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I would like to express my thanks to Dr. Vincent Quas and his Wife Dr. Juliana Panchura who welcomed me to observe the functioning of their office in Bend, Oregon on Monday and Tuesday, August 27 and 28, 2007: jpanch@bendcable.com

How to make Indirect Bonding Trays; One tray 30-40 minutes two trays 60-80 minutes.

Take a perfect impression (no parts of the tray showing through)
Prevent distortion of the model by pouring it up soon after taking it. Two impressions and two pour ups one hour.
Doctors mark the exact postion where the brackets are placed and place the brackets on the model.
Lab assistant takes over:
Brush  "Alcote" (a separating medium) on labial and lingual surfaces of the teeth  on the model and allow to dry 10 minutes.
Using LC Blockout Resin (Blue) (Ultradent Products:www.ultradent .com) place it in every undercut place on the model that may possibly make the removal of the indirect trays difficult and light cure the material to hardness.
Position the Precoated-with-adhesive brackets on the model where you marked them to be placed. You have now created a custom fitted-to-the-tooth bracket base.
Light-cure the brackets on the model: 5 seconds on the occlusal and 5 seconds on the gingival
Always hold the light cure rod right up against the material or the bracket.
Place  "Cake frosting"  (a softer kind of undercut material)  under those gingival[-extending parts of the brackets that would create undercuts. It is not necessary to place this material under the tie-wings of the bracket, nor is it necessary to light cure it.
Vacuum form the "soft-shell material" (1mm thick) over the brackets-model.   Make sure the soft material has molded into the all the crevices of the bracket.
Silicone Spray on the surface of the soft-shell material to prevent fusion of the soft shell material to the hard shell material which you are now going to vacuum form over the  soft-shell material.
Vacuum form the "hard-shell material" "about 1mm thick" over the soft-shell material.
Using a wheel-saw rough cut through the soft and hard shells about 4 mm below the cervical margin of  the tooth.  When you  do this you have melted the hard and soft shell together
Soak the model under water water for 15 minutes. This will soften/dissolve the Alcote material you brushed on at the start to help the brackets you placed on at the start to help the brackets stick on to the model.
Remove the rough-cut hard-soft shell tray containing the brackets.
Light cure all the brackets from the inside of the tray.
Microetch the custom-built adhesive side face of the brackets in the tray in preparation for bonding.
Cut off the hard-soft-shell material as close to the gingival edge of the bracket as possible thus creating two layers of material that are not fused at the edges.

CHAIRSIDE FOR BONDING TWO ARCHES AND PLACING TWO WIRES (90 MINUTES):
Clean, dry and etch teeth
Place all salivary suction devices or have patient take 1mg tab of Atropine Sulfate one hour before bonding procedure. 
The doctor will now place a thin layer of very flowable light-cure adhesive on each bracket toward the gingival.
The indirect bracket bonding tray is now carefully placed over the teeth so as to make a perfect fit of the tray on the dental arch.. There should be no wobbling  or popping up of the tray anywhere.
Light-cure the brackets directly through the hard shell first: 5 second at the gingival and 5 seconds at the occlusal and gently tease of the hard shell.  It should remove without any difficulty.
Now light cure each of the brackets 5 seconds at the gingival and 5 seconds at the occlusal.
Always hold the light cure rod right up against the material or the bracket.
Remove the soft-shell material: DO NOT RIP OR TEAR THE MATERIAL OFF. RATHER, PRESS THE BRACKET ON TO THE TEETH AS YOU LIFT IT UP AND OVER THE BRACKET.
Light-cure the adhesive for 5 seconds on the mesial and 5 seconds on the distal of each bracket.
 

09-01-07