Have you tried using Indirect Bonding? Do you think that it might be a good Idea? Do you think that it saves DR-Tx-Time in your schedule? If not sure, maybe this pearl can help.
Indirect bonding isn’t for everybody—some do very well with it and some can't seem to make it work. So let's look into what might make it work or not. Most people get into indirect bonding because they feel it will save them chairtime and Dr-Tx-Time in their daily schedule—you may be surprised at what actually is the case.
The average doctor can direct bond one arch in 8 to 15 minutes. I can take up to 15 minutes if the doctor does every step after the surface prep to the selection of archwires. It will take less Dr-Tx-Time if the DA places the brackets and the doctor finalizes the positions and gives a light tack before leaving the chair. It is important to keep ambient light from setting the bonding agent while working on the patient. Some doctors (where it is legal) allow an experienced DA to bond and light tack or light cure the arches and then the doctor re-bonds any brackets needing it.
The average doctor can indirect bond one arch in 3 to 7 minutes. I can take up to 7 minutes if the doctor inserts the tray and holds it until ready to light cure. It will take less Dr-Tx-Time if the DA holds the tray in place until ready to light cure. It takes even less overall time if the doctor does both U&L arches with one trip to the chair.
Another key is to have a tray stiff enough to hold the brackets in place, yet flexible enough to allow for removal of the tray without tearing the brackets off or shifting their positions. This is where an excellent lab comes into place. Frankly, I find that most doctors are not that thrilled with outside lab setups, especially those companies that offer a "system" for indirect bracketing and archwires.
So, to save yourself chairtime and Dr-Tx-Time you need a great lab doing your indirect trays and an effective procedure for delivering those trays at the initial appliance insertion visit. And an in-house lab with an experiences lab tech seems to be the way to achieve this. But this is not easy to accomplish and the minor savings of 10-15 minutes of DrTx-Time at the initial appliance visit can cost you a great deal in lost chairtime, Dr-Tx-Time and extended Tx time for your starts.
Most doctors don't consider the consequences of a "non-ideal" bracket placement from indirect bonding or inaccurate direct bonding. Every practice I work with either does one re-bonding of 1-4 brackets during treatment (usually when bonding/banding the 7's) on at least 50% of their full starts. Some practices schedule it on all of their full starts just to be sure. And some practices do it more than once, especially if they have not perfected their indirect bonding technique. Of course, not all brackets can be perfectly placed with crowded cases and need to be re-bonded later.
Unfortunately, whether doing direct or indirect bonding, too many of today's ortho-graduates have not been sufficiently taught how to bend wire and end up doing many re-bondings...this a waste of Dr-Time, chair-time and extends treatment time. My advice for these graduates is to learn how to bend wire so that numerous 10- to 20-minute appointments don't turn into 40- to 60-minute appointments. Or, they can learn how to bond perfectly on the initial appliance insertion; a good philosophy for all practitioners.
Bottom line, unless you bond perfectly, the chairtime saved (20-40 minutes) and Dr-Tx-Time saved (10-15 minutes) with indirect bonding may turn into hours of lost chairtime, much more Dr-Tx-Time and the extension of overall treatment time.
