11

Adhesive: DenMat® - Geristore® Dual-Cure Glass Ionomer Primer*: *Reliance - Assure™ or *Unitek - Transbond® MIP Etch: American Orthodontics - Acid Etch Gel (001-913) American Orthodontics - Porcelain Conditioner (001-966) *Ultradent - Ultra-Etch®

RECOMMENDED MATERIALS

*Available from your local distributor. Not available from American Orthodontics.

TRAY PREPARATION

BRACKET PREPARATION (ALL SURFACES)

B

B

A Bring recommended materials and instruments chairside. If adhesive is stored in a refrigerator, allow 45 minutes to return to room temperature.

B Assemble mixing tips and inspect adhesive syringe to ensure that it was stored properly and that there is sufficient glass ionomer for the bonding appointment. NOTE: The auto-mixing tip is designed for direct delivery to the bonding pads using the intra-oral tip, which snaps onto the auto-mixing tip.

A Check the transfer tray to ensure that all brackets are present and correctly positioned in the tray.

B Using a microbrush, apply a very thin layer of Reliance Assure or Transbond MIP on the bracket pads, which have been pre-treated with ROCATEC, a metal primer, at the Harmony Technical Center. Do not micro-etch pads before bonding.


12


01 Micro-etch (sandblast) the lingual surface of each tooth to be bonded for 1-3 seconds with 50 micron Aluminum Oxide media.

BONDING TO ENAMEL SURFACES

ENAMEL SURFACES

01

02

02 Rinse tooth surfaces thoroughly to remove any Aluminum Oxide particles. Check to confirm that the bonding surfaces are clean and without any residual bio-material (tartar) that would compromise the bond integrity.

NOTE: Micro-etch and rinse before inserting the NOLA System.

13

04 Etch the tooth surfaces to be bonded with 37% phosphoric acid for 60 seconds.

05 Use suction to remove the bulk of the etch and then rinse each tooth thoroughly for 10 seconds minimum. Dry tooth surfaces with an oil-free and moisture-free air supply until the surface of the enamel appears ‘frosty’ white.

14

ENAMEL SURFACES

03

03 Place a cheek retractor and evacuator system - ‘NOLA’ is recommended - to establish a dry, accessible working environment.

NOTE: When bonding the mandibular arch, be sure to place 2 cotton rolls in the ‘NOLA’ retractor.


07

ENAMEL SURFACES

15

06 Apply a thin layer of Reliance Assure or Transbond MIP to each etched tooth surface. IMPORTANT: Do not allow saliva to contaminate the etched surfaces before the primer is applied.

07 Apply a small amount of Geristore* dual-cure adhesive to the exposed bracket pads in the transfer tray. NOTE: The mixing tip has two components that must be assembled before attaching the syringe.

06

NOTE: A. The application time should be less than 35 seconds to avoid

premature curing of the adhesive.

B. Reduce the level of ambient light exposure to the adhesive.

C. Be judicious in the amount of adhesive applied to avoid excess

flash around the bracket bases or self ligating clips.

*Geristore is recommended but other dual-cure resins may be used. Contact American Orthodontics for a list of other approved dual cure resins.

08 Insert the tray in the mouth making sure it is completely seated on the teeth by pressing the tray with finger pressure on the occlusal and lingual surfaces. This ensures that the brackets are in intimate contact with the tooth surfaces. “Tack” each of the brackets in place with a 5 second light cure.

09 After all the brackets have been “tacked,” use an LED light to cure adhesive from the labial for 10 additional seconds per tooth to completely polymerize the adhesive. After the last tooth has been cured, wait 30 seconds before removing the tray. TIP: Use a second LED curing light to shorten the bonding time.

16

ENAMEL SURFACES


10 After removing the transfer tray, remove any excess adhesive from the tooth surfaces, especially interproximal, with an appropriate instrument. Check contacts between teeth with dental floss to make sure there is no adhesive “bridging” of teeth.

11 Check the occlusal contacts with articulating paper for any bracket-tooth interferences. Place “shims” (posterior bite blocks for opening) as necessary to eliminate any interferences.

17

ENAMEL SURFACES

11

BONDING TO METAL SURFACES

01 Micro-etch (sandblast) the metal surfaces to be bonded for 4 seconds with 50 micron Aluminum Oxide media.

02 Rinse the micro-etched surfaces thoroughly and dry.

03 > 05 Follow Procedures 03-05 for Bonding to Enamel.

06 Apply a thin coating of Reliance Assure primer to the metal surfaces and leave undisturbed for 5 seconds. Dry with a gentle stream of air for 3 seconds and light cure (polymerize) for 3 seconds. Apply a second thin layer of Reliance Assure and follow the same light cure procedure.


18

METAL SURFACES


01 Micro-etch (sandblast) the lingual surfaces of the (porcelain) teeth with 50 micron Aluminum Oxide media for 4 seconds, each tooth.

02 Rinse the micro-etched surface thoroughly and dry.

03 Follow Procedure 03 for Bonding to Enamel.

04 Coat the surface of the porcelain with a thin layer of liquid etch — 37% phosphoric acid (American Orthodontics). DO NOT RINSE!

05 Leaving the layer of acid etch on the porcelain, apply a layer of Porcelain Conditioner (American Orthodontics) on top of the phosphoric acid. After a few seconds, apply a second layer of Porcelain Conditioner over the first and let sit for 60 seconds. Rinse thoroughly.


BONDING TO PORCELAIN SURFACES

19

PORCELAIN SURFACES

STEP-BY-STEP SEQUENCE FOR MIXED BONDING SURFACES

01 Micro-etch (sandblast) the tooth surfaces of ALL teeth whether Enamel, Metal, or Porcelain for 4 seconds.

02 Rinse and dry as previously instructed.

03 Start with Porcelain teeth first.

04 Coat the surface of the porcelain with a thin layer of liquid etch — 37% phosphoric acid (American Orthodontics). DO NOT RINSE!

05 Leaving the layer of acid etch on the porcelain, apply a layer of Porcelain Primer (American Orthodontics) on top of the phosphoric acid.

06 Apply a second layer of Porcelain Primer over the first and let sit for 60 seconds.

20

MIXED SURFACES


MIXED SURFACES

07 Etch the remaining teeth with 37% phosphoric acid and wait for 60 seconds, as in Bonding to Enamel, above.

08 Rinse and dry all teeth (enamel, metal, porcelain).

09 Apply a thin coat of Reliance Assure primer to the metal surfaces. Leave undisturbed for 5 seconds. Dry with a gentle stream of air for 3 seconds and light cure (polymerize) for 3 seconds. REPEAT THIS STEP TWICE.

10 Apply a thin layer of Reliance Assure or Transbond MIP primer to the other teeth to be bonded.

11 Insert the tray in the mouth making sure it is completely seated on the teeth by pressing the tray with finger pressure on the occlusal and lingual surfaces. This ensures that the brackets are in intimate contact with the tooth surfaces. “Tack” each of the brackets in place with a 5 second light cure.

21

22

14

MIXED SURFACES

12 After all the brackets have been “tacked,” use an LED light to cure adhesive from the labial for 10 additional seconds per tooth to completely polymerize the adhesive. After the last tooth has been cured, wait 30 seconds before removing the tray.

13 Remove any excess adhesive from the tooth surfaces, especially interproximal, with an appropriate instrument.

Check contacts between teeth with dental floss to make sure there is no adhesive ”bridging” of teeth.

14 Check the occlusal contacts with articulating paper for any bracket-tooth interferences. Place “shims” (posterior bite blocks for opening) as necessary to eliminate any interferences.


REBOND

01 Micro-etch (Sandblast) the base of the pad (bonding surface) of the de-bonded bracket, removing ALL adhesive from the pad. Clean the surface with a stream of oil-free and moisture-free air.

02 Prepare the tooth surface to be re-bonded, following the appropriate instructions for bonding to enamel, metal, or porcelain.

03 Apply a thin layer of Reliance Assure or Transbond MIP primer to the pad and leave undisturbed for 5 seconds. Dry for 3 seconds and light cure (polymerize) for 3 seconds.

04 Repeat Step 3.

REBOND PROTOCOL

FOR REBONDING ANTERIOR TEETH

23

05 Place the corresponding Positioning Jig on the tooth to be rebonded to ensure the correct jig has been selected. NOTE: Positioning Jigs provide a mechanical guide for direct bonding Harmony brackets to anterior teeth at any time during treatment.

24

REBOND

06 Apply a small layer of Geristore adhesive on the pad of the debonded bracket. While holding the positioning jig in place, press the pad firmly against the tooth, remove the jig and clean excess flash. Place the jig on the tooth a second time to ensure accurate positioning. Light cure (polymerize) for 10 seconds. Check contacts between teeth and occlusal contacts.

FOR BONDING POSTERIOR TEETH

07 For posterior teeth, place the bracket on the tooth and press firmly to ensure a good fit with the enamel surface. Remove any excess flash. Light cure (polymerize) for 10 seconds. Check contacts between teeth and occlusal contacts.

OPEN/CLOSE INSTRUCTIONS


OPEN/CLOSE INSTRUCTIONS

01 Position the angle of the HARMONY Open/Close instrument (REF 010-300) so that it is parallel to the long axis of the crown (i.e. the root). Hold the opening instrument lightly, but firmly (similar to holding a pencil).

02 Using the anterior teeth for stability, place the 90° tip of the instrument in the hole in the face of the clip and then place the index finger of the opposing hand over the tip of the instrument.

03 Press the tip of the index finger against the tip of the instrument and push toward the occlusal surface until the clip opens. The hand holding the instrument does not pull to open the clip, but rather guides the instrument so that it travels in a straight line parallel to the long axis of the crown.

OPENING ANTERIOR CLIPS

02 03

26

CLOSING ANTERIOR CLIPS


02

01 While holding the HARMONY Open/Close instrument parallel to the long axis of the crown, insert the 90° tip of the instrument in the hole in the face of the clip. Position the index finger of the opposing hand over the tip of the instrument to prevent the tip of the instrument from poking the patient.

02 Using the anterior teeth for stability gently push the tip of the instrument toward the palate until the clip closes. Maintain the proper angle of the instrument as the clip closes. The index finger on the opposing hand protects the soft tissue as the clip closes and the tip of the instrument releases from the facial hole of the clip.

01



03

03 A second instrument (REF 010-301) may be required to hold the arch wire in the slot while the clip is being closed.

NOTE: Use caution when closing the clip to ensure that the archwire is fully seated in the slot.

OPENING POSTERIOR CLIPS

28

01 Insert the 145° tip of the Harmony Open/Close instrument in the hole in the face of the clip. (REF 010-300)

OPENING POSTERIOR CLIPS

01

02 Using the patient’s anterior teeth as leverage, lift the instrument STRAIGHT up toward the occlusal surface. Do not rotate the tip of the instrument. Apply a light and controlled force.


CLOSING POSTERIOR CLIPS

02 Push the tip of the instrument toward the palate (gingivally) until it clicks closed. Inspect bracket to ensure clip is fully closed.

NOTE: The clip can also be closed by inserting the instrument tip in the facial hole and pushing the clip down (gingivally).


01

02

01 Insert the 145° tip of the Harmony Open/Close instrument in between the pad and the clip. (REF 010-300)

30


03

03 A second instrument may be required to hold the arch wire in the slot while the clip is closed. (REF 010-301)

NOTE: Excessive force can damage the clip if it is contacting the wire while attempting to close the clip. If clip does not click into its closed position, adjust the wire to ensure it is fully seated in the slot.


NOTES

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© 2012 American Orthodontics Corporation

protocol handbook - american orthodontics

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