Orthodontic bonding in special circumstances

This clinical paper provides an in-depth exploration of advanced techniques for bonding orthodontic attachments under special circumstances. Challenges arise when bonding brackets to non-enamel surfaces, such as dental restorations, and in conditions such as amelogenesis imperfecta, which affect enamel integrity. Distinct approaches required for bonding to different restorative materials, including glassy ceramics, zirconia, resin composites and metals, are outlined. Moreover, we describe strategies to manage bonding in conditions including amelogenesis imperfecta, hypodontia and microdontia in a multidisciplinary context. Key points Awareness of the precise composition of existing dental restorations can be invaluable as it will inform the approach to bonding orthodontic attachments. This is especially the case with ceramic and resin composite restorations. Conditions affecting the dental structure, such as fluorosis, amelogenesis imperfecta and dentinogenesis imperfecta, have highly variable presentations. The required approaches to attaching orthodontic components to these teeth range from normal enamel bonding protocols to specialised modifications. Patients with existing dental restorations or enamel conditions need to be made aware of both the increased risk of attachment bond failure and risk of damage to the restorations and/or teeth as a consequence of fixed appliance orthodontic treatment.