We read with interest the article on a modified technique for indirect bonding in the April 2012 issue (Ciuffolo F, Tenisci N, Pollutri L. Modified bonding technique for a standardized and effective indirect bonding procedure. Am J Orthod Dentofacial Orthop 2012;141:504-9). First, we congratulate the authors for their efforts in describing this technique. We agree with all things they stated about this standardized and effective procedure.
Although the authors gave information about the procedure, they provided nothing about the problems encountered with this technique. For the past 2 years, we have applied a similar technique with a single tray from second molar to second molar. However, we have had a problem. We would like to draw attention to it and get additional information about this technique.
In the direct bonding technique, the excess composite on the base of the brackets can be removed with a sharp-pointed dental scaler. However, with the indirect technique, it is difficult to remove the excess composite, even if only a small amount was placed on the bracket base. Thus, plaque could accumulate on the mesial and distal bracket margins (especially on the mandibular anterior teeth), under the archwire, and near the apical margins. Enamel demineralization around the brackets could be seen frequently from plaque accumulation.
We have tried to remove the excess composite from the base of the brackets with a sharp dental scaler in the indirect tecnique. But we want to learn whether there is a better way to remove this excess. Is there such a method?