A groove-guided indirect transfer system for lingual brackets.

JCO/JULY 2007 P bracket placement is even more important in lingual orthodontics than with labial appliances.1-5 New bracket systems and more flexible wires have eliminated many positioning problems; examples include Kyung’s Mushroom Bracket Positioner,5 the STb system* developed by Takemoto and Scuzzo,6 Wiechmann’s Transfer Optimized Positioning** (TOP), which produces customized archwires with computer-assisted technology, and the Lingualcare bracket system,*** also developed by Wiechmann.7 Still, accurate placement of lingual brackets requires an effective method of indirect bonding. The most popular bonding systems can be divided into three major categories: 1. Systems in which the brackets are positioned directly on the patient’s pretreatment casts. These include the Torque Angulation Reference Guide† (TARG), the Slot Machine,‡ and the Bond with Equal Specific Thickness†† (BEST) system, later renamed TARG Professional (TARG-Pro).8 Although these techniques minimize laboratory and bonding time, they require expensive equipment and do not use setup casts, which can be helpful tools for diagnosis and case presentation. 2. Systems in which the brackets are initially positioned on a setup cast with an ideal archwire, then transferred to the patient’s mouth using a minitray for each tooth. These eliminate the step of transferring the brackets back to the initial cast, but increase the time required for bonding.8-10 3. Systems in which the brackets are initially positioned on a setup cast, then transferred to the patient’s initial cast for fabrication of a transfer tray. This is a simple, effective method that reduces chairtime in bonding, but requires a precise transfer of the brackets from the setup cast to the initial cast. Prieto and colleagues described such a procedure in 2005, using a red DuraLay‡‡ resin as a guide for the bracket transfer.11 The present article describes a modification of that method that ensures more precise and reliable indirect bonding. The key improvement is a change in the position of the red DuraLay resin: Instead of being placed at the center of the bracket pad, the resin is applied more incisally or cervically, depending on the tooth, thus freeing the bracket from potential interference (Fig. 1).