Bonding in the COVID-19 Era

PAUL GANGE JR.*

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With a return to offices in sight, Reliance has spent the past five weeks testing various procedures to mitigate your risk when bonding/rebonding patients. As we all know, a thoroughly clean, dry, isolated tooth surface is ideal for bonding. The bonding process has become exponentially complicated, however, due to advice to avoid high-pressure water spray and forced air. Given these restrictions, Reliance has finalized the bonding protocol to the following two procedures.

Initial Bonding/Rebonding with No Adhesive on Enamel

1. Have the patient brush vigorously for two minutes with a unidose 1st & Final pumice.** Instruct the patient to thoroughly rinse the teeth at least three times.
2. Blot dry thoroughly with a cotton roll or 2 x 2.
3. Acid etch with liquid phosphoric acid*** for 30 seconds.
4. With a disposable-tip squeeze bottle† filled with water, rinse for 10 seconds per tooth. Blot dry thoroughly with a cotton roll or 2 x 2. Do not scrub.
5. Apply one coat of Unidose Assure Plus†† with a bristle brush and stroke over several times.
6. With a new, dry brush, stroke over the surface again several times to evaporate the solvent. This dry brush may be used for four teeth until needing to be discarded. Light-cure the tooth for 10 seconds.
7. Apply one thin coat of Assure Plus to the bracket base and stroke over several times. Apply GoTo††† paste to the bracket base, place the bracket on the tooth, and light-cure.
   NOTE: Applying Assure Plus to the bracket base is an optional step, but recommended because overall strength is slightly compromised due to less-than-ideal surface conditions.

Rebonding with Residual Composite on Enamel

1. Remove as much composite as possible with adhesive-removing pliers‡ without crazing the enamel.
2. Manually roughen the composite on the enamel with a paper disk.
3. With a disposable-tip squeeze bottle† filled with water, rinse for 10 seconds per tooth. Blot dry thoroughly with a cotton roll or 2 x 2.
4. If there is enamel present, follow the steps for acid-etching above.
5. Apply one coat of Unidose Assure Plus with a bristle brush and stroke over several times.
6. With a new, dry brush, stroke over the surface again several times to evaporate the solvent. This dry brush may be used for four teeth until needing to be discarded. Light-cure the tooth for 10 seconds.
7. Apply one thin coat of Assure Plus to the bracket base and stroke over several times. Apply GoTo paste to the bracket base, place the bracket on the tooth, and light-cure.
   NOTE: Applying Assure Plus to the bracket base is an optional step, but recommended because overall strength is slightly compromised due to less-than-ideal surface conditions.

Please remember, these procedures were developed as a response to concerns about forced air and water spray. EVERY step in these protocols is intentional and vitally important to a successful bond. Due to the slight (10-15%) decrease in strength and extreme technique sensitivity, these protocols should not be utilized after we are past the COVID-19 crisis.

*Vice President, Reliance Orthodontic Products, Itasca, IL; paulgangejr@relianceorthodontics.com.

**www.relianceorthodontics.com/product-p/ff.htm.
***www.relianceorthodontics.com/product-p/el24.htm.
†www.amazon.com/30Milliliter-Precision-Applicator-Needles-Applications/dp/B07CMQSWKJ/ref=sr_1_8?dchild=1&keywords=squeeze+bottle+needle+tip&qid=1587602175&sr=8-8.
www.amazon.com/Syringe-Bottle-15Pcs-Dispensing-Needles/dp/B07S1S1HMG/ref=sr_1_15?dchild=1&keywords=squeeze+bottle+needle+tip&qid=1587602240&sr=8-15.
www.amazon.com/100Pack-Injection-Dispensing-Accessories-100Pack-Needles/dp/B07GXJJVD6/ref=sr_1_51_sspa?dchild=1&keywords=squeeze+bottle+needle+tip&qid=1587602342&sr=8-51-spons&swrs=0B9043D78865946B1B01984496F7E9CB&psc=1&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUEyQ1FTTFZYUEpUQ1lBJmVuY3J5cHRlZElkPUEwNjg0NzkxM0lHVTFOQ1NaSUxXJmVuY3J5cHRlZEFkSWQ9QTEwMzc4NDAzTEZYRzRSlFTSkNNJndpZGdldE5hbWU9c3BfYXRmX25leHQmYWN0aW9uPWNsaWNrUmVkaXJlY3QmZG9Ob3RMb2dDbGljaz10cnVl.
††www.relianceorthodontics.com/product-p/uap50.htm.
†††www.relianceorthodontics.com/product-p/gtt.htm.
‡www.orthopli.com/products_debonding.htm.