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References

Murfitt PG, Quick AN, Swain MV, Herbison GP. A randomised clinical trial to investigate bond failure rates using a self-etch primer. Eur J Orthod. 2006; 28::444-449
Fleming PS, Johal A, Pandis N. Self-etch primers and conventional acid-etch technique for orthodontic bonding: a systematic review and meta-analysis. Am J Orthod. 2012; 142:83-94

Reflections on twelve years of breakages – lessons to be learnt

From Volume 10, Issue 4, October 2017 | Pages 140-145

Abstract

Abstract: This paper describes the nature and extent of emergencies and breakages recorded in one clinician's orthodontic practice over a 12-year period. As this long-term audit progressed the author's bonding regimen changed to reduce an initially high failure rate and then to cope with even greater bond failure rates as self-ligating brackets and self-etch primer were introduced. Overall, the bracket failure rate was reduced 61% over the 12-year period and 73% from its peak value. This was achieved by rigorous cleaning of the enamel, higher quality etchant, uncontaminated dry air, compomer to protect brackets from occlusal forces, as well as the occasional use of a Nola dry system.

CPD/Clinical Relevance: All orthodontic practices need to reduce emergency appointments and breakages at routine visits. This paper, by highlighting the use of a breakage book, gives the clinician a strategy to improve both.

Article

Breakages and emergency appointments disrupt the clinical management of patients during treatment, incurring administration time and expense. In 2004, the author visited a colleague in another hospital and noticed a ‘breakage book’. This seemed an excellent idea in order to keep a record of all patient/appliance-related emergencies. It is not easy to improve any aspect of clinical practice until the nature and extent of the problem has been determined.

The aim of this project was to record all breakages, whether at routine or emergency appointments and then use the first year's figures hopefully to reduce the failures and emergency attendance rate year on year.

The following data were recorded:

All teeth, including molars, were routinely bonded; bands were only used on teeth that required auxiliaries such as a lingual or palatal arch. All teeth showing bracket failures were re-bonded with a new bracket. Bands were not used to replace debonded brackets or tubes; the tooth was re-bonded.

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