Now, as we enter the digital age, we can produce indirect-bonding trays in our offices using three-dimensional printers. Once again, this requires adopting new software and technology—a new procedure with a learning curve. We need to work with and track a digital representation of something we can’t see as a physical model on a desk or in a bin, or as brackets on the model. We work in a virtual world of acquiring stereolithographic (STL) data, transferring the STL data to a laboratory or into specialized software, and verifying that these data were submitted to the lab or person responsible for turning it into a physical reality. Everything is virtual until we hit the print button, and then out comes a model, a splint, or—in the procedure so well documented here—an indirect-bonding tray.


Accurate bracket placement is crucial for tooth alignment and efficient orthodontic treatment, especially when using preadjusted appliances.1,2 Repositioning brackets and bending archwires to fix errors are both time-consuming procedures that can lead to longer treatment times.2-4

The indirect bonding technique was first described in 1972.5 Since then, various materials and methods have been used to transfer brackets to the teeth, including hard and soft vacuum-formed sheets, rubber-base impression materials, jigs, and wax guns.6,7 Some studies have reported advantages over direct bonding, such as better visibility during bracket positioning and reduced chairtime.3,4,8 Nevertheless, neither indirect nor direct bonding can ensure ideal bracket positioning.8

Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has been beneficial in other orthodontic procedures, from treatment planning to the fabrication of clear aligners and customized lingual and labial appliances.4,9,10 Studies indicate that the use of CAD/CAM software may enable more accurate bracket placement, thus improving orthodontic treatment efficiency.11

The present article illustrates the application of CAD/CAM technology to digitally position brackets and to design and print transfer trays for indirect bonding.


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